Welsh Conservatives have announced plans to give patients a greater voice in the Welsh NHS with elected health commissioners replacing a system of political patronage which allows Welsh Government Ministers to appoint decision makers onto local health boards.

The announcement coincides with the publication of findings from a survey of more than 3,000 health service users across Wales.

The survey sought views on a range of issues affecting the Welsh NHS – including GP services, outpatient appointments, hospital admissions, the complaints process, ambulance services and NHS performance – and also  the Welsh NHS.

Your Welsh NHS: public reflections on the health service in Wales.

Key findings – a summary

• 71% backed an independent inquiry into the Welsh NHS
• 60% believed that NHS performance had declined in the last 5 years
• Just 29% supported the Welsh Government’s scheme of free prescriptions
• 1 in 5 respondents who had been admitted to hospital felt that their complaints were not taken seriously by hospital staff
• 46% reported having difficulty registering locally with an NHS dentist

A ‘culture change’

The Leader of the Welsh Conservatives, Andrew RT Davies AM, said that the survey identified the need for a ‘culture change’ at the heart of the Welsh NHS – with many patients reporting that complaints are handled poorly by the Welsh NHS and a high number of NHS staff members describing a culture of ‘fear’ where, as one senior nurse claimed, whistleblowing is perceived as “the death knell for the person trying to improve standards”.

Mr Davies said:

“In a system as complex and diverse as the Welsh NHS, things will go wrong. What you cannot afford to do is bury your head in the sand and blindly hope for a happy ending.

“We heard from a large number of medical staff that a non-listening culture permeates the Welsh NHS. Whistleblowing is all too rare, not because issues are few, but because of a fear that drawing attention to serious issues will harm career prospects and make life difficult for those brave enough to speak out.

Attitudes towards standards of patient care were generally high (76% recording positive ratings for hospital care, 83% for appointments through outpatient clinics) but concern often stemmed from how incidents were handled when they went wrong.

“Our survey suggested that many patients feel complaints are not taken seriously by staff, and often not acted upon at all.

“One lady described how the care her daughter had received had affected her so much that her daughter had made two attempts at taking her own life. Their complain remained unacknowledged seven months later.”

Elected Health Commissioners

Investigations into allegations of malpractice by nurses at hospitals in Abertawe Bro Morgannwg have led to a number of police arrests, though one respondent (a staff member at the Princess of Wales Hospital where the incidents took place) said that – “it is clearly unacceptable that no one at management level has been held accountable for these failings.”

Mr Davies said that Elected Health Commissioners would “usher in a new era of openness and transparency – a culture change absolutely necessary to ensure that fundamental issues within the governance of the Welsh NHS are addressed.”

Elected Health Commissioners would replace the system of patronage where the Welsh Government is free to appoint key decision-makers onto local health boards.

They would:

• Replace outgoing Local Health Boards, taking on their responsibilities, including the allocation of resources, setting budgets and defining local priorities;
• Be directly accountable to the local electorate by whom they were elected;
• Be required to appear before local authority scrutiny committees on a quarterly basis, and the National Assembly for Wales’ Health & Social Services committee on an annual basis.

Darren Millar AM, Shadow Health Minister said:

“In recent years communities across Wales have felt powerless to influence the decisions which have been made about health services in their areas.

“The message we received from thousands of NHS service users was that many of them feel ignored.

“The Welsh NHS must become more accountable to those it serves and more responsive to the taxpayers who fund it.”

Mr Davies, Leader of the Welsh Conservatives, added:

“Elected Health Commissioners will put the patient voice at the heart of decision making in the NHS, transferring decision making over health services from central government and into the hands of the people.

“Directly elected Health Commissioners, with a mandate from the communities they serve, will be able to reflect local priorities when bringing about the transformation our NHS needs to be fit for the 21st Century.

“You vote them in, and you vote them out – that’s our vision for patient voice in the Welsh NHS.”

Next Steps

The Welsh Conservatives will now reflect on the findings of the report before bringing forward a range of detailed proposals in the coming months to address the many specific operational issues covered by the survey.

This work will focus on several key areas, including – but not limited to:

•  Measures to broaden access to GP appointments during evenings and weekends;
• Improving recruitment and retention rates for senior medical staff in Wales;
• A whistleblowing ‘charter’ or framework to protect NHS staff who raise concerns;
• Plans to increase NHS dentistry provision;
• A scheme to tackle the issue of missed hospital appointments.

A follow-up recommendations document will be published in the coming months as a companion to the report which can be accessed online.