Vaughan Gething: ‘You can go to A&E and be there five hours but have a good experience’
|
Version 0 of 1. Vaughan Gething is feeling bullish. The Welsh health secretary has reason to believe things are looking up for NHS Wales – until now, Labour’s stewardship of the service has been a useful foil for the Westminster government to deflect criticism of its handling of the English health and care system. Although Wales continues to suffer unfavourable comparison with England on many hospital waiting times – Theresa May resorted to the tactic yet again in the Commons recently, when under fire over social care – the gap in overall performance is closing and the Welsh system may be inching ahead in key areas, including ambulance response. “I don’t expect [English health secretary] Jeremy Hunt will say, ‘I got it wrong about Wales and I’m sorry’,” says Gething. “I don’t expect a sudden outbreak of honesty, rationality and reasonableness when it comes to describing what we are doing in Wales. I expect we will continue to get attacks from Conservatives, and other opponents, saying everything is awful in Wales. And that’s difficult, not so much for us politicians, but for the staff.” Gething, a 43-year-old lawyer little known outside Wales, is steadily building a reputation at home for driving performance improvement and system reform. Last monthIn February, in his boldest step yet, he made a permanent change to ambulance response times that has abolished targets for all calls except those reporting life-threatening illness or injury, aiming to ensure they get priority. Set a target of responding to 65% of these “red” calls within eight minutes, the Welsh ambulance service did so continually under the 17-month pilot and hit 75% or higher in each of the nine months to February this year. Average response time was less than five minutes, enabling Gething to claim the best ambulance performance in the UK. The approach has attracted international attention and an evaluation by researchers at Sheffield University found “clear and universal acknowledgement … that moving to the new model was appropriate and the right thing to do”. This success has given licence to Gething to think equally radically about hospital waiting-time targets, which he wants to turn from blunt instruments into measures and incentives that are more sensitive to outcomes for patients. Taking the four-hour target for assessment in A&E as an example, he says: “You can go to A&E and be there five hours but have high-quality care and a good experience. You can be through and home again in two hours and have a really awful experience.” This has echoes of what Hunt seemed to be arguing in January, although he appears to have recanted since last week’s budget announcements of an extra £2.5bn for the health and care system in England. Gething knows he will be accused of moving the goalposts. In January, the Welsh NHS performance on the four-hour wait slipped to 79% – the target for Wales and England is 95% – although the English system was also down at 85%. But Gething has pointed out that overall waiting times in Wales fell 20% between 2015 and 2016, and he can point to an improving record on delayed transfers of patients from hospital – numbers have dropped by a fifth since last November – while the trend in England has been going the other way. The Welsh government attributes this to its protection of social-care funding, slashed in England, and an overall level of spending on health and care, 6% higher than on the other side of Offa’s Dyke. But Gething is demanding change in return for continued investment, telling last month’s annual conference of the Welsh NHS Confederation: “Reform is an essential part of the future. If we do not reform, we will not deliver the change and improvement that is needed.” He is insisting on progress over the next 12-18 months in key areas – in particular, the organisation of elective or planned hospital treatments, out-patients and certain specialties, such as eye care. The guiding principle is so-called prudent healthcare, interpreted in Wales as a requirement for care professionals to “only do what you can do” or, conversely, and more pertinently, not to do anything that does not need their level of expertise. Although a parliamentary review of health and care in Wales is due to report later this year, Gething says reform cannot wait. “Our budget settlement becomes more difficult over the next couple of years so, if we don’t make these changes now, it will become progressively more challenging to do so.” Gething, one of just two non-white members of the 60-strong Welsh Assembly, was elected in 2011 and became secretary for health, wellbeing and sport last year after serving two years as deputy minister. Born in Zambia to a Welsh father, a vet, and Zambian mother, he came to the UK as a boy and grew up in Dorset, but has been immersed in Welsh Labour politics and trade unionism since university days in Aberystwyth. As a former president of the Welsh TUC, he enjoys strong support from the unions that, some think, will one day help him claim the Labour leadership in Wales. But does it work to his advantage or disadvantage in achieving change in the NHS? “It means I get some direct honesty,” Gething says. “When they say, ‘Are you really going to be able to do this, while making sure it’s all still publicly funded and publicly accountable?’, it allows me to look them in the eye and say yes.” CV Age: 43 Lives: Penarth Family: Married, one son Education: Beaminster comprehensive school, Dorset; Aberystwyth University; and Cardiff Law School (LLB law) Career: 2011-present: Welsh assembly member, Cardiff South and Penarth (2016-present: cabinet secretary for health, wellbeing and sport; 2014-16: deputy minister for health, 2013-14: deputy minister for tackling poverty); 2001-2011: employment lawyer, Thompsons (partner 2007-2011); 1999-2001: researcher for Welsh assembly members Public life: 2008: president, Wales TUC; 2004-08: Cardiff city councillor Interests: Tudor and Stuart history; watching sport; “largely retired” cricketer |