Part of the debate – in the Senedd at 3:17 pm on 3 July 2018.
Thank you for the comments and the questions. First I'll reflect on the progress made since pre the health service, as has been eluded to. Yesterday, I was at Llandough hospital looking at the mural where they'd actually developed some of the recognition and research into pneumoconiosis. After that, I saw a patchwork quilt with a number of different stories about the NHS. One of them was a grandmother who had done a patchwork quilt in memory of her 10-year-old sister who had died before the creation of the national health service because her dress caught fire, and the coroner's report said that the doctor refused to attend without payment of his fee. That shows the sort of progress that has been made. So, for all of our arguments, there is enormous progress—things that simply do not happen now, or if they do, they are a national scandal rather than a common part of life.
It's also worth reflecting that prescription growth in Wales—as you mentioned prescriptions—the growth has been lower in Wales than in England since the introduction of our free prescriptions policy, so it's not led to a ballooning amount of prescriptions being provided.
On your questions, I think the two biggest threats facing the national health service are the twin storm clouds of Brexit and austerity. If we continue to have not just the health service, but the wider range of public services that are key determinants of people's health, being underfunded, then we'll continue to pile on more demand into the health service, and we'll be blamed for that, whilst other services complain about more money going into the health service itself. We will have an unvirtuous circle.
You will recall from last week's statement the significant risks that a hard Brexit provides for the national health service. There's a level of a lack of awareness about the scale of those risks. I don't think it's a fair or accurate presentation to say that this Government is in any way complacent about those risks, or is somehow being blasé about not needing to plan for them. Of course preparations are being planned for a hard Brexit, but the point being made is, some of the consequences of a hard Brexit are impossible to resolve without consequence.
Last week, we had a really good example that you raised, and that I've mentioned at other times before. The radioisotopes used for treatment in the health service, almost all of them come from Amsterdam. If we have a hard Brexit, we will not be able to replicate production of those between now and March next year, or even the transition period that's likely, and so treatment will simply not exist in a range of areas. You have to be honest that that is one of the consequences of a hard Brexit, and you can't stockpile radioisotopes. So, there are challenges that we simply can't replicate if we leave on hard Brexit terms. And as I said last week, the biggest danger to the future of the health service, in the immediate future, is a hard Brexit. And, of course, Simon Stevens and NHS England recognise it too, which is why they've mentioned it in public.
On workforce planning, the creation of HIW will give us a new structure to plan for the whole workforce. And, again, we can't have competing demands from staff groups asking for more of them or for lobbying groups. So, whether it's more people in one part of medicine, more people in one part of nursing or therapy, we'll have to look at the whole service in the round and recognise that there is a team of professionals who work together to deliver healthcare. I expect to see a significant improvement in workforce planning and you'll see more of that once HIW is created from October this year.
On your point about care, it's worth reflecting that, of course, social care has always been means-tested. Part of the difficulty in integrating health and social care is that the health service is free, paid for by taxation, and social care is means-tested. What we're looking to do is to try to eliminate some of the wrangles about funding, so that the citizen does not fall between the cracks, between the two services. That is why the parliamentary review recommendations and the plan we have for health and social care is so important. It's why I place such value on having regional partnership boards for health and social care to plan together, so that the citizen need not know and need not worry too much about whether they're in health or social care. It'll make it easier for the citizen to access those services, which is why the progress on pooled budgets is but a means to an end of making sure that we derive much greater value from the £9 billion of integrated funding that exists there, and much greater outcomes. I expect that integrated model will deliver exactly those outcomes that all of us in this room would wish to see.