Healthy valleys: Welsh Government health chief on the devolved NHS, committed staff and Bevan’s legacy
The land of NHS founder Aneurin Bevan, Wales has seen a lot of changes since the health service was created 70 years ago. The Welsh Government’s top health official Andrew Goodall reflects on the enduring legacy of one of the nation’s favourite sons
Photo: Welsh Government
As we celebrate the 70th anniversary of the establishment of the National Health Service, it is a privilege to have a role leading and overseeing the NHS in Wales. I combine the role of director general for health and social services in the Welsh Government with an outward-facing NHS Wales chief executive role. My background is a 27-year NHS career in a range of roles, responsibilities and settings, including 13 years as an NHS chief executive. But currently I balance both ministerial requirements and service response through my joint role.
“No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means” – Aneurin Bevan
This is an important moment to focus on the values, principles and the population offer of the NHS. The NHS has changed greatly, with advancements in technology, medicines, services and clinical practice. We have seen improving life expectancy over seven decades with the emergence of care and treatment that was not envisaged at the outset of the NHS; we have universal vaccination programmes in place, keeping the population safe; we have clinical practice that has translated weeks of hospital stay into days or even hours; we have technology offering treatment solutions at an ever-increasing pace; and we have developing approaches in diagnostics and genomics that will lead to much greater anticipatory care rather than simple illness response. The NHS is a service of scale and complexity, delivered in a range of settings from community to specialist hospital provision, yet while delivering volume of scale it must continue to focus on individual care and treatment. When the NHS was established in 1948 there were 126,000 staff working for it across the UK; in Wales alone we now have over 90,000 staff and contractors.
Health policy and oversight of delivery of the NHS has been devolved to Welsh Government since 1999. This has led to the divergence of policy and facilitated different government approaches across our borders. We reorganised our health structures in Wales in 2009 to create integrated population health organisations responsible for health and local service delivery. We adopted a planned system to create an environment where organisations work alongside each other on behalf of their populations and were removed, as a matter of policy and political choice, from an internal market environment.
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These changes provided Wales with structures that facilitate better coordination within single organisations, align our primary and community services alongside hospitals, and support patient care pathways and that assist closer working with social services and other public services. It is also significant that the health spend in Welsh Government has now exceeded over 50% of its overall budget, recognising the additional funding allocated to the NHS over recent years. In Wales it has also been possible to protect social care funding alongside growth in the NHS allocations.
We have also passed legislation in respect of social services and wellbeing, which has set out a clear framework for social care delivery, aligning joint expectations closely with the NHS and our structures in Wales. In my view, there has been a definite advantage to our structures in Wales in having health and social care, for some time now, combined under both ministerial and director general responsibilities. This brings line management of the NHS alongside the policy oversight of social care in Wales and reinforces our offer of an integrated care system sitting across the NHS and social care. This does not remove local government responsibility for the delivery of social care but sets expectations for coordination and joint working across NHS and social care, including through use of pooled budgets and regional working.
From my perspective, working in devolved government also brings a closeness to our services and partners, both geographically and in relationships. It is very easy for the NHS to live in its very large bubble, but it can have a much broader impact on Wales, for example through its status as largest employer, and proper use of its £7.5bn budget. We have been particularly focused on life sciences and innovation over recent years as an emerging opportunity.
This is also a key moment to influence the development of health policy and provision into the future. The Welsh Government’s latest commitment to the development of our health and care system is: “A Healthier Wales: our Plan for Health and Social Care”. This has been developed as a response to a recent parliamentary review, a process uniquely attracting cross-party support, which draws in national and international expertise in respect of health and care systems. Launched in June, the plan represents a 10-year vision and plan for the NHS and social care system, supported by clear milestones for delivery for the next three years. It stands out as the first time a joint health and social care plan has been produced in Wales and has been developed jointly with the service and our stakeholders. It places an emphasis on alignment across health and social care; a focus on health and wellbeing activities, rather than the traditional NHS illness response; the importance of community-based services based on “cluster” models representing populations of between 50,000-60,000 as well as a clearer national direction and decision-making to make change at pace.
Working in Wales, supporting a population of just over three million does allow for close contact with our workforce, which is key to the successful operation of the NHS, and to our communities and the wider population. This also means coming into contact with people who are special to the NHS and its history. Recently, I was speaking at an event alongside Aneira Thomas who was the first child to be born in the NHS at one minute past midnight on the 5 July 1948 (and who, of course, is Welsh). I am pleased to report she followed a nursing path herself and has seen many members of her own family do the same and commit their careers to the NHS. It was not my first time meeting with Aneira and I expect, given the 70th anniversary of the NHS, it won‘t be my last in the forthcoming weeks of celebration, but her most salutary observations were her description of her family’s access to health services before the NHS was created and, in contrast, the level of access and support we now take for granted.
It is important that in an environment of demand and pressures, we take a moment to pause and celebrate the impact the NHS has made in serving the UK population. It continues to stand out internationally for its universal offer, free at the point of delivery, regardless of means. The 5 July 2018 represents an important date of celebration for the NHS and what it represents for the UK population; in Wales, it has a particularly strong resonance given Aneurin Bevan’s Ebbw Vale constituency, and the influence of the Tredegar Medical Aid Society model and principles in the establishment of the NHS. In a previous chief executive role, I was responsible for the opening of a new hospital in Ebbw Vale, Ysbyty Aneurin Bevan (Aneurin Bevan Hospital), in December 2010. You may be as surprised as I was to know that, despite his historic impact as the founding father of the NHS, Ysbyty Aneurin Bevan became the first hospital to be named after him but it felt appropriate we were able to do this in Wales.
We are all touched by the NHS in our lives at both the happiest and most difficult moments and it continues to care for us and our families through our life course. I am very proud of the committed and caring staff who, every day, support better health and outcomes for all our population. To all of them, thank you very much – diolch yn fawr iawn.
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