This is an extract from the Plaid Cymru manifesto 2003

TOWARDS A HEALTHIER WALES

A commitment to build a healthier nation will be at the top of a Plaid Cymru government’s priorities. It is a massive challenge, and there are no quick fixes or miracle cures.Wales has a legacy of chronic ill-health, especially in some of our poorest communities. It is a sad fact that our country suffers from some of the highest incidences of cardiac disease, respiratory problems and cancers in the western world.

As well as securing better provision and prompter availability of health services, the building of a healthier society involves longerterm measures aimed at improving the general health and well-being of all our people. Health means much more than the absence of disease; it implies a sense of well-being, vigour and fulfilment.This is influenced by a range of factors in which the delivery of health services is only part – albeit a vital one.

The creation of a healthy nation is a project which must involve all our people, all our services, and all government departments. It calls for waging war on poverty, strengthening our economy, building a fairer society and safer communities, good houses and a pleasant environment, and a rich cultural life For this reason every department in a Plaid Cymru government will need to show how its work and decisions contribute to this task.

Action is required on at least three fronts:

  • tackling the poverty that causes so much ill health;
  • increasing the capacity of our health services to deliver speedy and effective treatment to the sick and needy;
  • the promotion of healthy lifestyles.

(a) Poverty and Ill-health

There is now indisputable evidence of the link between poverty and ill health. Not only are the poorest the sickest members of our society, but illness of itself is also a key generator of poverty. Clear evidence of this link was provided by the Black Report in 1980, but the Conservative government of the time chose to ignore its findings and the problems grew worse. More recent research has highlighted the link and the deep seated nature of the problems caused by poverty. A Plaid Cymru government will ensure that a full understanding of this destructive synergy between poverty and sickness will be mainstreamed into all government policy and decision making. Further research has shown that the extent of inequality in societies also has a direct effect on levels of sickness.Therefore the creation of a fairer society must be a fundamental part of the drive towards a healthier Wales.We will ensure that our economic policies will be geared to achieving greater equality, and thus reinforce our efforts to tackle all the determinants of sickness in Wales.

(b) Health and Social Services

In the short to medium term, our quest for a healthier Wales will depend heavily on improving our health and social services. This is our front line of attack upon illness and disease. These services should be guided by the principles of equality, respect and dignity for all people. Organisations exist to provide for people, and it is their responsibility always to strive to enable and promote well-being, responding always to individuals’ interests and choices.

Discrimination in the provision of services is unacceptable, and we will take proactive steps to promote equal treatment; ensuring for example that same-sex partners are regarded as next of kin when medical decisions are being made.

Responsibility for health is one of the National Assembly’s main functions.The NHS accounts for around 35% of the Assembly’s budget, which means that £4,158,448 will be spent in 2003-4.The NHS is also Wales’ biggest employer, with a total of 87,000 full and part-time staff members, accounting for 7% of the total Welsh workforce.

We all admire the dedication of its doctors, nurses, social workers, other health professionals, and the ancillary staff, who perform daily miracles in very difficult circumstances. Both they and their clients have been badly let down by governments over the years. Our health service today is suffering the effects of 20 years and more of neglect and under-funding under both the Conservatives and New Labour. In Wales, despite having the worst incidence of sickness, we have the least capacity to treat it of any part of the UK. The Barnett formula for calculating the National Assembly’s block grant takes no account of our ageing population. Neither does it take account of the increase in deprivation levels and therefore illness caused by industrial collapse in many communities. The result is that it is well-nigh impossible for expenditure for improved provision to keep up with levels in England, except at the expense of other policy areas, such as housing, transport or economic development, themselves crucial for improving health and well-being. The effect of this is illustrated by the fact that at the beginning of 2003 no-one was waiting over 18 months for an operation in England while the figure for Wales was 5,391. This despite the fact that Wales has only 5% of the UK population! On top of this, our health service is still suffering from the misguided policies of past Conservative governments, whose introduction of the internal market into the NHS has been so damaging.A further blow to health services in Wales occurred in 1993, when John Redwood in effect abolished strategic national planning. Today, patients in Wales are paying a heavy price for the decision of Tony Blair’s government to keep to Tory spending plans for its first four years. While we certainly welcome the extra investment that is at long last on its way to the Health Service,we regard it as still inadequate, and deplore the fact that it has come at least four years too late. Lack of spending in health is disproportionate in that the effects of underspending in one year affect succeeding years. For each pound not spent in the late 1990s, much more must be spent now.

