Hywel, Betsi, Angela, Antoinette
- 15 January 2013
- From the section Wales
When the Assembly Government launched Designed for Life back in 2005, its purpose and ambition was "to create world class healthcare and social services in a healthy, dynamic country by 2015".
"Through this strategy we outline a change process based on clear principles where we will engage with patients, service users, staff and the wider general public in making the transformation happen. In doing so we will create a vibrant culture of challenge, improvement, and delivery."
It had another side-effect too, as it turns out. Over the years it brought both Angela Burns and Antoinette Sandbach into politics, two Conservative AMs who this morning tore into current plans to make fundamental changes to that service - at the start of 2013.
I was about to write "the current government's plans" but that, if you ask Angela and Antoinette, is questionable. It's as it should be but not as it is.
These should be the Health Minister's plans. The changes to health services in Mid and West Wales announced today should embody her vision, her strategic direction, her clear principles put to work on the ground by the Local Health Board. But what they had seen was a consultation process that was "at best inadequate, at worst deeply flawed."
How come, they argued, that the government "set a strategic direction then let Local Health Boards canter off in a different direction?" How was it, they argued, that the clinicians, the Royal Colleges and the Deanery have had "more influence on this process than the Minister or the Health Boards put together?"
What Angela Burns wanted were "humane and practical" decisions. She feared her wish was not about to come true.
What Plaid wanted was a government taking responsibility. Labour ministers had to show leadership, stand up and be counted.
What does responsibility mean? That Labour members should not be allowed to "look both ways." It wasn't on, said Leanne Wood, to claim in the chamber that potential future judicial reviews prevent ministers from voicing an opinion, yet locally - and on the Senedd steps - Labour members voice opposition to change on their patch through a megaphone.
Plaid - the scare mongerers - simply weren't listening, said Carwyn Jones. There are rules, he must obey them.
But he could say that his government will support any changes that are "safe and sustainable". The government's priorities are clear and there for all to see. There is no unsafe care in Wales now but without change, there will be.
First Minister's Questions came alive. "We're being honest with the people of Wales." Just a pity, he thundered, that the coalition in London had been caught not being honest with the people of England.
Back to Angela and Antoinette - on a roll.
If neo-natal services in North Wales were "outsourced to England" it would be "an outrage". If babies from Pembrokeshire are still "hoiked out to Bristol" because care can't be delivered locally, or by the Health Board next door, that would be wrong.
How could people be persuaded to trust local community services when they weren't there when and where they were needed? Why hadn't that been got right first, before redefining chronic care in a systemic way?
Treating a rare cancer? No, that doesn't come under 'universal care' but Angela Burns, who reckons she's a pretty simple soul, lists what she believes does: being born, dying, having a heart - that's pretty universal, orthopaedic care. Her point? "There is an awful lot of care in the middle" that people deserve without having to travel too far.
And there you have it.
There is universal agreement that change is needed. There is universal agreement that Wales must preserve a cohort of specialist clinicians who can offer that world class healthcare envisaged in 2005. No matter where you live, there is agreement that you deserve the best care possible. Yet for a consultant, or a surgeon to maintain his or her expertise, they must see a lot of patients with challenging conditions. In a small country with vast rural areas, that means patients must travel to specialist centres.
But what counts as 'specialist' and what does not?
When does safe become unsafe?
How far is too far?
On a sliding scale of safety and distance, where do you place your marker?