Election 2015 Wales

Election 2015: Should health be an issue in Wales?

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Image caption Health in Wales and England is run by different ministers, Mark Drakeford and Jeremy Hunt

The health service is a big issue in the General Election. But it is complicated for voters and politicians in Wales, Scotland and Northern Ireland as the NHS is devolved.

So should we care? Prof Roger Scully, of the Welsh Governance Centre at Cardiff University picked through the arguments with me.

Q It's a devolved issue so why should we worrying about health in Wales at this election?

Prof Scully: In theory, it's a devolved matter so it shouldn't be in play in Wales. In practise there are a number of ways it's relevant: The Barnett formula - which funds the Welsh government - means decisions on NHS in England have direct consequences on the money we have to spend on health service in Wales. Also because so many people in Wales live very close to the border with England, it means decisions, such as big changes to NHS services, inevitably have some sort of spill-over to Wales, whatever they may be.

Image caption Prof Roger Scully said there are consequences for the NHS in Wales in decisions made in Westminster

Q: If the Westminster Government wanted to do something radical on public services, how would that impact on health decisions in Wales?

Prof Scully: The way the Welsh government is funded means the money we have to spend in Wales is a direct consequence, pretty much, of the decisions made by the Westminster government over matters which the Westminster government is only formally responsible for in England.

So the amount of money it spends on health then has what's called a "Barnett consequential" for the amount of money given in the Welsh budget. It gets very complicated so even different bits of the health budget have different exact consequences for amount of money coming to Wales.

Broadly speaking, if the UK Government is deciding to cut spending then that means the money coming to Wales will also be lower.

Even if the Welsh government wanted to have a radically different policy direction, to boost spending, to a fair extent it's tied to the broad policy agenda at Westminster. If the UK government decided we need a smaller public sector, then more or less inevitably we will have a smaller public sector in Wales, even if the Welsh government doesn't want it.

Q Given Wales has such a big public sector, does that mean the Welsh government's hands are tied financially?

Prof Scully: Health takes up a very large proportion of Welsh Government spending. So if money coming to Wales through the formula is reducing, it's very difficult to avoid at least some cuts to the health budgets. If you tried to protect the health budget that would lead to some massive cuts to pretty much everything else. The Welsh government has argued that given health is such a big part of its budget it can't really protect it from cuts without being utterly savage to spending on education.

Q If a future UK government decided to charge for some health services in England what could happen?

Prof Scully: If say, the UK government decided to move the NHS to a fundamentally different funding model - where more money would come directly from patients - that might mean less money being put in directly by the government, so therefore less money under the formula would be going to Welsh government to put directly into the health service here.

So if the Welsh government wanted to follow a different model of health service provision it simply wouldn't have the money to do so. We're effectively tied through the mechanism to policy decisions made in Westminster, in the funding model. If reform of that scale ever happened if would have clear, direct and very substantial consequence for the NHS in Wales.


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Media captionDale MacDougall and Tracy Derrett live across the River Wye from each other in England and Wales - how do they choose their GP or hospital?

I visited the Wye Valley and the village of Llandogo in Monmouthshire. Across the border and the river bridge is Gloucestershire.

Patients I spoke to living in Wales - and just over in England - are using GPs and hospitals on different sides of the border. Convenience seems to be an important factor rather than which side the services are located.

And health was an issue, wherever they lived.

Q So 50 million people could be voting directly on health policies in England unlike voters in Wales. Do Welsh parties face a dilemma in whether to talk about health or not?

Prof Scully: Health is pretty much one of the two or three most important issues for voters in all the opinion polls. Lots of the London-base news media are talking about health a lot of the time. So for parties to say 'it's devolved we're not going top talk about it in Wales' could leave them appear out of touch. They're in an awkward position, because they feel they should say something about it but they're aware that devolution complicates things in Wales considerably.

Q Does it also give a flavour of what could happen if whatever party takes control in Westminster also took over in Wales next year?

Prof Scully: What it appears to say about health is also taken as an indicator of that party's broad approach to public services, pensions, welfare, education and the public sector. Although formally a devolved matter for Wales, Scotland and Northern Ireland, it could be seen by voters as "what sort of party is this and what policy agenda is it looking to follow?"

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