Will there be life after 60 for the NHS?

In a couple of months time the NHS will celebrate its 60th anniversary. The memory of Nye Bevan will evoked again and again as as the crowning achievement of the 1945 Government is celebrated.

But as I've found out over the last few months, the Health Service is in turmoil.

Like most people who consider themselves to be on the centre left I strongly believe in the founding principles of the NHS. When presented with anecdotal evidence of failings by the Health Service and its staff I have been amongst the first to make an excuse.

But my grim experience of the NHS maternity service in the last few months has left me pondering some very uncomfortable questions.

Perhaps I have been naive in not realising the depth of the difficulties facing the NHS (after all there have been no shortage of warnings), but I was deeply shocked by the resignation of the staff towards the sub-standard nature of the care that is all too often administered.

When I was a journalist I was wary of over using the word crisis, but I can think of no better way of describing the state of the NHS. Not simply in operational terms, but strategically.

In the face of an ever demanding consumer mindset, can the NHS adapt quickly enough to rising expectations to prevent middle class flight? That I think is one of the biggest challenges.

Those who can afford it (at a push) are routinely going elsewhere for care when they can.

For example, to avoid the prospect of an amniocentesis test for Down Syndrome, couples are increasingly prepared to pay £180 for the less invasive and more accurate nuchal scan at private health care centres. Once introduced to the world of private medicine many return to it in times of uncertainty when the NHS is found wanting. Meanwhile those who cannot afford it are effectively left with no choice.

It is not simply a matter of a gap in provision. I won't self-indulgently list my own gripes but I doubt very much the problems I encountered are restricted to Cardiff and Vale (clearly they are not), or indeed to maternity services. Some of the problems I encoutered were localised, others suggest there a deeper systemic malaise. In fact, a senior nurse in Wales' leading hospital told me recently that patients routinely 'slip through the net'.

The flow to private providers may only be a trickle now, but there's a danger that it will become a hemorrhage if the support of middle income groups for the NHS is eroded.

Let us not fall back into the familiar narrative here, it is not simply a matter of the rich having choice and the poor having none, many of the people turning the private sector have to borrow money but in desperation feel they have no choice.

It will become increasingly difficult to protect the services relied upon by the poorest if the allure of the Private Sector and the opportunism of the Right undermine the broad consensus which sustains the NHS.

As the NHS reaches its 60th birthday some unpalatable questions need addressing.

It is not just a matter of funding:

Doctors, nurses and midwives must ask themselves if they always give the best care that they can;

professional bodies and trade unions must examine whether their stranglehold on the
NHS is in the long-term interests of their members or the public;

politicians who enjoyed the easy kill of the internal market must show how in its absence the NHS can respond to patient demand;

and voters must confront the uncomfortable reality that if we want public services to meet our demands as modern consumers we cannot rely on solidarity alone to be sustain them.

I don't pretend to have the answers. But if the NHS is to be more than a fall back service for those who cannot afford to go private, the Welsh political elite must acknowledge the problem and engage with the search for solutions.

What do the local election results mean?

Anyone who spent a few minutes glancing at the local government election results in Saturday's papers couldn't help being struck by the remarkable divergence in results across Wales. There is no doubt that the results were awful for Labour, but even for Labour there were chinks of light in Neath Port Talbot and Bridgend. For every other party there were significant opportunities to celebrate but also the odd downside or two.

The question now is what kind of pattern of political control will we see emerge from the mish mash of results that was May 1st? I'd say the jury is very much out at the moment, and it is very much a case of watch and wait.

BUT, and I think this is a crucial point for the whole future of Welsh politics - political pluralism is here to stay. If these results prove anything they show that the once dominant force of Welsh politics, the Labour Party can lose anywhere. [Labour has also shown over the past 15 years in Wales that it can win anywhere]. For those who still think that coalition government in Cardiff Bay is an aberration, some rethinking is very much in order. Because, at a local level while Labour could reasonably aspire to play a leading role in a dozen or so authorities, if it adopts old ways of thinking in its approach to negotiations, it could end up in opposition in all but a few authorities.