In 1999, Labour promised that no-one in Wales would have to wait more than six months for an out-patient appointment.The figure in February stood at 76,400, as compared to 676 in England. Labour must bear full responsibility for failing to deliver on its promises. Disguising the truth through spin and double-counting must no longer be allowed to deceive us. The reality is growing waiting times, deficient infrastructure, treatment failures, shortage of medical personnel including nurses, GPs and consultants, and a committed workforce demoralised by sheer pressure of work.

In 2003 we face a further threat to the Health Service with the sixth restructuring in 13 years.We have opposed these so-called ‘reforms’ because they divert resources and attention from the real issue of increasing capacity, and because we do not believe that the new structures will be fit for purpose. The logic behind scrapping the five health authorities and imposing 22 new Local Health Boards (LHBs) is far from apparent, and has been met with a deep-seated anxiety and scepticism among health professionals.As well as the LHBs, various other organisations are to be established, bringing the total number of bodies responsible for health care in Wales to 52. There is grave concern about the capacity of many of the LHBs to carry out their duties efficiently and effectively, and their sheer number will reduce the possibility of strategic planning.With the Trusts being retained, a key element of the Conservatives’ internal market remains in place, despite Labour’s claims that one of the purposes of the reorganisation was to tackle it. The costs of setting up and running such an elaborate structure will add up to many millions of pounds, whatever misleading claims are made by the Assembly’s Health Minister.

A Plaid Cymru government will therefore inherit an under-funded health service newly thrown into the turbulence of an inappropriate reorganisation.

More doctors, nurses, and beds

The immediate priority will be to develop greater capacity in terms of more doctors, nurses, other health professionals, and beds. A Plaid Cymru government will put in place a detailed and coherent strategy towards this end; and we will co-operate with health professionals to find the best and most efficient ways of delivering these services. On taking office we will begin an immediate audit of the present capacity of the NHS in Wales, including the key interfaces with social services, by amending the remit given to Derrick Wanless in October 2002. Once this is complete, in consultation with representatives of the medical and care professions, we will draw up a National Capacity Plan.This plan will provide an all-Wales strategy with short, medium and long term goals for:

  • more doctors, nurses, dentists, physiotherapists and other health professionals;
  • the provision of more beds and appropriate equipment in hospitals;
  • the provision of adequate and suitable nursing and residential care for the elderly;
  • a campaign aimed at the retention of qualified staff.

Hospitals loom large in public consciousness. Consequently, in any debate on the NHS, a fact often overlooked is that 90 per cent of health care contact remains at the primary level. Recognising the crucial importance of primary care, we will place particular emphasis on GP recruitment as part of our National Capacity Plan. Given the alarming statistics about a looming crisis in the number of GPs, and reports of waiting lists for a month or more for a doctor’s appointment, urgent action is clearly needed. In addition to implementing the new GPs contract, we will offer an attractive package to encourage GPs, including the option of salaried GPs, to serve in underprivileged areas where there are severe health needs.

We will be seeking ways of stripping away bureaucratic burdens on staff. Doctors, nurses, and other health and social services professionals must be able to concentrate their time on caring for patients, rather than being tied down with unnecessary paperwork. In consultation with representatives of the nursing and medical professions we will also be seeking imaginative and effective ways of skill-mixing. This will not only free up time for doctors to concentrate on making full use of their professional skills, but also enhance the potential of trained nursing staff.

As well as being primary-led, Plaid Cymru has always insisted that health provision must be community-based in all its aspects.We wish to encourage, where appropriate, a fuller integration of health centres and community hospitals.We will also take steps to ensure that the care and support provided by social services is accessible in health centres and surgeries.This will be part of a drive to develop a closer working partnership between health and social services, and local authorities have a clear role to play in this.

