21 January 2005
Welsh confidence has been dented. The young Assembly government was determined to be different and remodel the NHS around the principle of health promotion rather than the target-driven regime operated in England. But a stinging report from the auditor general for Wales, blasting the mismanagement of waiting lists, might have shattered those dreams.
Too many Welsh people are waiting too long for health services: more than 7,000 have been waiting more than 18 months to see a consultant, and a further 1,500 have been waiting a similar length of time for admission. Progress on waiting times has been slow in comparison with England and Scotland and use of NHS capacity is inefficient: hospital stays are too long, beds are left empty and little use is made of day surgery.
First Minister Rhodri Morgan pre-empted the auditor general's bad news with a surprise reshuffle on January 10. Long-serving health minister Jane Hutt was demoted to Assembly business manager and replaced with practising GP Dr Brian Gibbons.
Gibbons paid tribute to his predecessor, saying her efforts had been 'Herculean'. But the new minister faces something of a Herculean task himself, needing to sort out the waiting list problem while maintaining a distinctly Welsh flavour to health policy.
The Assembly is currently engaged in a major consultation on the future direction of public services in Wales. The competitive model pioneered in England has been eschewed in favour of a system built on co-operation and co-ordination across the public sector. Morgan has expressed confidence that this approach will produce better results.
Gibbons has been granted a free rein to develop policy as he sees fit but has begun cautiously. He has admitted that he has no magic solution to the problems in Wales and called for a period of consolidation.
'There is still a challenge ahead of us in tackling long waits but I am confident that we will continue to build on the good work already under way to reduce long waits in Wales,' he said.
The auditor general's report singled out Wales' approach to health policy as a factor. Although waiting lists, the usual barometer of good NHS management, were included in the target-setting regimes in Wales, targets were looser and timescales not clearly defined. For example, the aim to ensure that no-one waited more than 18 months for inpatient or day case surgery merely had to be achieved 'over time'.
John Osmond, director of the Institute for Welsh Affairs think-tank, is unsurprised by the auditor general's diagnosis. 'The [waiting list] situation has been quite static for some years now,' he says. 'The Assembly government says things are getting better but we are so far behind that it is going to take quite a while unless there is some dramatic intervention.'
Osmond believes lessons can be learned from England, particularly with regard to the management of bed blocking. 'In England, social services have to pay to keep people in hospital, which has had a fairly big impact. That doesn't apply in Wales.'
The British Medical Association also advises the Assembly to look beyond Offa's Dyke. Tony Calland, chair of the BMA's Welsh council, says: 'The BMA recommends a wider acceptance of innovations proven to work in other countries, where they have achieved a reduction in waiting times for surgery and outpatients' waiting lists.'
But Steve Davies, senior research fellow at the Cardiff School of Social Sciences, says the Assembly government should have the courage of its convictions and continue to pursue its own way. 'The report does not invalidate the Welsh attempt both to improve public services and map out a different course to the market-oriented approach adopted in England,' he says.
'Some of the Assembly's critics, particularly those Labour MPs closest to Downing Street and nervous of losing their seats have tried to make out that the problems of NHS Wales stem from the government's rejection of large-scale use of the private sector and the Private Finance Initiative. By contrast, the auditor general made a series of recommendations that could and should be adopted as sound managerial improvements within the overall existing strategic approach.'
In the meantime, there is more waiting to be done. Gibbons is waiting for the Assembly's audit committee to report on the auditor general's findings before he announces the way forward, while the public service consultation is not due to close before the end of January.
How much the dragon chooses to follow St George remains to be seen.
PFjan2005
