Mr Andrew Scotson
Rheolwr Cefnogi Corfforaeth/Corporate Support Manager

Llinell Union/Direct Line                                (01978) 72 5130
Estyniad/Extension                                                         5130
Ffacs/Fax                                                      (01978) 310 326
E-bost/E-mail              andrew.scotson@new-tr.wales.nhs.uk

Dear Sir

Re: Consultation - The Powers of the National Assembly for Wales

I am pleased to forward for your consideration the response of the North East Wales NHS Trust to the Consultation on the Powers of the National Assembly for Wales. As an NHS Trust we do not believe we are appropriately placed to pass formal comment on matters that do not directly relate to our function. However we are keen to offer a number of views on the impact and function of the Assembly as it affects our ability to provide healthcare services.

In what practical ways do the powers of the Assembly...?

There can be no doubt that the Assembly has a very direct impact on the workings of the National Health Service in Wales. We also note the NHS accounts for a significant proportion of the Assembly's expenditure. As a consequence the relationship between the Service and the Assembly has a crucial influence on the services that we are able to provide to our local communities.

The freedom of the Assembly to prioritise spending, both between public services and within services offers the potential to maximise sensitivity to local needs. We recognise that there have been instances, such as in the creation of the Children's Commissioner position, where the Assembly's ability to initiate new developments has been beneficial. However this same flexibility can also undermine longer term planning and can result in short-term centrally driven priorities overwhelming genuine local issues.

However the greatest issues for the North East Wales NHS Trust arise not from the direct actions of the Assembly but from the confusion of having two separate NHS systems working in close proximity.

This has a significant impact, particularly on those organisation close to the English / Welsh border. Within an NHS context the disparity between resourcing and performance targets has created a two tier NHS that offers differing levels of service depending on a patient's place of residence, the location of their GP and the location of the hospital to which they are referred. At best this leads to confusion, at worst a sense of intense frustration and comparative deprivation for service users and staff and the potential to undermine the financial stability of the North East Wales NHS Trust.

This conflict cannot be ignored because north Wales sits as part of a larger health economy area which of necessity extends into the North West of England. The need to link with health services in this area has already been recognised by the Assembly in the context of clinical networks, while existing referral patterns around the English / Welsh border and the need to access specialist tertiary services mean that the NHS in Wales cannot be viewed independently from the rest of the Service.

How effective has the Assembly been in influencing UK government...?

Within an NHS context we do not believe that the Assembly has exerted any influence within Westminster. We would also contend that Welsh MPs have been left in a position where they cannot influence the development of healthcare policy that affects their constituents. This might not be such a significant factor were it not for the fact that our experience is that the public still tend to turn to their MP, rather than their AM, to raise matters relating to healthcare.

What would be gained or lost if there was a clearer separation...?

The First Minister has recently expressed enthusiasm for increasing policy divergence between Wales and England and we have very strong concerns about this within a health context. As noted previously, the separation between England and Wales significantly disrupts the operation of organisations that serve populations on both sides of the border. Differential targets and an imbalance in investment are disrupting efficient working and undermining cross-border co-operation to the detriment of the population that we seek to serve.

There would be benefit in measures to make clearer to the public the separation that exists between the two nations as this might help to manage their expectations and increase understanding of the differences that are being introduced between the neighbouring health services.

Funding streams

As noted previously the freedom of the Assembly to redirect funding streams can lead to local priorities being marginalised. The creation of the Assembly appears to have further accentuated a North/South divide within Wales. With the functions of the Assembly based almost exclusively in South Wales there is a growing frustration that events are driven largely by the needs of the M4 corridor. This is most evident with the diversion of NHS funding from the north to address the significant waiting list problems of the south: the perception is that those organisations that have done most to meet the targets set for them are being penalised to bale out the less efficient.

I trust that these comments are of assistance.

Yours faithfully

Andy Scotson

Corporate Support Manager