An overview of the Policy Forum for Wales event
Organised by the Policy Forum for Wales, this event which was held on 19 October 2016, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.
The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate. The Joint Health and Social Care Bill in Wales was mentioned but no mandatory action by the Cabinet Secretary has yet been taken and there would need to be a combination of desire and authority to make it happen. She also proposed commissioning small pilot areas of this Bill to prove how it would work in practice. Although ‘tariff’ and ‘contracting’ are not familiar words in Wales, it was suggested that some parts of Wales health and social care might benefit from an approach similar to the one taken in England.
Dr Rebecca Payne, Chair Royal College of GPs in Wales shared with attendees of the forum how GP performance, reference panels, QOF, clusters, clinical governance and GP safety assessment tools are all there to measure and maintain quality. She shared the fact that the average female GP retires in Wales at age 47, with the male GP retires at age 54 and, at present, Wales is short of 500 GPs. She stated that the functioning of the National Clinical Advisory Service for GPs is embedded in PHLS Wales. Dr Payne informed delegates how, and why, performance lists of GPs are maintained by Health Boards and the Welsh Government. She discussed the value of signposting patients to alternative services rather than approaching their GPs for many non health related issues, and also the role of the media and voluntary sector in promoting this. She discussed the validity of cluster related funding, similar to examples in England where higher co-morbidity and poor health population clusters are funded preferentially.
Sue Fish, from Mid Wales Health Care Collaborative, spoke about rural health care and the challenges of acute care in remote settings. She mentioned that standards set by the royal colleges for the minimum number of patients and consultants in a speciality may not be achievable in many rural settings, and standard measures should about outcome rather than volume of work. She gave two examples of how Ysbyty Gwenyyd has achieved the top position in the UK on diabetic foot care and Bronglais on Emergency Laprotomy outcomes. She stated that network solutions and review of payment system to Networks may be a way to hold Government to account.
Dr Dindi Gill, Interim National Director of Emergency Medical Response Team Service, Wales presented on the Welsh Air and Road Response Service and how this is working for whole of Wales. They are stationed in one Health Board and work in partnership with the Welsh ambulance services, and contract out emergency medicine consultant sessions from various Health Boards, and even deliver sessions in neighbouring English areas, including Stoke. He also reminded delegates of the benefits of working with the third sector and how money raised can be used successfully for a new service.
Ruth Marks, Chief Executive of Wales Council for Voluntary Action highlighted the amount of opportunities for health and social care professionals to work with the third sector. Every health board will know their local groups and their need. There were also comments about whether health board executives should be democratically elected locally, rather than nominated. Alyx Peters from MPS Health Care highlighted the nursing crisis in the UK, with 23,000 unfilled posts and one in four leaving the profession. He also stated that training and retention of nurses should be flexible, with service models reducing in some cases. He also stated there was an urgent need for a cross sector task force to meet this need, looking at an ageing population and nursing needs, 7 day working and work force, the changing role of nurses (specialists & NP), changes in light of the Francis Report and safe nursing levels in Wales.
Chris Tidswell, Head of CIPFA (Charted Institute of Public Finance and Accountancy) spoke about the constraints local authorities are facing in Wales at present. They by law (section 114) are not allowed to have a deficit budget (unlike health boards) and he made a call for ring fencing 10% of GNP in Wales for health and social care and setting up an Independent Commission on Health and Social Care. There were comments from the delegates about the Bevan Commission recommendations and public engagement, which has happened without being acted on by the Welsh Government.
Following a coffee break, Dr Dai Lloyd, Am and Chair of Health, Social Care and Sport Committee in the Welsh Government (a cross party select committee) spoke about role of this committee and how during public consultation in the summer of 2016 it identified the top five issues in health and social care in Wales as dementia, primary care, loneliness, use of antipsychotics and physical fitness. This committee scrutinises the Health Minister (now Health Secretary) on monthly basis and checks his/her performance. He also raised the point about valuing NHS and social care staff which will help retention.
Huw Irranca-Davies, AM and member of Cross Party Group on Cancer spoke about project “Spirit of Llynfi” in Maesteg Valley where the community is trying to help each other address smaller health issues. He mentioned cross cutting themes like health inequalities, the effect Brexit may have on the NHS and taking into consideration of a global view of health.
Dr Kate Chamberlain, Chief Executive of the Health Inspectorate Wales discussed the recent publication of the Hospital and Primary Care Service Visit Report which is a living document accessible to all. The report addresses infection and medicine management, patient wrist bands, staffing and skill mixes, management and leadership according to people’s experience and also inspections. She mentioned that hospitals need in short term to get the basics right, keep standards consistently high, protect and engage their assets (personnel) and spread what works well. In the long term they need to describe their ‘destination’, think about how the system can get there and develop the courage to think differently and let personnel have space to think.