Published: 03/04/2003, Volume II3, No. 5849 Page 12 13
The process of establishing health boards in Wales faced tough opposition - and there are still doubts over the quality of the new order of chief executives. Clive Betts reports
The NHS in Wales was this week due to undergo its 11th reorganisation since 1976.
It should have been simple, with few risks involved. After all, the boundaries to be used to deliver services have been in existence for several years. And it should surely be an easy task to shunt the bosses from the old system into the equivalent slots in the new local health boards.
But members of the Welsh Assembly were told last week that the health service is£4m a year short of achieving the costneutral status promised by health minister Jane Hutt for the replacement of health authorities with health boards throughout the country. And fears have been expressed that the quality of senior management in the new boards may not be up to the job.
Ms Hutt told the Assembly that she had made 'huge strides' towards keeping the budget to the original estimate of£71.3m, but NHS director for Wales Ann Lloyd admitted to the Assembly's audit committee last week that there was still a gap of£4.15m.
This is an improvement on the estimated£8.5m black hole identified by auditor general for Wales Sir John Bourn last year.
Under the restructuring, each of the health boards will match the area of one of Wales's 22 county and county borough councils. Local councillors will sit beside senior medical staff to build up what they hope will develop into a 'seamless' service.
Yet the passage of the reform through the committees of the Assembly has been far from smooth. At times it has seemed that Ms Hutt's sole friends have been the whipped members of her own Labour Party, plus the Liberal Democrats locked into a coalition administration.
Just before Christmas, Plaid Cymru, the main opposition party, issued a formal call for the whole reorganisation to be put back a year because of 'problems with recruiting finance directors'.
Plaid's plea for delay might sound like pure politics - had not Royal College of Nursing Wales board secretary Liz Hewett added her worries.
Ms Hewett wondered whether the boards were 'fit for purpose' and said her own board had 'concerns that local health boards may not be able to deliver effectively for patients'.
The LHB chief executive was appointed only in January. And doubts have been expressed about how well this crucial level of management will perform.
One former trust chief executive disparagingly characterises post holders as 'middle management', pointing out that the job of general manager of a local health group, from where many managers have been recruited, is fundamentally different to that of chief executive of a board: 'The groups were merely sub-committees of the five regional HAs.
The job of their general managers was merely to do what they were told by the authorities.
The new boards will be different creatures, and the chief executives will make their own decisions.'
Powys board chair Chris Mann 'agrees absolutely' that the fitness of the chief executives for the post was one of the most critical questions underlying the reform.
He says: 'These people are changing from being general managers giving effect to other people's decisions to taking a key role in shaping those decisions.'
The Assembly, he says, had been acutely aware of the difference. 'It was very influential in ensuring that we were looking for people who were of the right calibre.'
Mr Mann wonders how many managers failed to make the grade: 'Some managers would have decided to retire, but there might be others who thought they were above the line, but did not make it.'
Seven chief executives of the new boards were previously with the much larger trusts, and three with HAs.
Some observers in Wales ask whether the best people tried for the jobs.
Professor Siobhan McClelland, head of research at the Centre for Health Leadership Wales, says: 'They had terrible difficulty in appointing. Perhaps people asked how long these jobs will exist for.'
Ever since the local authorities were set up in 1996, the small size ofmost has been questioned, with the future ofMerthyr (56,000 population) and Blaenau Gwent (71,000), most often raised, with reform possible after 2010.
Although little is made publicly of the fact, the boards will be closely watched by the three new Wales NHS regional directors.
Derek Griffin, former chief executive ofWrexham county borough council, Stuart Sharples, chief executive of the Institute of Healthcare Management, and Robert Hudson, chief executive of Gwent HA, hold the important task of 'holding to account' the local bodies.
Bob Broughton, Welsh secretary of the British Medical Association, admits to being 'worried about the calibre' of people appointed: 'I am hopeful but not overly optimistic about the changes.'
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