Having passed through the House of Commons last Monday, the Wales Bill is now to be presented, probably for rubber-stamping, to the Lords. This means that the Welsh Assembly is set to get tax powers and potentially another 20 or 40 members.
In 2011, the political class was so convinced of the unpalatability of this to the Welsh public that it closed ranks to strenuously deny that a Yes vote in the referendum on legislative power would lead to it.
That question remains: what will the people of Wales – fresh from giving politicians a bloody nose over Brexit and what they perceived to be the Brussels gravy train – feel about the likelihood of higher taxes and more politicians in Cardiff Bay?
Since I started writing about Welsh politics for Heat Street, two Labour AMs have expressed similar concerns on the real danger to the Assembly as a result of perceived underperformance and failure in delivery.
Welsh Tory leader Andrew RT Davies went further in arguing that the 1997 devolution referendum would be lost if the initial campaign to establish it were to be fought now. I don’t believe we have reached that point yet.
However, it is certainly the case that passive and chronic disinterest could rapidly build to opposition if the people of Wales start to equate the Cardiff Bay political bubble with the sort of disconnect that so many Welsh citizens clearly came to associate with the distant and unaccommodating elite in Brussels.
One point is glaringly clear: the Assembly will never become part of the fabric if it doesn’t improve the general performance of the health service.
NHS Wales has a doctor shortage because Labour cut the budget. #BBCDebate
— Ⓑrother Ⓑob Ⓒrow (@BBCPropaganda) April 16, 2015
When Aneurin Bevan set up the NHS, he wanted it to be a universal service with common standards from John O’Groats to Land’s End. After nearly two decades of devolution, we find that cross-border anomalies compromise NHS cohesion and equality of treatment.
Recruitment failures continue to blight the service. Only last Tuesday, we learned that the number of Welsh students applying to study medicine has fallen by 15%, the steepest decline in the UK.
Severe problems with the NHS in England, Scotland and Northern Ireland shouldn’t be overlooked, but waiting times for treatment and diagnosis are longer in Wales than in England for almost all of the main categories.
The Royal College of Surgeons warned the public that this winter cancelled operations will become the “norm.” Last winter, at least 84,477 operations were postponed.
Dementia diagnosis rates are poor compared with the rest of the UK and it is often difficult to get the necessary support. Mental health problems are estimated to cost the Welsh economy £7.2bn each year, yet waiting times for treatment are far too long.
In January 2015, pressures at Cardiff’s University Hospital of Wales led a senior nurse, who had worked on the front line during the second Iraq war, to pin a heart-rending three-page letter on the noticeboard, outlining how nurses in the Emergency Unit faced higher levels of stress than she had experienced in a war zone.
Far from improving, this year’s figures for January show just 78.5% of cases spending fewer than four hours in major or minor A&E units before being treated, discharged or transferred – a deterioration from 81.4% in December 2015 and 82.4% in January 2015. The target is 95%.
— Gammyleg (@Cymrugas) May 21, 2016
Brexit has shown that the people are watching. They will not look on kindly if politicians casually tax them to pay for their chauffeur driven cars, shiny glass palaces and generous salaries, while seemingly managing the decline of the NHS.
A new Welsh health minister has recently been appointed. Free from the dogged ideological millstone of his predecessor, he would do well to be bold and invoke a new zeal in his approach.
Instead of perpetually immersing itself in tawdry constitutional battles, the Welsh Government should use the minimum two year window before the UK exits the EU to get its house in order and free up its own funds to deliver fundamental NHS reform to create a service fit for the 21st Century.
Can't deal with this much more! If I was in Gloucester I would have had this sorted by now… NHS in Wales are shit!!!!!!!
— Natasha Evans (@tashaLhearne) March 23, 2016
It should begin with a purge of sacred cows.
Free prescriptions, free bus passes, free school meals and free swimming are all longstanding schemes that have sapped the Welsh budget while doing very little to advance lasting systemic change in Welsh communities.
While it is right to protect and help those who need it the most, the universal aspect of the majority of these schemes is not only unaffordable in the long term, but grates with the aspirational in Wales. The lack of social contract with its people is one of the great failures of successive Welsh governments since the advent of devolution 17 years ago.
A reintroduction of means-testing for prescription charges would be a start. Rather than hiding behind old dogma, why not charge those who can afford their own Bonjela, Calpol and paracetemol?
Given rising life expectancy levels in Wales, raising the threshold of the free bus pass eligibility age from 60 to 70 could free up much needed additional capital to reinvest in our dilapidated and under-staffed hospitals.
The issue of any private sector involvement in the Welsh NHS is highly contentious when in reality it should be anything but. Let’s be clear here; we are not talking about Private Finance Initiative schemes or allowing business to profit from sickness, but opening our eyes to the latest health technology and drug research to transform Wales.
— Dr Una Coales (@drunacoales) June 25, 2014
This innovation, this research and development, is only happening in the private sector, in countries like the United States and Germany. We should be embarking on a programme of modernisation and digital transformation to cut bureaucracy and cost, using methods pioneered by companies like Oscar Health in the US, instead of pulling up the drawbridge because they dare to aspire to make a profit. The Welsh Government must abandon the antiquity in favour of solving the problems of 21st century Wales with radical solutions.
Implementing a Digital NHS hasn't happened in Wales, even though software is twice as safe as Doctors.https://t.co/piij0Xbz50
— David Jones (@djcardiff) September 22, 2016
The Welsh Brexit vote underlines the urgent need to invest all effort into delivering tangible improvements in the NHS to the people of Wales. This means resisting the temptation to respond illogically to every question with a demand for more constitutional power.
If disaffected people in Wales continue to observe their politicians grabbing powers and associated extra bonuses for themselves, but failing to deliver the promised devolution dividend to those whose condition the Assembly was meant to improve, the next anti-politics murmurings will be closer to home.