Where health and social services should meet

John Osmond looks at the agenda of the Welsh Government’s Commission on the future of local government

On occasion in Welsh politics important matters slip though the net and get little attention. One of these is the Welsh Government’s Commission on Public Service Governance and Delivery that was announced earlier this year (here). If it sounds as though this is about boring bureaucracy in one sense it is. Nonetheless, the Commission’s deliberations will have profound consequences for the future of both Welsh local government and the health service.

The chairman is Sir Paul Williams, former Chief Executive of Bro Morgannwg NHS Trust, later of Abertawe Bro Morgannwg University Health Board, and then NHS Wales itself, between 2009 and 2011. This may suggest a likely health service bias to what the Commission will decide.


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Mike Hedges says another reorganisation of local government could cost some Council Tax payers dear.

That would probably be wrong. In it’s terms of reference, lately published on the Welsh Government’s website (here), the Commission has been told explicitly that it must not interfere with the boundaries of the seven NHS Trusts in Wales. On the other hand, it appears to have a free hand to recommend what it will so far as the boundaries of the 22 local authorities are concerned.

But that, too, might be wrong. This is what First Minister Carwyn Jones told the Assembly when he made a statement about the Commission at the end of April:

“When I made my announcement two weeks ago, many leapt to the conclusion that this was just a step towards the inevitable reorganisation of our local authorities. That is premature. Resources are scarce; no responsible government would incur the cost and disruption of any major structural reforms without a clear, coherent and compelling case for doing so. So, while there may well be a case for reorganisation, it has not yet been made clearly. I am not going to pre-empt what the commission might conclude on this issue or anything else, and I urge others not to do so either. However, I am clear that the status quo is not an option. Change is inevitable and essential, whether in terms of the structure, funding, leadership or accountability. All those involved in public service management and delivery should prepare for that—not apprehensively, but by contributing fully to the debate and helping to shape the future.”

Apart from Sir Paul the Commission has six members. Again, their names have been slipped out on the Welsh Government’s website with little fanfare, and little if any notice from the media. They are:

  • Nick Bennett, Chief Executive of Community Housing Cymru and one time Liberal Democrat Assembly candidate in Ynys Mon.
  • Nick Bourne, former AM for Mid and West Wales and former Leader of the Conservatives in the Assembly, and currently a member of the Silk Commission.
  • Nerys Evans, former Plaid Cymru AM for Mid and West Wales, a Welsh Government commissioner in Blaenau Gwent, and part of the Deryn lobbying firm.
  • Juliet Luporini, owner of the Kardomah restaurant in Swansea, chair of the Swansea Business Improvement District, and a member of Economic Minister Edwina Hart’s Task and Finish Group that looked at Business Rates.
  • Gary Owen, Wales Regional Officer of the Unite Union and former chair of the Wales Labour Party.

Quite why this group has been chosen and what their expertise is in local government, the health service and relations between them is unclear, though plainly they touch base with each of the four parties in the National Assembly. However, they’ll have to get their skates on because their terms of reference (here) say they have to report by the end of the year. The terms of reference list the following factors which the Welsh Government says should inform their findings:

  1. The current structure of Local Health Boards within Wales is already supporting the move to integrate services more effectively and to put services on a sustainable footing for the medium to long term. The Welsh Government would not, therefore, expect LHB configuration to require consideration by the Commission.
  2. The action already underway in developing the provision of public services including, but not limited to, the work of the Public Service Leadership Group as overseen by the Partnership Council for Wales; the Welsh Government’s footprint for collaboration in public services; and the range of legislative measures such as the Social Services Bill, the Sustainable Development Bill and the Planning Bill.
  3. The need for greater simplicity in governance and delivery arrangements for services in order to enable effective integrated planning and delivery for people in Wales, including through the work of Local Service Boards.
  4. The recommendations of the Hill Review into education improvement.
  5. The proposals put to the Silk Commission by the Welsh Government (and any emerging outcomes from the Silk Commission).

By far the most important of these is the first, since one of the most important issues facing the Commission – indeed, probably the most important – is the relationship between the delivery of health and social services. This is where the wicked issues in the system are to be found, and where most money is lost. The implication, as leading figures in Welsh local government– from Russell Goodway in Cardiff to Dyfed Edwards in Gwynedd – have already acknowledged, is to align the boundaries of local government with the health authorities.

However, that immediately raises a major problem, which is north Wales. There is widespread acknowledgement that the Betsi Cadwaladr Health Board, which covers the whole of north Wales, from the Lleyn to Wrexham, is dysfunctional because it is too large and unwieldy. There are already calls for it to be split into in effect the old Gwynedd and Clwyd. If that were to happen, then a local government reorganisation to fit with NHS delivery could more easily follow.

