Owen Smith MP (Labour, Pontypridd) is the Shadow Secretary of State for Wales
Fifteen years after devolution, and nearly three years into the coalition government, we are starting to see clear differences emerging in the delivery of public services between the constituent parts of the United Kingdom.
In opposition in Westminster, there is much we can learn from the Labour-run Welsh government, and, as we develop our manifesto for the 2015 general election, we should be taking forward the best ideas from all parts of the country.
One Nation Labour is about protecting our public services for the future and ensuring they deliver more even when money is tight. The need to radically reform the way we deliver services to the elderly, those with long-term disabilities or health conditions cannot be ducked any longer.
With our ageing population leading to huge financial pressure on services, we’ve not done enough to ensure patients are treated with dignity and receive care that meets all of their needs, whether health or social, physical or mental.
A National Health Service that meets the needs of the whole community, publicly owned and financially sustainable for the long-term, is at the heart of Ed Miliband’s One Nation vision.
Last month Andy Burnham set out his ideas for reform in an ambitious speech to the Kings Fund think tank. At the heart of his proposals is a vision of ‘Whole-Person Care’. To achieve this, he argues, there needs to be a single service bringing together physical health, mental health and social care, and a single budget to prevent the perverse incentives under the current system.
Put simply, too many older people end up in expensive hospital beds, when cheaper preventative services would keep them at home for longer. Yet local authorities are forced to ration social care services because of budget cuts, while hospitals get paid for every patient who ends up being admitted.
It is not hard to see how the financial incentives in the system force people into secondary care, when all the evidence points to community services being more effective and, most importantly, people prefer care at home.
At the same time as Andy is setting out these radical ideas to have a fully-integrated health and care service for England, there is emerging recognition the NHS and local authorities in Wales are leading the way with jointly-delivered services.
This formula is reducing emergency admissions for those with chronic diseases (such a 15% fall in emergency admissions for diabetes patients), thereby reducing the need for hospital beds. Right across Wales, the NHS is coming together with local authorities in the region to redesign services in a way that benefit patients, save money and improve staff satisfaction.
The Acute Response Team (ART) at Hywel Dda Health Board in west Wales is one such project, and it has saved 3,800 bed days in just a year by treating patients who require intravenous antibiotics at home.
A new Bill introduced by Welsh health minister Lesley Griffiths takes this a step further and introduces a duty on councils to cooperate with the local health board to promote the health and wellbeing of adults and children who require care and support. It also explicitly requires them to seek to prevent the need for care.
The NHS in Wales is also investing in services that will identify and prevent future health conditions, such as ‘cascade testing’ for inherited heart conditions like familial hypercholesterolaemia. This approach was recommended by the National Institute for Health and Clinical Excellence (Nice) in 2008 but still isn’t offered in England. Already proving successful in Wales, it is estimated it could save more than a thousand lives in England.
All this has been achieved despite the tough financial environment the Welsh government faces with a budget which will be £2.1bn lower in real terms by 2014-15 than it was in 2009-10. Health currently takes up 43% of this budget, and rather than passing on the cuts proportionately, ministers have protected it in cash terms at £6.4bn per year over the next three years.
Furthermore, while Wales has been modernising hospital care and has seen the fastest rate of improvement across the UK for survival rates for cancer, the Tories in England are spending billions on a top-down reorganisation and are forcing the privatisation of huge swaths of the NHS.
In Wales, following a model of cooperation, the services remains true to the principles laid down by Bevan. It is therefore not surprising a BMA poll last year found more than eight out of ten doctors prefer working in Wales to England.
In other areas too, if the coalition runs to its full term, we could see very different outcomes by 2015 either side of Offa’s Dyke.
Education has been a high profile example, and the Welsh government’s decision to cap Welsh students’ tuition fees at £3,575, and to maintain the Education Maintenance Allowance, shows a commitment to maintaining routes to social mobility through education which risk being closed off by the Tory-led government in England.
Contrast too the approaches taken by Welsh education minister Leighton Andrews and that of UK education secretary Michael Gove, and a very different attitude to reform emerges.
Following a review of qualifications for 14- to 19-year olds, Welsh ministers have proposed to retain and strengthen GCSEs and A-levels, acknowledging the respect these exams command among employers and universities around the world. They will be supplemented with additional qualifications in literacy and numeracy, with a more rigorous Welsh Baccalaureate at the heart of the education system.
In England, even the cross-party education committee has criticised Gove’s rushed and unilateral announcements, last week describing the case for his reforms as unproven.
So across these two major areas of public services we can see stark differences between high-handed Tory ministers determined to push through expensive changes against the wishes of frontline professionals, and Welsh Labour ministers who have taken a principled stance and consulted widely.
As we see this latter approach pay dividends, both financially and in public perceptions, Labour’s task first and foremost is to win in 2015. Only then can we heal the wounds caused by this divisive Tory-led coalition, and set our much-loved public services on a course of reform that will transform lives across the whole of the UK.