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Post  Admin on Wed 1 Oct 2008 - 15:06

In the ten years since we have had the Assembly we have seen the NHS in Wales moving in a different direction to its counterpart in England. For example PFI is no longer being used to build hospitals, the internal market is being dismantled and we have introduced legislation which is intended to pave the way to better redress in cases of complaint and, hopefully, a more transparent and accountable system. These are, of course, policy decisions which could just as easily be reversed by a future Welsh Government, but they seem to show that our ideas of what a National Health Service should be are rather different from those in some other parts of the UK.

So what should the guiding principles of health care in Wales be? Would we want to be more radical yet, for example in the way that private medicine operates? Should we encourage diversity of provision, or is it more consistent to discourage it on the grounds that people would not pay for something privately unless they thought it was better ... which means that they think the publicly provided service is not as good?

Alternatively, are we moving in the wrong direction? Is any free-at-the-point-of-need service sustainable, or will it always be a drain on our resources that it would be better to replace with an insurance based model perhaps with a choice of provider, but not necessarily operating on a commercial, profit making basis?

How do we deal with wider health issues such and dentistry and optical care? Over recent years these have moved away from the NHS and are now largely privatized. Is this a good thing, or should we seek to bring them back into mainstream public provision? Do we in fact need to widen health provision even further to include general fitness, healthy eating and more screening on the grounds that early, preventative measures will, in the long term, reduce the future burden on the NHS? If so, how do we do it without compromizing diversity and freedom of choice? What can we learn from the way other countries handle these issues?

What are the appropriate levels of provision in different localities? The primary point of reference has in the past been the GP, but there has been a trend lately towards nurse led primary care. In an age where communication and referral is much easier does this make sense, or is it a compromise to save cost? Is it a good thing for care to be available at an even more immediate level such as schools and the workplace and, if so, how would small businesses be able to get the same level of benefit?

What balance should we aim to strike between surgeries, clinics, and small and large hospitals? How far should we expect to travel to get to full A&E facilities or for specialist care? How do we ensure that Wales develops the appropriate specialist centres of excellence, since at present some are more easily available by travelling to England? How should reciprocal arrangements work with other countries, especially if our respective systems diverge?

How do we train the professional staff necessary for the health service? There are, for example, no colleges of medicine, dentistry or pharmacy anywhere in west, mid or north Wales.

How do we handle the loose boundary between medical care, care for those with disabilities or who are old, and social services generally? How do we ensure that people don't fall though any gaps between them? To what extent should such care be provided in the community, and when does it become appropriate to use residential institutions? How do charities and voluntary organizations fit into the picture?

Those are just some of the questions we can discuss in this forum.


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