The future of Welsh services

John Osmond links the debate on big salaries to Welsh approaches to public service.

Strong views exist on the interconnected subjects of profit, incentives and salaries. These debates often lead into wider issues of the public and private sectors. Tonight John Hutton, the UK Government Minister for Business, Enterprise and Regulatory Reform, will say to the Progress organisation that ‘Rather than questioning whether huge salaries are morally justified we should celebrate the fact that people can be enormously successful in this country.’

These debates have a resonance in Wales, where there are particularly strong views about the roles of the private and public sectors. The One Wales coalition agreement said ‘the people of Wales sought a government of progressive consensus’ in the May 2007 elections. This year the IWA has been hosting seminars to discuss this consensus, featuring talks from John Kay (economist and FT columnist) and Will Hutton (Observer columnist and Chief Executive of the Work Foundation), with David Marquand (former MP) and Peter Stead (Welsh historian and cultural commentator) to follow.

As discussions have taken place in the IWA seminars it has become apparent that the progressive consensus of One Wales raises many questions. Wariness of the private sector features in the One Wales document, which said: ‘We firmly reject the privatisation of NHS services or the organisation of such services on market models. We will guarantee public ownership, public funding and public control of this vital public service.’ However, issues about medication, for example, challenge this assumption that the NHS is purely public. Paying for medication, and specifically which drugs are available on the NHS in Wales, has been debated throughout the UK. Pharmaceutical companies make huge profits from drugs delivered by the NHS. In light of this, is the NHS a purely public service?

Wales needs to have more informed debates about the role of the private and public sectors. Do our current public service arrangements allow innovation and provide adequate (and not merely financial) incentives? Will Hutton’s criticism of the progressive consensus was that it assumes the concepts of state and public to be the same. In the broadcasting realm the BBC is, for example, a public rather than state broadcaster. In Wales, and the UK also, Hutton said we need a more sophisticated understanding of what ‘public’ means.

Returning to the medicines issue: advances in medicine have increased expectations and costs in a way that the architects of the NHS could not have conceived 60 years ago. There are strong attachments to certain ideals, meaning concepts such as private medical insurance and charges would not be popular in the current Welsh setting.Yet, there is a responsibility on politicians to make tough decisions in allocating and deciding on sources of funding.

The overall UK budget has been running a large deficit for some time and many of the indicators suggest a slowdown in the economy, which will have a direct effect on public spending. The challenges are great but so, now, is the opportunity to cultivate Wales-specific solutions to Welsh issues through the Assembly. If we are to continue to develop health and other services in Wales we must have these debates about the public, private, profits and their connected issues.

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