My View on the Welsh Budget

First, the budget needs to be looked at in the context of the Westminster Government cuts that are being imposed on the Welsh block grant. The budget in 2015-16 is nearly 10% lower overall, in real terms, compared to 2010-11, which equates to over £1.5 billion removed from the Welsh public purse, or, more importantly, removed from Welsh public services. The long period of sustained reduction has had an impact on all services, even those that have been relatively protected. The fear is that, in future years, if the coalition continues in Westminster, things will only get worse.

 

The amount available for capital investment will be 30% lower than it was at its peak in 2009-10. I listened to speeches earlier from both Peter Black and Nick Ramsay, when they talked about being unhappy with some of the cuts. What they have failed to do is come up with a balanced budget that replaced those cuts with others. I think that the people who wish to amend the budget need to come along with suggestions—if you add £200 million here, you have to take £200 million off somewhere else.

On the budget strategy, the budget increases health expenditure by £226 million, which equates to a real terms increase of £121 million or 1.9%. This has been mainly paid for by a reduction in local government of £193 million, which equates to a reduction of £262 million in real terms, or 5.7%. Effectively, this is a movement of resources to hospitals from local government services, such as leisure, environmental health and social services, whose activities are important in ensuring that people stay out of hospitals.

Another £44 million has been added to the pupil deprivation grant, which I know has been welcomed by most of the schools in my constituency, because my constituency has one of the highest numbers in Wales of pupils receiving free school meals. However, after two years of the pupil deprivation grant, a resulting improvement in the key stage 1 results of children receiving free school meals should have occurred. I look forward to seeing these results show that the expenditure has had beneficial results in terms of educational attainment. After four years, we should be seeing improvement in key stage 2 results and, after five years, in GCSE results for free school meal pupils. This is one of the easiest expenditure headings to identify success or failure in.

I now turn to the increase in health expenditure, which has been welcomed across Wales, including by many in my constituency. In the 10 steps towards a future NHS Wales discussion paper by Tony Beddow, Julian Tudor Hart, Wayne Richard and John Richards, recommendation 5 is to stop doing all work categorised by the National Institute for Health and Care Excellence as ineffective or harmful.

Nick Ramsay

Mike, you have just welcomed the injection of cash into the health service. Do you therefore regret supporting a Government that, over the last four years, has taken more money than that cash injection out of the health service? That is your Government; you supported it.

 

Mike Hedges

If you listen to what I have to say in the next few minutes, I am going to explain why health needs to be run efficiently. I have serious concerns about some of the work being done in health. If you had listened to what I just said, it should stop doing all work categorised by NICE as ineffective or harmful. I can think of no other public service outside health where such a recommendation could exist. I cannot imagine having in education a recommendation that we should stop teaching people in a way that means they do not learn or we take knowledge out of them. Surely the Welsh Government should tell health boards to stop funding such work. How much of the health budget is being spent on such work? To quote remarks made by Mark Drakeford in January 2014, roughly 20% of customary medical activity is either ineffective or harmful to health, based on US research.

 

The report I mentioned earlier also crushes some health myths. Facts cited in the research report show that the average time in hospital before death does not increase with age and admission rates fall after the age 85. That is from the BMJ, which is an organisation that has been quoted in the Chamber several times in the past. After reviewing major trials, the Cochrane Centre for meta analysis concluded in 2012 that treatment for the borderline range of blood pressure is more likely to harm people than help them, except for those with diabetes. However, GPs are still being encouraged to treat this group as part of their quality and outcomes framework.

I also share the concerns about polypharmacy and the detrimental effect on health it can have. Rather than charging for prescriptions, perhaps you should be looking for a reduction in the number of prescriptions, especially those whose interaction with others can make health worse. So, yes, more money for health is good, but it needs to be money that works. Every time somebody goes to see a doctor, they do not have to walk out with a prescription and they do not have to walk out with a doctor’s paper: they can actually be given advice on how to improve their health, and that might well be a better way of making progress than doing what we are doing at the moment.

On a major point, we cannot continue to increase the proportion of the Assembly’s expenditure on health, or sometime in the next Assembly, health will hit 50% of total Welsh expenditure. If we keep on going like this, in the middle of this century, it will hit 100%, and, towards the end of it, it will be over 100%, but I am not quite sure how you spend more than 100% of your budget.

5 easy ways to Improviethe lives of older peole

Public toilets

Public toilets play a vital role in ensuring that visits are accessible to people of all ages. They can be a lifeline for older people, providing them with freedom, independence and the confidence they need to lead fulfilling and active lives. Adequate public toilet provision but more importantly not just the number but their location is vital to enable older people to maintain their dignity and participate in community life.

 

The Welsh Government funded Community Toilet Grant Scheme launched in 2008 provides local authorities with grant funding to encourage local businesses to open their facilities to the public.

