Monday, 7 May 2018

Wales 'Future NHS (2) - grow our own staff or depend for ever on other countries?

Wales was officially part of England during the early years of the NHS  and this is reflected in the organisation of the Welsh NHS ,more a regional sub branch than an integrated health service for Wales. Devolution could have produced more control of doctor and nurse training - a system reflecting the geography and needs of the people.  Instead our government took over the administration of health services but not the training and recruitment of doctors and nurses for Wales.
The other UK small nations have been more proactive and better resourced, helped by their political importance and greater historical investment in some of their facilities. As in other things devolution for Wales also devolved the chronic under investment in the Welsh Health Service. No catch up funding.

Scotland {pop. 5.4m}has 5 medical schools. Northern Ireland {pop 1.8m} opens its second medical school next year in Londonderry. Magee College, University of Ulster, already has a well regarded school of nursing and this new medical school will have a postgraduate entry and an annual intake of 120 students. The Republic of Ireland, a nearby EU country with a population of  4.7million, has 6 medical schools, 5 undergraduate (one of which specalises in foriegn students) and one postgraduate.

According to the GMC we only have one medical school in Wales {pop 3.06m,} which presumably means that the small postgraduate medical school at Swansea is listed under "Cardiff" The figures they give is total medical student numbers in Wales 12016/17 are undergraduate 1,521 students and postgraduate 61. the undergraduate courses are generally 6 years long and the postgraduate ones 4 years long. This suggests an annual "production" of  doctors in Wales of around 330 . The GMC breakdown shows ethnicity amongst other things and figures from the National Assembly which funds Welsh Students assembly suggest that the number of Welsh domiciled students entering the local medical schools is around 20% of the total. I've asked for figures of the number of Welsh Students studying in the rest of Britain but they have not been provided.

A legacy of the UK's imperial past is the widespread use of foreign doctors. In the past students were attracted here from the colonies as were young doctors in training.  In the early years of the NHS the idea was that they stayed here a few years then returned with  their knowledge to their own countries but the UK became ever more dependent on these foreign doctors. In more recent times doctors from the EEC have come, attracted in part by the higher salaries doctors enjoy here compared with continental Europe .

In recent years the conversion of nurse training to a university degree qualification and the inadequacy of local nurse training numbers has led to foreign recruitment of nurse on a large scale,. Countries such as the Philipines  encourage their nationals to train as nurses, in large part to work abroad and send money home to their families, boosting the economy of their country. Taking the gift of nurses from the developing world may fill the gap but leaves us open to future shortages if these countries improve their own economies and  health services, so needing their own nurses and being able to provide a good wage, or if political instability or conflict reduces the supply.

I have asked the Welsh Government for the numbers of doctors and nurses we in Wales need annually, No answer. I have been informed though, that only 20% of Cardiff medical students are officially Welsh domiciled. I could not find out how many welsh students are at medical school in the rest of the UK where the Welsh Government and the Welsh NHS will be subsidising them through grants and bursaries.

The UK has for decades relied on foreign staff and acts as if the supply will always be there, Training doctors and nurses is expensive here and restricted to applicants with high academic qualifications. In order to improve the UK supply you may need not only more places on courses but also more doctors and nurses involved in teaching and expansion of the university departments. These UK degree courses are already oversubscribed with lots of intelligent young people turned away every year.  The higher number of women doctors and the predominance of female nurses also means that "in house" creche facilities and  transport from childcare facilities to school and back are needed. Doctors and nurses from the developing world are more likely to leave their families at home.

Wales needs to decide whether to adopt self sufficiency in staffing the NHS or continue to rely on the generosity of the developing world. Some countries have always planned on self sufficiency.

                                                Icelandic medical students in training.

In Iceland, {pop. 380,000} the policy has always been to train their own doctors and nurses. They produce 48 doctors a year from their only medical school in Reykjavik.  Their infant mortality is the lowest in the world, their longevity  figures are impressive (highest life expectancy for men in the world, women's in the top 10} and they train doctors using the Australian model through the medium of Icelandic. There is no private practice although there is a fee system for GP visits.

