Forest of Dean & Wye Valley


In Guest Feature on September 6, 2013 at 12:46 pm

A look at how the Health Service treats those in its care in Wales: by Dr. Brian Gibbons

Devolution was a major radical constitutional reform by the last Labour government. In recognising the national, social and cultural diversity across the UK, devolution has enhanced the democratic basis of our politics. Devolution allows each of the four administrations to innovate, and develop policies from which the other administrations can learn – for good or bad.

Health is a major area of responsibility for each of the devolved administrations and it is an obvious area where these varied approaches can be studied.


In January 2003, the Welsh Assembly voted in favour of a comprehensive ban on smoking in public places, the first national democratic body to do so. This mandated the Welsh Government to lobby Westminster for powers to give effect to this decision. In March 2004 the Irish Republic became the first country to implement such a smoking ban, followed by Scotland in March 2006. With clear evidence that the ban worked, a comprehensive smoking ban was legislated for Wales and England, coming into effect in 2007.

As part of its manifesto for the 2003 Welsh Assembly election, Welsh Labour proposed to end prescription charges. The management of long-term illnesses such as asthma, blood pressure, heart disease, arthritis and cancer are becoming more important in promoting health amongst the working class population. However, there was clear evidence that many patients were not able to afford the multiple prescriptions that the best treatment for these conditions required. In addition, the loss of free prescriptions was a barrier for many people in moving from unemployment to work.

In April 2007, free prescriptions became a reality for Welsh patients. The main concern had been that it would lead to an explosion in prescription costs. But this did not happen and they are now free in Scotland and Northern Ireland as well.

Whilst New Labour was in power, the three devolved administrations were never very keen on the use of PFI to build or renew their hospital infrastructure, and took a cautious line. The wisdom of this approach is now becoming apparent, as the English NHS finds itself tied into many expensive and inflexible contracts. In Wales the NHS was able to introduce free hospital parking without re-negotiating with PFI companies who were using parking charges as a funding stream.


Another area of major difference between Westminster and the devolved administrations has been the role that the private sector should play in health care delivery. The Welsh Government has consistently taken the view that partnership rather than commercial competition is the best way to deliver more effective and equitable health services.

This view is largely shared by the other devolved governments in the UK, even though they each have different ruling political parties. In 2004 the Scottish Government took matters further by abolishing NHS trusts and thus eradicating the internal market in that country. Welsh Labour announced a similar move in its 2007 Assembly election manifesto, and set up seven integrated local health boards in October 2009.

These moves stand in stark contrast to the Tory/Lib Dem coalition’s approach enshrined in the Health & Social Care Act, which passed into law last March. This highly divisive and controversial legislation places the very essence of a public service NHS at risk.


It is true that when people are ill, all that matters is that they get appropriate quality treatment in an appropriate and timely way, regardless of the provider. Some have used this to argue that the British public are indifferent as to who provides their health and social care. However, there is little doubt that the overwhelming majority wants the NHS to stay as a public service – and they were delighted with the way it was celebrated at the opening ceremony of the London Olympics.

This view is also shared by the overwhelming majority of the NHS workforce. The Health & Social Care Act has provoked a storm of protest from those who work in the service. Virtually all NHS staff bodies campaigned vigorously against the Act. Many Royal Medical Colleges were obliged reluctantly to join the fray, often in response to angry grass roots opinion.

Already over a hundred private sector firms are lined up to contract for NHS services in England. In 2012, the Nuffield Trust/IFS estimated that the English NHS contracted for £8.7 billion’s worth of services from non-NHS providers. This is a 55 per cent increase since 2006. Organisations such as Virgin Care, UK Care, Circo and Circle are lining up for further rich pickings as the Health & Social Care Act is rolled out.


The public and NHS staff in England remain totally unconvinced about the direction that their NHS is taking. The Tory/Lib Dem coalition has clearly lost the argument. Over recent months it has given up trying to defend its own position and has sought to shift the argument to one about the performance of the NHS outside England – especially in Wales. But this is only a desperate smokescreen to divert responsibility for the failure of its own policies.

The differences in performance and patient experience in England and Wales is not something that has just happened since the Tory/Lib Dem coalition came to power. It is long standing. It is partly due to differences in policies, but it must also be seen as an outcome of the different levels of wealth, private health care use, demography and health experiences in the two countries.

Wales has an older population than England, which has a major effect on disease patterns. The levels of illness have historically been higher, a reflection of industrial and social economic deprivation. Similar levels are also seen in equally disadvantaged parts of England. Service delivery is more challenging due to Wales’ relatively large rural land mass, and because many of the most disadvantaged communities are in post-industrial valleys. This is in contrast to the more compact population concentrations in England.

Any survey of health service performance between the four countries can show a very wide range of experiences. Recent reports by the National Audit Office and British Medical Journal show that no single country is best or worse at everything. The picture is much more varied and figures can easily be cherry picked to plead a particular case. The National Audit Office report summarised the situation as follows: “… we cannot draw conclusions about which health service is achieving best value for money. Where comparative data are available, we find that no one nation has been consistently more economic, efficient or effective across the indicators we considered.”


In the last twelve months the Welsh Government undertook a national survey of the opinions of 4,500 people across Wales on how the public services were run. It showed that Welsh people felt that their Government was clearly outperforming that of the UK. About 96 per cent of respondents felt that they had been treated with respect when they last used the NHS in Wales, with 90-92 per cent happy with the care received. This verdict speaks for itself.


Across all of the UK, the NHS is facing the challenge of service re-design to deliver high quality sustainable services in the 21st Century. This is made all the more difficult due to the disastrous impact of the UK Government’s austerity programme. The devolved administrations in Wales, Scotland and Northern Ireland have chosen to move forward with a public service model. In England, patients and staff face a top down, unwanted, dogma-driven programme of change which indeed represents a very dagger at the heart of everything that the NHS stands for.

Dr. Brian Gibbons hails originally from County Roscommon in the West of Ireland. He graduated in medicine at the National University of Ireland, Galway, and in 1976 he moved to Halifax in West Yorkshire to undertake vocational training in general practice.

He later moved to Blaengwynfi, in South Wales where he worked in partnership with Dr. Tudor Hart. He became a member of the Welsh Assembly, representing Aberavon, and for two years he served as Minister for Health and Social Services. He retired from the Assembly in 2011.

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