How has the Welsh Assembly affected Health and Social Services in Wales?

When the minister makes policy in these areas, she starts by doing consultation exercises. A consultation document is sent to outside pressure groups that have knowledge of the subject and whom the policy could affect. In response to the draft sent out, comments from the pressure groups are sent back and the minister then re-drafts the proposal taking the comments into account.

The proposal then gets given to the Health and Social Services Committee, one of the Assembly's many subject committees that are set up exclusively to scrutinise what the Assembly is doing in regard to their specific subject. Each subject committee includes members of all four political parties in the National Assembly, according to the party strengths in the full Assembly itself. They provide a means for minority parties and ordinary members of the Assembly to influence the Assembly's policies and activities. Subject committees are designed to act as one of the checks and balances within the system. There are in total seven subject committees, mirroring the number of subject Assembly Secretaries. Each Cabinet Minister is a member of the relevant subject committee.

The decision-making power lies solely with the minister, but relevant committee has the key role of calling the relevant Assembly Secretary to account. Another important role of the committee is to invite outside bodies and relevant experts to give their views and opinions of their organisation (if they are representing a pressure group or the like.) When we interviewed Kirsty Williams, the current chairperson of the Health and Social Services Committee, she told us that the Health Committee would call on pressure groups such as the BMA, representing doctors, the RCN, representing nurses, the CSP, representing mainly physicists, UNISON, representing the non-medical workers in the NHS, or the NHS confederation, representing the managerial aspect of the NHS. Also, the Royal Colleges are contacted for their opinions, as they are experts and powerful, therefore are very difficult to challenge. They may not be a visible aspect of the process, but they are consulted and the politicians need to listen to them.

The committee also needs closely with the Cabinet of Wales to develop policy within Wales. As the minister is a member of both these bodies, she is the main link between them and takes both their opinions into consideration when making policy. She would need to consult other ministers because, as I earlier stated, all the departments are interwoven with each other and the decisions of Jane Hutt would most likely affect at least one other area within the Assembly. For example, any decision of Jane Hutt concerning food safety or GM foods would almost defiantly affect the works of Carwyn Jones, the Labour Rural Affairs minister, so they would be in close consultation before deciding on policy. Also, during the Foot and Mouth outbreak, both Carwyn Jones and Jane Hutt would have been working together to decide on a suitable policy to combat the situation as it clearly affects both the ministers' work.

The finalised proposal is then put to the Assembly who vote on it. If it passes then it is passed as secondary legislation and comes into enforcement. If it fails, then it obviously does not become enforced, but can either be abandoned completely or can be changed slightly and put to the Assembly again.

The role of the Health and Social Services Committee entails three main things, which are identical to every subject committee. The first is to shadow and scrutinise the work of the Health and Social Services minister. As I previously mentioned, the committee has the role of keeping the minister in check and calling the minister to account. Its second responsibility is to scrutinise the people or associations that the National Assembly gives money to in relation to Health and Social Services. Its final duty is unique to the National Assembly of Wales, so none of the other political bodies in the UK have this power. The Health and Social Services Committee has the task of helping to make policy within Wales, as indicated above. The committee comes up with recommendations, which the minister then takes into account when making policy. The committee also makes reports to the Assembly, which the Assembly then vote on. Examples of the topics of such reports include the spread of BSE, child care, etc.

Pressure groups often lobby the minister and members of the Health and Social Services Committee and other AMs. I here quote John Jenkins, the Public Affairs Officer for the BMA Cymru Wales: "I lobby AMs on a range of issues and report back to members on Assembly activities. I meet opposition Assembly Members on a regular basis and often brief them on debate issues - offering them facts and figures and the opinions of the medical profession." Most pressure groups remain, or at least say they are, politically impartial and do not support any particular party: "I brief all Assembly Members equally and do not favour one over an other." Representatives of organisations such as the BMA, for example GPs, hospital consultants etc (members of the BMA), meet regularly with Assembly Members or officials (civil servants) to discuss issues that concern their interests or professions. In my research, I found it to be popular opinion of pressure groups and organisations that they find themselves fortunate that the National Assembly is relatively easy to access. Their colleagues in England, Scotland and Northern Ireland are not as fortunate and have to wait long periods of time to see government officials and politicians.

