Re-Balancing the Roles of Public and Private Health Sectors in Wales

Introduction

Although traditionally a unitary state, in the late 1980s, the United Kingdom (or Great Britain and Northern Ireland as it is sometimes known) implemented a form of political devolution to certain distinct regions within the UK. Thus, Wales is one of the four constituent parts of the UK the others being Scotland, Northern Ireland and England (which is by far the largest). This devolution process involved the creation of an elected parliament for Scotland and elected Assemblies for Wales and Northern Ireland.

Until 1989 the London based Parliament maintained responsibility for all aspects of public services and public policy in all parts of the UK. However, from 1989 onwards the devolved parliament and assemblies in Scotland, Wales and Northern Ireland assumed direct responsibility for certain public services such as: health, education, social care, local government etc. However, the provision and organisation of other public services such as: economic policy, defence, foreign affairs etc remained the responsibility of the London parliament for the whole of the UK (Cabinet Office 2012).

The nature of the devolution arrangements and the responsibilities involved are often mis-understood and need clarification. Taking health as an example, the Secretary of State for Health in the UK government (and the associated Ministry of Health) is only responsible for health services in England. They have no authority or responsibility for health policy and health services in Wales, Scotland and Northern Ireland this being the responsibility of the respective Ministers of Health in those countries. Perhaps not surprisingly, given the differences in history, culture and economic outlook, over the fourteen year period since devolution commenced, there have been significant divergences of public policy between the four constituent parts of the UK with consequent implications for public services in each country. This has often led to complications because of the remaining inter-connections between the different parts of the UK. For example, proposed changes to the school examination system in England were rejected by the Welsh Government but subsequently caused concern about the possible devaluation of Welsh examination qualifications and the impact on access to university and employment by Welsh students.

Traditionally, the NHS in the UK has been seen as a public sector monopoly with any attempt to involve the private sector in NHS activities viewed with suspicion. The former UK Chancellor of the Exchequer, Nigel Lawson, famously said that the National Health Service is “the nearest thing the British have to a religion”. By this he meant that the British public had a very strong affinity for the founding principles of the NHS and any attempt to change those founding principles (such as through the greater involvement of the private sector) would be viewed suspiciously. This is even more strongly felt in Wales which has traditionally had strong affiliations with the socialist Labour Party and where the political founder of the NHS, in 1948, Aneurin Bevan, was a Welsh Member of Parliament. On several occasions, Labour Party Welsh Ministers have criticised their Labour Party counterparts in the UK government for their greater involvement of the private sector in NHS activities in England.

The NHS in Wales now faces unprecedented challenges and consideration must be given to new policies and practices with regard to health services. This paper considers:

• 1.

  What are the challenges facing the NHS in Wales?

• 2.

  What are the potential roles for public and private sectors in health?

• 3.

  How might health services in Wales be rebalanced, between public and private sectors, in order to assist in dealing with the major challenges being faced?

This paper has been prepared through a combination of literature searches coupled with interviews with senior policy makers and managers in the health sector.

What Are The Challenges Facing The Nhs In Wales?

The NHS in Wales faces a number of daunting and deep-seated challenges. These are summarised under four main headings:

• •

  Poor health status and outcomes;

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  Ageing populations;

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  Weaknesses of current health system;

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  Resources and financial austerity.