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How Sustainable Is Bevan's NHS?

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+ Peter Lord Restricting access at the National Library Rosemary Butler Why we need more AMs Eurfyl ap Gwilym Taxing powers for Assembly Peter Riddell EU referendum threatens UK Stuart Cole Bypassing the Brynglas tunnels Kevin Morgan Age of the City Region Michael Sullivan Labour’s co-option of nationalism Peter Hain Welsh way for delivering post How Aled Eirug The language’s biggest challenge sustainable Maggie Cullinane Quilting for Africa Deian Hopkin is Bevan’s Remembering the trenches Alice Entwhistle Award winning Rhian Edwards NHS? www.iwa.org.uk | Winter 2013/14 | No. 51 | £4.95 The Institute of Welsh Affairs gratefully acknowledges funding support from the Joseph Rowntree Charitable Trust, the Esmée Fairbairn Foundation and the Waterloo Foundation. The following organisations are corporate members: Public Sector Private Sector Voluntary Sector • Aberystwyth University • ABACA Limited • Aberdare & District Chamber • ACAS Wales • Arden Kitt Associates Ltd of Trade & Commerce • Bangor University • Arriva Trains Wales • Alcohol Concern Cymru • BBC Cymru Wales • Association of Chartered Certified • Business in the Community • Cardiff & Vale College / Coleg Caerdydd Accountants (ACCA) • Cardiff University (CAIRD) a’r Fro • Beaufort Research • Cartrefi Cymru • Cardiff School of Management • BT • Cartrefi Cymunedol Community Housing • Cardiff University • Cassidian UK Ltd Cymru • Cardiff University Library • Castell Howell Foods • Community - the union for life • Centre for Regeneration Excellence Wales • CBI Wales • Crossroads Mid & West Wales (CREW) • Constructing Excellence in Wales • Cynnal Cymru - Sustain Wales • ColegauCymru • Core • Cynon Taf Community Housing Group • Countryside Council for Wales • D S Smith Recycling • Disability Wales • Glandwr Cymru - The Canal & River Trust • Elan Valley Trust • Eisteddfod Genedlaethol Cymru in Wales • Eversheds LLP • Federation of Small Businesses Wales • Grwp Llandrillo Menai • Historix (R) Editions • Friends of the Earth Cymru • Harvard College Library • Iaith Cyf • Gofal • Heritage Lottery Fund • Julian Hodge Bank • Inst of Chartered Accountants • Higher Education Wales • KIGG Ltd in England and Wales • Institute Of Life Sciences, Swansea • Lan Secure - IT • Law Society • Law Commission for England and Wales • LBS Builders Merchants Ltd • Play Wales • Llyfrgell Genedlaethol Cymru • Media Wales Ltd • RenewableUK • Mid & West Wales Fire & Rescue Service • Morgan Cole • Royal College of Nursing Wales • National Assembly for Wales Library • Morgan LaRoche • RSPB Cymru • National Assembly for Wales Library • Native HQ • Sustrans Cymru • National Museum Wales • OCR Cymru • Tenovus • National Theatre Wales • Odgers Berndtson • The Carbon Trust • North Wales Fire Service • Parker Plant Hire Ltd • The Learned Society of Wales • Pembrokeshire Coast National • Parthian • University of South Wales Park Authority • PricewaterhouseCoopers • Urdd Gobaith Cymru • Powys County Council • Principality Building Society • Wales Co-operative Centre • Public Services Ombudsman for Wales • Pullman Rail Ltd • Wales TUC • S4C • Rondo Media • Waterloo Foundation • Sefydliad Gwleidyddiaeth Cymru / Institute • RWE npower renewables • WCVA of Welsh Politics • S A Brain & Co • Wildlife Trusts Wales • Single Body / Living Wales • The CAD Centre (UK) Ltd • WWF Cymru • SSE • The Co-Operative Cymru/Wales • Swansea Metropolitan University • Wales and West Utilities • Swansea University • The Electoral Commission • University of Glamorgan • University of Wales Press • Wales Audit Office • Waste & Resources Action Programme For information on IWA events and publications please visit (WRAP) Cymru • WLGA our website at www.iwa.org.uk or call 029 2066 0820. the welsh How sustainable Editorial Manager: John Osmond Editorial Board: is Bevan’s NHS? Lee Waters, Geraint Talfan Davies, Kirsty Davies, Rhys David, Gerry Holtham, Jessica Blair, Marcus In our interview with Adam Cairns, chief The reality is, however, that whatever Longley, Clare Critchley executive of the Cardiff and Vale Health government is elected at Westminster in Literary Editor: Peter Finch Board on pages 25-27 he says the Welsh 2015, financial pressures on the Welsh NHS Office Manager: NHS can be insulated from the increasingly will be inescapable. Last September a Wales Laura Knight market-driven health service in England. As Audit Office report revealed that if the Design: he puts it, “Although they’re commissioning Welsh Government’s spending allocations [email protected] more and more of their services from the continue unchanged then health spending private sector, at the end of the day the state will rise from 42 per cent to 57 per cent To advertise, tel: 029 2066 0820 still pays the bill.” of its overall budget within a decade. The publisher acknowledges the The problem with this is that the amount In his article on page 20 David Phillips, financial support of the Welsh Books Council. the state will be paying in future is likely an economist with the Institute of Fiscal to fall