The Blue Print

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.

Our campaign to protect the Llanishen Reservoir has received another boost thanks to a decision in the High Court.

The owners of the site decided to question whether the Assembly Government was right to list the structure for its historical significance. Many of us had argued for some time that recognising the engineering contribution of this reservoir was in keeping with the listing that had already been applied to the three other connecting reservoirs.

Yesterday HH Judge Milwyn Jarman QC  ruled against Western Power Distribution on all the points that had been raised. This is superb news for our campaign and confirms what we all thought, that the Government was right to acknowledge the role that Llanishen has played since its construction.

As the AM in whose constituency the reservoir is based I am delighted with this outcome. However the battle doesn’t end here. Ultimately we need to be in a position where the site is protected from the threat of development and as far as I am concerned the only way to do this is for Cardiff Council to make a compulsory purchase of the site.

Cardiff Council has now decided to propose a 4^thoption for the reorganisation of school places in Whitchurch and once again they ignore the damage they will do to the excellent standards in this part of Cardiff North.

Having been part of a superb local campaign against the three previous options for change, the council is still determined to close one of the primary schools and reduce the size of the high school from a 12 to a 10 form entry, thus removing 60 pupils per year from the school.

The council still doesn’t get it. Whitchurch for both primary and secondary education is popular with pupils and parents, we produce excellent results and the breadth of the curriculum provides opportunities for students in many subject areas. The schools are well subscribed and the problem of surplus places in other parts of the city isn’t one which affects the north of the city.

Whitchurch, along with the north of the city generally is changing. Younger families are moving in and the demand for primary education, even on the council’s own figures, is likely to increase. Culling one primary school demonstrates not only a lack of vision but an ignorance of the standards achieved in this community.

Yet again this is an attack not just on excellence but on parental choice. The message from county hall is that the more successful you are as a school, the more sceptical and unsupportive our council will be. And beware because this issue not only affects the community of Whitchurch but those surrounding areas from where pupils are able to attend the high school at present. Rhiwbina, Birchgrove, Llandaff North and Gabalfa are all within the high school’s catchment area at the moment but if their children can’t attend the school in future where does the council propose to send them?

Cardiff Council is more interested in penalising success and dumbing down our education system instead of raising standards in schools where there are problems.

It was roughly this time last year that I stepped aside from the Conservative Shadow Cabinet, having been a front bench spokesman for the previous 10 years.

During the past year I have enjoyed the freedom accorded to backbenchers, the flexibility to speak on any issue and champion any cause, and as an ordinary AM without a policy responsibility it is refreshing being able to see the wider picture. These past few months have also allowed me to throw myself into the role of chairing the Public Accounts Committee.

As the Chair my role is quite varied, in addition to chairing the meetings and giving our function a sense of direction I have a close working relationship with the Auditor General whose appointment I recommend to the Assembly, and with the Wales Audit Office. Earlier today I visited the office to speak with the staff.

The past few weeks cannot have been easy on them. As an office their role is to support the work of the Auditor General and as such they would have worked closely with the former holder of this office. His departure shocked not only those of us in public life and those in the media, but importantly would have been felt in the audit office itself. I went there today to reassure them of our support for their work.

We are fortunate in Wales to have a big team of highly qualified, committed and professional audit staff. Their reports to the Assembly are of the highest quality, and in addition to their work in auditing public bodies they are also a major contributor to the raising of standards in policy delivery and public expenditure.

The room this afternoon was packed. One could sense what a difficult time they had been through, but after I had formally congratulated our new Auditor General Gillian Body one could also sense a new start.

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.

The confirmation of a Papal visit to Britain later this year has already sparked controversy, less than 24 hours after the Pope officially announced it to the 35 Catholic bishops of England and Wales in Rome.

He certainly has been forthright in his comments, which some have seen as an unprecedented attack on the UK Government’s Equalities Bill. However, it should also be said that he did preface those comments by stating the UK’s firm commitment to the equality of opportunity for all members of society is well know across the world.

Whilst I do not completely agree with what he went on to say regarding the ‘violation of natural law’, I do have some empathy with the thrust of Pope Benedict’s argument.

What he is saying that pursuing the objective of giving people absolute equality to all has unintended consequences of unjustly limiting peoples’ religious beliefs.

I thought the Archbishop of Cardiff’s conveyed the Pope’s view even more cogently in today’s Telegraph. He said:

“The Church of course upholds absolutely the equal dignity of every person, irrespective of their faith, age and ability. But I think there is a misunderstanding because sometimes in government legislation, government equality seems to be that we are all absolutely equal, which we are not. We are equal in dignity but beyond that, each one of us is unique.”

Therefore, we should strive for individual dignity and individual responsibility but not individual or absolute equality because doing that we will always encroach on someone’s personal beliefs.

Whilst not a Catholic I am a Christian and currently a governor at a Church-in-Wales Secondary School in Cardiff. In my view faith schools for example should have the option to employ someone of that faith to lead the direction and ethos of the school with personal conviction. Otherwise the whole basis on which that school exists is undermined.

Whether you agree or disagree with the Pope’s comments, I think we should look forward to his visit. I have today called upon the Assembly Government to tell the Welsh public what discussions and actions it has taken to bring the Pope to Wales in September.

I am sure many Christians in Wales remember Pope John Paul’s very prestigious and successful visit to Cardiff in the very hot summer of 1982. This visit will only be the second visit of a reigning pontiff to Britain in over 470 years and as we have seen, they only come along once in a generation. So for Wales to miss out on this significant and high profile visit would not just be a huge disappointment to the Catholic and wider Christian community, it would be a huge disappointment to the whole of Wales