House of Commons - Welsh Affairs

Select Committee on Welsh Affairs Fourth Report

Access to services

11. We are concerned about the access to services for patients in North Wales and in rural areas. For example, people in North Wales have to travel to Gobowen Hospital in Shropshire for treatment in orthopaedics, and there are long waiting lists. There needs to be a centre for detection of osteoporosis within North Wales. There are similar problems in Mid Wales, where people are frequently required to travel to Birmingham, Hereford and Shrewsbury for hospital treatment.

Waiting lists and waiting times

12. The Government has put considerable store on the reduction of NHS waiting lists.[24] The NHS Confederation, on the other hand, argued that waiting time was a more appropriate performance indicator, and that clinical priority should be taken into account, so that those who are in greatest need receive quicker treatment.[25] Their witnesses reported that the focus on reducing waiting lists for inpatient care was leading to increases in waiting times, particularly for outpatients.[26] We understand that the waiting list initiative is also creating problems for inpatient care, with planned operations being postponed. The Welsh Office maintained that their policy was to tackle both waiting times as well as waiting lists, and that waiting lists (though less significant to the individual patient) were an important indicator of overall activity.[27] The waiting lists/waiting times debate is clearly a crucial issue, on which the National Assembly should focus as a matter of priority. There is a strong case for disentangling planned work from emergency provision.

13. The NHS Confederation argued that the additional funding of £18 million, which Health Authorities had received in 1998-99 to reduce waiting lists, needed to be recurring if the reduction were to be sustained.[28] Their witnesses pointed out that non-recurring funding is much less cost-effective than recurring expenditure, and that as many as 50% more patients could be treated for the same money if it were provided on a recurring basis.[29] We welcome the Secretary of State's undertaking that the additional waiting list funding would be recurring.[30] We greatly hope that the National Assembly will be able to meet this commitment.

Resettlement for people with learning difficulties

14. We received representations from the Resettlement Task Force which is campaigning for the completion of hospital resettlement in Wales for people with learning disabilities.[31] While Ely Hospital in Cardiff finally closed at the end of January 1999, there are still 450 people left in long-stay hospitals in Wales (Bryn-y-Neuadd in Llanfairfechan, Hensol near Pontyclun, and Llanfrechfa Grange near Cwmbran) and there are no clear plans for their resettlement. The Secretary of State assured us that the Welsh Office was committed to the principle of resettling into the community people who are living inappropriately in long-stay hospitals, and that the programme would be completed "as quickly as the resources allow".[32] The Director of the Welsh Office Health Department admitted that "the key difficulty has been the mismatch between the cost of the resettlement programme and the amounts of money which have been available to fund it".[33] We urge the National Assembly as a high priority to set a timetable for completion of the resettlement programme for people with learning difficulties and to ensure that it is fully funded.

Fluoridation

15. The NHS Confederation are strongly in favour of fluoridation, which they see as "a major opportunity to improve dental health in Wales".[34] They point out that, since fluoridation ceased in Anglesey, tooth decay among young children there has risen by 168%. They suggest that fluoridation would save NHS Wales £50 million a year, or 65% of the cost of primary dental services. The NHS Confederation suggest that this is a public health issue which would merit the early attention of the National Assembly. While we fully accept that fluoridation reduces dental caries, we hope that the National Assembly will ensure that all the health implications are fully researched before any decision is made to add fluoride to Welsh water.

Clinical negligence

16. The NHS Confederation drew attention to the rising cost to NHS Wales of medical negligence claims. These cost around £10 million in 1998-99, and are projected to rise to £13-15 million in 1999-2000.[35] While the cost of actual claims is rising at around £3 to £5 million a year, the forecast cost of claims is rising considerably faster. The Comptroller and Auditor General reports that the total forecast cost to the NHS in Wales of known clinical negligence claims amounts to almost £145 million.[36] The Director of the Welsh Office Health Department assured us that £145 million was a "worst case" figure, and that the rise in contingent liabilities was a result of better management of the claims process, and earlier identification of potential claims.[37] The Comptroller and Auditor General confirmed that there had been some progress in the reporting of losses, but expressed continuing concern about the accounting for incidents "incurred but not reported". And, while he reported "significant progress" in the effective management of risk by NHS trusts, he noted that none of the Welsh health authorities had completed the Risk Management Standard assessment in 1997-98. He suggested that the assessment of risk should be subjected to external audit.

