March 29, 2016
David Cameron notoriously claimed at the April 2014 Welsh Tory Spring Conference that Offa’s Dyke had become “the line between life and death” due to the performance of the Welsh NHS. However fortunately for the truth and honest debate, almost to the day the Nuffield Trust published its comparative study “The four health systems of the United Kingdom; how do they compare?”. It reported :- However, this latest study ….. reveals that while there are few indicators on which a devolved country does better than England or its North East region, the performance gap between England and the rest of the UK has narrowed in recent years. There is little sign that one country is moving ahead of the others consistently across the available indicators of performance.
Despite being being caught out, the Prime Minister continued to misrepresent the state of the NHS in Wales. By October 2014, when challenged about the state of the English NHS, he demanded that “ …Let’s have an OECD inquiry … I want a comparison between the Labour NHS in Wales (and England)..” He went on to say that Labour was “ ..totally terrified of (its) .. failures in Wales on the NHS.” Indeed Monmouth Tory MP, David Davies, went so far as to suggest that the Welsh Government was doing everything it could to delay the production of such a report.
However despite all this rhetoric the report, “OECD Reviews of Health Care Quality: United Kingdom 2016”, was published in February 2016. And it concluded that from the limited country specific data available “… no consistent picture emerges of one of the United Kingdom’s four health systems performing better than the other.” In short, again, there was no evidence to support Cameron’s claims about the relative performance of the Welsh NHS.
The line between fact and fiction.
In his response to the publication of the review the Welsh Health Minister, Prof Mark Drakeford said “This report is the line between fact and fiction. Any claims of one nation having a second-rate NHS compared to others simply do not reflect the facts. The time has come for a real, mature debate about the future of our health services.” Can we expect Mr Cameron please take note?
While the OECD showed that each administration needs to improve its performance, in relation to Wales it concludes that continuously improving quality of care is deeply established and widely shared across the Welsh health system. And where things are not going well, the Review felt that the Welsh Government’s “Escalation and Integration Framework” was a robust tool for quality assurance and intervention.
These are important messages as for most of the last half decade Welsh Tories have been arguing for a total “Keogh style” review of the NHS in Wales with the implication that the NHS in Wales is in some sort of systemic melt-down similar to the situation in Mid Staffordshire NHS Foundation Trust. The OECD review shows no evidence to support this denigration of the Welsh health service.
How the planning system is working.
In stating that all of the UK shows an improving picture, there are still a number of areas where the NHS does need to do better. This applies in different measure across all of the four administrations not least in Wales.
The OECD Review reports that Wales no longer operates an internal market but uses a “planned” system underpinned by the principles of “prudent health care”. While the prudent health care principles give an important sense of direction to the Welsh NHS, the under-performance of health boards linked to an imbalance in favour of local autonomy means that there is room for improvement in planning health care delivery.
A greater sense of national purpose is needed which could be achieved by butressing the prudent health care approach with a clear action plan and by strengthening the use of the three year Integrated Medium Term Plans (IMPT).
Inequalities and primary care.
Welsh Health Boards are still adjusting and learning about their new planning role. The Review believes there is a need to give an increased emphasis to primary care as part of a wider agenda of tacking health inequalities. Both these areas have been judged to suffer from relative neglect under the new “planing” regime. This could be a consequence of the relatively weak role that the primary care sector and patients have in the planning system e.g. there are no GPs on the Health Boards by right.
Developing the role of primary care clusters (PCCs), covering populations of 50-250,000, could have a significant potential in this regard. And the latest investment by the Welsh Government in PCCs is an important step forward. The clusters will provide opportunities to broaden the range of services and expertise that patients may access in a primary care setting. In addition the clusters provide a workable population base for more sensitive health care planning where the local expertise of front-line clinicians can be usefully captured by the planning system.
The OECD seems to take the somewhat ideological view that the lack of a market in health care in Wales diminishes patient choice and influence compared to English. However, in making this point, it is acceptes that the geography and demography of Wales does not allow for a ready translation of the English experience.
Faced with this lack of “patient power” it recommends a strengthening of patients’ voices. More effort should be spent on capturing the patient experience. While coming at it from a different perspective, this is in line with the SHA Cymru view that we should “ use the visible hand of public accountability to improve standards rather than rely on the invisible hand of the market”.
Wales has retained its Community Health Councils as the patients’ voice within the NHS. It has been through a number of changes to improve its effectiveness down the years thought it is still debatable that they are fully fit for purpose. The Review recognises the need for CHCs to be more effective in the way they hold the service to account and articulate the views of patients. In improving its focus on these tasks there is a question as to whether CHCs add any value to NHS quality by continuing with their on-site inspection activities.
Collaboration rather than abusive rhetoric.
The four health administrations are doing things differently across the UK. New and innovative ways of doing things are being developed. The OECD acknowledges that this diversity provides an important learning opportunity that is being neglected by all four administrations. In part the lack of an agreed set of performance parameters and a lack of professional and political will is preventing this from happening.
Rather than using these differences as a cynical party political ploy, as the Tories have been doing, this form of engagement and collaboration seems a better way for the the National Health Service across the UK.