Mike Hedges argues that cutting local government funding in the next year’s budget will be bad for health
As we approach the start of another Welsh budget and a further reduction in the block grant by the Westminster Government, then cuts in public services are inevitable. Questions that arise are where they will be made and what will be the impact on each service area?
Giving the Welsh Government’s response to the lessons that the Welsh NHS needs to learn from the events of Mid Staffordshire, following the inquiry by Robert Francis QC, Welsh Health Minister Mark Drakeford made the following statement:
“Jointly with the Finance Minister I will be undertaking a review of the NHS budget over the summer to ensure that it reflects the lessons to be learnt from Francis, the additional burdens which face the health service and to ensure that there is a proper match between the quality of care, patient safety issues and the budgets to support them.”
This has been taken by many commentators to mean that there will be an increase in health expenditure next year relative to the other services funded by the Welsh Government. This is despite my having attended meetings at the Assembly throughout the last year where a whole plethora of organisations have explained how for every pound spent on them several pounds will be saved by the national health service.
Out of the Welsh budget for 2013-14 of over £15.5 billion, health and social services were allocated over £6.3 billion and local government over £4.7 billion. With more than 70 per cent of the total budget being spent in these two areas there is naturally a fear that if one increases its percentage in the next funding round, the other must go down. The easy option is to cut local government spending and use it to protect the health service. However, it is not as simple as that.
Local government provides a variety of services that contribute to the health and well being. For instance, if local authorities are unable to provide timely social care packages for those leaving hospital then bed blocking will occur. If Local Authorities do not intervene with home care provision soon enough then that will inevitably increase the risk of hospitalisation. As budgets become stretched then slowing down assessment and the production of a care package for hospital discharge could be the only way of staying within budget.
In order for some people to be discharged from hospital adaptations to their homes are often needed. The disability facilities grant is managed and funded by local authorities. Yet if there is insufficient funding available for the work to be done then the patient often cannot be released from hospital despite having no medical need to stay there.
Environmental health workers check food safety in premises where food is prepared. If there are less of them then obviously visits will take place less often and the chance of food poisoning such as salmonella will increase.
Of course, all these are statutory services. But if they are fully protected then the discretionary services would be hit disproportionately hard. Councils can reduce expenditure on road maintenance and street lighting but doing so increases the chance of accidents occurring and will add to the pressure on accident and emergency departments.
In a country where lack of exercise and unhealthy lifestyles are contributing to an obesity epidemic the last thing that the health of the nation needs is the closure of leisure facilities or a huge increase in their cost. Local authority run leisure centres and swimming pools provide an opportunity for people to engage in exercise at a reasonable cost. It will not improve health and fitness if they are either closed or prices are increased to such an extent that they exclude a large proportion of the public.
Welsh Government funding for free swimming in Wales for children and young people aged 16 and under during all school holidays and at the weekends, and for people aged 60 and over outside school holidays, has been very well received. It is an excellent means of increasing fitness. But what if we have to close our swimming pools in order to balance budgets? I remain unconvinced that if budgets are cut substantially then discretionary leisure expenditure will not face a major cut-back.
There are of course efficiency savings and invest to save opportunities such as more 3g and 4g pitches to allow greater use of sports facilities. Local authorities should be looking to use either the Welsh Government’s invest to save initiative, or their own reserves in order to reduce on going expenditure by investing to save. Local authorities can collaborate more to save money, especially with back office functions such as payroll. But the savings likely to be achieved will be around the edges.
If we continue to substantially reduce spending in fields other than the health service there will be big trade offs and health could be the loser. Health is not only about treating the ill and injured but also about ensuring preventative initiatives are in place. Local government is a major provider of preventative services. Large cuts in local government expenditure and a reduced provision of services could damage the overall health of the nation. We must remember that to keep Wales healthy local government has a major role to play.