These elections are not only a challenge to Labour, but will challenge all parties to think anew about patterns of political competition and cooperation; and that can only be healthy thing for the future of politics in Wales.

Women and Drink and Arrests

THE number of women arrested for being drunk and disorderly has increased nearly seven-fold over the past five years in Gwent.The UKs biggest rise in women arrested for the offence was in Gwent, where 190 women were arrested in the past year, compared to 29 between 2003 and 2004.New figures also showed the number of women arrested for being drunk and disorderly in Dyfed-Powys had increased from 65 five years ago to 120 last year – but there was no increase in South Wales.
According to the research by Channel Four News Online, Gwent showed the second biggest increase in the UK for women arrested for being drunk and disorderly. It was second only to the West Midlands, which reported a 12-fold hike from 59 arrests five years ago to 731 last year.
The statistics for 2007/08 only covered 11 months of the year, so the full picture is likely to show even higher increases.

What on earth is fueling this? Campaigners say pubs and clubs are deliberately targeting women with cheap drinks offers and free entry in a bid to encourage them to drink more. But prices are less in most parts of Europe and this is not the pattern. What circumstances or culture is different in Gwent . The whole culture of hard drinking among younger women and younger men is a trend that I feel needs some good rigorous research , we need to understand why getting "slammed" is an objective of more and more young women in particular. The health implications are serious , women 's bodies cannot deal with alcohol in the same way that their male counter parts can. May be this is an area WAG would like to commission Bevan to investigate.

Channel 4 News online asked all 52 police forces in the UK for details of the number of women that had been arrested for D&D offences in the past five years. Although 38 forces replied to the survey, only 21 were able to provide like-for-like figures over the five year period:Increase in arrests West Midlands: 1138 per cent Gwent: 578 per cent Leicestershire: 135 per cent. See their web site for more details.

Rethinking Regeneration in the valleys

In the last five years ago I have heard many derogatory things said about Merthyr - "it's like Beirut, the best have left, the problem is their attitude, why don't they get on the train to Cardiff" etc etc. I also have seen the Heads of the Valleys programme, announced nearly 4 years ago, full of good intent but with not enough money or action on the ground it has achieved little other than a mess in the town centre and the threat of a Status Quo concert in the park in the summer.

So, I have put pen to paper and written a pamphlet - Rethinking Regeneration: the Heads of the Valleys. I hope it will put to rest the insulting myths that swirl around the chattering classes of Cardiff and generate some real commitment to improving matters. It's being launched on 12th May at Merthyr College Theatre 4 p.m. - there will also be a 'question time' with local AMs and MPs. It's free too but you need to register in advance. The pamphlet will be available there or you will be able to download it from our website.

And, if you want more of this kind of thing, then you should JOIN the Bevan Foundation because that is the only way we can raise any money.

Wales and Community

One of the elements of life I have seen decline radically in my hometown and village is a sense of belonging to a community

What is happening to people getting together and working together, doing things to benefit young people, the local school,youth club ,OAP's etc etc. When I first moved into my "urban" village there were shops ,a vibrant local post Office, brownies ,guides, cubs etc. People met up for coffee had barbecues and even talked to each other . I only see my neighbours when we pass as we go to work or wave as we pass in the car.

Shops are gone,the Post Office I think will go when the present owner retires. No youth club ,scouts guides etc .I cannot remember the last time there was a community event. I did try to get some community education courses up here, but was told that there wasn't really any call for that and they had more pressing calls on the budget.

I contrasted this with Llangynidr this morning, They were holding a village "farmers market " in the local school to raise funds and just to have " another community activity". As I drove through, there were lots of young boys and dads and also a smattering of mams playing or watching football. Across the road a community centre ,open and a gardening group meeting. The school was really busy. Young people selling plants out side and helping in the refreshment room inside.

The "market" was lovely. Plenty of good reasonable local meat ,vegetables, home made bread ,jams ,cakes, pickles. Welsh cider and wine , wood and iron craft, a table selling tickets for an up coming country and western night. A bring and buy stall.