The voluntary sector has a vital role, for example through the hospice movement.We will work closely with the sector to ensure that funding is predictable and stable.

Recognising the disruption caused to the NHS by the constant reorganisation of recent years, a Plaid Cymru government will do everything possible to avoid further restructuring. Despite our misgivings, we will do everything possible to make the new system work as well as possible. However, we will be keeping a careful eye on the situation, working closely with professional and patient bodies.We will encourage collaboration among the LHBs, and the objective in the longer term will to integrate their work with the NHS Trusts, maintaining the principle of coterminosity, and thus move away from the remaining elements of the internal market.

Certain functions are best fulfilled at the national level, including strategic planning and a strategy aimed at generating significant savings through the rationalisation of prescriptions.

(c) Older People

It is fundamental and crucial that the enormous contribution made by older people to our society be fully recognised. Their accumulated wisdom and experience constitute an invaluable asset which can be of particular benefit to children and young people.We will work with relevant organisations to find ways of maximising this contribution. The stereotyping of the elderly as dependent and infirm is unacceptable as well as inaccurate. However, advancing years bring with them particular needs in relation to care, and it is an indicator of a civilised society that these are properly catered for, if only as a way of acknowledging a lifetime’s commitment to the welfare of others.

We regard the artificial distinction between nursing and personal care needs as particularly damaging. It can inhibit the provision of early medical intervention to prevent ill-health and possible hospitalisation. Quite apart from the sheer injustice of such a situation, it imposes unnecessary pressure on the capacity of the health service to treat patients. That is why we deplore the UK Government’s refusal to implement the key recommendation of its own Royal Commission on the Long-term Care of the Elderly: to abolish the distinction between nursing and personal care.The National Assembly, unlike the Scottish Parliament, currently lacks the powers to implement the Royal Commission’s recommendations, while the injustice of the Barnett Formula would make it extremely difficult to meet the cost. A Party of Wales Government will press for both these deficiencies to be corrected so that older people in Wales can be treated with justice and dignity In the meanwhile much can be achieved in other ways.

We will combat ageism in all its forms, for example by ensuring that assessment for services is made according to need not age, and by developing advocacy and consultation with service users and carers. In this we will work with Community Health Councils and Care Forum Wales.

In order to address the burden on carers, we will be looking at ways of adequately resourcing the National Carers’ Strategy. Older people with needs should have support to enable them to make their own choices about the settings that they regard as most appropriate, and services should be geared to this objective.

We will emphasise the need for early identification of needs and prompt intervention.This will help to reduce admissions to residential and nursing homes and hospitals, and the need for older people to uprooted as their needs change.To this end we will look to the development of integrated multi-disciplinary long-term care teams to provide for older people’s acute, rehabilitation, and assessment needs. An immediate issue is the crisis in the carehome sector which threatens to damage providers and clients alike, as well as exacerbating problems in our hospitals. It is of particular concern that family-run homes which provide the kind of homely environment so valued by clients face particular difficulties.This will need to be included in the Wanless review.

Older people have the right to maintain as much independence as possible, and the provision of services should be geared to this aim.We will provide LAs with the resources to pay for free home social care such as home-helps.

(d) Others with Long-term Care Needs

People of all ages can have long-term care needs.These should be met according to the same principles as those set out above.

(e) Mental Health

We will not tolerate any stigmatisation of those who suffer from mental illness.They are among the most vulnerable members of society, and must be given high-quality health care and treatment. We will continue to oppose the proposed Mental Health Act, particularly as its reactionary proposals for the detention and enforced treatment of the mentally ill offend against basic Human Rights. It lacks any sound scientific basis and will be costly to implement, as the resources do not currently exist.

We support the promotion and expansion of Community Mental Health Teams. However, we need to beware of any resultant rationalisation and reduction in beds, causing the centralisation of services. Indeed there is an urgent need for additional beds.

(f) Children’s Services

Our proposal to establish a Department of Education and Children’s and Young People’s Services will strengthen coordination in serving children.We will:

  • emphasise the need to work with children and families to prevent abuse from occurring;
  • ensure effective and swift child protection systems.

