Part of 1. Questions to the First Minister – in the Senedd at 2:15 pm on 4 February 2020.
Thank you. Llywydd, I had hoped not to take time up putting this on the record, but it's the third time these figures have been mentioned, so I feel that I must. The ratio of consultants to patients in England is derived by dividing the number of people attending major accident and emergency departments by the number of consultants. The figure quoted for Wales is derived by dividing the number of consultants into the people who attend all accident and emergency departments and minor injury units as well, and given that thousands and thousands of people attend minor injury units it is no surprise that, if you divide consultants into a different sort of total, you come up with a different sort of result.
So, I didn't want to have to go into all of that, but that's why I said in answer to Adam Price that the figure he quoted was not to be relied upon, because it is comparing apples and pears. As I said, it wasn't for me the central point of what he said, but given that it's been twice repeated since, I just want to make sure that people understand the basis of the figures that have been quoted and why they're not a reliable comparison in any way.
To the substantive point that Angela Burns makes, which I think is a very important one, when I was the health Minister, I worked with UK health Ministers on a report that the UK Minister had commissioned from the vice-chancellor of Sheffield university, as I recall, which proposed a new cadre of generalist consultants working with older people. Now, in many parts of what the health service does, the trend over the last 20 years to have ever greater sub-speciality is in the interest of patients. If you are going for an orthopaedic operation, you'd rather have it from somebody who is a specialist in the particular procedure rather than somebody who has a go at everything.
But when it comes to older people, in the way that Angela Burns said, people present with a whole variety of different conditions that have an impact upon one another, and what you don't want, I believe, is that patient being handed from one slice of speciality to another. You need a doctor trained as part of that new cadre of generalists.
I think the truth is that that effort—which I say her Government had a leading hand in generating—didn't make the traction that we had hoped, and that's largely because the thrust of general colleges is in the opposite direction. We have to do more to persuade the profession as well that the nature of medicine for older people needs a different sort of response than the one that has been the dominant trend for nearly 20 years.