Mike Hedges says there is no easy answer to bringing greater co-ordination to the delivery of public services across Wales
Within Wales we have a different organisational structure for every service: 22 unitary authorities, seven health boards, four police authorities, three fire authorities and one ambulance board.
For those who believe that big is beautiful then the ambulance service is obviously the ideal size, yet it has not been without its critics. As the Western Mail put it (7 May), “Calls have been made on the Welsh Government to take urgent action to improve the performance of the Welsh Ambulance Service after it was revealed that nearly all of its internal targets have been consistently missed.”
There is no natural affinity for the three areas covered by the fire authorities. Take the mid and west Wales fire authority, which covers an area from Port Talbot to the rural north of Welshpool and Aberystwyth, as an example. The land area is overwhelmingly rural but the population is almost equally split between the urban conurbations of Swansea, Neath, Port Talbot and Llanelli, and the small towns and rural areas of Powys, Ceredigion, Pembrokeshire and Carmarthenshire. There is no natural community ‘feel’ between these populations. Montgomeryshire looks more naturally towards Wrexham than Swansea.
The four police forces of South Wales, Dyfed Powys, North Wales, and Gwent have been in their current form since the late 1960s, with minor amendments made by the 1996 local government reorganisation. Whilst their boundaries are more logical than those of the fire service there is a huge variation in size. The South Wales police force covers over one and a quarter million people, whilst Gwent covers just over half a million people. I am sure that I am not the only one surprised that when the new fire authorities were formed that their boundaries did not mirror the police authorities to aid joint working.
We have had several health reorganisations over recent years. Prior to 2001 there were five health authorities. These were then reorganised into 22 Local Health Boards and hospital boards which mirrored the same boundaries of Wales’ 22 local authorities. Then, in 2009, the 22 Local Health Boards became seven, with widely varying sizes. The largest, Betsi Cadwaladr University Health Board provides a full range of primary, community, mental health and acute hospital services for a population of around 676,000 people across the six counties of north Wales – Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham). The smallest, Powys, covers a population of approximately 132,000, or roughly a fifth of the population of Betsi Cadwalladr. The problems of Betsi Cadwalladr are well documented with a report from the National Assembly Wales Audit committee pending following an investigation by the Wales Audit Office and Health inspectorate Wales.
Finally we have 22 local authorities set up in the mid 1990s providing a whole range of services to their local populations and also with a substantial variation in the council tax they charge. Again size varies from Cardiff with a population of over 340,000 to Merthyr with a population of approximately 56,000.
We’ve had Russell Goodway, a former leader of South Glamorgan and Cardiff Councils, calling for a reorganisation of local government so that it has the same boundaries as the seven current local health boards. This followed the calls of Gwynedd Council Leader, Dyfed Edwards, for the number of councils in north Wales to be reduced from six to two. Former Plaid Cymru Leader and Dwyfor Meirionnydd AM, Dafydd Elis Thomas, has also said that the number of councils in Wales should be reduced to between five and seven.
There is a strong argument for all services to be based on a county model based upon the pre-1996 structure, but with Powys merged with Dyfed, along with some other minor boundary changes. However, such an upheaval would be costly in time, staff changes and ICT costs. Whilst the structures are not ideal, full scale change at a time of financial cut backs would be disastrous.
For those convinced big is the way to go, I suggest they look at reports on the Welsh ambulance service and Betsi Cadwalladr Health Board. We would be better served by trying to make the current structures work, with organisations collaborating than having the cost and bureacratic problems that a full scale reorganisation would bring.
What is missing is the democratic element, I see a need for local councils and strengthening the role of community councils but there also exists a regional tier of administration in Wales, all with different boundaries, I’d suggest 5 regional authorities taking in health & social services, education, police, fire, ambulance and strategic planning – rather than this regionalisation by stealth that exists with the new consortia for education etc. It would rationaliase and democratise what we already have.
This is a useful summary of the current boundaries. The 22 authorities are a nonsense! Usual health planning guidance avers that a minimum of 250,000 population is needed in order to help make rational decisions. This would give us, roughly, 12 areas. However, we couldn’t really split Cardiff. So, perhaps, a rational approach would be to look at areas with populations of between 250,000 and 500,000. Another criterion should be coterminosity whilst a third criterion should be following ‘traffic’ flows. There must be political acknowledgement that we cannot have everything ‘just around the corner’ and support for rationalisation. Without this we will not succeed and it will mean closure of some our well-loved local facilities. It is important that services are provided on the basis of cost:effectiveness as well as cost:efficiency and that means looking at the level at which services can be provided where skills, experience and expertise are best placed. This means that some services can and should be local whilst others will need to be on a regional level and, even, supra-regional level. Without this we will not have ‘safe’ services delivering the best possible outcomes for all.
This is nothing to do with the debate above but in the english press there has been talk about thoold stethoscope. I’ve noticed recently 3 GP’s shopping in North Wales wearing a stethoscope around their necks . Is this anew style or trend? Is there any risk of spreading infection to shoppers or patients? Will Betsi make an observation or apology for this trend.They are probably doing their very best &are working very hard to keep infectios at bay. Thank God