Most important to me lots of people talking to each other and happy to talk to us over a coffee.What has happened to our more urban areas, why does it seem that there is more going on in rural villages. I am not talking about events and activities generated by Communities First and such like. Real community led and generated events and "dos". Are we just too wrapped up in work and our own sphere to spare time for our wider community, that is sad if its true, so much socialisation and feeling part of a larger whole is being lost and that is something worth fighting to keep. Where are our community leaders of tomorrow to get their motivation?

Low paid on £18K?

No, don't switch off, this post is NOT about the 10p tax rate that was, but about the media coverage about whom its abolition hits.

According to all the media coverage, the abolition of the 10p tax rate will hit "the low paid" and those on "low incomes". This turns out to mean those earning less than £18,000 a year.

Well, 18 grand might not be much to a politician or journalist but a quick look at the statistics shows that half the population (and more than 60% of women) in Wales earn this amount or less a year.

Time we wised up to reality.

what is causing social breakdown -thoughts from JRF

A century has passed since Joseph Rowntree set up the three trusts which bear his name to “search out the underlying causes of weakness or evil in the community”. In 1904, he identified
poverty, war, slavery, intemperance, the opium trade, impurity and gambling as the “great scourges of humanity”. Joseph Rowntree recognised, that times would change and he wanted the trusts to be “free to adapt themselves to the ever-changing necessities of the nation”. This consultation revisits the concept of ‘social evil’ and explores the underlying problems that cause the most damage to British society or the most misery to its people.
The public consultation asked ‘What are today’s social evils?’
The following concerns about how we seem to live our lives were highlighted:
• A decline of community: communities are weak and people are increasingly isolated from
their neighbours, at considerable cost to well-being and happiness.
• Individualism: people tend to see themselves as individuals and not as part of wider society,
leading to selfishness and insularity.
• Consumerism and greed: an excessive desire for money and consumer goods has eclipsed
values and aspirations rooted in relationships and communities.
• A decline of values: there is no longer a set of shared values to guide behaviour.
Participants emphasised a lack of tolerance, compassion and respect shown to others.
Against this backdrop, people identified the following, more concrete, social evils:
• The decline of the family: family breakdown and poor parenting were felt to cause many
other social problems and leave young people particularly vulnerable.
• Young people as victims or perpetrators: Young people were seen as perpetrators of social
evils like anti-social behaviour, or the victims of stereotypes and limited opportunities.
• Drugs and alcohol: misuse of drugs and alcohol was viewed as the consequence and
cause of many other social problems, like family breakdown and poverty.
• Poverty and inequality: poverty was viewed as a corrosive social evil in an affluent society,
underpinning other social problems, such as homelessness and family breakdown.
• Immigration and responses to immigration: participants felt that local residents lose out to
immigrants in competition for scarce resources. Others criticised negative attitudes to and
lack of support for immigrants and thought society should be more tolerant and inclusive.
• Crime and violence: people felt that Britain is more dangerous and violent than in the past.
Child abuse and exploitation were highlighted as particularly damaging evils.
Government, media, big business and religion were believed to be responsible for these social
evils. People also emphasised personal responsibility for social evils, but thought bad choices and
damaging behaviour could be symptoms of underlying social problems, such as poverty.

Full report is on their website.

Do any of these come as a surprise, is it any thing we didn't know? The first four really highlight where government should be looking at policy. To me it shows how much we have moved away from putting people at the centre of what our society is all about.

How often do we keep in touch with friends,and relatives Do we write letters ,make an effort to see them even telephone. What about neighbours on a scale of 1-10 where would you rate yourself.Community ,mmmm when was the last time you engaged in a community activity,volunteered for anything,thought about may be getting involved in civil society.

I really thought about these things and came up short. My intentions are always good, but something seems to interfere.I have resolved to look at my priorities and may be try working on the things that do count and are not so transient.

What is the point of the All-Wales convention?

I heard Sir Emyr Jones Parry sketch out his ideas about the role of the Convention he’s been asked to Chair last week.

There’s no doubting he’s a distinguished man and he’s been given a difficult task, but I found the plan he mapped out a little disingenuous.

In essence he said he intends to take his committee around Wales to take the pulse of the nation, hear the arguments, take evidence, and then form a view about the way ahead.