Since the Assembly was set up in 1998 when Parliament passed the Government of Wales Act, the changes due to the Assembly in the areas of Health and Social Services have been relatively limited until recently. Lately it has extended free eye tests to more categories of people in Wales than in the rest of the UK, Wales now provides free prescriptions for all aged 16 - 25 years and there is also a new medical school opening in Swansea, not forgetting the aforementioned Children's Commissioner.

There is however a current proposal from Jane Hutt to completely reorganise the Health structure in Wales over the next two years. It is in parallel with England but some argue that it is more drastic. These changes are based around two notions. The first is that Primary Care organisations, or Local Health Groups, need more power and independence to decide local priorities and implement disease management. The second is that the National Assembly should be closer to the Healthcare professional and patient. This basically entails the following:

Local Health Groups (LHGs) will become Local Health Boards (LHBs). There will be 22 new LHBs, which are just really a re-structure of the 22 existing LHGs. I here quote Alun Cairns AM: "I fear that doing this will increase bureaucracy and costs releasing less for patient care." Local health boards will be twinned with every local council and will have broad representation from the local community. Members will be voted to the boards and board membership will be expanded to include more lay members. These boards will have similar powers to the English Primary Care Trusts (PCTs), that is they will decide local priorities and have extra executive powers to 'buy in' appropriate services from local hospitals. These boards will be directly accountable to the following Regional Assembly Teams.

Regional Health Authorities will disband and three Regional Assembly Teams will take their place. They will be put in place covering north Wales, South and East Wales, and Mid and West Wales. The above LHBs will report to the appropriate regional Assembly Team. These then report directly to Jane Hutt, meaning that there is no middle-man (i.e. Health Authorities) and the LHBs are directly accountable to the National Assembly. Regional Assemblies will mainly contain, and I here quote the NHS: "strategic non-prescribers headed by a director." Doctors of Public Health will have a far more expanded role at this level and LHB level. I here quote Brian Gibbons AM, the Deputy Health minister: "We believe that the NHS in Wales has a major job in tacking health inequalities in Wales. This can be best achieved by working more closely with local councils.

Amongst other proposals concerning Health are a 40-50% increase in NHS spending over the next 3-4 years, a doubling of medical students post over five years, a 66% increase in nursing also over five years. I here quote Brian Gibbons AM: "I think that the National Assembly is playing a major role in re-shaping health services in Wales."

There are still, however, challenges remaining for the Health department to combat. I here quote Dai Lloyd AM, shadow minister for Health and Social Services: "Wales has the worst health levels in the UK and the least capacity (in terms of beds/nurses/doctors) to deal with all that illness. Priority should be to increase the basic building block, to treat more patients." Alun Cairns agrees with that statement: ". In March 1997, 101,000 people in Wales were

waiting to see an outpatient consultant. Now there are 210,000 waiting. In England, the figures are coming down, albeit slowly."

As for Social Services, there are many issues that are currently being dealt with by the Assembly. They include responding to the Waterhouse Enquiry on child abuse in North Wales, making sure the level of spending by local councils on Social Services is improved, Working to improve co-operation between the health service and social services - the new NHS Act will be especially important as it allows for pooling of budgets and joint planning between health and social services, improving quality standards by having all social care staff registered with the Social Care Council and have all care institutions subject to inspection by the Care Standards Inspectorate, improving recruitment and retention of social care staff and improving their training and qualification, improving community care and support for older and more dependent people.

The information I used to help construct my essay was generally fairly reliable as most of my sources agreed with each other, although I have allowed for each party having biased views as with regard to their position and political orientation. I could have written a more accurate essay had David Melding AM, the Conservative spokesman for Health and Social Services in Wales, replied to my query as other AMs have. I would like to mention that Brian Gibbons AM, the Deputy Minister for Health and Social Services in Wales, was very responsive to my questions and very helpful in writing this essay. Also, on our visit to the National Assembly both Kirsty Williams AM, the chairman of the Health and Social Services Committee, and Jane Hutt AM, the minister for Health and Social Services in Wales in Wales, were very helpful and co-operative in answering our questions.