BMA Cymru Wales manifesto for a healthier Wales
June 2006
Establish stability
The NHS has been subjected to constant change as different political administrations introduce their own reforms and reorganise how the service is managed. Some change is inevitable if progress is to be made but the BMA believes the service has suffered from too much disruption in recent years. Greater stability and better long-term planning are needed to ensure that services develop effectively to meet the needs of the future.
The BMA calls on all Welsh political parties to:
Provide an efficient NHS structure for the long term
Some change is inevitable and the BMA believes the current NHS structure in Wales needs to be reformed to improve its effectiveness. It is no longer tenable to have over 30 NHS organisations serving a population of only 2.9 million people. Major structural upheaval is unwelcome but there are opportunities for streamlining service provision and reducing bureaucracy. This could be done by amalgamating certain common administrative and organisational functions. Partnership, collaboration and sharing of resources and expertise between neighbouring local health boards would deliver a more effective and efficient service for patients in Wales.
Establish long-term planning and investment
We recognise that there has been huge investment into the NHS in Wales over the last few years. However, doctors working at the sharp end report that little of this money finds its way to them. Politicians want to improve the NHS but too often the concentration is on short-term solutions. Doctors are frustrated at the frequent announcements, new initiatives and the drive towards target setting that can divert them from the core work of treating patients. Without long-term strategic planning there is a danger that this money will be thrown at the problems of the NHS rather than being used to address the real underlying issues.
Stop the NHS being used as a political rugby ball
The NHS is suffering from being constantly under the political microscope. Ministers are challenged on a daily basis on health service matters and Assembly Memberss come under pressure to oppose strategic decisions on service reconfiguration in defence of local interests.
Politicians have to be responsible and to be held accountable for the health service
However, the BMA believes the day-to-day running of the health service should be made the responsibility of a Welsh NHS Governing Partnership with professional and public input. Politicians would establish the priorities and set the goals for the NHS. It would be up to the Governing Partnership to decide how these are to be achieved, free from day-to-day political involvement. It would be accountable at all times to the Welsh Assembly.
Strengthen community-based services
A range of treatments are now being offered in local communities which were previously only available in specialist hospitals. This has not been matched with extra resources to fund the extra work. The answer does not lie in taking money from the secondary sector since it is also under pressure from new demands for its services. Additional resources are required. More of these local services can be delivered but they require investment and support. This includes additional staff, adequate premises and access to resources. They can help relieve the pressure on bigger hospitals and are popular with patients who can be treated closer to home.
Develop community hospitals
Community and GP hospitals are a vital part of healthcare provision in many parts of Scotland. They provide a clear example of how GPs, given the opportunity, can provide intermediate care for their patients, keep patients in their own communities and relieve pressures on the secondary care sector. This helps to ensure that high-tech facilities in district general hospitals are freed up for those patients who require them. Community hospitals should be developed to enable GPs to provide as wide a range of high quality services as possible.
Develop better integrated services
Health services have been divided for too long into primary and secondary care. This is an artificial concept for many patients who move between services without any appreciation that they are in any way different. Better integration of services is needed to remove remaining barriers. Integration is also needed with the work of other professionals, particularly in social services. We need joined up solutions.
Develop managed clinical networks
Managed clinical networks (MCNs) offer an opportunity to improve the quality of services in the NHS in Wales. They can provide access to specialist services to a wider population than has traditionally been the case with individual hospital based services. They provide for better integration of care but they must be developed with sensitivity to their effect on other services.