The Blue Print

One of the main issues that was evidently clear on my visit to UHW A&E last Monday, was the problem of capacity – something touched on in my last post.

Central to this problem is the juxtaposition of concepts; the idealism of a 24/7 acute healthcare system, meeting with the reality of delivery – which is in fact a Monday to Friday service, often time limited.

One of the greatest barriers to staff on the ground was that patients were not being brought through the system but were either clogging up or being forced through the system because of problems of capacity.

For example, there were patients who had been waiting on trolleys in A&E or in the Medical Assessment Unit all weekend because there was no system of planned discharge over the weekend. This I found bizarre, as many were well enough and wanted to return home. However, because there was a lack of senior consultants working weekends who could make final discharge decisions or because there was no social care package in place so they could return home safely, they were left, stuck in the system, until at least Monday morning.

The other thing I found very strange was that the patients discharge lounge, where patients would wait to be picked up by loved ones, was only open during the working week from 8am-5pm. If pick-up arrangements fell outside those times, then patients could not be discharged – again they were left stuck the system.

This clash of concepts is a real concern and something WAG must face up to as a matter of urgency. The Government must get tough and change a culture that allows consultants, pharmacists and OTs not to work weekends. A 21^st century acute healthcare system cannot be constrained by old fashioned notions of working patterns nor should it be constrained by lack of resources. There are many examples of PCTs in England who have successfully adopted flexible models of acute healthcare planning that has ensured the publics expectations of a 24/7 service is realised on the ground.

WAG has set aside money to reduce bed-blocking in each of the health boards. My recommendation is that this be spent on alleviating unnecessary pressure points in the system by ensuring key staff are present throughout the weekend to discharge patients appropriately.

I never thought I’d be much good as a spy, but yesterday morning I went undercover at the A&E department of the University Hospital of Wales which happily for me is conveniently located in my constituency.

The purpose of my visit, at the invitation of a number of the nurses who live in Cardiff North, was to see at first hand the pressures they face throughout the day. One problem that became apparent within minutes of me arriving was the difficulty in managing a considerable number of patient admissions together with all the problems which impact on A&E due to factors elsewhere in the hospital.

We toured the GP out of hours clinic, which is co-located with the A&E and discussed the excellent work they do. I met with nurses and doctors in the Medical Assessment Unit and also the Surgical Assessment Unit and was struck over and again that regardless of the difficulties they face their commitment to their patients remained constant and strong.

Whilst I intend doing a couple of posts on this visit (starting later in the week) with some recommendations for the Assembly Government there was one fact which struck me hard. By 9am yesterday morning the hospital wasn’t just full there were 27 people waiting for a bed. Now 9am isn’t an especially busy period, apparently that happens between 11am and 3pm when GPs are in a frantic process of referring their patients to A&E.

What was worrying was that there were some patients who had been on hospital trollies for a long time. In fact at least 3 of them for more than 3 days because of a lack of beds in the hospital.

The Education Minister has agreed to close a school in my constituency which serves an area with few community facilities.

Cefn Onn Primary School has been a central part of one of the large housing estates in Llanishen for 5 decades. I would like to place on record my praise for the headteacher, staff and governors who have worked hard to save the school from closure. It is an incredibly sad day for local families who will feel very let down as a result of this decision.

When Cardiff Council decided to close this school the birthrate in the city had been falling, and this became the premise on which the school closure programme would progress. Since 2002 however the birthrate in Llanishen and across Cardiff has been increasing and the council has had to amend its own pupil projection figures. Pupils from this area will now have the option of attending 4 other schools, and whilst the alternatives are all excellent schools the loss of Cefn Onn has the potential to fragment the community.

This latest closure not only ignores the new birthrate trend it is fundamentally a nail in the coffin for the community the school has served.

At some point the Assembly Government will introduce a pilot laptop scheme for all children, and whilst a free for all seems a bit daft and lacking in focus, there is one idea I would put to them as a way of maximising this scheme.

Giving out laptops to children is not a new idea, it is happening elsewhere in the world such as Uruguay and Portugal. The big difference is that the project is targeted towards children in deprived areas where there is a need to provide better access to educational resources and eventually help lift them out of poverty. In Uruguay there has been a reduction in truancy and has helped those with learning difficulties who are traditionally the hardest to reach. Whilst in Portugal the government has been offering free laptops for the poorest households and subsidised for those with a bit more money. In both countries the software has included packages in English, Maths, Science and basic language skills, and geared towards addressing subject deficiencies.

A few weeks ago I suggested that the Assembly Government’s Communities First programme could be reformed to be more focused to start delivering the improvements that people need. It has been too broad in its approach, attempting to tackle everything and proving too difficult to measure. It is now subject to an investigation by the Assembly’s Audit Committee which I chair.

Having studied the scheme it would make perfect sense for monies to be targeted at children in our poorest communities where raising educational achievement will help with standards in our schools and provide a much needed economic lift. Laptops for these children with the right software and connectivity at home, together with training and resources for teachers, could make a substantial difference.

I would urge the Assembly Government to look at the schemes operating elsewhere and use the money in a more direct way.

On Thursday the BNP leader will appear on BBC1′s Question Time, and for once I might stay up long enough to watch what is clearly a watershed.

Personally I find the BNP to be lower than vermin. The prospect of ever sharing a platform with a bunch of racist thugs turns my stomach.

