The Blue Print

Yesterday the proceedings of the Assembly chamber were affected because of strike action, not by those who had voted to exercise their legitimate right to take industrial action but by Labour & Plaid AMs who simply refused to turn up for work.

We were left with the rather odd picture of only the opposition parties attending the Senedd to discharge their responsibilities as elected members; where we debated the need for legislation to separate AMs from setting their salaries and allowances, and also having a full debate on the Labour Plaid government. For us it was business as usual.

I have no problem with officials venting their anger at the actions of the UK government and I fully understand their concerns about their employment conditions. My problem is with the actions of leftist AMs who behave as though they’re an integral part of the dispute, they’re not. I accept that there are occasions when members might be absent, that’s the same for any profession. But to use the strike as an opportunity for a duvet day is utterly ridiculous.

This morning the Older Persons’ Commissioner Ruth Marks has announced her first major review, pledging to tackle the indignities suffered by older people whilst in hospital.

Having served for 6 years from 2003 as my party’s Health & Social Services Spokesman I know how needed this inquiry is, I encountered many people whose personal experiences of hospital had been a dismal one where nursing staff had failed to ensure that patients were treated with dignity. Sadly my own personal experience of family members upheld what I had found throughout Wales.

Before my re-election to the Assembly in 2007 my grandfather was admitted to the University Hospital of Wales with a suspected bleed on his brain. He spent about a week or so on the A1 link ward, a sort of temporary fix apparently before they could decide what to do with him. He quickly deteriorated, physically dishevelled and confused, and the nurses were pretty useless in helping him or family members to understand what was going on. On more than one occasion he told me about the attitude of a number of the nurses, uncaring, unhelpful and abrupt with patients including him.

My grandfather is not your typical retired octogenarian who takes life easy. He remains incredibly active, politically involved in the party and socially busy with family and organisations. He retired from serving as a County Councillor in 2004 when he was approaching 80 years of age having spent a total of 22 years on both the City & County Council; some years before that he was the city’s Deputy Lord Mayor.

And yet for a period of a week in UHW he had to tolerate the indignity of his treatment. I use this as an example of why this review by Ruth Marks is so important, and why it is right to ensure that the “caring professions” really know how to care.

Moving house or leaving a job can be stressful; leaving active service in the military for civilian life can be traumatic, chaotic and often unsupported.

Last week I met with a constituent who has left the army having served as an officer who faced the happy prospect of a long and productive career. This individual left because of an alleged period of bullying which caused a sustained deterioration in mental well being, leading to a family difficulties, inability to work and pay the mortgage. Poor mental health amongst ex service men and women is common, so too is homelessness. With all the evidence it is a national disgrace that so little is done to help our ex service men and women.

All too often it is merely left to the voluntary sector to pick up the pieces. Financial support provided by the Royal Legion and the Officers Association to those out of work and facing hardship goes some way to helping at times of crisis, their efforts should be applauded. The Big Lottery has also announced (March 8th) support for those leaving the forces with a funding boost of £35 million.

All of this is great but there is a question of the sustainability of just relying on the third sector who cannot guarantee the long term future of their work. Individuals need help not just to resettle but to cope with the biggest challenges of mortgage payments.

There is also the question of why the Government is happy to abandon its duty to help those who have served our country.

In February 2009 the Health Minister approved the outline business case to revamp the provision of mental health services in Cardiff and the Vale of Glamorgan, announcing that £120 million would be spent on a new hospital in Whitchurch and new facilities in Llandough.

However, Health officials have now halted the plans claiming that they want to go back to the drawing board. Apparently £80 million is still available to be spent on revised plans once the Local Health Board has done the work.

There are a number of imp0rtant issues about the decision and the impact on those services.

Firstly there’s the issue of delay and dithering over plans which had been approved for the redevelopment of the Whitchurch site and where work had already started. Buildings have been demolished, road and ground works started with £6 million already spent. Why stop this now, when the Assembly Government had already given the go-ahead after the final business case was submitted to them in the Spring of 2009?

