NHS under the spotlight

I was speaking to a former senior manager in the Welsh NHS this week who visibly winced when I brought up the subject of the latest ambulance response times.

The target for responding to Category A calls is 65%, but in December it was just 42.6%, the worst on record.

Often when he's asked about missed targets, Mark Drakeford talks about the reality that the vast majority of people are still seen within target.

On a number of measures he's right.

For example, one target is for 95% of people suspected of having cancer to be seen by a hospital consultant within two months.

It hasn't been hit for seven years but the latest figures show that 89% of patients are still being seen within the target time.

Three months

A miss is a miss but it is on the margins. That is clearly not the case with a figure of 42%

To make matters worse, Mark Drakeford said in the summer he'd give the Welsh Ambulance Service three months to achieve urgent improvements.

Despite the failure, I'm told ministers still have confidence in the management.

In the meantime, there could be changes in the future to the eight minute response target for life threatening calls.

A review two years ago by the health academic Professor Siobhan McClelland says it makes little clinical sense and pilot schemes are underway in England which would give paramedics three minutes to decide whether a call is in fact life threatening.

But ministers here know they can't look at changing it before at least bringing it under some control.

Highlights

BBC Wales has been running a series of articles all week on the state of the NHS. It's been covered in-depth elsewhere but here's my take on some of the highlights.

On Monday we ran a poll showing that almost half of those questioned believed the Welsh NHS performed just as well as the health service in England, while another 15% thought it was better and 21% worse.

My sense was that considering the levels of bad publicity surrounding the NHS, that figure could have been a lot worse for the Welsh government.

The Wales Audit Office weighed in with a report on waiting times. It said that while there are some difficulties with comparisons, it said Scotland and England are doing better than Wales against more stringent targets.

And we commissioned the Nuffield Trust to put together a report on the comparisons between Wales and England.

The main conclusions were that while there are problems with some waiting times, it's too simplistic to say the NHS in Wales is significant worse than in England.

In other words it gives both sides of the debate something to latch on to.

Benefit of hindsight

It's becoming increasingly clear that some of the most contentious decisions made in recent years by the Welsh government revolved around not protecting health spending in real terms between 2009 and 2012.

The Welsh government disputes the overall claim that spending on the NHS was cut, saying that it protected social care budgets in a way that didn't happen in England.

It has since tried to neutralise the criticism by committing an extra half a billion pounds to the NHS for the final three years of this government.

We'll never know whether there would still have been problems in health if the budget had been given more protection, but it would certainly have removed the main source of ammunition from the Conservatives, and a Prime Minister who is making it a central part of his strategy to attack Labour.

The benefit of hindsight is also a wonderful thing. I doubt whether anyone envisaged that the NHS would come in for this level of scrutiny.