The Blue Print

Last night my Legislative Competence Order on the devolution of powers to Wales to reform our mental health services was approved by The Queen in a meeting of the Privy Council.

This is the first time that an ordinary back-bench Assembly Member has succeeded in pioneering a transfer of legislative power from Westminster to Wales. The problem with being in opposition is that there are limitations on what can be achieved, the opportunity therefore to convince both the Assembly and Parliament of the pressing need to transfer powers is somewhat unique.

Now that these powers rest in Wales the Assembly can get moving with reforming mental health services which have lagged behind the rest of the NHS in responding to the needs of patients. In addition to giving early access to assessment, care & treatment, and advocacy, we need to use this momentum to tackle the stigma of mental illness.

The pain and suffering caused by a physical injury, perhaps a disease or broken limb or a hospital stay all inspire sympathy from friends, neighbours and relatives. The pain and suffering caused by a psychological injury is not always seen in the same context, even though 1 in 4, perhaps 1 in 3 of us will encounter such an injury at some point in our lives.

As the Assembly Government now moves to the introduction of a Welsh law to reform mental health services we need to use the opportunity to deal with the perceptions of what mental illness is, and how any of us can be affected. It doesn’t matter what we all do for a living or how wealthy, intelligent, or fit we are because mental illness knows no boundaries.

If attitudes are to change then politicians need to take a lead, children need to be educated as part of their understanding of health issues and a wider debate is needed.

Earlier today I asked the Local Government Minister whether should remove the social services function from local government and merge it with the new Local Health Boards.

This question built on my speech last week at the RESEC (Research in Specialist Elderly Care) conference in Bangor where I suggested that government departments ought to be working together in planning for our future care needs, and that they should be examining the regulatory framework & inspection regime to see whether it’s fit for purpose.

For some, giving the LHBs responsibility for social services would be a controversial step, especially those running our county councils; for others who are tired of poor performance in the delivery of social care this would be a sound move to make.

One of the biggest barriers to strategic planning and the provision of seamless care is the fact that two organisations are responsible for people in the health and care sectors. A person in hospital is the responsibility of the NHS, if they are discharged with a care package they will have the input of usually both health and social care workers, who in turn are accountable to the NHS and local government. In theory there’s no reason why this shouldn’t work but the practicalities are quite different.

The first problem is at the point where a person is capable of being discharged to their own home but the discharge planning is flawed. According to hospital managers local government are slow to put in place an appropriate package of care, I suspect they are right. However many of our hospitals are also slow to ensure that the district nursing service is lined up and involved in advising on the appropriateness of the discharge. Age Concern told me this week that they are seeing an increased number of unsafe care packages being put in place. This is a disgrace for a nation that purports to care about the elderly.

The second problem is for those who require nursing care in a residential home. The experience of most families is the long drawn out battle between LHBs and local government over who should pay the care home costs where a person has, for example, dementia. By 2050 there will be 1.7 million people in the UK with dementia, an increase of 81%, and for many a care home is needed. Having had constituency experience of the disagreements between statutory bodies over funding this is a big issue. The dispute is usually over the actual level of nursing care required for the patient, a rather stale and impersonal spat between two organisations charged with caring for the individual.

Planning for our future care needs is one of the greatest challenges we face, we must be bold. Who exercises these functions is an important part of that debate.

Before Christmas our new First Minister appointed his new Cabinet, including the surprise promotion of Jane Hutt as the Minister for Business and Budget. The use of the word budget sounds like she was found in “Pound Stretcher”!

After her failings in health and education I suppose the natural next step was to take control of the Assembly finances. In the debating chamber today I asked her what discussions she has had with the Chancellor of the Exchequer since her appointment. Cutting through the waffle in the reply she obviously hasn’t.

In all fairness she has met with the Chief Secretary to the Treasury and she does keep in touch with officials but the man in charge is the Chancellor. I find in incredible that she hasn’t even had a telephone chat with him in light of the 17% cut to public expenditure which he has ordered. The Treasury are making plans for significant reductions in public spending in an attempt to reduce the deficit. In the Financial Times on Monday the Chancellor said that this was “non negotiable”.

Surely any capable Minister would want to know what the thinking at Whitehall is and what the likely impact will be for Wales. We are roughly one month into the new Assembly Government and already we are seeing a poor performance by our new budget Minister.

But I suppose that’s always the risk with budgeting

The announcement by the Health Minister that she wants the Assembly have legislative competence over organ donation is flawed for two big reasons.

Firstly there is a question as to whether it is better for the UK as a whole to have a common system for regulating the use of organs or whether a nation like ours should have a separate legal system. The experience in mainland Europe is that organ donation and usage is organised at a national level, even in Spain one of the most decentralised countries in Western Europe where presumed consent operates, it is not left to the 17 autonomous communities.

Secondly there is the assumption that changing the law and the system to presumed consent suddenly leads to an increase in available organs. This is simply not the case. The law in Spain was changed in the 1970s but there was no positive impact. The breakthrough happened in the 1990s when the Spanish government invested in the clinical training so that medical staff could feel happy to approach grieving relatives. They also invested in the transplantation units and the coordination of the organs that were available. There is no evidence to suggest that the change in the law did anything. The investment though was absolutely key.

My concern with have an opt out system is that it relies on people being lazy, perhaps having never uttered what they feel about organ donation. In Spain there is no register of who has opted out, it’s just left to families who might not whether the deceased had any objections to their organs being used.

I have an organ donor card, my view has been recorded in a positive way, it’s a pity that the Welsh Assembly Government has given up on leading the nation in urging people to show their generosity.

