Future of NHS Wales 1:
Can Bevanite socialised medicine survive?

What future is there for the Welsh health service model at a time when, as evidenced by the Health Bill that was approved by the Westminster Parliament last week, England is striking out towards an Americanised market-oriented system? NHS Wales prides itself on delivering socialised medicine along Bevanite principles that are corrupted as little as possible by the private sector. But how sustainable will this be alongside a market-driven more privatised system across the border?

Future of NHS Wales Tomorrow: Professor Marcus Longley, Director of the Welsh Institute for Health and Social Care at the University of Glamorgan, gives his perspective on the future of the Bevanite Welsh health service model.

Certainly, so long as the National Assembly’s present Barnett funding system is maintained, with the block grant being calculated according to changes in English expenditure, Wales cannot be insulated. The clear intention in England is to reduce public spending on health and compensate this by services paid for from within the private sector. The direct impact will be to drive down the block grant coming to Wales, since cuts in English health spending will automatically reduce the Welsh block by a proportional amount.

This should be the single most persuasive argument that the Silk Commission should take on board in putting forward its recommendations on changing the present Welsh funding system later this year. But I wouldn’t hold your breath in hoping that the Treasury will be remotely anxious in listening to this case.

Apart from the direct impact of English spending decisions there are more fundamental and systemic underlying reasons why the present Wales NHS model may be unsustainable in the future. One is demographic change. The number of people in Wales living beyond 75 is projected to nearly double in the next 30 years, from 263,000 in 2010 to 409,000 by 2035.

Increased life expectancy is, of course, to be welcomed. But it comes with its downsides for the NHS. This is because the longer people live the more they will make demands on the service. The lifestyles of many people will make this inevitable. For instance, it is predicted that by the end of this decade a staggering 85 per cent of the Welsh population will be overweight or obese, with direct knock-on effects for health. By 2030 it is being predicted that NHS Wales will be dealing with 100,000 more cases of diabetes every year.

In its emphasis on providing state-of-the-art secondary care free at the point of use in a hospital setting is NHS Wales simply dealing with the symptoms rather than the causes of ill health? There are five criteria against which the Welsh Government judges whether the Welsh adult population is leading a healthy lifestyle:

• Body mass index

• Not smoking

• Eating an adequate amount of fruit and vegetables

• Taking moderate exercise

• Drinking moderately

What proportion of the Welsh population would you say is living a healthy lifestyle according to all five criteria? Would you be optimistic and say 20 percent, or pessimistic and guess it was closer to 10 per cent? In fact, the accurate figure is just 1 per cent.

At a time when conventional hospital-based treatments, especially new drugs and medical technologies, are becoming ever more expensive, this suggests that the Welsh NHS model is addressing the wrong priorities.

The Scottish health system has similar values to the Welsh, certainly in respect of rejecting the English market-based approach. It is different in that, due to the favourable operation of the Barnet formula in relation to Scotland, the Scottish Government has had significantly more resources to pour into the health service. Yet to what effect? In June 2010 a report by the Centre for Public Policy in the Regions, based at the Universities of Glasgow and Strathclyde, provided some sobering evidence. It concluded that although Scotland spends 16 per cent more money on its health care system and employed 30 per cent more staff, the additional investment was not able to secure better, or even equal health outcomes. The reason was the relatively poor lifestyle of many Scots, in terms of smoking, drinking and levels of obesity. Despite making huge inroads in tackling heart disease, strokes, and cancer, Scotland’s figures in regard to these illnesses, as well as smoking and alcohol consumption, remained persistently higher than in the rest of the UK.

Broadly the same message applies to Wales. In these circumstances what should be our public policy response? One positive factor is that broadly the Welsh Government has taken all this on board. Unlike equivalent authorities in England, our seven health Boards have a public health responsibility. This is an acknowledgement that lifestyle behaviours that impact on health are not solely down to individual choice. They can be motivated and influenced by public policy and societal attitudes. Legislation around smoking in public places and alcohol pricing are cases in point.

But I think we need to go further.  If we are to tackle the alarming impact of Welsh lifestyles that are determining health outcomes we will need a much more joined-up approach between health and education policy.  The major lever the Welsh Government has here is to require that our primary and secondary schools have a much larger role in influencing the lifestyles of our young people and their parents. Is there a case for some kind of merger between the health and education departments within the Welsh Government?