Game on, but will it be any different this time: NHS and 2026 Senedd elections

Rajan Madhok

As could have been predicted, the Reform Party is first out of the blocks with recent pronouncement by Richard Tice, Deputy Leader, about how they would solve the NHS crisis in Wales.

We will come to their policies later but meantime let us note their ambition and effort. The Reform machinery did not stop during the summer break – they have been relentless.

Interestingly, over the border, someone else is focussing on being ‘Relentless’ as Sir Keir Starmer promises relentless delivery through his recent reshuffle. As an aside, Jeff Bezos, the Amazon boss, had wanted to name his then nascent online bookstore “Relentless” and even bought the domain relentless.com, (this still redirects to Amazon).

So, let us get ready for relentless featuring of the NHS as the election fever gets into full swing.

Should we welcome this focus on the NHS, or be worried? Will things really get better, or are we likely to face more chaos, inequalities, and worsening services?

How will we know whom to believe, and more importantly can we, and how can we, make sure that we get the services we need?

Detail

I cannot answer all these questions, yet, mainly because we simply do not have the information. All I have seen is the BBC news where Richard Tice has been quoted as: “The NHS is not short of money. It’s the way that it is being mismanaged, the way that it wastes money.”

“It’s about managing it better. More people on the front line, wonderful nurses and doctors, less people in the back office, creating paperwork and bureaucracy that infuriates nurses and doctors.” And “We will commit to be absolutely determined to drive waiting lists down, improve productivity, improve healthcare for everybody across Wales.”

It will be unfair to comment on the Reform Policy on the NHS based on this news item, and I only wish to note that there is no detail on how these aspirations will be delivered and, in any case, will not all other parties be also working on the same issues?

I think we will be hearing lot more about Waste, Efficiency, Productivity, improving health, bashing the managers and lauding the wonderful nurses and doctors, not to forget the saviour – technology and AI revolution, in the next few months.

Important consideration

My problem with these pronouncements is that they do not tell me anything about what I believe are really important considerations, for example:

One, the NHS is not about waiting lists only, where is the comprehensiveness: what about services for children or the elderly, mental health, dentistry or choked A & E departments, for example, or the hugely important prevention and public health agenda?

Two, we do not just need investment in the NHS; what about education, housing, policing, local authorities and basic standard of living, most of which are being sacrificed on the altar of the NHS which sucks money out of these services. The most glaring example being Social Care, the lack of which is a major factor in creating and maintaining long waiting lists as patients are stuck in hospitals.

Three, will the three founding principles of the NHS: Tax funded, Free at the point of use, and comprehensive still be upheld, with high quality care from cradle to grave?

Four, will there be more structural changes, and what type, when and how? How will the culture be changed from the top – with better policy making, to the front line- basic humane care; it is easier to create the illusion of progress with structural changes and blaming and firing people.

Five, what role will the private sector play in any plans? How to ensure this does not undermine the NHS?

Six, how will they rebuild the trust with the health care workers? The strikes by doctors and nurses, and other groups, are further compromising the already stretched services and impacting on quality and waiting times.

Seven, I do welcome the need to address Waste- but sadly, I have been around too long to believe that it can be done, at least not easily or quickly, or safely. Usually, every change has ended up losing more goodwill and costing more.

I could go on, but that will be a repeat of what I have already written before – see previous articles in NationCymru, and my main point is that we need to use this time well and scrutinise any proposals carefully.

Road map

Frankly, any policy statement which either does not cover the main points including those above, or which does not come with a clear road map to show that all potential implications have been considered and there is a robust delivery plan, will be worrying.

Most importantly, what is needed is a clear vision recognising the current realities of society and the health and care system, and demonstration of new thinking – more of same, even if can be done faster, will not be enough.

It is important to recognise the nature of Wales, and where we need different systems for rural and urban areas, and for emergency and elective services; one size does not fit all. We need to design these accordingly. And there are opportunities to do so: for example, with recent crisis with so many unemployed GPs, and the tensions with physicians associates, why cannot we, in Wales, work with them and develop our community hospitals with extended services.

But it would mean a different approach to general practice and especially training to enable GPs to undertake lot more clinical care than they are doing currently.

To some extent it means re-creating the GPs of old who delivered lot of care locally, not just becoming a referral service, undertook deliveries and routine operations. They can work much more closely with secondary care hospitals and essentially create vertically integrated systems.

The danger I see with current policy making is that the leaders are accepting the way things are done now, and trying to find ways to increase efficiency and productivity within the existing model.

New model

Instead, we need to examine and challenge these constraints, and use imagination and ask Why Not, and create a new model?

There are many other such possibilities and it is important to know the appetite and ability of the policymakers to do the much needed but different things, and engineer the necessary changes.

I recognise the problem for politicians since getting a meaningful dialogue with the public is becoming very difficult, and there are very firmly held views. So, we will need policymakers who can balance today’s urgent demands with design of a future, more fit for purpose, and sustainable system.

Am I hopeful that this can happen- of course, one must always have hope but the history tells us to be very cautious.

Sir John Major went on to win the 1992 election, despite all predictions, at the time, partly because of ‘Jennifer’s ear’ case! And since then, the NHS and waiting lists have featured prominently in all elections, and yet the underlying ideology and plans have remained the same regardless of the party in charge.

We can learn a lot from history, if we choose to. People forget that the plans for the NHS came out of the Churchill’s Coalition Government, and as part of the Beveridge Report. Labour Government and especially Nye Bevan took this to the next stage and delivered the NHS, something not to be under-estimated, and we owe them immense gratitude.

But let’s also not forget that Nye resigned his position from the Labour Government because of the introduction of charges not long after the birth of the NHS.

Do not let the NHS be a party-political issue, clear and well thought through vision rather than sound bites and (unexamined) loyalty is what we should be seeking. It is not about how about bad others are or will be, but how will we know that they are the right choice – that is the question.

Choose wisely.

Rajan Madhok is a retired public health doctor, writing in a personal capacity