Fairer Outcomes For All: The Welsh Public Health Conference NHS Wales, Forging a Better Future A report by the Bevan Commission (2011) Professor Sir Mansel Aylward CB Chair: Public Health Wales and Director: The Centre for Psychosocial and Disability Research, Cardiff University

Wales now Health of the population continues to improve but The ‘inverse care law’ still persists - health inequities remain stark and resistant to change

Wales now confront poverty, especially child poverty make health everyone’s business - economy, housing, transport, education, etc. Tackling health inequities means we must

Response – Fairer Health Outcomes For All Inequities are intolerable, so we will: build health into all policies and all policies into health give every child a healthy start develop our health assets in communities tackle health literacy make health and social services fairer develop a healthy working Wales strengthen the evidence base

The Bevan Commission: First Minister’s Announcement ‘….. a source of independent, expert advice on the development of health services here in Wales. its core purpose will be to provide ………. assurance that the reforms ………. will succeed ….. a health service which is publicly owned and publicly provided; a service which is rooted in an ethic of care, rather than competition and a service which has, at its core, the pursuit of health, as well as the treatment of illness. A NHS, in other words, which would be recognisable to its founder.’ First Minister: 16 July, 2008

What Bevan wanted in 1948   Comprehensive treatment, within available resources Universal access, based on need Services delivered free at the point of delivery

What he might have added – the Bevan Commission additional principles A shared responsibility for health between the people of Wales and the NHS A service that values people Getting the best from the resources available A need to ensure health is reflected in all policies Minimising the effects of disadvantage on access and outcome A high quality service that maximises patient safety; Patient and public accountability Achieving continuous performance improvement across all dimensions of healthcare

Going for gold – “World Class Healthcare” Services best suited to Wales but comparable with the best anywhere1 Essential Elements include: Balance and integration Measured quality as good as or better than comparable systems A step change in population health A crucial leadership role for government Performs well against Bevan Commission Principles2 Bevan Commission Report 2008 – 2011 2. Bevan Commission. World Class Health Care for Wales (2010)

So how is the NHS doing? Outstanding business The NHS must do more on : cutting health inequalities and inequities promoting a ‘sea-change’ in public attitudes driving out waste in the health system effective partnerships across public health and local government getting solutions to health problems across all policy agendas.

The next challenges rising demands due to ageing and innovation unrealistic public expectations creating one integrated care and support system the fear of change real progress on inequalities and inequities the recession which will deepen health inequalities and force service cuts

The answer: Quality, quality, quality – and equity Target waste, harm and variation Think systems Share every success Offer excellence to everyone, and more to the most deprived Live in a goldfish bowl

The Answer: Partnership with the Welsh People Government, the NHS and the people of Wales need to work together to: look after themselves – with help take control of their lives use the system well redesign services get real about what is feasible

The answer: Real Political leadership Help and encourage people be responsible citizens Don’t change the system if it isn’t broken Look for health benefit in every policy area Help educate the public that change is needed; and Champion a culture geared towards quality

The answer: Real NHS leadership integration of services for users helping people help themselves the potential of staff to bloom ‘world class’ care every day those who can’t press their own case

The Commission, the NHS and the future Aneurin Bevan’s principles still stand as strong today as they did in the late 1940s The Welsh system will be distinctively Welsh Tough challenges that require commitment, tenacity, leadership and partnership throughout healthcare, government and society A system willing to match itself against the best

Welsh Government Plenary debate 14 June 2011 Welsh Ministers approved the Bevan Commission Report as the document which underpins the NHS in Wales Minister for Health and Social Services agreed to establish an independent commentator for the NHS in Wales Bevan Commission will be reconstituted

Professor Sir Mansel Aylward CB Contact: Email: Mansel.Aylward@Wales.nhs.uk Website: www.publichealthwales@wales.nhs.uk Big area for reform to increase the employment rate of sick and disabled people is incapacity benefits. Though not an end in itself There are now around 2.7 million people claiming an incapacity benefit (bit higher than in the chart due to a wider definition). Now have more than 3 times as many people on IB as JSA – stark contrast with the position in early 1980s where there were significantly more people unemployed. In fact caseload has more than trebled since 1979. Most of the increase (over 90%) took place before 1997. Since that time we have seen a reduction in inflows to the benefit (by around one-third since 1997), reflecting greater economic stability and policy changes. Problem is that outflows have fallen too – so we have seen a stabilising of the caseload. Not the case that there is a hidden unemployment problem – which has been in the press recently - unemployment fallen MUCH faster than rise in IB caseload, employment is up (levels and rates).