Published: 17/04/2003, Volume II3, No. 5851 Page 14 15
The Welsh Assembly has to do things big to get noticed, and Labour's pledge to bring in free prescriptions - costed at£31m - is certainly that.What else is on offer in the 1 May elections? Clive Betts reports First minister of Wales Rhodri Morgan is perpetually balanced on two horns of a dilemma.
One dates back to 1997 when the Welsh voted to set up a national Assembly. Over 1 million votes were cast, but the majority for 'yes' on a turnout of only 50 per cent was a tiny 7,000, which raised questions of democratic legitimacy.
The second is geographic: Wales' long border with England means that 50 per cent of the population can watch TV programmes from England - and many do - while the two Welsh morning papers are swamped by editions from England. Mr Morgan knows he is slowly winning on legitimacy, but gaining publicity is more difficult - not least when the second election since devolution is nearing.
To be noticed, he and the Assembly have to shout - to introduce policies which grab attention. This year's is free prescriptions for all, restoring a service which vanished 51 years ago when a charge of one shilling was introduced. It will not guarantee Mr Morgan the overall Assembly majority that he lacks by three seats, and he will probably have to continue his coalition with the Liberal Democrats. But it is a headline grabber with which no other party has managed to compete.
Free prescriptions is an idea that has been buzzing around the Assembly for several years, and in fact was rejected twice when health committee chair Kirsty Williams, a Liberal Democrat, put it forward.
As recently as February, Ms Williams proposed a motion for draft subordinate legislation for free prescriptions for 'chronic lifelong conditions', but the issue was kicked into the long grass by health minister Jane Hutt with the establishment of a working party to reconsider the list of medical conditions which currently carry free medication. Ms Hutt, under criticism from her own side, clearly had no inkling of what would appear in the manifesto. Mr Morgan probably did not, either.
Free prescriptions will cost the Assembly£31m a year. It is only one of a number of free services that Assembly members routinely try to get adopted. Labour and the Liberal Democrats want free breakfasts provided in primary schools, the Liberal Democrats want free eye tests and an extension of free long-term personal care, and Plaid Cymru would end charges for home helps.
So persuasive is the services-fornothing culture becoming in Cardiff that Conservative spokesman David Melding had to complain about 'quick and easy manifesto promises', realising that his party was the oddone-out, and reluctantly concede 'a very careful investigation' of the issues.
Some politicians claim that Labour has conceded free prescriptions in a bid to hide the party's failure to deliver on other healthcare pledges. Significantly, that is a problem to which none of the four main parties offers a simple solution.
Last October's Assembly review of NHS capacity, A Question of Balance, concluded that 479 extra acute care beds were needed in Wales - assuming that no reforms were carried out to the health and social service system.
Accordingly, the Liberal Democrats would build 10 more hospitals by 2010, Labour talks of eight hospitals being newly opened or under way, Plaid would bring disused wards back into operation and build some new ones, while the Conservatives want three new centres solely for elective surgery.
But to throw money at the problem, as the parties are suggesting, would be to fail the author of A Question of Balance, Bro Morgannwg trust chief executive Paul Williams.
Mr Williams argues that one reason for daytime bed occupancy at Morriston Hospital in Swansea reaching 117 per cent, with Wales averaging 98 per cent, is the 200 beds each day that are blocked by delayed transfers of care - with local authorities often to blame.
Wales possesses a communitarian political culture which emphasises the role of the public sector. It is easy to whip up prejudice against - or ignore - private and voluntary sector alternatives.
It is notable that Plaid Cymru, although claiming to be a socialist party, has joined the Conservatives and Liberal Democrats in calling for greater use of the voluntary sector, plus payment of higher fees to independent care homes.
The 22 new and strongly criticised local health boards seem safe at last in their roles as ways to ease the pressure on acute hospitals by boosting the primary care sector.
The next stage, say the Liberal Democrats, is to provide more community-based intermediate care facilities.
Health minister Jane Hutt will be engaged in the fight of her political life on 1 May against the Conservative with whom she has so often clashed on the Assembly health committee.
Ms Hutt and David Melding, both highly regarded for their competence, are fighting the marginal Vale of Glamorgan seat, near Cardiff, a constituency that used to be Conservative held.
If Mr Melding, former Carers National Association Wales manager, loses he will almost certainly return via his current South Central regional seat. If Ms Hutt loses, she has little hope as she is seventh on the regional list.