Why NHS Wales needs a political consensus

Malcolm Prowle argues that the parties should come together to agree a way forward for the Welsh health service

The political furore, a few months ago, over the Longley report on health service reconfiguration in Wales indicates what is wrong with the politics of health in Wales, and indeed the UK as a whole. For many years now health policy has been an emotional issue in Wales and the NHS is always a hot topic in any national election campaign.

The NHS was perhaps the greatest achievement of the post-war Atlee government and is seen by most people, especially in Wales, as beacon of civilised society. It has two great attributes. Health care is free at the point of consumption and access to health care is largely based on clinical need and not ability to pay. Consequently, it is not surprising that people have great faith in the NHS and are very reluctant to see any changes made to something they strongly trust.

However, the NHS in Wales and throughout the UK  is now in need of radical reforms for a range of clinical and economic reasons. But, for this to happen there needs to be a political consensus that such reforms are essential and that the status quo is not an option. Unfortunately such a consensus does not exist. All parties seem more concerned with achieving short term political advantage and point scoring.

When any political party is in government it tries to achieve some reforms and change in the NHS. However, when in opposition parties of all colours fall back on policies which, by and large, comprises the following:

  • Spend more public money on the NHS.
  • Employ more doctors and nurses – other health professionals rarely get a look in.
  • Reduce the number of NHS managers and administrators.
  • Not close any hospitals, however decrepit, unsafe and ineffective they may be
  • Not change anything.

Unsurprisingly these sorts of policies are almost universally supported by health professional representatives and trade unions. Coupled with strong publicity from the media this makes it incredibly difficult to achieve the level of change actually needed in the NHS.

Moreover, this sort of mentality often blocks reforms which are needed to improve health care. I recall an elderly relative awaiting surgery for an artificial knee implant complaining because he was being referred to a regional specialist centre for orthopaedics rather than his local hospital. “It’s all to do with the cuts,” he said. “It’s in the newspapers”. I patiently explained that it wasn’t to do with the “cuts” since there weren’t any cuts in overall funding. Rather, it was to do with the fact that such specialist centres generated better clinical outcomes than a local district general hospital and so would be good for his recovery. He thought about this for a while and then suddenly said, “No, I don’t believe that. It’s all to do with the cuts. We should fight it.”

The publication of the Longley report on NHS reconfiguration in Wales was an opportunity to build consensus and take forward the necessary changes needed for the NHS in Wales. Yet, rather than support the Labour administration in taking forward what are rather sensible reforms, the opposition parties in the Assembly preferred juvenile political point scoring by questioning the validity of the report and suggesting that maintaining the status quo was an option (which it isn’t).

Of course, Labour is not immune to this tendency either. In the UK parliament, the Labour opposition (in harmony with, yet again, health profession representatives and trade unions) chose to oppose Coalition Government proposals for NHS Reform in England, again attempting some short term political point scoring. The Government’s reform proposals had several flaws but also incorporated some sensible reforms. However, the combined opposition of the Labour Party, NHS vested interests and indeed the Liberal Democrat partners in the Coalition Government resulted in an emasculation of the reforms and put an end to real NHS reform for the duration of the current parliament.

As a consequence of the financial and economic crisis the NHS faces perilous times. Since its formation in 1948, the NHS has received an average growth in its annual funding of 3.7 per cent. Between 2001-2005 the average was 7.1 per cent. But for the foreseeable future the NHS is likely to get growth in funding of approximately zero.

Indeed, the NHS in Wales and the rest of the UK is expected to make large scale ‘efficiency’ savings in order to find funds to meet growth in service demands largely as a consequence of the ageing population. I am afraid the image of the proverbial oil tanker heading for the rocks appears before my eyes. For 60 years the NHS has consumed significantly increasing sums of public funding and now (almost overnight) it is expected to live on virtually no growth in funding.

There is a cat in hells chance of the efficiency targets being achieved and we will soon hit a major funding and political crisis in the NHS. At that point, politicians of all parties may regret trying to kid the public that the status quo is sustainable and that there is no need for reform.

Malcolm Prowle, who lives in Wales, is professor of business performance at Nottingham Business School and a visiting professor at the Open University Business School.

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