Other countries have different systems. The irony of the shortage in Wales is that  some of the areas where staff are hardest to retain are the last strongholds of the welsh language. Although welsh speaking nurses are in evidence, welsh speaking doctors are not so much and the Welsh government policies are not helping . The " Gifted and Talented" program in Welsh Schools encourages the academically outstanding to make the most of themselves, go to  Russell Group universities and especially Oxford and Cambridge. The planned new acute hospital between Narberth and St Clears will bring a large influx of staff who are unlikely to be well speaking and because of its geographical isolation will be looking for homes in the area, or possibly not coming at all. The choice of a job is not just about filling a vacancy but about what is best for your partner and family. Cities are ideal as there is more chance of getting a job for your partner, more choice in childcare and education for your children and, especially if you are in training and will need to move on, more chance to find suitable accommodation. 

Most ambitious students may well end up going to "well known"medical schools of which there is a good choice in England if you make the grades. The financial support is the same whether or no you decide to study in /Wales,  in contrast to Scotland where only if you stay in your country to study medicine or nursing (or any other degree except those not offered in Scotland}will your fees be paid.

Many countries with remote rural areas struggle to get doctors to settle there and it may lead to adoption of more high tech diagnostics in the GP type units, efficient extraction of the very sick and injured to specialist hospitals, as happens in the highlands and islands of Scotland, and sometimes long journeys to get specialist operations like hip and knee replacements, as in Sweden, where the expert surgery is done away from home and the rehabilitation provided by the local hub.

What we need in Wales is not isolated organisation of GP and hospital services dictated by local authority boundaries but leadership from our government to shape a future for healthcare in Wales. 



Siân Caiach




Sources:
Student numbers :https://www.gmc-uk.org/-/.../201617-medical-school-annual-return-overall-student-n
www.bbc.co.uk/news/uk-northern-ireland-foyle-west-43595014
www.nursinginpractice.com/article/nurse-training-places-wales-will-increase-10-2018

Thursday, 3 May 2018

Wales' Future NHS - (1) How can the NHS give the best service in Wales?

Wales, unlike Scotland and Northern Ireland, does not have the geographical isolation from England and internal transport connections that assists the other 2 smaller nations in the UK to organise their NHS on a clear geographical basis with a degree of independence. Wales is dependent in some areas on using the English NHS and this anomaly has never been addressed, or even seen as a problem at all. Health is a devolved issue so in supposedly the hands of the Welsh Government.

Welsh Government has kept the NHS within local authority boundaries and reorganisation has provided larger Health Boards but not necessarily better care. In fact, internal asset stripping and pet projects have often seemed to make things worse rather than better.

Lack of internal transport infrastructure means that the North and South of Wales cannot easily integrate NHS services or share resources. For instance there is only one specialist Children's hospital in Wales, in Cardiff, our Capital city.  Transport from the north of Wales to the South is difficult , relatively slow and often expensive and so Sick children in the North of the Country go to Liverpool. People in parts of  Mid Wales also use hospitals in England much easier for them to access than those in Wales.

As I've mentioned, health boards serve geographical models based on conforming to local government boundaries. I live near Llanelli. Our A&E was downgraded some time ago to a minor injury/illness unit. Last year I had a housework accident where I fell off a chair and cut my head open while clearing cobwebs. I didn't have concussion but needed a lift as the cut required pressure on it to stop the bleeding. I went to the local minor injuries unit at our local hospital 5 miles away where a nice GP put a couple of stitches in. A good job. If I had a more serious injury I should go to Carmarthen but in reality would go to the nearer A&E at Morriston, in the neighbouring Health Board, Abertawe Bro Morgannwg..

After various reorganisations Llanelli's District General Hospital, Prince Philip Hospital, has been repeatedly downgraded. Of course, that is not the official description as the publicity for the "Front of House improvements would lead you to believe that this is a ground breaking new way of centralising services in a very positive manner.

The proper Accident and Emergency I should go to if I had suffered a more severe illness or injury is in Carmarthen, some 16 miles away down a road {A484} that does not lend itself to easy or speedy driving. Parking is very restricted and not free, access to some departments often problematical.

 Hywel Dda health board have downgraded Llanelli safe in the knowledge that many local residents will go the nearest A&E with medical emergencies if they can access transport. Abertawe Bro Morgannwg Health board them picks up the tab in Morriston and Hywel Dda saves money. Call an Ambulance in the Hywel Dda Area and you will be taken to your own area acute hospital, irrespective of how far away it is and the proximity of other hospitals "over the border".

Wales has a heavily populated city belt on its South Coast, a less dense population in the valleys to the north of these cities and a vast area populated much more sparsely. Roughly, the population of Wales is 3million people.  Approximately one third  live in the 3 southern cities, a third in the post industrial valleys relatively close to the cities and the rest in a variety of towns, villages and homesteads scattered over the rest of Wales.