I believe that the Scheme, together with the provision of toilet facilities for public use within all public buildings, must be better publicised and promoted.

There must be clear and visible branding and signage (eg notices in windows of premises taking part in the Scheme), if they are to form a solution to toilet provision alongside public toilets provided by the local authority.

I welcome proposals in the Welsh Government’s Public Health Bill to strengthen the role of public authorities in planning for the provision of and access to toilets for public use, to meet the needs of their communities.

 

 

Voluntary meeting places

I believe that local authorities have a vital role in supporting community facilities and activities through working in partnership with voluntary and community groups, and exploring the co-design and delivery of such services. Such facilities could also promote intergenerational activities.

 

Older people have said that local authorities could do more to support and facilitate informal interest groups and clubs, and have suggested that public buildings such as community centres and libraries could be used more than they are now.

An example of a good practice initiative to improve the quality of life for older people is Age Cymru Gwynedd a Môn’s Age Well centres, where six dedicated centres have opened throughout Gwynedd and Anglesey utilising funding from the Big Lottery, Gwynedd County Council and Lifelong Health and Wellbeing funding in partnership with Bangor University. The benefit of these centres, which are hubs for the community, is to introduce people back into their local communities and help older people to overcome isolation and loneliness.

 

The Age Well work has had a major impact on the lives of individuals that have attended either in a cognitive, physical or spiritual sense.

Research has shown that participants at the Age Well Centre in Nefyn gained positive benefits over a 12 month period, and reported that it is possible for over 50s to make meaningful changes in lifestyle that can help to improve health and wellbeing, given suitable community resources and a small amount of  support. 

Participants showed improvements in aspects of mental fitness, physical health and physical fitness. The Age Well Centre model is inclusive and is based around social engagement, with a choice of activities based on members’ preferences and interests. It is an ideal vehicle for improving health and well-being, and draws people in to a community which offers support to maintain positive changes.

 

Nutrition in care settings

In recent years the public health agenda has focused resources on tackling the obesity crisis with much less attention being paid to malnutrition. This is despite the economic burden of malnutrition in the UK being estimated to be around £7.3 billion a year - equivalent to obesity. Over half of these costs are being expended on people over the age of 65.

It is important to stress that whilst work has been done to try to tackle malnutrition and dehydration in hospitals, unfortunately it still remains a problem in some wards.

 

The recent ‘Trusted to care’ report, an independent review of the quality of care for older people at the Princess of Wales hospital in Bridgend and Neath Port Talbot Hospital, identified some very specific areas where there were failings in the care of older patients. These included failures in ensuring patients are kept hydrated. The report issued a number of recommendations for Welsh Government including to commission a strategic campaign to increase public and professional understanding that regular hydration and feeding are as important as hand-cleaning for older people in hospitals. Therefore further work is required in hospitals as well as care homes to improve nutrition and hydration.

 

Hydration standards are particularly welcomed as we often hear anecdotally in care homes (and in hospitals) that people do not have constant access to fluids, often if you miss the ‘tea trolley run’, you may not be offered a drink for hours.

 

A balanced diet is also clearly important for good health, but we note standards must be careful to avoid restricting individual preferences and right to choice over foods. People with dementia often experience a change in their taste preferences and flexibility must be incorporated to allow for this.

No Cold Calling Zones

I am calling on the Welsh Government and local authorities in Wales to examine the case for drastically increasing the scope and the scale of No Cold Calling Zones to protect older people from rogue traders and high pressure salespeople on their doorsteps.

I would like to see cold calling zones extended to cover all of Wales, preferably with an exemption for political candidates.

 

I have seen how well they have been received in my own constituency including the relatively new one at Clasemont Park.

 

Research among 1000 individuals across the demographic groups showed 86% of all respondents were in favour. This number rose to 93% among older people.

 

The zones currently in existence are not legally enforceable. Traders who cold call in these zones are not committing an offence. An offence is only committed if a cold caller persists in trying to sell goods or services after they have been asked to leave - this is regarded as harassment. I believe we need a change in the law which would give the zones legal enforceability so that flouting them is potentially a criminal offence. Just making it easier to set them up and to extend them would generate peace of mind for many.

 

Low Cost adaptations

Substantial progress has been made on this since I first started promoting it in the 1990s but again more needs to be done, more handrails especially in gardens and replacing lino with carpet to reduce slip hazards would improve lives rather than expensive DFG when many elderly people want neither the disruption or mess of large scale work  or dealing with the result of the slip with long term hospitalization.

 

 

In conclusion

These are five relatively cheap ways of improving the lives and the health of elderly people, not as headline grabbing as spending hundreds of millions of pounds extra on dealing with the consequences of not carrying out what I have described.