This afternoon my back bench legislation proposing a transfer of powers from Westminster to Cardiff Bay has been approved by the Assembly.

This is a watershed for devolution as it is the first non government sponsored proposal to transfer legislative competence to be agreed by the National Assembly. It is now up to a vote in the Commons and the Lords, and providing they’re happy, the Order will be confirmed by Her Majesty The Queen.

During today’s debate I described the challenge of reforming mental health services as “the last great social reform” because I firmly believe that those who live with mental ill health deserve to be able to access the highest quality of help and support, and in doing so we can tackle the stigma which still exists today. 

There is also an excellent article on the subject of mental health on the WalesHome site by Felicity Waters highlighting the challenge to all of us. http://waleshome.org/2009/12/the-hallmark-of-a-civilised-society/

Anyone can develop a mental illness. It doesn’t matter how intelligent, fit, or wealthy you are. It respects no boundaries, it doesn’t need to rely on a person’s physical characteristics, it can simply happen at any time in early childhood through to retirement. It is estimated that one in four of us will develop mental ill health at some point, others believe the number to be closer to one in three.

In the past 10 years the Assembly Government and AMs generally have debated big changes to how we provide services to people with a range of physical ailments, it is now time as we progress through the next 10 years to show the same vigor in reforming mental health services

Rhodri Morgan’s retirement today as the nation’s First Minister is a big event in our history. Party politics aside one cannot avoid the enormous contribution he has made to political life not just in Wales but locally here in Cardiff.

I wish him well for the future and for the transition from head of the government to back bench Assembly Member whose sole focus will be representing the people of Cardiff West until 2011.

His successor has quite a task in front of him, not just to succeed in leading his party in and ouside the Assembly but in building a national profile. Following and attempting to match Rhodri’s public image and appeal, not necessarily as a Labour politician but as a Welsh politician, will not be easy.

With the decline of some broadcast media together with a poor performance by Wales based printed media this task becomes even more difficult.

This morning I have  formally laid my draft Mental Health Legislation in the Assembly in readiness for a debate and hopefully approval on 9 December.

This is the first non-government Legislative Competence Order to get this far having received approval from the UK and Welsh Assembly Government. If the Order is approved by the Assembly and Parliament it has the chance of completing its process by March 2010, which means that competence to legislate will be given to the Assembly.

Devolving powers to Wales over mental health has become something of a personal crusade. I have never quite understood why physical health became part of the devolved legislative remit without mental health. I suspect it happened this way partly because of the links between mental health and the power of the state to detain patients.

If this legislation passes and it all works out then Wales has the chance to lead the way in mental health services reform. Very often our debates have been around the need for Wales to catch up with the rest of the UK and certainly services here do need to change.

There may well be a golden opportunity to lead the rest of the UK in reforming this important service, demonstrating how devolution is not about doing things differently for the sake of it, but doing it better.

Congratulations to Carwyn Jones on his election as Leader of the Welsh Labour Party, although I suspect the honeymoon will be short lived – less like a three week luxurious break  in the sun and more like a wet weekend in Cardiff Bay!

My sympathies to Edwina and Huw who fought strong and vigorous campaigns. It’s not easy playing catch-up to an opponent who was tipped as the front runner before the poll opened and tipped as front runner before the result was even announced.

I wish him well in his Cabinet cull once he’s confirmed as First Minister, so many supporters to please, his opponents to include and enemies to dump. Not an easy task although a necessary one.   

Becoming the second First Minister (Alun Michael was First Secretary) and following Rhodri is no easy task. Rhodri achieved a sort of folk hero status, instantly recognised and respected regardless of political affiliation. Few politicians find themselves in this position during their careers.

The difficulty for Carwyn will be achieving the public recognition that leadership requires partly because of the lack of penetration by the Welsh media. Rhodri was well known before he became an AM. For those of us with only 10 years under our belts it’s slightly more difficult!

The other problem for Carwyn, which reared its head last week, is the battle between Labour MPs and AMs. He needs to ensure that he becomes more than just Peter Hain’s deputy.

We can all agree that today has not been Rhodri Morgan’s finest.

The intervention yet again by Peter Hain must be a source of great annoyance to Plaid and Labour members who are signed up to a referendum before 2011. If he wants to put Labour out of office in Wales then the Secretary of State is going about it the right way.

The question as to who is in charge in Welsh Labour is an important one. In the chamber earlier today I said that in the leadership for the Welsh Labour party that it looks as though Peter Hain has won, and that either Carwyn, Huw or Edwina will end up as his deputy.

The University Hospital of Wales in my constituency is in the news this evening for investigating & confirming a person-to-person strain of swine flu which is resistant to Tamiflu.

Having spent this afternoon on the phone to the Health Minister and to senior officials at the hospital I have been impressed with the speed at which the authorities have responded. Clearly the biggest hospital in Wales needs to ensure confidence amongst the public that it continues to be a safe environment and the thorough investigation by the National Public Health Service (NPHS) has reassured me as the Assembly Member for Cardiff North.

What we don’t know is whether this strain of Tamiflu-resistant swine flu is unique to Cardiff or whether clinicians here have been quick off the mark in identifying an issue which could also exist in other parts of the UK.

Whilst the only other person-to-person strain of Tamiflu-resistant swine flu was found in the US there is a feeling of inevitability that it would happen in Europe. What is impressive is the way this has been handled, the care being shown to those patients who are ill, the monitoring being done by NPHS and the advice being given to families.

It is important for people to feel confident in our hospital services and the response to swine flu in Wales has been professional and decisive.