The Blue Print

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.

The debate around the future of care for the elderly is not just important in the context for how we provide services to an increasing number of older people, but how we can support people to be as active as possible.

Many politicians visit residential care homes. I am a regular visitor to Ty Coch in Llanishen, where I spend time talking to the residents about the work I do in the Assembly and also listen to what they have to say. Today we talked about the the big care debate and what the major challenges are. It was more than useful as their experiences are current.

Paying for domiciliary and residential care is a big factor when we consider that in 20 years time the number of retired people will outnumber those in work and that half of today’s new born children will live until they are 100 years of age. The demographic picture of the UK is rapidly shifting and we are at last waking up to this major challenge which cannot be avoided by simply hiding behind the couch.

The financial question poses two problems, the first is that we don’t know how to plug a £6bn gap in expenditure just to carry on doing what we do now for a bigger audience, and second it doesn’t take into account how services might have to be re-designed in future to cope with changing expectations. Personally I don’t see how we can avoid a form of “old age insurance” but this might not be universally popular.

The group I spoke to today talked about the cost but also about the quality of life. Some residential homes are very good at providing a varied social calendar, catering for different interests. For many of the residents I know, the quality of life through activities and societal engagement is important, it’s about actually living.

I sometimes think we have traditional come at this debate from the wrong angle, looking at the cost. The problem is that we haven’t figured out first what it is we need to provide and what people might want to do in their old age.

The Assembly’s Equality of Opportunity Committee, of which I am a member, has today started an inquiry into whether people living with HIV face discrimination by health care professionals and providers.

This is an important inquiry, not least because we are dealing with a subject matter that is sensitive and one that politicians traditionally have not looked at. It’s also a tricky subject for the clinicians who provide care for people living with HIV, whether for that illness or any other that may require attention.

Two problems occurred today with the evidence. In questioning the BMA and the BDA it was clear that some professionals might not be as sensitive to the subject as they should be, a point that neither body tried to deny. A further problem was the lack (at the moment, admittedly we’ve only just started the review) of a body of substantive evidence, beyond the anecdotal information provided by organisations with an interest in the welfare of people with HIV.

The evidence provided by AIDS Trust Cymru suggests that some people are referred by their GP to a Specialist even if the medical condition is not related to the HIV, some patients are put into inappropriate infection control rooms in hospital and there are some who feel discriminated against by dentists who “triple glove”.

The committee may well struggle with this review, regardless of how worthwhile the subject matter is, because of a lack of hard data, I hope I am proved wrong.

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.

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?

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.