Wednesday 17 February 2016

How about a Voice in our own Health Care?

Llanelli is the largest town in Dyfed. The population of town proper and  suburbs is over 80,000. With nearby towns Burry Port, Kidwelly and a host of small villages the Llanelli area probably contains well over half of the population of Carmathenshire. Why has its Hospital been shrinking for so long and its health services declined? 

I started working in Prince Philip Hospital in 1994 and was forced to leave in 2005. By that time the District General Hospital had already two mergers which had the character of hostile takeovers. I was only one of a number of consultants "let go" over that period. Our management's reaction to senior doctors who wanted to keep services in Llanelli was generally to shoot the messengers. The political power was always in Carmarthen where West Wales General Hospital originally had the largest collection of managerial staff and packed the executive boards after every merger. Now my old hospital, like others in Dyfed crowded out by the "Carmarthen Effect," may end up as just a ghost of its original function with local patients not getting the hospital care they need close to home.

Where is democracy in this system? Although the Welsh Government approves senior managerial appointments, its lack of directional planning means that the new leaders are not necessarily all singing from the same hymn sheet. To be honest, I strongly suspect that neither Government nor management actually have a hymn sheet. I even doubt the Welsh Government Health Minister has a full audit of what services and staff are at each location and how the service is performing. We cannot continue a system where decisions are seemingly random in each Health board area with different initiatives and policies followed in different ways with differing results!

In Scotland a pilot project in 2010 to elect two health boards was not successful enough in changing the boards and the plans to roll out the direct elections across Scotland were abandoned. The problems were low turnout and the election of the usual suspects which led to the same type of elderly white middle class male dominance that the non elected boards had previously.  Scotland also trialled a different recruitment system with much wider advertisement of the non executive board posts and directly advertising to healthcare user groups, minorities and Community Councillors as well as general local radio adverts etc., to cast the net wide. This was very successful in producing diversity and a more representative local community input and was the mode chosen for the future. It was also a lot cheaper than elections.
The former entrance to Prince Philip Accident and Emergency Department
 is now taped off with the same tape Police use at accident sites

The full details can be found at:

For the pub quiz aficionados please note that the first time in the UK that 16 and 17 year-olds voted was in the 2010 Scottish Health board elections.

In both cases the number of voting staff executive directors was reduced. The non-voting directors still attended board meetings and the new non-executive directors had the numbers to challenge executive decisions.

Its very nice to see a progressive Government running pilot projects to decide how to democratise the control of healthcare. We might not have had the many futile bus trips to lobby the Assembly if our Health Boards had been more representative of the people they served. As it is we in Wales have what looks like the double whammy of no political control at all from either our Welsh government or local people as our Health Boards make changes without consulting anyone other than themselves. 

As a member of People First/Gwerin Gyntaf and our main aim is to bring the voice of ordinary people into Welsh Government and all aspects of the services the welsh state provides.

Today I visited the former entrance to Prince Philip Accident and Emergency Department. It is taped off with the same tape Police use at accident sites. The paint is peeling and the A&E signs fading. If the local people had the power to put their case, if our health service was under our control, this "accident" would not have happened!

Siân Caiach


  1. I'm told that the official reason for the tape was that a sign was lose and in danger of falling and this has now been resolved. The A&E signs were due to be changed to whatever the "Front of House" project is going to be called. "Nurse led minor injuries and GP minor illness service and drug and alcohol abuse advice service is a bit long. I'm sure the spin merchants can come up with something more snappy. no wonder the sign wanted to leave on its own accord.

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