4 thoughts on “Spending dilemmas for Welsh Government”
Mike, where is the empirical evidence to suggest that leisure centre have had any effect on the health of the nation? In fact all the evidence suggests that obesity has increased since the development of the local leisure palace. My father’s generation would run rings around today’s teenagers. The key isn’t fancy gym machines for the muscle bound, but general fitness which includes encouraging walking to school from an early age. It doesn’t cost the taxpayer a penny – unlike a running machine – and is the most cost effective exercise known to man .
I have a huge respect for Mike Hedges AM. In particular, respect for his personal understanding of, and commitment to, public service in Wales. I appreciate his stance and agree that there are very real dangers in seemingly simplistic budget cuts that place health and local government into direct competition for a finite and diminishing pool of resources.
Mike Hedges is right to point out that the fiscal pressures are about to get very serious indeed – as much of the easily obtained gains in terms of efficiency have now been exhausted in both health and local government. Where he and I differ though is in the default assumption that it is inevitable that there must be winners (Health) and losers (Local Government) and also that cuts to services and jobs are inevitable.
A different point of view is that these measures will only be necessary if our public service leaders (Political and Executive): (i) Fail to demonstrate courage by adopting a more adaptive emphasis to their leadership; and (ii) Choose to depart from the essence of our core public service values of sustainability, equity, fairness, inclusivity, and putting the Citizen FIRST.
Our leaders have choices. They can decide to limit their response to industrial-era, divisive, regressive, short-term thinking driven largely by the desire to protect the status quo. This choice inevitably ends up with the type of scenario Mike Hedges is rightly concerned about. Another option is to choose to be progressive, innovative and to leave a legacy. This can be done by shaping new public-service value-propositions that are overtly underpinned by our public sector core values, discussed above, that are admired and respected across the World.
Given that we face years of fiscal pressures ahead, the questions do not have to be: “Where do we cut?” and “Which services should be sacrificed?” A better series of questions might include “How do we urgently shape new public service value propositions that have at their heart the imperative of protecting and enhancing services?” and “How do we do more than satisfying citizens/customers; how do we delight them?”
From all of the stakeholder consultation that we have engaged in, there is a consistent view that the solution to the health/local government conundrum facing public sector leaders lies at the interface of these two big, inextricably-linked, spending priorities.
Our research shows that it is possible and that we can, if we choose, create a truly sustainable health and social care model. All it takes is courage, leadership, vision, unity, urgency and purpose. The truth is our fantastic public servants are more than capable of making it happen if only our leaders (Political, Executive and Trade Union) allow them the freedom to do so. That will require leaders to make the right choice!
Our invitation to leaders is to start with a clean slate and design with intent (by those who deliver the care and services) a new health and social care model that is more agile in order to deliver seamless and integrated care, at significantly better value. Our gentle provocation, based on extensive research, and worked case studies is that such design can result in no one losing their livelihood.
Our point of view is that this health review need not be about dealing with a financial crisis in a predictable way. It is a once in a lifetime opportunity to heal, shape and protect the care and well-being of our citizens both in and out of hospital.
Jeff, are you seriously suggesting that leisure centres are not good for improving fitness. At my local leisure centre swimming, 5 a side football, sports training and badminton predominate. Working in mines and steelworks meant that people exercised as they worked.
Mike Hedges does not exaggerate. If anything he understates the problem. Health already consumes 45 per cent of Welsh government recurrent spending. That proportion has risen, is rising and will rise further unless something radical is done. If complimentary services are cutto feed the insatiable demand for health spending, the demansd on the creaking health service will rise further leading to more instances of neglect and scandal, as both Messrs Hedge and Dew point out. That is why a radical re-think and ground-up plan, as urged by Mr Dew, is not optional but a necessity. I have seen no sign that the Department of Health or the various Health Boards are engaged in such radical planning. They appear to be sleep-walking towards the cliff. Let’s hope that impression is wrong and Mr Drakeford will soon announce considered but drastic reforms.
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