If your only insight into health care in Wales was from Prime Minister’s Questions, you’d be forgiven for thinking that the Welsh NHS has been brought to its knees by a lack of funding, lack of access to rare cancer treatments, and long waiting times. The reality is a little more nuanced.
In fact at the recent Welsh NHS Confederation conference, people were openly proud that the NHS in Wales had taken a different path to the NHS in England. The current Labour Government has largely steered clear of any private provision of health care, there is no commissioner-provider split and the system is small and has had minimal reorganisation recently, meaning people have had time to build relationships and trust each other.
Outside of the system however, people don’t appear to be overly aware of a ‘Welsh’ NHS. A BBC commissioned poll in 2014 showed that only 48% of the Welsh population knew that the NHS was in the hands of a Welsh Minister. However, perhaps the bad press has made more people aware of health care’s devolved nature; health is now reported as being the number one issue for the Welsh public ahead of the election.
So what’s in store for an NHS that is proudly different, but also needs to improve, and some would argue transform?
Money
The impact of austerity across all four health care systems of the UK means that difficult spending decisions abound – not least the balance between health care and social care. So what do the main parties in Wales say about their spending priorities?
The Welsh Conservatives commit to protect the health budget and guarantee to increase health spending year-on-year; similar to the current policy in England. Welsh Labour state they will spend £172 more per person on health and social care services in Wales than England but do not provide a breakdown of what proportion will go to each service or whether this is an increase on current spending. Plaid Cymru will commission a Welsh version of the Carter Review with the target of saving £300 million annually, and the Wales Green party say they will ensure health and social care funding reflects the needs of Wales and will not be less than the EU average. Taking a different approach the Welsh Liberal Democrats promise to set up an ‘all-party and non-party Commission to ensure Wales has an NHS that is clinically and financially sustainable and to secure a historic and long-term plan for health and social care’.
Access to treatments
The NHS in Wales has been criticised for not providing some cancer treatments that are available to patients in England. Perhaps to reassure Welsh voters on this issue, a few funds are promised in the manifestos. A Cancer Treatment Fund by the Welsh Conservatives, a New Treatment Fund by Welsh Labour, a New Medicines and Treatments Fund from Plaid Cymru and a Health Technologies Fund from the Welsh Lib Dems. All are arguably similar in theme but there isn’t much detail on where the money would come from.
Quality
The 2016 OECD report comparing UK health systems concluded that 'in many respects "quality" is at the heart of the Welsh health system'. However, in 2014, the BMA called for the Welsh Government to commission a full-scale independent inquiry into the NHS in Wales that analyses ‘the factors that led, or have the potential to lead to fundamental breaches of care’. All parties have taken heed to a greater or lesser extent.
Both the Welsh Conservatives and UKIP have pledged a review. The Wales Green Party promises to strengthen the regulatory system. Plaid Cymru say they will create an independent and integrated inspection system and introduce a ‘Fit and Proper Person Test for NHS and Care Managers’. Welsh Labour would review the functions of the Healthcare Inspectorate and the Welsh Lib Dems would replace the Inspectorate with a Health Watchdog.
Workforce
The new Nurse Staffing Levels (Wales) Act 2016 makes Wales the first country in Europe to have a requirement around safe nursing levels set out in legislation and workforce remains a key issue in the run up to the election. Welsh Labour promise £85m to support education and training programmes for health care professionals and would increase the number of nursing training places by 10%. UKIP would retain nurse bursaries and introduce the equivalent of State Enrolled Nurses to allow health care assistants and others to train as nurses without requiring a degree.
I’ve wondered if the conflict about the junior doctors’ contract in England could result in doctors moving across borders. Welsh Labour see it as an opportunity, promising to ‘attract more GPs to Wales and encourage more doctors to train in Wales’ and, with a nod to the dispute, ‘preventing industrial action by respecting NHS staff’. Plaid Cymru say they will offer financial incentives to new doctors joining hard-to-recruit areas and specialisms.
As I read the main parties’ manifestos, I was surprised to find little on offer to make the Welsh NHS distinct and reflect that pride in their difference I’d heard spoken of by NHS staff. Any election will bring promises about money, access to treatment, quality and workforce. But given the recent passage of the inspirational Well-being of Future Generations Act why was there so little mention of public health, sustainability and wellbeing? Ultimately, will it be what’s not included that separates the parties?
A full list of all Welsh Assembly candidates and links to the parties’ manifestos is available on the BBC website.
Emma Ryan is a Policy Fellow at the Health Foundation
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