But isn’t that exactly what the Richard Commission did?

He plans to fill his committee (not quite sure what makes his model a Convention?) with representatives from all the parties and some independent people. Again, I’m sure I’ve seen that approach adopted somewhere before?

Of course, we can’t expect people to support more powers for the Assembly until it has been proved that the existing powers have been fully used, he said.

And – he added – in the timeframe available it isn’t realistic to expect the Convention to recommend anything that is not already on the statute books courtesy of the 2006 Government of Wales Act. In other words, extra members and further powers are off the agenda.

I sat there scratching my head. I’m sure I remember the Richard Commission spending a Million pounds in an exhaustive evidence taking exercise, reaching a unanimous view (including the Tory representative) for more powers, more members and a new voting system.

So what’s point of this new Constitutional Convention? To fill time until conditions become favorable for a successful referendum campaign – which most likely means a Tory Government at Westminster.

Politics will decide the fate of devolution, not some pseudo scientific consultation exercise presided over by the great and the good. That’s stating the obvious, but let’s be honest about it.

Credit Crunch Cymru

The debate about the credit crunch has mostly been about banks, shareholders, the Treasury and first time buyers, and not a lot about the people who always bear the brunt of any economic crisis - the less well off. It might all seem a long way away but the credit crunch is here in Wales and its time the Welsh Assembly Government started to think about how to cope with the consequences.

We could see the return of loan sharks as people can longer borrow from the likes of Ocean Finance and Picture; we could see more homes repossessed as hard-up owners can't afford to pay their mortgages; and we could see people desparate for a home but unable to borrow the money to buy one. Add to this the risk of blight as unsellable houses are boarded up, as construction sites are put on stop, and jobs lost in finance companies based in Wales.

So, there needs to be an urgent increase in the capacity of Citizens' Advice Bureaux and credit unions, a big investment in social housing, and urgent discussions with developers about their intentions, to name but a few.

There is some argument that the credit crunch will blow over, and is only the market rectifying itself, but meanwhile hundreds if not thousands of people could suffer - time for WAG to do something.

Welfare to where?

I see Rhodri Morgan is saying (in today's Western Mail) that helping people into jobs is 'a key objective' of his and Ieuan Wyn Jones' government. I agree - getting people into work is the best route out of poverty.


Strange that this priority is an area of government that is not devolved and over which Morgan and Jones Ltd have no control.


What is more urgent is making sure that the people of Wales are not penalised when the draconian reforms come into effect in the autumn - by providing childcare, better occupational health, public transport so people can get to jobs, not to mention creating jobs themselves. Otherwise it won't be welfare to work it iwll be welfare to .... nowhere.


http://icwales.icnetwork.co.uk/news/wales-news/2008/04/17/welfare-to-work-key-says-rhodri-as-he-defends-political-leadership-91466-20776211/

Eight, twelve or twenty two - here we go again

It didn't take long for the question of local government reorganisation to rear its ugly head again. But whereas the speculation has, in the past, been confined to political commentators and has been brushed away by the powers that be, this time reorganisation is a real possibility because the source was no less than local government Minister Brian Gibbons.

The threat of reorganisation this time is because of poor performance. But if Dr Gibbons looks a little closer he will see that there is no obvious connection between size and performance - some of the best performing authorities on some measures are the smallest (and some of the worst are the largest). And performance varies WITHIN authorities - some authorities who are good at, say, waste recycling are very poor at other things e.g. processing housing benefit claims. So it's not at all certain that a shake-up would improve matters, but it would inevitably cost millions.

What we do need is a thorough review of the PURPOSE of local government. I can't see, for example, any rationale for having 22 authorities process housing benefit claims. However I do see good reasons for having local organisations to consider planning applications. There is no number that is magically right - it all depends what you want the authorities to do.

…Go on, say something!

Within 18 months, at the most, Wales will get a new First Minister; and Labour a new leader.

At the risk of repeating myself, there should be no assumption that the person who fills these offices will be the same.

But for the Party that assumes they will remain in control, shouldn’t it be a cause of concern that there is no debate about what the future holds?

