Anticipating the assembly

Ron Davies' adventures on Clapham Common added spice to the NHS Confederation in Wales' annual conference in Cardiff last week.

Like the national media, managers wanted to know who would emerge as Labour's candidate for first secretary of the Welsh assembly. But they also wanted answers to more mundane questions. Where will members of the assembly, to be elected in six months' time, come from? What impact will the new body have on the health service?

Welsh Office permanent secretary Rachel Lomax prompted a ripple of laughter when she told delegates: 'I am too old a hand to predict next year's political dogfights. Sometimes I cannot predict next week's.

'But resource allocation will be at the centre of the debate in the Welsh assembly and the NHS will be at the centre of the debate about resource allocation (because) health will take up one third of its budget.'

The assembly will not be able to raise taxes or pass primary legislation, but will be able to influence crucial policy details by passing secondary legislation.

It will be led by a first secretary and an executive committee with eight committee secretaries, handling different portfolios.

In addition to the eight subject committees, expected to include a committee for health, there will be regional committees.

Ms Lomax said the committees could be 'the most distinctive feature' of the system.

'I think the health committee will start probing the reasons for the differences in spending between England and Wales,' she said.

'Some of the differences will depend on health need, but some depend on differences in structure and costs.'

Ms Lomax argued that the assembly would also want to focus on health service performance and wider issues affecting the health of people in Wales. And she was 'cautiously optimistic' that 'a brand new, elected body, close to the people it represents' could 'make a real difference day to day'.

Conference delegates were just as convinced that the assembly would have an impact but, perhaps, less optimistic that it would be a positive one.

Peter Stansbie, chief executive of Dyfed Powys health authority, voiced a common concern. 'There are going to be some difficult decisions,' he said. 'How do we influence a Welsh assembly, with 60 members, often parochially based, to get those tough decisions made?'

Ms Lomax argued that managers could play a key role, a point later picked by NHS Confederation chief executive Stephen Thornton.

'Some might say these individuals will be naive and inexperienced. I prefer to think of them as ready to learn and anxious to make their mark,' he said. 'We need to be ready as a health service and an organisation to make an impact.'

But in a discussion session on 'the national assembly, for better or worse', Dai Lloyd, prospective Plaid Cymru candidate for Swansea West, had little time for this attitude. 'Whatever you think of the people of Wales or the assembly is irrelevant. It is going to happen,' he said.

'We have a£2.5bn budget for health and we cannot alter it, we can only fiddle with it,' he went on. 'Our policy is basically streamlining management costs. We would back a modified health authority model with no trusts or local health groups.'

Kirsty Williams, the Liberal Democrat's prospective candidate in Brecon and Radnorshire, tried to dispel doubts through enthusiasm.

'I do not claim to have any great experience in the area of health,' she said. 'But we want to listen as well as talk.

'We are aware that we drink too much in Wales and we do not eat the right sort of food and do not take enough exercise. And our industrial past means that problems are seen in GP surgeries up and down the country. The great thing about the assembly is that we will be able to take these problems and tackle them.'

But she added: 'We would want to see health and social services working together, perhaps sharing things like payroll so more money can go straight into patient care, which is what people want.'

In response, Cath Edwards, a non-executive director of Ceredigion and Mid Wales trust, wanted to know what the panel thought of 'the people in this room' and 'our work over the past five to seven years'.

There was a long silence, eventually broken by Mr Lloyd.

'A lot of jobs in trusts and HAs have the words poison and chalice attached to them,' he said.

'And given that there is not enough money available and given the constraints of things like trusts, which were a mistake, I think many people have done a remarkable job.'

His charity was not shared by Labour's Gareth Thomas, MP for Clwyd West. In a spirit of 'constructive criticism' he told his audience he had been 'surprised' by figures showing how treatment costs varied across Wales and urged them to 'get a grip' on the anomalies to ensure 'best value for money'.

Another audience member pointed out that this would require good managers, when 'managers seem to be coming under attack from every side'.

Ms Williams had some advice to offer. 'You need to get out and tell people what managers do because all they know about managers is that they annoy Charlie on Casualty.'

Mr Lloyd had a view as well. 'Yes, people do not like managers but that is partly because there are too many of them,' he said.