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Last Updated: Tuesday, 12 April, 2005, 05:59 GMT 06:59 UK
Welsh NHS remains election issue

By Sian Lloyd
BBC Wales health correspondent

Surgery (generic)
Since the Welsh assembly was set up in 1999, decisions about the NHS have been taken by the assembly government.

Only a few areas, including genetics and fertilisation, are not devolved.

The general election will be fought on a UK manifesto, with parties outlining health policies which could be irrelevant to Wales.

But health is still likely to be a key issue for voters, and whoever wins power in Westminster will need policies which work alongside the assembly.

Total population (2002) - 2,918,700
People on hospital outpatient waiting lists - 219,600
People on hospital inpatient and day case waiting lists - 74,700
Inpatients waiting more than a year - 8,500
Source: Welsh assembly health statistics 2004

Voters are concerned about issues which directly affect them and, when at the ballot box, may not recognise the distinction between matters devolved to Cardiff Bay or decided at Westminster.

The election of a government at Westminster is certainly significant. It is where the budget for the Welsh Assembly Government - currently around 12 billion a year - is set.

Health spending in Wales - 4.9 billion - makes up the largest slice of this budget.

Wales and Westminster

The health strategy of the assembly government has consistently ploughed a different furrow to successive UK secretaries of state.

Department of Health-led reforms concentrating on performance-managed waiting lists targets, star ratings, and foundation hospitals were rejected by the former Welsh Health Minister Jane Hutt in favour of traditional, centrally-dictated policies run by 22 newly created local health boards.

First Minister Rhodri Morgan has chosen to put "clear red water" between the assembly government and New Labour in Westminster.

Around one million people in Wales suffer from chronic (long-term) illness
Most common are back pain (30%), arthritis (25%), respiratory conditions (23%) and heart disease (21%)
Chronic illnesses account for more than 25% of GP consultations in Wales
Estimated that 80% of all prescriptions are required to treat chronic conditions every year
Source: Welsh assembly

His vision is of a "health" rather than a "sickness" service, and encouraging health promotion, has been at the core of the assembly government's policy.

Labour has announced that more than 70m will be invested in health promotion by 2007-08.

There are 62 projects across Wales including one in Ely, Cardiff, where Cardiff and Vale NHS Trust staff run a scheme to help patients at risk of heart disease.

Specialist staff provide advice on lifestyle, smoking, diet and exercise, while participants take part in exercise glasses, gym work, stress management workshops and occupational therapy.

Project coordinator Cath Washbrook said: "Coronary heart disease is one of the biggest problems in the community and obesity is on the increase.

"Health promotion needs to be kept at the top of the agenda to prevent the long-term health issues that come from poor lifestyle."

Waiting Times

Observers have pointed to a change by the assembly government over the past 12 months, with waiting times made a more visible priority.

Marcus Longley, from the Welsh Institute of Health and Social Care, told BBC Radio Wales: "When it came to power... the main emphasis of the assembly government was improving people's health and it almost seemed as though waiting times were a secondary issue.

Patients waiting
Waiting times are a key battleground in the health debate

"We had a number of quite critical reports from the Audit Commission and others, and about 9-12 months ago there was a discernable shift as Jane Hutt, who was then the minister, appeared in public to recognise the fact that you couldn't leave waiting lists on the back burner."

The assembly government's second offer scheme, introduced in April 2004, gives patients with the longest waits the chance of treatment at a hospital elsewhere.

So far it says its provided more than 8,700 operations and the assembly government said the scheme had "made great strides in cutting long waits in Wales".

Figures for the month ending February 2005 showed the number of patients waiting more than 12 months for admission to hospital as an inpatient or day case has fallen from 5,186 to 3,555 (31.5%).
The number of people waiting more than 18 months for a first outpatient appointment fell from 5,485 to 3,381 (38.4%).
People waiting more than 10 months for cardiac surgery fell by 12 to nine.
The number of people waiting more than 18 months for orthopaedic surgery fell by 17 to 15.
Source: Welsh assembly

The new Health Minister, Brian Gibbons, also announced new waiting time targets.

By 2009, the maximum wait for patients from the time they visit the GP to having treatment will be 26 weeks - still higher than the 18-week target set for England by 2008.

In February, the assembly government announced 32m in funding to tackle waiting lists.

But Labour's critics point to the disparity over waiting time figures with England and argue its stance has materially worsened the level of care provision in Wales.

So how would the other parties tackle the problem?

In March, Plaid Cymru published its 12-point action plan to improve waiting times and waiting lists. Its strategy would be to provide 500 additional beds in NHS hospitals and increase the number of intensive care beds by 50.

Health Minister Brian Gibbons
Brian Gibbons took over as Health Minister from Jane Hutt

The Welsh Liberal Democrats have identified cutting waiting lists as a top priority.

The Lib Dems' health plan includes setting up walk-in health centres, which already exist in England, and extending the second offer scheme to patients waiting longer than nine months.

The Conservatives promised to use "spare capacity in English hospitals and the private sector to treat the enormous backlog of waiting patients" and would introduce walk-in centres in urban areas to relieve pressures on A&E departments.