One disadvantage of our representative democracy is that many health decisions are dictated by the pressure to be seen to "do something" to improve health care in the 4-5 year election cycle. That has led, over the 70 years of the NHS , to hospitals and facilities being provided and updated for communities based on perceived local needs and internal political and medical  and independent of what  neighbouring areas were doing or planning and although the creation of the National Assembly should have been an opportunity to take stock of what we had and administer  the separate Health Authorities within  a  regional and national context.

 Instead we seem to have mergers  which are administered by new local managements with the risk of acquisition of  funds,staff and departments by those units politically stronger , often because they had the largest hospital in the merged group and have used their majority on Executive boards which tend to reflect  this strength. In Carmarthenshire this has meant till now a major bias towards Carmarthen with more and more facilities crammed on to the site at the West Wales General Hospital there.

The 2 issues which restrict sensible decisions on our hospital services are the management structure and the lack of accountability.

Firstly,Health Board  Management, especially when isolated and also constrained by local authority boundaries, may make poor decisions For example,  Accident and emergency departments are the most expensive, needing 24 hr staffing with full support services, so there is big financial imperative to limit their number. However, without increasing capacity in the lucky surviving A&E unit(s) plus adding more ambulances and paramedics due to the distances now needing to be covered to deliver the patients to the care, the result is usually loss of quality in the service, with long waits and possibly dire consequences for individuals not seen and treated in good time. The only sum they add up is the one related to the "savings" of closing units with no apparent consequences for poorer patient care. The Health Board acts alone, consultations are done after the basic decisions are made at Board level and if a choice is given, it is a choice between options almost everyone will find unacceptable on one level or another.
Prince  Philip Hospital after A&E removal


Accountability is very poor, representation on the "lay"positions in boards meant to represent the public are often poorly representative of the local communities. Few local elected representatives are featured and the public meetings of Health Boards are well choreographed publicity performances which allow little or no meaningful contribution by the public.

 Many other small countries have rural areas with relatively low population density and other areas with high density. The general UK social trend may well be  urbanisation and in low population areas it is hard to provide the quality of  emergency care that most cities do. Putting "University" in the name of all our health boards will not fool junior doctors and young consultants into thinking that academic high quality medicine is equally spread all over Wales and attracting them to fill our jobs.

We do not have enough Academic Medicine in Wales, we don't train enough of our own children as doctors and nurses in Wales{80% of medical students in our medical schools come from outside Wales} and we do not have a plan to improve our services in a way which will address these issues. Such a plan can not be left to the isolated and geographically constrained Health Boards. It needs an all Wales solution. Not only the NHS provision must improve , but also the way our country works.

Siân Caiach,

Wednesday, 18 April 2018

TRANS WOMEN BELONG IN WOMEN'S PLACES - a personal view on Ladies' toilets and other facilities for women. The call to exclude some women because their chromosomes are male is addressing a non existent problem.


I am deeply saddened by the rhetoric of supporters of the “Women’s Place” movement who recently met in Cardiff. Trans women may upset some people because they were born as male infants, but gender, like sexuality is something directed by your brain rather than your physique or chromosomes.

Trans people have always been with us but until the last century were restricted to dressing and acting like the gender they preferred and there are many historical accounts of those who chose to do so, sometimes so successfully that their biological,  natal gender was never revealed or only discovered after their deaths.

Trans people, like gay people, are not mentally ill and the Transgender Pioneer Dr John Randell, a Welsh man, was the first doctor in the UK to provide an NHS service to the trans community. A psychiatrist himself, he realised the "problem"was resolved by helping his patients to live in the gender they knew they really were. 

 In the 60s and 70’s his treatments were restricted and cautious not only because they were new but also as Randell feared the hostility towards providing this treatment on the NHS, which some of his medical colleagues expressed at the time, would be fed by any patient who regretted having body changing surgery or hormone treatment. John died in 1982. At that  time there was no way for trans people officially change their gender but now it could soon be a simple process.

The majority of people now agree with equality for homosexual people and favour gay marriage and are comfortable with gay people having equality. I doubt that there is any serious opposition to trans people changing their gender more easily on their official documentation. 

