So David Cameron, in a recent PMQs, has resorted yet again to the old trick of trying to deflect an attack on one of his policies by criticising what he purports to be Labour’s record in office. In this instance, he rounded upon the Welsh government’s running of the NHS in Wales to pretend that the ill-conceived coalition proposals in the health bill are the only way to ‘save’ the NHS. Never one to let the facts get in the way of a good line, Cameron tried to claim that waiting lists in Wales were growing, stating that  this is what happens ‘when you don’t put the money in and don’t do the reform’.

He could not have been further from the mark on both cases. It can be argued that the reform of the NHS in Wales, while not yet complete, offers those of us who believe in a cooperative, mutual structure for public services a real alternative to the privatisation and dismantling of the NHS, which is the best that the Tory and Liberal coalition has to offer. NHS funding in Wales is still increasing, but cannot keep pace with inflation, mainly thanks to the cuts to the Welsh government’s budget settlement by Cameron’s government. Waiting lists for some specialities have been growing, but the Welsh government has responded to this by increasing funding to help bring the waiting times down. When compared to what is likely to happen to the NHS in England, if the current health bill goes through, then never have so many of us who live to the west of Offa’s Dyke been grateful for devolution!

Both the previous Labour government and that in Cardiff identified the same drivers necessitating the restructuring of the NHS in the middle of the last decade. The rising numbers of older people in the population, meaning that the NHS needed to invest in more preventative, community-based services, continues to force those running the NHS across the UK to reassess not just how much money is being spent, but where that money goes and what outcomes are produced by every pound invested. While prior to the 2010 general election there were some slight differences between the Westminster government’s views on the NHS and those of its sister administration in Cardiff, they normally tended to be matters of nuance rather than ideology ie England’s primary care trusts were local health boards in Wales. But the broad direction of travel was the same: massive investment into services took place on both sides of the border and, while the Welsh government did not accept that there was a role for the private sector in the modernisation programme, from the consumer’s point of view, there was no real differences. In fact, for those of us living on the border with England we continued to access the NHS, as though devolution had never taken place, with many people using both district general hospitals and more specialist services alike.

Where there were differences, the Welsh option was often more progressive than those adopted in England. Some of the charges that undermined the ‘free at the point of need’ principle at the heart of the NHS from its creation, especially in relation to prescriptions, were abolished, free car parking became the norm in most hospitals and massive investment in NHS dentistry meant that many people were able to access an NHS dentist for the first time in years. More significant, but less publicly obvious, in terms of where the NHS finds itself in Wales in 2012, were the changes to the structure of the NHS put forward in a strategy document published in 2009 entitled Setting the Direction.

This set out clear plans to refocus the NHS in Wales so that services are shifted from the secondary care setting back into the community, something which all sides of the current debate about the NHS agree needs to happen. However, where these plans differ most radically from the Tory-Liberal coalition proposals in the health bill is in how services are commissioned and delivered. One of the biggest areas of dispute about the health bill centres on the role of GPs in commissioning services, with proponents of the bill arguing that GPs are best placed to know what services are needed by their patients. However, as most GPs are too busy to get involved in this, or lack the skills and/or motivation to do so, this lets in private firms who are offering to organise the commissioning function and at the same time make a profit.

In Wales, the commissioning of services is being led by a partnership made up of the executives of the new local health boards, the clinical directors working in those Health Boards, and a number of ‘Locality Leadership Teams’. These are comprised of a range of health and other professionals, drawn from a distinct geographical area each with roughly the same population. In north Wales, for example, there are 14 of these groups, who meet together to agree on local priorities, set action plans for delivery of improved services and feed information up to the executive of the local health board about what is needed in the medium to longer term to achieve the outcomes it has agreed. While these groups are indeed chaired by a local GP, each one also contains representatives of other services in the area, helping to make the seamless health and social care services vital to the delivery of a modernised NHS a reality. Even the third sector and patients’ representatives are included. Informing the work of these groups are ‘Reference Groups’, made up of local residents, councillors and other key stakeholders, who are there not only to be used for consultative purposes, but who can also have their say on what the local community thinks and what it needs.

While some people might argue that this structure is similar to the GP-led commissioning groups and the health and wellbeing boards being bought in by the health bill, the similarities are only superficial. The so called localism of the Tory-Liberal Democrat bill is a smokescreen for the breaking up of the integrated structure of the NHS. The various parts of the structures proposed in the bill are likely to work against each other rather than promoting cooperation. Conflict is inherent in the proposals, as four different groups, all having alleged influence over how services are developed, are left to agree on the priorities for local health services. In reality it is likely that the only real power will lie with the group that holds the purse strings – the GP-led commissioning groups. The government uses all the right trigger words on the face of the bill: transparency, accountability, localism and liberation all put in an appearance. But while it is true that David Cameron and his health secretary have identified the same challenges being faced in the NHS as the government in Wales, they have used them as an excuse to finally introduce an ideologically rightwing ‘solution’ to the ‘problem’ of the NHS, which even the privatising pioneers of the Thatcher governments would not have attempted. If the health bill goes through in the form favoured by Cameron and Lansley, it will eventually lead to a two-tier NHS that will see those who can pay to access privatised insurance-based services. Those who cannot will have to hope that where they live, the NHS services remain good enough.

The new structures for the NHS in Wales have taken time to develop and roll out; this is in part due the fact that the people developing and implementing the changes have tried to keep the NHS as a whole, with all elements of the system still integrated with a minister of health ultimately responsible for the service as whole.   However, much still remains to be done, and it is to be hoped that the Labour government in Cardiff will be in control long enough for the new structures to bed in and begin to fulfil their potential. If they do, I believe that in Wales at least we will have at last achieved a NHS balanced between the needs of the producers and the needs of local communities; which has a focus on preventative services and does more than simply respond to an ever rising tide of ill health, often caused by either lifestyle choices or poverty; and which can be all that those who fought for its creation back in 1948 dreamt it could be. The Labour party needs to be forthright in its defence of the NHS that we created, showing it has a viable, credible alternative to the Tory-Liberal Democrat plans. It may just be that the Welsh Labour government has created that viable alternative, despite what Mr Cameron has claimed.

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Margaret Hanson is a candidate for the National Policy Forum in Wales

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Photo: Visa Kopu