Devolution – health services and the older person
Updated July 2006
This section will examine the current medico-political situation across the UK’s devolved regions with specific reference to the health service provision for the older person.
The current devolved regions are:
Wales is part of the United Kingdom, with two thirds of the population living in the southern valleys and the lower-lying coastal areas. The chief urban centres are Cardiff, Swansea and Newport in the south and Wrexham in the north. The Welsh language is used across the country, is one of the UK’s official languages, and is used in both private and public company communications, including the National Assembly for Wales.
Politics and devolution:
In July 1997, the UK government published its white paper, A Voice for Wales, which contained the government's proposals for a Welsh Assembly and outlined its proposals for devolution in Wales. These proposals were endorsed in the referendum of 18 September 1997. Subsequently, Parliament passed the government of Wales Act 1998, establishing the National Assembly for Wales, and the National Assembly for Wales (Transfer of Functions) Order 1999, which enabled the transfer of the devolved powers and responsibilities from the Secretary of State for Wales to the assembly.
Health services and structure:
On 19 July 2001 a consultation document 'Structural Change in the NHS in Wales' was published in order to meet the requirements set out in 'Improving Health in Wales – A Plan for the NHS with its Partners'. This document envisioned a strengthened role for NHS organisations at both the national and local level. This was followed by the NHS (Wales) Act 2003, which further advocated the creation of the Wales Centre for Health (Canolfan Lechyd Cymru), an independent organisation with responsibility for training, advice, and research-related functions aimed at promoting and improving the health of the people of Wales.
To achieve the goals set out in 'Improving Health in Wales', NHS Wales established a new system of healthcare in Wales. There are local health boards (LHB) in every area, building on the previous local health groups, which decide what services are needed for local people and make sure they are provided. NHS trusts will continue to run hospitals and community services, and will work with local health boards and other partners to meet local needs. These new arrangements were introduced on 1 April 2003.
Health trusts:
The reforms, embodied in the NHS and Community Care Act 1990 established NHS trusts providing all the acute, community, mental health and ambulance services for Wales. These are corporate bodies which have assumed responsibility for the ownership and management of hospitals and other health service facilities that were previously under the control of the district health authorities. There are 14 NHS Trusts in Wales, including one all-Wales ambulance trust, each comprising a chair and a board of non-executive directors appointed by the National Assembly for Wales.
Local Health Boards:
There are 22 local health boards that were established as part of the fundamental NHS structural changes announced in November 2001 by the Minister for Health and Social Services. LHBs came formally into effect on 1 April 2003.
Each LHB assess health services their populations need and then pay hospital trusts, family doctors, dentists and so on to provide those services. Different areas of Wales have different health needs and priorities. For example, heart disease is a greater problem in some areas than others. It is therefore important that health services are planned locally by people who really know the area and what local people need and want.
The National Public Health Service for Wales (NPHS)
The NPHS brings together the public health resources of the five former health authorities in Wales, which includes input from academic departments, with those of the Public Health Laboratory Service in Wales, which includes the Communicable Disease Surveillance Centre.
Healthcare for the older person in Wales:
There are many initiatives aimed specifically at healthcare for the older person in Wales. Some examples include the National Service Framework for Older People in Wales (2006), free nursing care, and the Strategy for Older People in Wales (2003). Wales spends over £4 billion each year on its health services.
Further information:
- The National Assembly for Wales
- NHS Wales
- NHS (Wales) Act 2003
- Introduction to NHS Wales, microsite provided by NHS Wales
Northern Ireland
Northern Ireland is the only part of the United Kingdom which has a land-border with another state - the Republic of Ireland. Before 1922 the whole of Ireland formed part of the United Kingdom, but in that year the Irish Free State, as it was then called, comprising 26 of Ireland's 32 counties and some two-thirds of the island's population, established itself as a self-governing entity outside the United Kingdom, a process which culminated in the declaration of a republic in 1949.
Politics and devolution:
In 1972, the Westminster Parliament suspended and subsequently abolished the Parliament of Northern Ireland in response to the outbreak of communal violence which began in the late 1960s and to insistent demands for political reform. Since 1972 the government's aim has been to transfer substantial power and responsibility to locally elected representatives on a widely acceptable basis.
The latest attempt to broker a political settlement began with the multi-party talks in June 1996 and came to a conclusion in April 1998 when the Belfast Agreement (sometimes referred to as the 'Good Friday Agreement') was negotiated by eight of the political parties in Northern Ireland, including Sinn Fein and those representing the main loyalist paramilitaries, and the British and Irish governments.
The Northern Ireland Assembly (currently suspended), established as part of this Good Friday Agreement, meets in Parliament Buildings and is the prime source of authority for all devolved responsibilities with full legislative and executive authority. The Secretary of State for Northern Ireland, however, remains responsible for Northern Ireland Office matters not devolved to the assembly. These include matters such as policing, security policy, prisons, criminal justice, international relations, taxation, national insurance, regulation of financial services and the regulation of telecommunications and broadcasting. The Secretary of State will represent Northern Ireland’s interests in the United Kingdom Cabinet.
The Northern Ireland Assembly consists of 108 elected Members, 6 from each of the 18 constituencies. Its role is to scrutinise and make decisions on the work that the government departments deal with, and to consider and make legislation.
Health services and structure:
The Department of Health, Social Services and Public Safety was established by the Departments (NI) Order 1999.