However, the  “feminist” group called “Women’s Place” seems to want to restrict the activities of trans women by claiming that women need their own special places – these include, according to various speakers : female public toilets, female changing rooms in shops, the girl guides and Labour Party All Women Shortlists.

Trans women feel equally female as the natal (or “cisgender”) females who wish them to restrict their movements into these special places for women. The argument is that these natal males are men, and as such they will use these places not to get changed in privacy or check their make-up as one might expect a reasonable person to, but to upset or even assault women.

Former Plaid Cymru AM Helen Mary Jones discussed her opposition to the new proposals to allow trans people to freely officially change their gender on her Facebook page on 10th March 2018. The rights of women and girls are in her opinion threatened. She said:

At first glance one might say, 'why not? Can't a person be whoever they want to be?' And this was what I at first thought.
But I have reflected. This means that a male bodied person would then have the legal right to access all women's spaces - from changing rooms in shops and swimming pools to rape crisis centers, domestic abuse refuges, and women's prisons. Simply because they say they feel they are a woman and therefore they are one. The perceptions of the women and girls in those spaces may be very different. What happens then to the right to privacy of those women and girls? What happens to their right to feel safe, away from men, if they have been hurt and abused?
These changes have already begun to happen, without a change in the law. For example, people who define as transwomen are already held in women's prisons, without the need for any medical transition to have taken place. Topshop has already changed its changing room policy so that to access the women's changing rooms one simple to state that one is a woman. These changes may enhance the rights of some trans people, but in my view they undermine the rights of women and girls.

Trans women are women. Mentally, they have never been men. They are feminine in outlook and psychology. They do not belong in male toilets and changing rooms and they are sometimes at real risk from trans phobic men, who have, on occasion, violently assaulted and even killed trans women. Can you imagine what might happen if they were forced to serve sentences in male prisons?


 The comments about domestic abuse and rape crisis centres seems particularly callous to me, as these women are at equal risk of family and partner violence and sexual abuse and yet Helen seems to believe trans women who have been assaulted are a terrible danger and should be abandoned. Does she intend to stand on the steps of a rape crisis centre demanding all women seeking refuge undergo chromosome analysis to determine if they “deserve” sanctuary?

They are no more risk to other women than natal women, and for them these female only spaces are also safe and valued; they want to pass as women, they want to live as peacefully as any other woman would. To exclude them from women’s public amenities because they have male sex chromosomes is bizarre. It is surely cruel to force them to use male “spaces” and therefore “out” themselves every time they need to use the facilities.

 It is probably much more dangerous to trans women to be excluded than the imagined horror of a possibly “male bodied person” being allowed to register as a woman. Imagined horrors are the stock and trade of these arguments. The proposition is to force these women to “out” themselves as trans every time they use a bathroom or changing room because of hypothetical stories driven by the idea that the physical traits you are born with will drive one to become a sexual criminal.

The stories of what can happen to some of these women when they are “found out” in public and alone, are not hypothetical, the risks to their mental and physical health are very real. And if they chose not to take that risk, they will be forced to live their lives in the closet, which we now know has devastating effects to mental health. How can you live as yourself in public if you cannot even use a bathroom safely?

If a man truly wanted to assault a woman he doesn’t need to go through months of therapy, hormone treatments, surgery, name and legal gender changing to do so. In fact under Helen’s proposals he could simply claim to be a trans man, a group Helen seems to have forgotten, and who, after a period of hormone therapy generally are, I assure you, completely socially indistinguishable from natal men. She's also not clear about which toilets non-binary transgender individuals should use. 
  
It seems unlikely that anybody would go through the often harrowing experience of coming out to their families, possibly being disowned by their loved ones, being disrespected in the media and on the streets, living in fear of being found out, applying for legal changes and undergoing long hormone treatments and serious surgery, just for the chance to leer at women in a bathroom.

Punishing trans women as a group for imagined crimes will not protect natal women any more than they are now, but it may throw trans women to the wolves. This proposition of segregation is hurtful even if in practice it is impossible to "police".

I am not comfortable doing this to my fellow women, trans or otherwise. Helen’s argument hinges on the idea that trans women are inherently, from birth, a threat, no matter what the personality and morals of each individual woman may be. That seems to me a very unfair and cruel judgement, and it is on this basis that in her own words she believes their rights should be curtailed. I simply disagree.

 I see other women still suffering indignities and humiliation simply for who they are. As a feminist I believe in offering solidarity to all women who need it. Surely trans women are our sisters, who equally share our marginalised position in society and deserve solidarity from feminists, not hostility? 