substantially. There will then be a Studies, sets out in stark terms what this Institute of Welsh Affairs knock on impact on the Welsh block grant would mean for spending on other areas 56 James Street, Cardiff Bay, Cardiff, CF10 5EZ as a result of the way the Barnett formula, such as local government and economic Tel: 029 2066 0820 which determines the amount the Welsh development. The Welsh Government has Email: [email protected] Government receives, is calculated. These changed tack in its budget for 2014-15 and www.iwa.org.uk implications were made transparently clear is planning to increase real-term spending The IWA is a non-aligned independent think-tank and research institute. in a speech Prime Minister David Cameron on health and social services by 1.3 per Members (annual subscription £40) gave to the Lord Mayor of London’s banquet cent. But that means spending on local receive agenda three times a year, can purchase reports at a 25 per cent in November. He said his government was government will fall by 9.1 per cent and reduction, and receive discounts when sticking with the task of bringing down the education by 11.5 per cent. If this were attending IWA events. deficit, and then added, “But that doesn’t just to continue for a decade then the Welsh mean making difficult decisions on public Government’s budget would be distorted Branches spending. It also means something more beyond recognition. North Wales Secretariat profound. It means building a leaner, more In their interviews with us both Adam c/o Huw Lewis efficient state. We need to do more with less. Cairns and Mark Drakeford acknowledge this 6 Maes yr Haul, Mold, Flintshire CH7 1NS Not just now, but permanently”. reality. Drakeford has some interesting ideas Tel: 01352 758311 This is a significant change of emphasis about how health and social services could be that will have major consequences for redesigned to deliver services more cheaply Gwent Secretariat c/o Rob Southall Wales. When he became Prime Minister and efficiently. Tackling the 20 per cent or University of Wales, Newport, three years ago David Cameron said he so of medical interventions which he says Caerleon Campus hadn’t come into politics to make cuts. They have little or no benefit is one. Recalibrating PO Box 179, Newport NP18 3YG were being forced on him by circumstances. waiting lists so that a points system is deployed Tel: 01633 432005 Now, however, he is talking about a to prioritise patients is another. Adam Cairns West Wales Secretariat permanent project of building a smaller is thinking about alternatives to the way the c/o Margaret Davies state. Certainly, that is what Welsh Health market is used in England to produce health Principal’s Office, Trinity University College, Minister Mark Drakeford believes. As he efficiencies and drive down costs, suggesting Carmarthen SA31 3EP tells us on page 25, if David Cameron wins more transparency and reporting of results – Tel: 01267 237971 the general election in 2015, he will have a competition of naming and shaming Swansea Bay Secretariat another five years to pursue a smaller state, between hospitals. c/o Delith Thorpe after which “the NHS in Wales will be a If they are to work such ideas will 38 Southlands Drive, very different organisation to the one it is demand a major culture shift in the way Swansea SA3 5RA today”. That is why he believes the general the Welsh NHS is managed. Some heroic Tel: 01792 404315 election will be decisive in influencing future optimism is required to envisage that IWA Women planning of the Welsh NHS. For, as he says, the necessary savings will be achieved c/o Kirsty Davies if Labour wins, although austerity measures without making the service unrecognisable [email protected] would have to be continued for a while, compared with the one we have today. But Tel: 07900 692898 at least there would be a UK government at least we should welcome the fact that key in power that believed in growing state leaders in the Welsh NHS are facing up to services rather than reducing them. the difficulties they face. the welsh agenda winter 2013/14—issue 51 | 1 Contents Agenda 51 Winter 2013/14 35. Loose ends of 50. Why Labour could First Minister Carwyn Jones pictured alongside Robert J.R. Thomas’s statue of Aneurin Bevan, asymmetrical lose half its income erected in 1987 at the west end of Cardiff’s a Queen Street. Photo: Natasha Hirst constitution building Mark Lang examines the James Mitchell asks how implications of a fundamental the Scottish referendum will shift in the relations between 4. Essay affect Wales the trade unions and the party Clouds of witnesses they created Peter Lord takes issue with the National Library’s new policy of restricting access to its collection 3 9. News Economy 5 10. ClickonWales Education 38. Newport’s blue route 12. Outlook Stuart Cole examines 52. PISA challenge to Dreaming fiction in options for by-passing the Welsh education the Valleys Brynglas tunnels on the M4 Philip Dixon says seeing Welsh –-Peter Stead north of Newport GCSE-drilled youngsters – Jane Aaron performing in Pisa is like –-Daniel G.
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