1. 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

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

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

4. 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

5. 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

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

7. 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

8. 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)

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Professor Sir Mansel Aylward CB
Contact:
Website:
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).