 Siân Caiach

Tuesday, 10 April 2018

Future Wales - Population Shift - Older and wiser?

We are living longer. In Wales not quite as long as our neighbours in England but now longer. on average, than our parents or grandparents. Statistics show the trend clearly {ref my last blog Future Wales-How Long Shall We live?} Add to this a low birthrate and the result is a growing  proportion of the elderly. By 2030 most people in Wales , it is projected, will be over 50 years old and in many communities outside of our cities, the majority of adults may well be even older.

What are the likely consequences of this population shift?

The Health Service is most energised by the demographic predictions from the current data. The number of people aged over 75 years is expected to double in the next 10 years.  At a recent conference leading GP Dr Clare Gerada  asserted that over 65's will, in the near future, be the largest population group in the UK.

Currently more and more of the medical care of the elderly is being provided by general practitioners. As this age group visits a GP for a consultation 12-14 times on average the GPs are concerned whether they can cope. There is little sign of a sufficient  increase of GPs and old age specialist doctors in the pipeline to cover this expanding need but there has been a shift to offer more services in the community.  Many common,chronic conditions are already monitored by nurses and other allied medical staff, rather than doctors. Despite long waits, occasional failures and regional inequality, the NHS is, though imperfect. still the best overall health service in the World. 


The increase in lifespan is, for most people, likely to be an experience of better health in middle and later life, so the actual amount of and length of disability and ill health in individual lives may  not increase in direct proportion to  our longer lifespans. 

  
It is the increase in the numbers of  elderly people in our populations which has to be planned for. Increasing pension age and so keeping the fit elderly working, makes them economically active for longer. but also occupying jobs which would have been vacated in favour of younger workers in the past

As in many things, Wales has less primary health care provision per head of population. According to  BMA figures the number of GP's per head in Wales is low.


GP numbers in the UK :

England 7,613

Scotland 958
Northern Ireland 349
Wales    454


How will the elderly vote and what for?


World Economic Forum Report 2015


An old saying goes, “If you’re not a liberal when you’re young, then you don’t have a heart – but if you haven’t become a conservative when you’re old, then you don’t have a brain.”

In the UK home ownership is said to shift your views to the right and certainly older voters are thought to be less radical. 


 By 2030 the majority of voters in most European Countries will be over 50.

This is part of the conclusion of the World Economic Forum report in 2015. After noting that the elderly are currently politically more likely to support pensions, healthcare and even crime fighting over provision of jobs and housing there is uncertainty as to which way this growing group will act politically.. 

"However, our results also suggest that we should be cautious when projecting age patterns, since they are far from deterministic. In other words, some young liberals may become old conservatives, but it also depends on the economic circumstances and events through which they live".

.https://www.weforum.org/agenda/2015/.../how-will-ageing-populations-affect-politics



There is little doubt that there is a significant  growing  expansion of the elderly populations of the developed world. Whatever their  personal politics, in democracies the issues which effect and influence our older citizens are likely to become more and more important as their numbers grow.

Democracy will ensure that the elderly have a bigger voice in the future here in Wales. Already older people vote more often than younger ones, but their growing numbers should significantly affect the political outlook. A 60 year old in wales today can expect, on average, to live a further 25 years. Life expectancy is still increasing, although the rate is slowing, so it could be even more.

In later life will people still follow the tribal politics of their youth or will they mobilise to form powerful groups to represent their own interests? 
Probably a bit of both, but to win power, no party can ignore them. In fact, as the majority of voters will be elderly, every political organisation will be tailoring their message to the mature voter. 

The elderly used to be a relatively easy for governments to ignore. A nod to social conservatism or community policing was all that was needed.

 Closing care homes, reducing social care support , giving the elderly free bus passes while reducing bus services, reorganising health services for the convenience of Health Boards, not patients, planning new home builds for the maximum profit of the developers. not the needs of residents, the elderly have seen these things played out all over Wales. They may decide to use their electoral power to knock some sense into the shallow politicians whose lies have usually gone unchallenged. Many criticise politicians as untrustworthy, self interested and having poor memory of their electoral promises. Now those with the most experience of successful and failed political delivery have the most power to chose their elected representatives. 

Importantly, the older citizen is not only more likely to vote but also more likely to be geographically settled and have more concern for their homes, community and environment. Many financially and practically support younger family members. They will have developed an overview of their local areas and economies based on their personal observations and experiences. 


