Time to Deliver

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Time to Deliver

• The Third Term and Beyond
• Policy Options for Wales

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The Third Term and Beyond Policy Options for
Wales in Health and Social Care
Edwards RT, Cohen DR, Phillips CJ, Owen JW
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Thanks to

• Chair John Wyn Owen, Chair, Board of University
  of Wales Institute Cardiff
• Professor David Cohen, Health Policy and
  Economics, University of Glamorgan
• Ruth Davis, University of Glamorgan
• Dr Ian Lane, Medical Dirctor, Cardiff and Vale
  NHS Trust
• Dr Malcolm Lewis, Deputy Dean, Post Graduate
  Education, Cardiff University
• Dr Stephen Monaghan, Public Health Director,
  Cardiff Local Health Board
• John Osmond, Director, Institute of Welsh Affairs
• Professor Ceri Phillips, Institute of Health
  Research, University of Wales Swansea
• Professor Malcolm J Prowle, Office of Public
  Management
• Professor Stephen Tomlinson, Deputy
  Vice-Chancellor, Cardiff University
• Dr Rhiannon Tudor Edwards, Centre for the
  Economics of Health, University of Wales Bangor
• Jan Williams, Chief Executive, National
  Leadership and Innovation Agency for Healthcare

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Policy Agenda for Welsh Assembly Government

• Assess the experience of the first two terms of
  WAG
• Examine realistic policy options for the third
  term
• Horizon scanning for longer-term issues and
  questions

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Terms of Reference

• Produce a paper examining medium-term,
  longer-term and broader health issues in Wales

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Context

• Expenditure
• Health status of people in Wales
• Policy focus

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Expenditure by WAG
billion
38 of total
33 of total
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.but Debt
http//news.bbc.co.uk/1/hi/wales/6148012.stm
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Welsh Health Survey Health Status

• Percentage of adults currently treated for
• high blood pressure 18
• arthritis 14
• respiratory illness 13
• back pain 12
• heart condition (other than high blood pressure)
  10
• mental illness 9
• diabetes 5
• cancer (includes those ever treated) 4.
• 12 of children reported as being treated for
  asthma.
• 28 of adults and 5 of children reported as
  having a limiting long-term illness.

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Welsh Health Survey Lifestyle

• 26 of adults reported that they currently
  smoked.
• 40 of adults reported that they usually drank
  more than guidelines.
• 54 of adults were classified as overweight or
  obese, including 18 classified as obese.

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Welsh Health Survey Utilisation

• 16 of adults reported that they had talked to a
  GP about their own health in the past two weeks.
  Of these, 75 had received a prescription.
• 19 of adults reported attending a hospital
  outpatient department in the past three months,
  and 6 attending a hospital casualty department.
• 10 of adults reported being a hospital day
  patient in the past twelve months, and 10
  reported staying in hospital as an inpatient
  (overnight or longer).
• 48 of adults reported being on regular
  prescribed medication.

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..but inequalities

• Life expectancy of males born in UK 76.6 years
• Life expectancy of females born in UK 80.9 years
• Life expectancy of males born in Wales 76.2
  years
• Life expectancy of females born in Wales 80.6
  years
• Life expectancy of males born in Merthyr Tydfil
  74.3 years
• Life expectancy of females born in Merthyr
  Tydfil 78.6 years
• Life expectancy of males born in Monmouthshire
  78.4 years
• Life expectancy of females born in Monmouthshire
  82.7 years
• Infant mortality rate in the 20 most deprived
  areas 60 higher than in the 20 most affluent
  areas

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Welsh Index of Multiple Deprivation 2005
Strong correlation between health domain and
overall index and income/employment domains
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Policy Development

• Wanless Report, 2003
• Designed for Life, 2005
• Health Challenge Wales
• Beecham Report, 2006
• Government of Wales Act, 2006

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Wanless Report 2003

• The current position in Wales is worse than in
  the UK as a whole
• Wales does not get as much out of its spending
  as it should
• Tough decisions to remove waste and the
  unsustainable aspects of current provision must
  be implemented
• I hope this report leads to action (on a
  systematic basis)
• remedy system deficiencies
• secure developments in the Welsh health service
• generate improvements in health outcomes for the
  population and
• redress the inequalities in health that exist
  within Wales and in comparison to the rest of the
  UK

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Designed for Life 2005

• The Assemblys 10 year strategy for reform and
  improvement
• An ambitious plan to deliver world class
  healthcare by 2015
• Fast, safe and effective services
• Public health and tackling inequalities remain
  priorities
• Lifelong health
• Improving NHS performance is now recognised as
  equally important

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Beecham Report, 2006

• limited progress made in using the citizen model
  to improve performance
• need for a much more rapid and far-reaching
  transformation in public services than achieved
  to date
• proposals
• more effective engagement with citizens
• a stronger focus on delivery
• a reinvigorated approach to partnerships
• more emphasis on constructive performance
  challenge

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Health Challenge Wales

• the focal point of efforts to improve health and
  well-being
• recognition that a wide range of factors impact
  on health and well-being
• coordinated action can help to create a healthier
  nation.

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and what a challenge it is!
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Ministers In-tray

• Waiting times including diagnostic services
• Hospital closures and reconfiguration
• Drug expenditure and new high cost drugs
• Power to the centre or the periphery
• Move towards primary-care based NHS

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Voices from around Wales
Daniel Ellis
Enid Morris
Gwyn Pritchard
Granville Roberts
Sian Jones
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Challenges for New Term

• Pursuit of healthy public policy rather than just
  public health goals.
• Promotion of a culture of policy evaluation and
  evidence based policy.
• Pursuit of fully integrated health and social
  care services.
• Practical steps to move towards a truly Primary
  Care led NHS.
• Relationship between economic wellbeing and
  health of the population.
• Health policy needs to balance encouragement of
  personal responsibility for lifestyle.
• Improved performance and financial management in
  the NHS and Social Care.

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and more

• An open debate about the options for necessary
  capital investment.
• Fostering of a free but responsible media who
  support health goals.
• Restructuring of the NHS into rational sized
  health economies that allow for local priority
  setting but acknowledge our limited skill base
  and experience of commissioning and financial
  management in the NHS.
• Use of incentives to bring health professionals
  to Wales and reduce vacancy rates and encourage
  clinical career development in Wales.
• Political courage to look beyond England, for
  models of good practice in health policy
  development.