STRATEGY Assembly pledges 'radical and focused approach' to reform

Published: 26/05/2005, Volume II5, No. 5957 Page 14

The health service in Wales is bracing itself for a public backlash after releasing plans for a major rationalisation of services alongside the introduction of new targets.

A 10-year plan released by the Welsh Assembly government aims to develop a 'world-class health service for Wales' by focusing on evidence-based medicine delivered through clinical networks. It outlines a clear commitment to partnership with local government.

The strategy, Designed for Life, is backed by a proposed investment plan that will see capital spending tripled in the next three years, rising to£309m in 2007-2008. Five major projects are already approved or under consideration.

But the strategy also envisages major secondary care rationalisation. It recognises this will create public concern and warns: 'The scale of change required will be challenging. But the prize will be the resolution of many long-standing problems.' First minister Rhodri Morgan last week told the Welsh Assembly: 'We have too many hospitals trying to do the same thing too close to each other. We need rationalisation.' In a separate press briefing, NHS Wales chief executive Ann Lloyd added that the medical royal colleges are also driving change by refusing to back specialist services that are 'too scattered'.

The Welsh regional offices have been asked to produce secondary care plans that propose centralising specialist services. Mid and West Wales are due to deliver theirs by September; South East Wales by December; and North Wales by March 2006.

Ms Lloyd said she expects to release details of closures and changes in three tranches over the next ten months. Mr Morgan last week admitted that there is not sufficient revenue to staff all the new units proposed under the capital spending plan, and he is expecting new hospitals to produce savings.

Designed for Life envisages a review of financial arrangements in Wales and a shake-up of performance management, with a 'sharpened incentives and sanctions scheme' and the introduction of demand management strategies.

It says: 'We will take a much more radical and focused approach to performance management. We will set targets that will be clinically grounded and focus on real benefit.' Over the next year the National Leadership and Innovation Agency for Healthcare will visit every health community to undertake a modernisation assessment. Meanwhile a support team will help improve poor performing organisations.

Mike Ponton, director of the NHS Confederation in Wales, welcomed the strategy: 'World-class health services for Wales by 2015 are achievable, but only if we make the case for change, invest for change and support our NHS in delivering change.'

Key milestones for 2006

Recruit 3,000 extra nurses and 400 doctors.

Access to primary care staff within 24 hours of requesting an appointment.

95 per cent of patients to spend less than four hours in accident and emergency.

80 per cent of GP practices to achieve at least 700 points in the quality and outcomes framework.

15 per cent reduction in delayed transfers compared to 2004-05.

New NHS financial information strategy.

All patients to be seen within 12 months for a first outpatient appointment.