I doubt the older voters will continue to tolerate the politics of spin, the endless manifesto promises which were never going to be delivered and the same old "jam tomorrow" story of a better, fairer society which has failed to materialise over their long lives. It would be good to see more honesty and candour in politics, with an electorate who, in large part, really have heard it all before! 

Siân Caiach 



Monday, 2 April 2018

Future Wales: Reading the Tombstones - How long shall we live?

As in Education, Wales was devolved a health system which was not quite up to the average standard of facilities throughout the UK. To this add a "sicker" population. We also took over a depressed economy and many areas with inadequate housing and infrastructure. Poorer people tend to have less healthy lifestyles, less adequate housing, and less money to pay for the "extras" available to enhance health, from private services to helpful aids and home modifications. 

Since devolution we do live longer, but there is still a significant gap between Wales and England. However, the overall figures show even within Wales there is great variation. Life expectancy is something easy to quantify as births and deaths are registered.  Why life expectancy is improving is less clear.  Wales is following the trend, but not catching up. Wales may not feel like a rich country but compared with all the world's nations it is one, as it has generally good nutrition and healthcare. However, we should look to improving the standards at least up to the UK average.

Most deaths occur in the elderly and the big killers in 2016 were cancer, 28.5% circulatory illness [heart attack, stroke etc] 25.5% and Alzheimer/other dementia 15.6%. Over 75's are showing a small decrease in mortality.

Prince Phillip Hospital, Llanelli. 


LIFE EXPECTANCY IN WALES

Last year's [2017] data from IDS Scotland indicates a 1 year lag in the average life expectancy of Welsh men – who live to an average 78.4 years from birth- compared to their English equivalents, with Welsh women trailing behind by 0.8 years in living to an average age of 82.3.

In the field of  gross life expectancy the gap between England and Wales is obvious, with the sexes showing similar widening between English and Welsh men and women. The life expectancy increases in both populations but more in England than Wales.

Figure 1: Life expectancy for babies at birth by sex and country - ONS

England and Wales, 1991-1993 to 2012-2014
Male - England
Female - England
Male - Wales
Female - Wales
2012–20142007–20092002–20041997–19991992–1994
72.57577.58082.585
Years
1993–1995
 Male - England: 74.18
 Female - England: 79.44
 Male - Wales: 73.42
 Female - Wales: 78.99
Source: Office for National Statistics
Notes:
  1. Figures are based on deaths registered and mid-year population estimates, aggregated over 3 consecutive years.
  2. Figures for each country exclude deaths of non-residents.
  3. Newborn life expectancy has steadily increased in England and Wales since 1991-93. Life expectancy is higher in England then in Wales, while the gap between both countries has widened over the last 2 decades.
  4. The gap between male and female life expectancy at birth has also narrowed in both countries


Looking at the UK as a whole there is notable variation where, as a rule, poorer areas have poorer health.

Figure 3: Life expectancy (LE) at birth for males and females, by local area, UK, 2013 to 2015

Notes:
  1. Local areas include lower tier local authorities (LTLAs) in England, unitary authorities in Wales, council areas in Scotland and local government districts in Northern Ireland.
  2. Isles of Scilly and City of London have been excluded from the map because of insufficient population counts

Poor health does not necessarily mean hospitals or community health resources are lacking. Nutrition, housing, geographical access, education and lifestyle issues are all factors and these figures above are indications only of how long people currently live. In all the UK countries there are sharp differences between the best and worst areas.

  

Life expectancy at age 65 differs by up to 5.6 years within U.K. countries

The opposite can be seen for females where the majority of highest and lowest life expectancies are different for each country. The only figure that was the same at birth and at age 65 was the lowest life expectancy in Northern Ireland, which was in Belfast.

In Wales we can be proud that people are living longer and larger portions of our lives are spent in reasonable health. This is common amongst developed countries throughout the world and thought to be due to a combination of healthier living and improved routine successful  treatment of many medical conditions and prevention of others through vaccination and education.

 In Wales the question is always "why the gap?".  We know the gap was there before devolution, and this gap remains despite general  progress in health and longevity.
 

How long we live is not only a function of formal healthcare but a range of nutritional, social and environmental factors which affect our health. The current movements to reorganise formal hospital based healthcare in Wales seem to be more related to the needs and difficulties of the health care providers than easy access to provision of  healthcare and adequate social care, which is arguably the more pressing concern of the population. 