The department administers the business of:
- Health and Personal Social Services, which includes policy and legislation for hospitals, family practitioner services, community health and personal social services
- Public Health, which covers responsibility for policy and legislation to promote and protect the health and well-being of the population of Northern Ireland; and
- Public safety, which will encompass responsibility for the policy and legislation for the Fire Authority, food safety and emergency planning.
Organisation:
The administration of the Department is organised under the Permanent Secretary, into several groups and one agency. These are the Planning and Resources Group, Strategic Planning and Modernisation Group and Primary, Secondary and Community Care Group and the five Professional Groups. The Department’s Executive Agency is the Northern Ireland Health and Social Services Estates Agency (known as Health Estates).
Further information:
- Age Concern Northern Ireland
- Department of Health, Social Services and Public Safety for Northern Ireland
- Northern Ireland Assembly
- Northern Ireland Executive
Scotland
Scotland is a country of around 75,000 square kilometres with a population estimated at 5,078,400 and 19 per cent was of pensionable age (30 June 2004). By 2016 over 22 per cent of the population is projected to be over pensionable ages. Significant changes to the age structure of Scotland are expected. By 2028 it is projected that the number of people aged 60-74 will increase by 37 percent, while those 75 and over will increase by 63 per cent.[see reference 1] In addition to English, the national language, Gaelic, is spoken by some 80,000 Scots.
Devolution and politics:
Devolution of power from the UK government to Scotland occurred in May 1999. The Scottish Executive is responsible for most of the issues of day-to-day concern to the people of Scotland, such as health, education and housing, and manages a budget of more than £27 billion for 2005/06 which is due to rise to £30 billion in 2007/08.
Other responsibilities include:
- local government
- social work
- planning
- tourism, economic development and financial assistance to industry
- some aspects of transport, including the Scottish road network, bus policy and ports and harbours
- law and home affairs, including most aspects of criminal and civil law, the prosecution system and the courts
- the police and fire services
- the environment
- natural and built heritage
- agriculture, forestry and fishing
- sport and the arts
- statistics, public registers and records.
Some matters such as defence and foreign policy are not devolved, and remain reserved issues at Westminster. Other reserved issues include:
- constitutional matters
- fiscal, economic and monetary system
- immigration and nationality
- energy: electricity, coal, gas and nuclear energy
- common markets
- trade and industry, including competition and customer protection
- some aspects of transport, including railways, transport safety and regulation
- employment legislation
- social security
- gambling and the National Lottery
- data protection
- abortion, human fertilisation and embryology, genetics, xenotransplantation and vivisection
- equal opportunities.
The Executive is currently a coalition between the Scottish Labour Party and the Scottish Liberal Democrat Party and is led by a First Minister who is nominated by the Parliament and in turn appoints the other Scottish ministers. Scottish Executive civil servants are accountable to Scottish ministers, who are themselves accountable to the Scottish Parliament.
Health services and structures:
The Chief Medical Officer is the Scottish Executive’s principal medical adviser, and as such has direct access to ministers and is also Head of the Scottish Medical Service.
The Scottish Executive Health Department (SEHD) is responsible for health policy and the administration of the National Health Service in Scotland. The Chief Executive of SEHD leads the central management of the NHS, is accountable to ministers, including the Minister for Health and Community Care, for the efficiency and performance of the service, and heads a Management Executive which oversees the work of 15 area health boards responsible for planning health services for people in their area, and 24 self-governing NHS trusts responsible for providing services to patients and to the community.
The department also has responsibility for the State Hospital, which cares for patients who require treatment under conditions of special security, and the Health Education Board for Scotland, which promotes positive attitudes to health and encourages healthy lifestyles. The department is also responsible for social work policy and in particular for community care and voluntary issues.
In 2002, the NHS in Scotland had around 143,000 staff, including more than 63,000 nurses, midwives and health visitors and over 13,000 doctors, family practitioners and allied health professionals.
Healthcare for the older person in Scotland:
In 2002 the Chief Medical Officer for Scotland and the Expert Group on Healthcare of Older People published Adding Life to Years which fulfilled a commitment given in the Scottish Health Plan, Our National Health – a plan for action, a plan for change. It was commissioned because of serious concerns about the healthcare of older people. There were concerns about the long-term needs of older people as patients in NHSScotland. Scotland’s population is stable but is growing older. Already older people are – quite rightly – the main users of many of Scotland's community and hospital services. This report points out what must be done now to meet the challenges that lie ahead. It puts older people and their care right at the top of the NHSScotland agenda, and challenges the Scottish Executive, the NHS, health professionals and patients themselves to play their part in responding to that challenge. The Adding Life to Years Annual Report 2002-03 provides an overview of progress.
The Community Care and Health (Scotland) Act 2002 provides free personal care for everyone in Scotland aged 65 and over who needs it. Free nursing care is available for people of any age.
The Adults with Incapacity (Scotland) Act 2000 was passed by the Scottish Parliament on 29 March 2000 and received Royal Assent on 9 May 2000. The purpose of the Act is to provide for decisions to be made on behalf of adults who lack the legal capacity to do so themselves because of mental disorder or inability to communicate. [see reference 2]
References:
[1] General Register Office for Scotland (2005) Scotland's population 2004: The General Registrar's annual review of demographic trends (150th edition). Edinburgh: General Register Office for Scotland.
[2] The Scottish Executive
Further information:
- Age Concern Scotland
- Our National Health: a plan for action, a plan for change
- The Scottish Executive
- The Scottish Parliament
- With Respect to Old Age: Long-term care - rights and responsibilities
- Older people, from the Scottish Executive website
- Free personal care, from the Scottish Executive website
- Future care services for older people, from the Scottish Executive website