The answer, surely, is to bite the bullet and make the NHS properly accountable on a local basis, just as education, social services, housing, waste collection and the rest are now. We should put them altogether into one democratic structure. Perhaps we could then have a real democratic debate about the reconfiguration of hospitals and the location of accident and emergency and maternity services. Will Sir Paul’s Commission have the vision and courage to follow this line of thought?

John Osmond is Editor of ClickonWales.

8 thoughts on “Where health and social services should meet

  1. Major structural change is always a tempting option for politicians, and the management of major corporations, because it gives the impression that something big and dramatic is being done when what is really needed is less spectacular, lower profile cultural, strategic, and administrative change over a longer period, which is harder to achieve in practice and has fewer immediate political benefits. It is therefore reassuring that Mr Jones’ statement is cautious about reorganisation, acknowledging the potential cost and disruption, and putting equal emphasis on the consideration of funding, leadership, and accountability. If this means that he is also open to meaningful cultural and strategic change in public service delivery, then the Williams Commission could indeed be the most important thing to happen in Wales since devolution.

  2. Anyone who was really serious about radical reform would not have appointed a commission with the sort of membership set out above. Why does the Assembly always it seems feel the need to allocate positions for all 4 main political parties? What is the point when common sense would suggest that any commission worth its salt looking into an issue should look at that issue with an open mind? You sometimes wonder where the Tories and the Liberal Democrats would be if both Nick Bourne and Nick Bennett had not been rejected by the electorate. Recently the Labour Party in England appointed a commission to look a policy area and produce a report which will inform party policy on the area concerned. The Commission is packed with experience of the area concerned either from a practical perspective or from an academic perspective. There are academics in Welsh Universities and institutions such as Birmingham University’s INLOGOV who could easily have been appointed if the Assembly was serious. Sadly in my view this is yet another example of ‘Clive Rowlands’ politics. In Wales the reaction of the political elite is to ‘Kick for touch’ and postpone the difficult decisions. In the process, of course, pleasing those with a vested interest in the status quo and they don’t include service users I’m afraid.

  3. John – your list of commissioners omits Aly Thomas Leader of Neath Port Talbot County Borough Council. I’ll leave it to him to explain his local government knowledge. For my own part I worked in local government for 3 years in the early 90s, then spent 5 years representing Welsh local government in Brussels (where i first met Mr Jeff Jones!). I’d argue that there is considerable interplay between housing assocations with both local government and health – strategic housing function, supporting people, residiential care, domiciliary etc- and i also found 2 years as Spad to the Welsh Deputy First mInister instructive of broader public service reform issues- but I’m sure we’ll all be judged on the quality of our final report. Jeff was that a complement?? Thanks for raising the profile of the commission though John- we want to interact over a short timeframe so I’m sure IWA can help us in that. regards Nick

  4. Nick if you were there because of your housing association experience there might be an argument. But would you have been appointed if you were not a Liberal Democrat is probably the more relevant question? Answers on the back of a postage stamp perhaps. First Minster has already made it clear in other places to reassure councillors frightened of having to manage without the allowance that there will be no reform until after 2017. Given that it is now only 2013 you might argue why the rush to produce a report by the end of the year. I suppose the question that you might have to answer given that local government in any meaningful sense ceased to exist in the 1970s is what does the Assembly actually mean by the words ‘local government.’ A lot of people might attend lots of meetings at the moment but it is hardly local government as either Joe Chamberlain or Herbert Morrison would understand it.

  5. Jeff -for the record I have not been a member of the liberal democrats for some time!

  6. Glad to see that you have seen the light Nick but perhaps you could explain why they put your name forward. Having just watched ‘The Americans’ I assume that you have now become a sleeper !!!

  7. it must because i’m so enlightened Jeff. With Welsh Housing – unlike the American ‘sleepers’ what you see is what you get- delivery. You had a key part to play in this through the leadership you showed on stock transfer- so I look forward to receiving your evidence!

  8. There seems to be a fixation on County boundary reorganization to create bigger regions with many pros and cons. Yet what is being overlooked is what is happening now. The number of regional (Health Boundary) and sub regional (old County Boundaries) work streams being created is quite significant. There are already elements of adult and children’s Social Care being commissioned regionally by Regional Partnership Boards, Education Support Services, Integrated Family Support, and Community Safety Partnerships. Many of these are being developed supposedly to achieve savings yet any that are made do not seem to be bankable.

    Chief Executives and Leaders of Councils meet regionally. Council Members are already raising questions however over what their role is in such regional structures and where does the democratic accountability or ‘Member’ scrutiny take place. Should there be a role in these structures for Regional AMs?
    Even if the Commission does not come out with wholesale recommendations for Boundary changes they will undouptably come up with the need at service level to develop an expansion of the developing regional working practices. By default this may weaken LAs due to the budgetary and management control of key services being devolved to a regional Body with the need by default to merge.

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