Although most of us now can look forward to living longer, why are we not be living as long as our neighbours? 

  Siân Caiach

Monday, 19 March 2018

Future Wales : Children's Education - Why isn't the "investment" delivering?

Siân Caiach looks at school performance.

Local Authority Schools for primary and secondary education are provided, maintained and staffed by the City or County Councils who administer that Area. The Welsh Government, anxious to improve our standard of education, adopted a policy to do so involving encouraging new builds and school amalgamations. The idea was to fund these projects centrally but have the schools matched funded by Council borrowing. It was called the Modernising Education Project, MEP .This was to give our children an improved education at reduced cost to the Councils as Welsh Government put in a proportion of the finance. There are now, I believe, unintended and serious consequences, both financially and culturally.

Assembly members have had deep concerns over the quality of education in Wales. The focus has been on improving the buildings because many buildings were old and poorly maintained. Educational results may have not been shown to be directly related to the age of buildings, or the total number of pupils but Local Authorities always seem to like new building projects as they are visible structures of positive change and modern builds economically often have the advantages of low maintenance and lower running costs. 

However, they are very expensive projects and can be very disruptive to communities where they are built and often have larger numbers of pupils who have to travel long distances.The trend has been to close smaller schools and build bigger ones with larger catchment areas. Economies of scale and lower running costs, but not necessarily more successful in hitting educational targets.

Then there is the the actual teaching part of Education. The number of curriculum and test changes reflects what has been seen as poor performance of educational standards in Wales. We are currently in the process of changing our curriculum once more with the outline improved plan to be released next year, so we are still not good enough?

Where I live, this is the official, upbeat presentation of the MEP currently on the Carmarthenshire County Council website.


Modernising education programme

Some £250 million has been invested in schools across Carmarthenshire – and more is on the way. Since the county council launched its Modernising Education Programme, massive investment has taken place in both primary and secondary schools.
To date, eight new primaries and two new secondary schools have been built, with major refurbishment and extensions in another 37 primary schools and 11 secondaries. Work is continuing with two new schemes expected for completion soon – a new build at Trimsaran and an extension and refurbishment at Coedcae.
New schools are also being built for Ysgol Pen Rhos in Llanelli and Ysgol Parc y Tywyn in Burry Port; and an extension at St John Lloyd. The MEP is funded by Carmarthenshire County Council with support from the Welsh Government’s 21st Century Schools initiative.

OTHER WELSH COUNCILS HAVE VERY SIMILAR STATEMENTS ON THEIR SITES WITH MANY OF THE SAME PHRASES


The recent replacement for the School I attended  half a century ago.



The MEP continues onward as this February 2018 WG press release below shows :
"£100m is to be invested over the next three years to accelerate the delivery of the flagship 21st Century Schools and Education programme, Cabinet Secretary for Education, Kirsty Williams and Minister for Welsh Language and Lifelong Learning Eluned Morgan said today.
An extra £75m, has been allocated to the 21st Century Schools and Education Programme a major, long-term and strategic capital investment programme to modernise education infrastructure.
In addition, £30m will be released from the programme in future years for immediate investment in capital projects that will contribute to the goal of reaching a million Welsh speakers by 2050. This is a shared priority with Plaid Cymru."
Welsh Government
The money will bring the total invested over the life of the programme to almost £3.8bn. The first phase of the programme will finish in 2019 having invested £1.4bn to support the rebuild and refurbishment of more than 150 schools and colleges across Wales. The second phase will see a spend of £2.3bn. However, no information on the improved school standards promised with the shiny buildings.

PISA TESTS.
As in other fields, we lag behind.

 The Programme for International Student Assessment (PISA) is a global bench marking study of pupil performance by the Organisation for Economic Cooperation and Development (OECD) . It provides a comparison of what 15-year-olds within participating countries know and can do in the core subjects of science, reading and mathematics. Additionally, contextual information collected from pupils and their school enables associations between performance and other factors, such as pupil engagement or teaching resources, to be compared between and within participating countries.

In the last set of results published in 2016, Wales had not improved on previous scores and was bottom of the UK league and still middle ranking in the overall scores. The WG ambition for Welsh pupils to achieve top 20 status was dropped officially in 2017. How relevant this Pisa scoring system  is in practice is disputed and our teachers are already stressed by increasing paperwork and the pressure to obtain the other desired goals, such as 5 grade C or above GCSE passes.

