Monday 25 June 2012

2020 Vision

Excellent article in the Western Mail about the future of mental health services in Wales.

The trouble is that the Welsh Government has observed the dog's breakfast made of reform of the NHS in England by their Conservative and Lib-Dem opponents and, I suspect, this has reinforced a view that the top-down, monolithic NHS which Carwyn's last government created is the way forward. Now we can all agree that the abolition of the 22 old LHBs was right. Further, I would agree that the present system is more efficient and defensible than the pretence of a commissioner-provider split which the old system played at. But the return to a 1970s NHS just cannot be the answer for the long term and Wales must find a way forward which learns from the English mistakes but still moves towards flexible commissioning and patient choice.

And this is not, in spite of current appearances in England, a party-political matter. The Labour government in Westminster was unmistakably in favour of the same kind of reform for England (Gordon Brown when Prime Minister said "In the NHS of the next decade, real power must lie in the hands of patients, not the bureaucracy...No longer can we sustain the approach of patients as the passive recipients of services. Increasingly patients and their families and carers must be seen as active partners in their care with enforceable guarantees, real choice and control over services") - though of course they are entitled to point to the deficiencies in detail (rather than principle) of the new government's approach.

I'm not optimistic. There isn't really a debate going on about this (no doubt because of what's going on in England) and instead the Welsh Government is preoccupied with the challenge of bridging the huge chasm which divides citizens' loyalty to their local hospitals and the financial and clinical reality that we need to close several down and centralise or regionalise services.

Actually these matters are linked. It is because people are powerless to control their own health care that they attach their loyalty to buildings instead of to the quality of services. If they were used to making decisions about their health for themselves then they would think through the issues more clearly. Let me illustrate this point - would you prefer (i) to wait a year to have an essential life-saving operation at your local hospital or (ii) have it done next month at a facility which is 30 miles further away and which has a decisively superior survival rate? It's a no-brainer but nobody seems willing to raise such questions and trust to Welsh people's good sense to provide the right answers.