What are the healthy options?

You have to admire Welsh Lib Dems for gnawing away at the old health bone with such tenacity. But the effectiveness of their shroud-waving on a slow-news Monday tends to fall apart when they describe ‘lost’ ambulance hours at A&E departments as “a totally unacceptable situation and must change” yet fail to propose how and where change should be effected.

The ConDem government at Westminster has specific plans to de-structure the monolithic NHS apparatus in England and is pressing ahead despite widespread concerns from GPs, the British Medical Association and professional health bodies. The government is to publish its Health and Social Care Bill on Wednesday and it will be interesting to see the comments of Welsh Lib Dems or if they have similar radical plans in mind come manifesto time.

Earlier this month, Helen Mary Jones stated that the Welsh ambulance service should be handed back to health boards as it is “essential for people with local knowledge to be in charge of local services”. It’s a long-standing Plaid view one which lacks any real rationale as to how such a move would address significant service variations throughout Wales which originally prompted the merger of ambulance trusts into a single entity.

The localist approach is popular at several levels. Politicians quite often evoke a collective yearning for a health service made up of cottage hospitals run by vaguely middle-class but selfless doctors with nurses in starched uniforms who all live in fear of a redoubtable matron. But the illusions of a corner-shop approach to health-care rapidly come apart in the face of a need to configure dwindling NHS spending in order to tackle the clinical challenges presented just by obesity, alcohol abuse and increasing longevity – without the odd pandemic or winter emergency.

For democratic governments, a public health service can be a blessing and a curse. There is probably no clearer sign of an egalitarian society and yet it is constantly prone to subjective inconsistencies, if only over how differently we react to the victims of disease than we do to those who contribute to their ill-health through life-style choices. There is massive scope for individual and broader political platforms to argue that the cost of treatment should not be the sole criteria of determining whether someone is deserving of care whilst condemning systemic bureaucratic abuses & shortcomings elsewhere.

The task that faces the Mrs Hart and the One Wales Government, should either manage to survive after May, is how to balance the conflicting front-loaded requirements of sustaining an effective health service at the point of contact with the back-office burdens it has set for itself in terms of targets, hybrid ideology and costly commitments to staff unions. The probabilities are that it cannot begin to meet such a formidable challenge – but the same can be said of any other party (or parties) that try to engage the key issues within a single term and deliver improvements into the bargain. Inevitably, one is left with the distinct impression that ConDems identified this particular conundrum some time ago.

Devolution means that Welsh health policy is no longer simply an English solution with a six month time-lag. But the debate which David Cameron has kicked off in challenging the status quo will also have to happen in Wales, sooner or later.