Money
Under funding of education in Wales compared to England was present before devolution and continues. It is not clear that putting the "improvement" money into buildings is the best use of funds. However, Councils can borrow to fund "capital projects", i.e. new builds and these funds are also contributed to by Welsh Government, the money referred to above. In other cases, a scheme which seems to be failing to produce the desired results might be paused for further examination of the reasons for failure and alternative strategies available. Not here. We are going to build more new schools with very little evidence that it is the most efficient spend on education in the circumstances. With Councils chosing the new school sites, they may be influenced by local politics rather than real need. 

Currently money spent by Councils on education per pupil averages out at about £678 less per pupil in Wales than England [source NASUWT] and the average figure per pupil across wales spent by local authorities is over £5,000 but in real terms has dropped around £370 in the last 6 years up to 2017 [BBC NEWS Dec. 2017]. This compares to stagnation rather than a drop in funding in England. The Councils have to produce this money from their incomes. About 80% comes from Welsh Government and the rest from the Council tax. 

However, the money for capital projects which funds the new school builds is borrowed by councils, usually at low interest rates and long terms, up to 50 years. This is regarded by these local authorities as very much "free money" with no consequences. The same favoured Architects and Constructors seem to get a lot of the work in various areas and the temporary construction jobs are much lauded as a boost to the economy, often with the promise of a handful of apprentiships during the build. Is this working? I'm not convinced.

 Further Education in Wales is also in trouble:-

!n 2016, Colleges Wales pulled no punches when it talked about the 50% budget cuts to adult learning: “With a 50% reduction in funding for part-time adult learning, Wales will have to brace itself for a workforce that has lower skills. Lower skills reap lower wages and affects health and wellbeing. All factors combined, there will be a negative impact on the nation’s economy.”
This relative shortage of cash reflects across a lot of public spending in Wales including Health and transport infrastructure. [source ATL Cymru] Overall FE Colleges were reporting up to 10% cuts. Post-16 learning seems to be in decline also, numbers dropping steadily over the last decade,

The Wales Audit Office Report shows that the funding cuts are expected to be recouped from "commercial operations". In a pretty stagnant economy this could be a tough ask, however keen the Colleges are on selling their services.

Welsh Government oversight of further-education colleges’ finances and delivery

28 Feb 2017 - 12:01am






"We have examined whether the Welsh Government is fulfilling effectively its oversight role to ensure that, despite financial constraints, further-education colleges are financially well placed to deliver the Welsh Government’s expectations.
We concluded that, while generally sound, the Welsh Government’s funding and oversight arrangements would benefit from a longer-term and more integrated approach. In response to reduced funding, colleges have cut part-time provision and costs substantially and are aiming to develop their commercial operations to increase revenue". 
Wales Audit Office
More cuts and less opportunities for skill training. Part time adult courses especially have been lost, so less second chances for those who fail to get the skills they need at school.

WHAT EXACTLY ARE WE DOING?
Having devolved government closer to the people should improve the management of public services and the economy in general. There is sometimes little that government can actually do in some sectors, but in education the Welsh Government is surely firmly in the driving seat?

Why then is the performance so poor? Lack of money for school staff , equipment and building maintenence but a major program of new school building pushed forward regardless of results.

I have yet to see the research proving that new schools, in themselves, improve education. 

The new builds do look very nice, are perhaps more pleasant to work in and produce temporary construction jobs. What is the degree of educational improvement exected from the MEP ? Who argued for this plan and where are the predictions of the improved results expected from new schools? Do areas with more new schools show better results? Are we spending enough money in the right places?


However, the fact that the running of schools is not funded by the "free money" of permitted Council borrowing means that more "efficency savings" (cuts) are being made by Councils who cannot afford to keep the current levels of teachers and resources on their budget of "real" money. Many schools, even new, shiny ones are being asked to make significant cuts in their running costs. Does this really make sense? There is a common belief that teaching is the lynch pin of school education. Research may be available to show that en suite classroom toilets are a more significant driver of excellence, but I've never seen it.

Small Countries may do better as their management of services and resources should be more focussed and more efficient? In Welsh Education, where are we going wrong?



We in Wales are criticised for not "catching up" with the rest of the UK  in many areas but the gap remains. In large part perhaps, due to the chronic underfunding in many areas. relative to the rest of the UK.  Its not a level playing field any means.