Over the weekend there was some excellent writing in the press, most notably the articles in the Sunday Times on the issue facing the BBC this week and on the rise in support for the BNP.

Martin Ivens’ excellent commentary touched on the paradox that whilst support for the far right has increased, Britain has generally become a more tolerant and accepting society. The problem is the pattern of voting amongst those C2DE male voters whose shift to the BNP is based on a fear of immigrant workers “taking their jobs”.

Whatever the reason for the recent shift of political allegiances mostly of natural Labour voters in working class towns in England, this is a growing problem that cannot be defeated by the Left alone. Traditionally we’ve all been happy to sit back and leave the protesting and arguing to the usual collection of communists, Anti Nazi League members and other assorted leftists. However it’s in no-one’s interests to allow the BNP to claim for themselves those voters who are disillusioned with the political process.

For those of us on the centre right we need to remind people that voting BNP does not make Britain more British, that our country has welcomed people from across the world, absorbed their culture and has become richer for it. But this does not mean that our proud assertion of Britain’s place in the world should ever be a deterrent from discussing immigration.

There has been a reluctance within the mainstream parties to discuss immigration for fear of dealing with a sensitive subject. Whatever one’s views about population projections, public service pressures and community cohesion, if we don’t start talking to the public then the BNP will fill the gap instead.

I hate what the BNP stand for but we must take them head on.

During yesterday’s Assembly plenary session I replied to our debate on tackling violence against women.

The statistics are worrying when we consider that 70% of domestic violence victims are women and that on average a woman suffers 35 attacks before even seeking help. As a nation we cannot ignore the fact that we have a higher proportion of attacks against women compared to the UK average.

Whilst there was a huge amount of agreement about the issue and the challenge to produce a strategy which combats this, there is still a lot of work to do in tackling the cultural issues.

For all the strategies to help women who have been attacked, in the provision of  immediate help whether in protection, housing, health or counselling, this does nothing to address the route causes. Prevention has to be the goal.

We need to start addressing gender stereotyping and issues in the home. We need children to understand what it means to respect another individual. Ultimately unless we understand and challenge what it is that persuades  a man to attack a woman then we won’t succeed in bringing the number of assaults down. We’ll just carry on dealing with the consequences instead.

For us, violence against people because of their sexuality, race or religion is unacceptable, so why are we so sluggish when that person is female?

I represent a constituency which has excellent schools with superb standards and results, popular with pupils and parents.

Other parts of Cardiff are not so lucky, some have lower standards and falling rolls. Instead of addressing why some schools are not as successful Cardiff Council has determined to close schools in my constituency in order to save those where the problem actually lies.

We are expecting the council to consult over their plan to reduce the number of primary schools and reduce the size of Whitchurch High School. This is madness. Our primary schools are popular and well subscribed, the combined places at Eglwys Newydd and Eglwys Wen, according to the council, will require an increase in places by 2014 not a reduction. The high school is the biggest in Wales and delivers a diverse and high standard of education to its pupils and in my view should not face a cut in its numbers from a 12 to a 9 form entry school.

Cardiff council will be opposed by me and our councillors for Whitchurch & Tongwynlais. There will be a vigorous campaign and the council will be challenged on its proposal because we do not want to see successful schools penalised. Let the fight begin.

According to the Welsh Assembly Government, Wales is a fair trade nation, in fact we’re the first.

I think this claim requires a bit of thought. Have we all suddenly converted to fair trade products (beyond the coffee and the chocolate), an end to sweat shops making our cheap clothes and a commitment to spend more on overseas development? No of course we haven’t.

I ask this because of a meeting I’ve just had with Rev James Karran from Ararat Baptist church in Whitchurch. He and many others are leading the campaign against some of our retail outlets whose sub-contracting of clothes manufacturing uses sweat shops, mostly in Asia. What it means to be fair trade is interesting, and I suspect easy to define if we gloss over some of the difficult bits such as clothing.

It’s easy to buy fair trade food and drink products from the shelves and they tend to taste better than the brand products. It’s also easy to argue for more international development money from the UK government. How easy is it though to avoid spending money on cheap clothes in Asda or Primark in favour of higher prices in Next?

On this, the trendy notion of fair trade is replaced with an obvious personal economic reality check.

As an interested observer of the race to succeed Rhodri Morgan as Labour leader and First Minister I have for some time assumed that Edwina Hart would be a runner.

The announcement of support by Andrew Davies was confirmation that the presumed Carwyn Jones v Huw Lewis battle was about to get a new protagonist. For the first time in 30 years since the election of Margaret Thatcher it is possible that a national government could be led by a female politician.

Having shadowed Edwina from the opposition benches until February I have witnessed her work both in public and private. In addition to being hard working she is capable of building cross party working relationships, taken some bold decisions, and has on more than one occasi0n happily ignored her officials to do as she pleases, demonstrating a rather unpredictable nature.

Once, during a rather public spat about the performance of the Cardiff & Vale NHS Trust, I referred to her as Boudica on a bad hair day! There have been some occasions where this description is apt. Whether you would regard her sometimes erratic decision making process as risky for someone who might become First Minister, or just part of her character which people respect, is hard to judge and probably a matter of personal opinion.

Either way, it is possible that the Welsh Labour Party might have found their Margaret.