However, health is not as good as it might be in Wales and the NHS faces serious challenges.
The recent report of the Bevan Commission, established to provide independent expert advice to the Welsh Government, pointed to poorer health in some communities, a rising elderly population, more people with chronic conditions, a shortage of doctors and some specialist services being spread too thinly.
Together for Health, developed with the help of clinicians and the trade unions, presents our response to that report and offers something better for Wales – a real chance over the next five years to achieve better health for everyone and create an NHS that can reliably deliver safe, high quality, effective care and top class outcomes for patients despite those challenges.
However that will mean change.
I know that sometimes people see changes to the NHS as a threat to much-loved services but there is increasing, independent clinical evidence that we could do better, improving care and saving lives in the process.
The NHS is there to serve the public and has been very successful. On almost every indicator people are living longer lives than previous generations. Last week, new figures were published which showed the number of people aged over 65 in Wales is set to reach more than 860,000 by 2035 – one in every three people. However we still have real threats to health such as smoking and obesity and too many children have a poor start to life. We, as a Government, are determined to change that.
In addition, we want to see Wales have an NHS that reflects the best modern practice. The hospital network in Wales grew as the NHS coped with the challenge of caring for patients suffering from the big killer diseases, often a legacy of Wales’s industrial heritage. New technologies and treatments now mean diseases once fatal or requiring long years of hospital treatment can be handled without a major lasting impact on people’s lives. As a result, the number of hospital beds has been falling for decades.
Scientific progress will continue to improve care. Evidence suggests that to use this best, some services should not be provided to a few patients in a lot of places, but should be focused in highly specialised centres. That’s why Together for Health sets out the intention to establish a number of centres of excellence – such as for cancer surgery or stroke care – to ensure the very best skills and equipment are on hand round-the-clock for the most complex, life threatening conditions.
We can also see the growing importance of community-based services. Wales is driving forward a programme to strengthen and improve primary care, using all the skills available in the GP surgery, the pharmacy and locally based teams to support people in and close to their homes.
I want to assure people that local hospitals will retain an essential role. Some patients with very complex, life threatening conditions will initially be treated in very specialist acute facilities before being transferred to local settings, such as district general hospitals or community hospitals to continue their recovery. For example, after the first 72 hours in a specialist centre, a patient would be moved to a hospital more local to their place of residence for ongoing care and rehabilitation. Local hospitals will themselves become centres of excellence in their own right, with a much stronger focus on achieving the best possible results for everyone using them.
That brings me to two other strands in this programme. The first is about openness and transparency. I have said the NHS is there to serve the public and I want the public to see far better how well it is being served, which is why we will publish annual reports to show how well the NHS is doing.
The second point links to that. The people of Wales respect the NHS. It was born here. Sometimes that relationship is a bit blurred. Does the NHS always serve people as well as they would wish? Do people really always respect what the NHS can do for them? I think there could be a much clearer relationship, recognising that the Government, the NHS and the public all have responsibilities. I want a real partnership around getting the right services and right relationships for the 21st century.
Let me be clear about one other thing, this is not about money. It’s true that in recent years rising demands and expectations were largely matched by increased budgets. Investment in the NHS in Wales has more than doubled since 1999 and investment will be maintained by the Welsh Government, but because of the reductions in the budget allocated by the UK Government, there will be slower funding growth than in recent years. However there are powerful reasons for change even if money were plentiful.
We need to be brave and honest and accept that in order to achieve better health and deliver higher quality care, change is necessary.
The Bevan Commission report stated that “if there is a demonstrable need for the NHS to change services, opposition from politicians may meet the short-term desires of local people while threatening sustainability and improvement of services over the longer term.”
I understand the politics of this. Even if a strong case for change is put forward, communities often still feel attached to local services, because their local hospital has been the public face of their NHS for decades, despite primary and community services already being the new engine room of the NHS. So politicians have shied away from publicly backing the case for change – even though it could deliver higher quality and more efficient care for their constituents.
Given the challenges facing us, that is no longer an option.
That is not to say there won’t be debate over local issues and there should be. People should take an interest in the services they pay for and rely on. I want the NHS to explain health issues better and engage fully with local communities.
Now is not a time for us to hold onto what is there just because it is familiar.The status quo is not an option. The Welsh Government wants an NHS comparable with the best in the world and so should we all.