17. When a negligence claim is agreed, it is settled in full by the health authority or trust involved, which is then reimbursed by the Welsh Risk Pool — to which all health authorities and trusts belong — for any amounts in excess of £30,000. The NHS Confederation felt that the Welsh Risk Pool was "a very effective organisation".[38] We note that on the abolition of the Welsh Health Common Services Authority on 31 March 1999, management of the Welsh Risk Pool passed to the Conwy and Denbighshire NHS Trust. We also note with approval that the premiums which trusts pay will be geared to their performance against risk management standards, providing a clear incentive to improve performance.[39]

18. The rising cost of clinical negligence claims is clearly a matter of public concern. Though media reports of a "ticking timebomb" may well be exaggerated, we would urge the National Assembly to monitor the situation closely. We understand that the Committee of Public Accounts may consider the cost of medical negligence claims in its scrutiny of the NHS Summarised Accounts for England. We note also that the Health Committee is inquiring into the procedures related to adverse clinical incidents and outcomes in medical care. We await those Committees' conclusions with interest.

Talygarn Rehabilitation Centre

19. We received several representations, including from Members of Parliament, about the proposed closure of the Talygarn Rehabilitation Centre in Pontyclun. The Centre used to provide a specialist rehabilitation service for miners from the whole of South Wales, but Health Authorities have gradually developed alternative local services, leaving Talygarn underutilised. It is now used only by patients from the Bro Taf Health Authority area, and of these former miners are only a very small proportion. The Bro Taf Health Authority, and the Pontypridd and Rhondda NHS Trust (until 31 March 1999, the East Glamorgan NHS Trust), which runs the Centre, propose to close Talygarn and to transfer services to the new Royal Glamorgan Hospital, which opens in Llantrisant in November 1999.[40] The Trust's Chairman (who is Chairman of the NHS Confederation in Wales) told us that Talygarn's Grade II listed building had a maintenance backlog of some £1 million, and that the Centre's closure would save some £158,000 a year, which could be redirected to patient care elsewhere.[41] The Talygarn Forum, which is campaigning for the retention of the Centre, argues that the case for closure has not been made. In particular, it maintains that there is a significant group of people whose need for intensive and supervised rehabilitation will not be met at the Royal Glamorgan Hospital or in the community.[42]

20. The proposed closure was referred to the Secretary of State for decision in December 1998. Understandably, the Secretary of State was not willing to say very much about the case in advance of announcing a decision, except that it involved a number of complex legal and health issues.[43] The decision will now be for the National Assembly. We call on the National Assembly swiftly to reach a decision on Talygarn's future: continuing uncertainty is in nobody's interest.

Conclusion

21. From 1 July, the National Assembly of Wales will have responsibility for the management and funding of the NHS in Wales. This is a great opportunity to re-examine priorities and to mould the service to Welsh needs. However, we recognise that what the National Assembly can achieve in this area will be heavily constrained by the funding available. We pass on to the Health and Social Services Committee of the National Assembly responsibility for scrutiny of health policy in Wales and would ask them to consider carefully the matters raised in this Report. While it will not be for us to second-guess the decisions of the National Assembly, it is inevitable that health issues, which are of such importance to our constituents, will impact on our future work, and we shall follow the development of health policy with great interest.

24 Evidence, p 54, paragraph 10. Back

25 Evidence, p 44; Qq 34-38. Back

26 Q 36. Back

27 Qq 143-154. Back

28 Evidence, p 46; Q 37. Back

29 Q 37. Back

30 Q 152. Back

31 Evidence, pp 74-75. The Resettlement Task Force comprises representatives of SCOVO, Mencap in Wales, the All Wales Parents and Carers Forum, advocates and advocacy organisations, and First Choice Housing Association. Back

32 Q 179. Back

33 Q 180. Back

34 Evidence, p 44; Qq 66-75. Back

35 Evidence, p 46. Back