What are we to make of Carwyn Jones’ reshuffle at the end of last week? First the good news. The arrival of Cardiff West AM Mark Drakeford as Health Minister offers the prospect of some strategic decisions being taken on the future of NHS Wales, and just as important, their being communicated effectively to the electorate.
Health is the most difficult and dangerous of policy issues for politicians. Everybody is either directly effected, is close to someone who has recent experience of the NHS, or is worrying about what might happen if they did. Politicians typically react by keeping health problems as far at arms length as possible. In England the Conservative instinct is to marketise health provision and devolve as much responsibility as possible to customer choice.
In Wales Health Ministers have decentralised decision-making to the seven Health Boards. But this only works when the Boards can persuade the Community Health Councils to acquiesce in their plans. With the current options around hospital reconfiguration this isn’t happening, certainly in north, mid and west Wales. Decisions are being thrown back to Cardiff Bay, but former Health Minister Lesley Griffiths gave little sign that she had much of a vision about where the Welsh NHS was going.
Earlier this month Carwyn Jones told the Assembly that he was taking over the decision-making process in relation to reconfiguration issues within the Betsi Cadwaladr north Wales Health Board, because Lesley Griffiths’ Wrexham constituency was affected. An especially controversial question is the Board’s proposal to transfer intensive care neonatal services out of Wales to Arrowe Park hospital in the Wirral.
This is what Carwyn Jones told the Assembly on 4 March: “Just to make it clear, I will be taking that decision, because the Minister herself has a constituency within the Betsi Cadwaladr Board area.” This was an extraordinary reflection on the former Health Minister who was judged incapable of separating out her own constituency’s interest from that of a balanced view about the needs of the health service in north Wales as a whole.
The new Welsh Cabinet
Llyr Huws Gruffydd AM says the reshuffle has left responsibility for the Environment in Wales betwixt and between Ministers.
What is the Welsh Government’s policy on the need to rationalise the provision of health specialities across Wales? How does it intend to achieve the safest and highest standards consistent with optimum patient access and value for money? These are exceedingly difficult questions to answer to be sure. But the Health Boards have just been allowed to get on with it. There may have been a good deal of behind-the-scenes encouragement, exhortation and advice from Cathays Park. But there has been precious little public advocacy.
When did Lesley Griffiths last make a keynote speech about her vision for the NHS in Wales along the lines, for example, of Education Minister Leighton Andrews? In the last few years he has stepped on to more podiums than I can remember to lecture us about his philosophy and political priorities.
Does this matter? You bet it does. One of the reasons why Labour came so adrift in its last attempt to reconfigure hospitals across Wales, in the run-up to the 2007 Assembly election, was because it signally failed to convince the electorate about the coherence of its plans. Instead, much of the electorate took the view that the real agenda was saving money rather than improving the service. This contributed to Labour’s loss of five seats directly affected by proposals to remove services from hospitals – three in west Wales (Llanelli, Carmarthen West and South Pembrokeshire, and Preseli), and two more in the north (Clwyd West and Conwy).
So Mark Drakeford has a big job on his hands. First he has to develop a coherent and intellectually convincing all-Wales approach to the provision of hospital care, and then communicate it to a sceptical and untrusting electorate.
However, he brings to the task some formidable qualities. He has been Professor of Social Policy at Cardiff University and has studied the relationship between health and social care for decades. He was chief policy adviser to Rhodri Morgan when he was First Minister, authoring, for example his ‘clear red water’ speech. Since succeeding Morgan as AM for Cardiff West he has chaired the Health and Social Care Committee in the Assembly and has a detailed understanding necessary to override, if necessary, the civil servants in his department tempted to reach for the ‘too difficult’ file.
Above all, however, Drakeford has the communication skills (in both languages) and confidence that is vital to take the complex arguments around the challenging difficulties in his brief to the electorate and make a convincing case.
There were two other positive aspects to the reshuffle. First transport has been placed within Edwina Hart’s economic development portfolio, where it belongs. The improvement of Wales’s connectivity, that hopefully will be achieved by projects such as the Metro in south east Wales, is as much about economic regeneration as communication links. Secondly, it makes all kinds of sense to put responsibility for European convergence funds within Jane Hutt’s finance brief, rather than within economic development, since it allows the possibility for giving greater co-ordination and impetus to the Welsh Government’s Infrastructure Investment Plan.
Yet, apart from these welcome changes there’s not a lot to be positive about in the new line-up. Ministers were demoted but not sacked. Stripped of her health responsibility Lesley Griffiths was rewarded by being given control of local government where a reorganisation is on the horizon. Carl Sargeant lost local government but held on to housing and regeneration. He was reported as being “very pleased with this vote of confidence”. Deservedly, John Griffiths lost the Environment portfolio where he has made little impact – witness the current ineffectual legislation on Sustainable Development – but has been handed culture and sport.
Indeed, what has happened to sustainable development, allegedly the government’s “central organising principle”? Gone, or rather dissipated, primarily to Huw Lewis’ new Communities brief, but also to the newly created department for Natural Resources and Food, the responsibility of Alun Davies who enters the Cabinet for the first time.
These three ministers lost their leading roles because they were not up to the job of communicating government policy. In fact we have scarcely heard from them in the past two years. Some months ago, after refusing to respond to questions about hospital changes Lesley Griffiths was chased by a television crew which was then attacked by her special advisers for having the temerity to try and put her on the spot. The Welsh Government press office even attempted to extract an apology from BBC Wales until they were told that unless they provided a spokesperson to talk about the government’s policy, footage of Lesley Griffiths being chased down the road by the camera crew would be broadcast.
These Ministers lacked confidence and were not on top of their jobs. Yet they remain in the Cabinet. Why? A few months ago, writing on ClickonWales former Welsh Office Minister Jon Owen Jones, latterly Chair of the Forestry Commission which is being absorbed into Natural Resources Wales, remarked that a distinguishing feature of Welsh devolution is that no politician or civil servant has ever paid a price for conspicuous failure:
“In Westminster politicians and civil servants often avoid the consequences of their actions but often they do not. The two DEFRA Ministers responsible for the plan to sell the Forestry have been sacked and thanks to Branson’s deep pockets the Civil Servants who messed up the West Coast rail franchise are suspended. In England and in Scotland a failed policy can end your career but not so here.”
Maybe Carwyn Jones is biding his time for a more fundamental shakeout. Depending on how soon the Silk Commission’s recommendations on tax and borrowing powers for the Assembly are put into effect – and we will have a response from the Treasury in the next few weeks following Wednesday’s budget – the Welsh Cabinet will have to take on a new shape. Moves are already afoot to build a civil service Treasury function within the Cabinet Office – another central recommendation from the Silk Commission.
When responsibility is devolved for tax and borrowing powers the really serious business of government will begin in Wales. In turn this will require the strategic decision making across government that has so far has eluded us. Carwyn Jones will then need to grasp the nettle of creating a new department, equivalent to the Treasury in Whitehall, with the authority to knock heads together to drive a coherent programme forward. Is he up for that?