Health: Delighted, Daunted and Down to Work

Siobhan McClelland says that being clear on our priorities is key for improvement in Welsh healthcare.

Vaughan Gething was “delighted and a bit daunted” to be appointed as the new Cabinet Secretary for Health, Wellbeing and Sport. As the former Deputy Health Minister he knows he has taken on arguably the most challenging portfolio comprising the largest proportion of the Assembly’s budget but which struggles to meet the increasing demands placed upon it. He is going to have to navigate the turbulent waters of a minority administration and one in which Labour’s stewardship of the NHS will continue to be highly challenged and scrutinised.

Just holding the ship steady might seem enough but the major challenges are such that radical action needs to be taken. The Compact with Plaid prioritises increasing the number of GPs and setting up a Treatment Fund and the agreement with the Liberal Democrats sees consideration of an extended nurse staffing levels law. There is also a commitment to establishing a Health and Social Care Commission which could shape the future if it has clear terms of reference and rules of engagement and more than the usual suspects sitting around the table. The big challenges won’t wait though.

Here are my top five for health:

Mental Health: I’m putting this first and top of the list. There is a clear cross party consensus that this should be a priority but it has to go beyond the rhetoric and the best way to demonstrate parity of esteem is to allocate funding and ensure that mental health plays as large a part in the performance management of the NHS as physical health.  Improving services for the one in four who experience mental health problems could be one of the greatest achievements of this administration.

Primary Care: This is the part of the NHS that is perhaps most in danger of meltdown. It is where most people experience healthcare and where we can all recount a story of the problems of trying to get an appointment. The unrelenting and growing pressures on primary care needs robust thinking and action that includes recruiting more GPs but goes beyond that.

Access: Waiting times whether in A&E or for a cancer diagnosis or an operation are one the main ways in which people judge the success of the NHS. I would like to see a greater emphasis on measuring outcomes for patients but it is difficult to do this until the time targets are met so we need to do that and move on.

Meeting the Needs of an Ageing Population: This requires that health and social services work much more effectively together. We have been talking about this since I started work in the NHS nearly 30 years ago so what’s going to be different now? Requiring the pooling of resources is just a start but a good one.

Health Inequalities: The gap in terms of good health and long life continues to widen between the richest and the poorest. The determinants lie across portfolios and in reinvigorated public health. Health checks, early diagnosis, better access to treatment and holding health boards to account for improving outcomes for the most disadvantaged could also help.

You could add to this list but not everything can be a priority. Being clear about what the priorities for improvement are and putting in place mechanisms to ensure that they are delivered is key and there are some infrastructure issues that can help or hinder.  There is much strength in the model of integrated health boards but as the OECD pointed out we have yet to realise that potential. There needs to be some consideration of whether the responsibilities and composition of the management boards of Health Boards are fit for purpose. As the OECD also observed there is a place for a more central directive approach but also for exploring how the voices of the people health boards serve are better heard. Delivery can’t happen without a focus on developing leadership particularly from clinicians.  Data can power improvement and a greater investment in bringing health into the digital age will be worth it.

As the new Cabinet Secretary observed there is a lot to do.

Siobhan McClelland is an expert in Welsh Health Policy and has worked in and with NHS Wales as a manager, non executive and academic.

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