A big day for health in Wales
Guest post from @TobyMasonBBC
There are few days in the Assembly at the moment where the state of the health service isn't in the spotlight - today was exceptional in that there were three major stories happening at once. They're at once separate but linked.
First up, the current top brass of Betsi Cadwaladr health board were in front of the Public Accounts Committee to answer some tough questions about the joint WAO/HIW report into governance. They got a pretty rough going over, not helped by the disclosure by consultants, hours before the hearing, of a claimed spike in mortality statistics at Ysbyty Gwynedd. The officials refused to confirm figures, but admitted they were urgently looking at the reasons behind "a drift up in numbers".
They also lit the fuse on a slow burn row - which was the admission that some acute and specialist services are unlikely to be viable across three sites in North Wales. It means that they're facing a similar controversy to that in South Wales around services at the Royal Glamorgan in the fairly near future.
There were also questions about cancelled operations at the end of the financial year, lengthening waiting list figures and tensions at the top of the organisation. It wasn't a surprise that the session ran well over its allotted time.
We also got a much better idea today about the future of another troubled institution in the health service - the Welsh Ambulance Trust.
Health Minister Mark Drakeford said he had considered dissolving it entirely - but rejected that because of the upheaval involved.
Instead, from now on, ambulances will be funded by a new National Delivery Body made up of the seven health boards in Wales, rather than by the obscure Welsh Health Specialised Services Committee, as before.
The idea behind this is simple - the new delivery body should be much sharper - laying down what it expects from the ambulance service in terms of performance in return for the funding that it gives out. Don't forget the Ambulance Trust has missed its key response time targets for each of the past 12 months. One nagging question remains - each of the health boards will naturally want the maximum resources for their area; it's not clear from the Minister's statement who will arbitrate between them in the event they can't agree.
The response from the opposition parties was a cautious welcome. The ambulance service, renamed or not, will face just as much scrutiny after this announcement as it did before.
And then, a few moments ago, came the announcement that could have the greatest impact in the coming months.
Giving the Welsh Government's response to the lessons that the NHS here needs to learn from the events of Mid Staffordshire, Dr Drakeford made the following announcement:
Jointly with the Finance Minister I will be undertaking a review of the NHS budget over the summer to ensure that it reflects the lessons to be learnt from Francis, the additional burdens which face the health service and to ensure that there is a proper match between the quality of care, patient safety issues and the budgets to support them.
Now that is stone that he will have thought very long and hard before turning over. The implications are potentially massive. The NHS in Wales consumes more than 40% of the total devolved budget. The health boards have been grappling with "cash flat" budgets for several years, being forced to meet inflationary pressures with efficiency savings or straight up and down cuts.
It's hard to see, on this basis, how any credible review won't suggest some increase in resources for health boards.
The timescale for this review means - critically - it will be complete in time for the start of this autumn's inter-departmental wrangling over the Welsh Government budget for the 2014-15 financial year. If it recommends any significant uplift in the £6bn NHS budget, even a small percentage, then the other portfolios had better look out.
The political implications could be huge. Remember the Finance Minister's options for getting the votes she needs to pass her budget have reduced sharply in the past month, with the announcement that Plaid Cymru and the Liberal Democrats will jointly negotiate to get their priorities implemented in return for their votes. Neither, historically, have put health spending top of their wish lists, opting for economic development and education respectively.
There is one party that has consistently called for significantly more of the Welsh Government's budget to be allocated to health - and they will be Labour's only other option if a Plaid/Lib Dem deal can't be made to work. They're the Welsh Conservatives.
Quite a day.