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Morgan: The future of NHS Wales

Conservative Party Minority Debate in the Welsh Assembly

"It is no exaggeration that the subject of today's debate encompasses the central concern faced by this institution today, and eclipses almost everything that has been talked about in this chamber since the advent of devolution - the future of our NHS in Wales.

Health, after all is not only the biggest asset an individual can possess, it can also be the very greatest loss. It is certainly the most important policy area that this Assembly has been given devolved power over, and therefore the Minister responsible is charged with the greatest responsibility.

No other Member of the Cabinet can affect people's lives so dramatically by deciding when people will receive their lifesaving operations; no other Minister can determine how long Ambulances should take to respond to emergencies, how long people should wait to be seen by their GP, and whether our national health service will be there for them when they need it most. In short, no other Minister on the front bench in this room can make decisions that could mean life or death for people of Wales.

I hope that this debate will provide an opportunity, not only to highlight the severity of the situation faced by the NHS, but also to establish a watershed for the Health Minister, an evaluative appraisal for her four and a half years in office, and hopefully a stark warning to the Welsh Assembly Government. But I also want this debate to bring forward workable solutions to the way in which NHS Wales can get back on its feet, give the service a roadmap for clearing the backlog of waiting patients and become a service that we can all be proud of. I along with many in the health sector are firmly of the belief that this is the last chance NHS Wales has before irreversible damage is done, before this winter brings about a chaotic meltdown in acute services as staff struggle to cope, and before NHS Wales is locked into spiralling waiting lists, growing demand and dwindling staff morale.

This problem cannot be overstated. NHS Wales is in a critical condition. One in ten people - 10% of the Welsh population are now on waiting lists, a figure that has doubled since devolution. Thousands face delayed transfers of care, with no reduction in the problem whilst the number of hospital beds has fallen 14% in certain areas. Bed occupancy rates on the other hand are well above those in England and far higher than the Wanless review recommended - over 95% in some hospitals. In the Heath in Cardiff, over 200 people are facing delayed transfers of care - the equivalent of 3 wards.

However, it is important that the people of Wales understand exactly what the Minister has done for NHS Wales, what her impact has been since taking office, and how, despite the vast injections of tax payer's money, the performance of NHS Wales has waned;

In March 1999 2,200 people were waiting over 18 months for in-patient treatment

In March 2003 5,250 people were waiting over 18 months for in-patient treatment

(that figure is now 5,527)

This despite the 1999 Welsh Labour Manifesto pledge that;

"By the end of a Labour Assembly's first term, no one will wait more than 18 months for inpatient treatment."

To give these figures some context, there are currently a grand total of 7 people in England waiting over 18 months for any kind of treatment, despite an average spend of 16% more per head on health and social care here in Wales.

March 1999: 4,900 people were waiting over 12 months for out-patient appointments

March 2003: 24,600 people were waiting over 12 months for out-patient appointments

This despite the 1999 Welsh Labour Manifesto pledge that;

"By the end of a Labour Assembly's first term, no one will wait more than six months for out-patient treatment."

The Welsh Assembly Government set a target of a 25% reduction in bed blocking by March 2003. Figures in March suggested 1,186 beds were blocked - a 38% increase from the previous year. Yet another promise from the Labour Government broken.

The situation has become so bad, "unsustainable" in the words of Derek Wanless, that the Health Minister's own colleagues in Westminster are terrified of losing their jobs because of her record - the ones that aren't too embroiled in self publicity that is!

Frankly, the Health Minister's record makes it all too easy for me as opposition Health Spokesman to score points, kick the political football about and so on - none of which benefits the people of Wales in the slightest. The only way that real improvements can be made and delivered to the health service is if the Minister listens to our proposals as well as the recommendations made in The Review of Health and Social Care, and acts upon them now.

NHS Wales doesn't face 'challenges' that can be met by 'key targets', 'worked towards' by 'focus groups', 'public bodies' and QUANGOs. Frankly, the NHS has one almighty fight on its hands - A fight that it looks in grave danger of losing if the Minister does not clean up her act.

What would the Conservative Party do to save NHS Wales? - and lets face it someone has to - we all remember the Labour Party line in 1997 "only 24 hrs to save the NHS".

We would instruct doctors and consultants to perform an immediate priority assessment of every patient on the waiting lists, so that those in greatest need are treated first. We would also bring in specialist doctors and consultants to help treat the backlog of patients, giving the doctors themselves the power to treat patients according to their own priorities. We would not lay those priorities down for them.

Where appropriate, we would send patients for treatment in English hospitals where waiting lists are a fraction of those here in Wales. We would also send patients who are in very urgent need of treatment, and where immediate space cannot be found, to private hospitals, paid for by the health service, a recommendation endorsed by Derek Wanless.

And we would reduce the number of follow-up appointments and false admissions by designating teams of experienced mobile nurses to assess the situation at the patient's location. This has proven to be far cheaper and more effective in England than admitting a patient to an A&E department, and through the referral process.

The Conservative Party does not underestimate the size, scale and cost of this process. Even if each of these proposals were enacted tomorrow, it would take several years before no one in Wales was faced with a significant wait for treatment.

These are also short-term measures, simply designed to treat the 307,000 patients who are waiting for treatment. Once the backlog has been erased, strategic long-term measures will be implemented, providing the NHS with a clear pathway to future success and stability.

The empowerment of hospitals and trusts is at the very forefront of our health policies. Hospitals should be given extensive local decision making power, allowing Trusts the flexibility to respond to the different demands placed upon them. They will be given total freedom over their budgets to allocate resources as they see fit. One heavy hand cannot work for 22 different health boards here in Wales - demand in the health sector is far too varied for that. It is only these frontline staff, working at the forefront who know exactly what is required for effective and efficient service provision - it certainly isn't the politicians.

As such, we would eradicate the centralised top-down ethic that is stifling our health service. Doctors and nurses will be accountable to the people they serve, and not Assembly targets.

GPs will be encouraged to branch out into specialised 'problem' areas where there the service looks to be struggling. This will help the service be more responsive and will relieve the massive burden from other primary care services which operate in general areas, particularly A&E.

We would encourage a concerted take-up of new medical technologies. The are many technologies, in the form of telemedicine initiatives and ICT equipment that can unlock remarkable benefits to the NHS, in both their cost and potential to reduce hospital attendances. Under a Conservative administration, the private sector would also be allowed a far greater degree of involvement with health and care provision.

These again are fundamental reforms, which not only form central planks of a Conservative future for NHS Wales, but the major recommendations made by Wanless.

What we have seen from the Health Minister is a government response that is weak, poorly constructed and defeated here in plenary. It lacked imagination and it lacked trust in our health care professionals and managers. Furthermore, it lacked a true understanding of the emerging crisis. Sadly, it looks as though this poorly constructed response will now be shoved past the Assembly with little regard for democratic protocol.

If this crisis is to be faced, it must be faced head on. For the sake of 307,000 people waiting, Jane Hutt must remove her head from the sand."

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