Of course there is lots of speculation and gossip within the Cardiff Bay bubble about personalities: Will Leighton get enough nominations to take on Carwyn; Has Andrew lost his appetite; Will Edwina take the advice of those around her and stand etc.

But on the question of what any of these (potential) candidates will do with power there is silence.

“Too early to start campaigning yet”, I am told by those who have the ear of one of the contenders. But with Labour facing certain losses in the next month’s Council elections, am I the only one who thinks we should be hearing more about what those who wish to lead their Party plan to do to bring about a revival?

Ideas Wales has done nothing since its interesting, but ultimately pointless, seminar in Feburary. Wales 2020 has published three interesting pamphlets but has generated little debate.

And the source of debate and ideas outside the Labour Party is little better. The Bevan Society deserves credit for staring this blog, but the IWA has become a prisoner of caution.

Tempting as it is to blame others, culpability rests of the door of those who wish to lead.

Rhodri Morgan has given his party the courtesy of a leaving date. The job has been advertised, so let’s see the CVs – and more importantly lets here the presentations.

It seems at times that no one wishes to offend the First Minister by taking him at his word and planning for his departure. What is everyone waiting for? I’m sure they’re all busy Governing Wales and keeping a coalition together, but they won’t have to worry about it for much longer unless they start thinking, and talking, about the future.

In a brilliant speech to the Labour Party conference in Manchester 18 months ago Bill Clinton told Labour that unless they presented themselves as the agents of change somebody else would fill the gap. “Make no mistake about it”, he said, the question for voters “is not whether you will change. It's how you will change and in what direction.

But at this rate the only change Labour is heading towards is opposition.

A Welsh art gallery - whose culture?

The culture vultures are at it again, this time about whether a national art gallery should be housed at the National Museum in Cathays Park, Cardiff. Well yes I am sure we need at some point to have a National Art Gallery (but given the number of excellent art works already there why can't we just call it that and have done with it) but we also need lots of other things too, like a good childcare, better facilities for cycling and walking, better education for children etc etc. And even within the culture brief, is it really right that yet more investment goes into high art in Cardiff? What about other aspects of Wales' culture - its political heritage, its music - and other parts of Wales?


And as for moving artifacts currently in the museum to St Fagans, most of those that were moved from the old Industrial and Maritime Museum to Swansea's Waterfront museum - like the beam engine pictured - have never been seen again. 'Resting in a warehouse' I've been told.


Let's hope this one withers on the vine.

Wales - a sick nation?

Sobering statistics from the Welsh Health Survey published last month show the incredibly unhealthy lifestyles of many people in Wales. 25% smoke occasionally, 39% of us drink too much booze, 58% don't eat enough fruit and veg and a massive 29% of us don't exercise regularly.

Hardly surprisingly with this lifestyle, more than half of us are overweight or obese.

Just when we are going to get some government action and joined up thinking to promote public health in Wales? I fear that we need more than allotments and free bicyles.

http://new.wales.gov.uk/topics/statistics/publications/hsw2008/?lang=en has the details

Passive driving

We all understand what is meant by passive smoking. Well, just as non-smokers suffer the effects of other people's actions, so pedestrians and non-drivers suffer the consequences of other people’s travel behaviour.

People who make relatively little use of a car (and therefore cause less pollution, noise and congestion within communities as a result of their travel) are still exposed to the pollution, noise and damage to communities caused by other people’s car use.

As a report out today by Sustrans shows, a quarter of all households are car-less, in Merthyr and Blaenau Gwent the figure is as high as 36%. And yet the availability of jobs, goods and services are planned on the assumption that we can all hop in the car.

Many families on low incomes feel forced to 'invest' in a car to prevent social exclusion. The poorest spend a quarter of their incomes on the cost of motoring and Citizen's Advice report that buying and running a car is a major cause of getting into dept.

If you spend more than 10% of your income heating your home you are considered to be suffering from fuel poverty. Although there is no similar official definition of ‘transport poverty’, that is what these families are experiencing.

As oil prices rise this will only get worse. And with 95% of all transport reliant on oil our economy is deeply vulerable.

So long as we continue to place road building at the centre of our transport policy we will reinforce car dependecy and deepen transport poverty.