Secondly it looks as though the Assembly Government’s own decision making ability is questionable. Their original decision would have been based on a thorough analysis of the outline business case and then a final approval before starting to spend money. It does require some explanation as to how effective the Assembly Government is in ensuring that service reform proposals are robust and deliverable.

Thirdly, in February 2009 the Assembly Government announced almost £120 million for the work and spent £6 million before halting the scheme. On Monday officials told the local press that £80 million had been ring fenced, so what’s happened to the other £34 million that was part of the initial allocation? They’ve either run out of money or the remainder of the money is being spent elsewhere.

Fourthly, the effect of this decision on local services means more disruption and delay which puts the modernisation of the service back on the shelf. This will not be good for patients, families and clinicians who were geared up for this reform. I believe that the Health Minister needs to explain who quickly she expects this matter to be resolved.

Whichever way you look at this saga, there are many questions which require answers, the present position is frustrating for all of us who want to see mental health services reformed.

Earlier today I raised an ongoing concern I have, that since 1999 the Assembly Government in all the reorganising and restructuring of the NHS has failed to take a strategic look at what’s needed to improve public health.

When you compare Wales to the rest of the UK and most of the EU we are in a poor state of health. On the big health indicators, whether its rates of cancer and survival, cardiovascular disease, coronary heart disease, obesity or diabetes, we are in a bad way. I passionately believe that unless we start tackling the causes of ill health we will be consigning generations of young people to a bleak future.

The former Health Minister and GP, Brian Gibbons, said that free prescriptions were part of improving public health. This shows the lack of ambition on the part of government supporters, the health of the nation won’t improve by tackling the symptoms of ill health, we need to tackle the causes. At present there are growing numbers of young people who are too fat and are at risk of diabetes, there are too many people binge drinking and are at risk of liver cancer, and we are seeing our country develop in a way which does not promote healthier lifestyles.

In my view the Assembly Government needs to focus on long term public health planning, we need to see the National Public Health Service having a stronger role in delivering improvements and Ministers need to take this issue seriously.

Longevity in life can never be assured, regardless of the fact that on average people are living longer. Because of our lifestyles we risk witnessing a generation of children who are unable to live as long as their parents.

As Chair of the Assembly’s Public Accounts Committee I am all too aware, as any of my colleagues will be, of the likely public expenditure constraints we face over the next few years.

Over the past 11 years the Assembly Government has spent money at an astonishing rate, many services have seen money being thrown at them in an attempt to provide better services to the public. Much of this money has gone on staff and the significant changes to their contractual arrangements. Whether the money spent has deliver a better service is debatable.

Part of the problem is a lack of genuine reform beyond the structural changes that has dominated the government’s  agenda. Why reform the delivery of a health care service when you can merely change the structure of bureaucracy and give the impression of real reform? The outcome of this should be streamlined decision making, but rarely is the outcome about getting more from the money we spend through new models of planning and delivery.

Local Health Boards are now starting to find savings in order to comply with the Assembly Government’s requirements. Cardiff’s health board for example has to make savings of around £40m which is an astonishing position to be in bearing in the mind the overall increases in the budget since 1999. One of the cuts will hit those with the early onset of Alzheimer’s where £17,000 is being taken away from a local project.

This cut is a false economy. The number of people with dementia is growing and is excepted to rise across Wales by some 35% in Wales over the next 20 years. This is a massive challenge and cannot be seen in isolation. The socio-economic cost of dementia is in the range of £7bn – £14bn, higher than heart disease (£4.05bn), stroke (£3.2bn), or cancer (£1.6bn). The need for better planning of services and the involvement of the third sector is paramount if we are to provide for the future picture.

I am not sympathetic to health boards who have had record sums of money in the past but are not struggling. Cutting the budget and making the service more efficient is one thing but scrapping a service that provides for the most vulnerable misses the point.