Working in partnership with LAs, we will give the highest priority to child protection and seek to ensure that no part of the system fails our most vulnerable children.We will work with the Children’s Commissioner and voluntary and community organisations to take forward the principles outlined in the Children’s Manifesto.

(g) Disability

An area which has seen enormous progress over recent years is in attitudes to and provision for, disabled people. However, discrimination is still common, and the capacity of disabled people to fulfil their potential and contribute to society is still frustrated in too many ways.We recognise that disability issues are fundamentally about equality,which is why the recommendations below go well beyond the scope of health and social care.

A Party of Wales Government will operate on the basis of the “social model” which recognises that it is society that disables the individual. Recognising this reality is crucial to implementing equal opportunities.

2003 is the European Year of the Disabled and we will mark this with a fresh commitment to remove obstacles to real equality.We will work with disability organisations to make improvements in key areas such as:

  • support and confidence-building programmes and advocacy and advisory services;
  • equal access to health services and community and leisure activities;
  • educational opportunities to enhance quality of life;
  • countering discrimination in employment;
  • empowerment of service users through promoting direct payments.

We will recognise British Sign Language (BSL) as a language in its own right and promote its use.

(h) Recruitment and Retention in Social Services

As with the NHS, difficulties with recruitment and retention of Social Services staff inhibit the capacity to provide consistent services of high quality.Whereas pay levels contribute to this, morale is also undermined by the burden of bureaucracy and the targetsetting culture, which diverts time and resources from the essential task of serving clients’ needs, and also distorts priorities.

A PLAID CYMRU GOVERNMENT WILL:

  • emphasise and disseminate good practice;
  • work with the Wales Care Council and the Regional Care Partnerships on workforce planning and recruitment;
  • emphasise the right of workers to benefit from training and career development opportunities;
  • seek to improve job-security and conditions of work;
  • encourage flexible work opportunities so as to promote equal opportunities, reduce strain, make best use of available skills, and respond better to the needs of users.

(i) The Promotion of Healthy Living

As well as being better than cure, prevention saves money in the long run. A Plaid Cymru government will seek the necessary powers to introduce free eye tests and free dental checks for all.The additional expenditure will be more than justified in both human and financial terms through the early detection of disease which would result.

We will develop an effective programme of health promotion. Present initiatives to reduce smoking and encourage the eating of fresh fruit and vegetables, though laudable enough, are too narrowly focused on the individual. As a result they have had little impact where most needed. Our programme for health promotion will be evidence-based and focused on communities.

We will learn lessons from other European countries and regions where community based initiatives have been successful in tackling entrenched problems of ill-health.

Our programme will in particular build on the Communities First programme.There will be a focus on achieving recognisable health gain in the hundred most deprived wards which will be designated as Community Health Action Zones. Healthy living will be promoted through our early years Educare programme We will act upon the National Assembly’s resolution to seek primary legislation specific to Wales to ban smoking in certain public buildings.

We will also issue guidelines to schools to discourage the selling of sugar-saturated drinks and fat-saturated foods to our children, and ensure that school meals are healthy, nutritious and attractive. Learning from the lessons of the Powys Food Initiative we will also work with local uthorities to develop procurement policies so as to favour local sourcing of good quality produce.

We will build upon and extend current initiatives for free access to swimming pools and leisure centres, particularly for children and young people and in disadvantaged communities.

A PLAID CYMRU GOVERNMENT WILL:

  • ensure that all government departments work towards a healthier Wales by tackling the poverty that causes ill health;
  • produce a National Capacity Plan to employ and retain more doctors, nurses and beds;
  • press for adequate funding to meet Wales’s greater needs;
  • seek alternatives to PFI and all other schemes aimed at ‘privatisation by stealth’;
  • reduce bureaucracy and the proliferation of structures that set up boundaries between agencies, particularly health, social services and the voluntary sector;
  • fund the provision of free home social care.

WE WILL SEEK PRIMARY LEGISLATION TO:

  • • enable the implementation of the recommendations of the Royal Commission on long term care for the elderly;
  • • to provide free eye tests and dental checks for all;
  • • to effect a ban on smoking in certain public buildings in Wales.

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