PEMBROKESHIRE MP Henry Tufnell attracted local attention this week after a survey of his constituents identified massive dissatisfaction with Hywel Dda UHB. In a video post, Mr Tufnell sounded aghast at the results. However, they could not have come as a surprise to anyone who lives in Pembrokeshire or has more than a passing acquaintance with the county.
NHS MAKES PEMBROKESHIRE BLUE
Mr Tufnell’s undoubtedly sincere reaction copped an awful lot of abuse about his seemingly gauche political naivety (see this week’s Badger for a bumper helping). Among those who wasted no time in drawing the MP’s attention to who was ultimately responsible for the public’s attitudes was Preseli Pembrokeshire MS Paul Davies, who cordially invited Mr Tufnell to join him and others for a doorstep action day about NHS services in Pembrokeshire.
Not wanting to miss out, a host of other Welsh politicians took turns expressing bemusement and amusement at the Mid & South Pembrokeshire MP’s determination to sort out problems in the NHS that were almost wholly his Party’s fault.
One local Conservative councillor found a social media post from Mr Tufnell celebrating his selection as Labour’s candidate and stating that he would work alongside then-Health Minister Eluned Morgan to address the issues affecting Withybush Hospital.
As hostages to fortune go, that one is a doozy.
NO MYSTERY IN THE HISTORY
Since 1999, the Welsh Government has been responsible for the Welsh NHS. It sets targets, priorities, strategies, and budgets, and successive health ministers are ultimately responsible for the Welsh NHS’s performance.
The Welsh Labour government’s actions and Hywel Dda UHB’s implementation of the former’s NHS strategy ensured that it took a national collapse of the Conservative vote for Mr Tufnell to win his seat in Parliament on July 4. Until then, Pembrokeshire had been solidly blue in the South since 2010 and in the North since 2005, and the same happened in successive elections to the Welsh Parliament.
The fingerprints of Labour’s Welsh Government ministers are all over the Welsh NHS.
Labour reorganised the Welsh NHS into its current form. Its ministers are responsible for NHS management structures in Wales and are ultimately responsible for approving and appointing non-executive and independent members of Wales’s Health Boards. The powers of Labour ministers in this regard were amply demonstrated by then-Health Minister Eluned Morgan’s 2023 decision to force the independent members of Betsi Cadwaladr’s Board to resign.
Welsh Government ministers’ approaches to the Welsh NHS have all suffered from the same fatal flaw: an overemphasis on technocratic managerialism combined with Olympic-level buck-passing. Those approaches, combined with unashamed tub-thumping about how “the NHS was born in Wales,” have worn thin. The public is also increasingly cynical about ministers conflating criticism of the shambolic state of the Welsh NHS with criticism of “our hard-working NHS staff”.
MANAGEMENT NOT LEADERSHIP
Technocratic managerialism allowed Welsh Government ministers to hide behind experts. If the experts said to do x, Welsh Government ministers (or so it was claimed) were bound to do x. That approach crumbled when Welsh Government ministers moved to halt service closures in seats where Labour was under pressure. It had the foundations knocked out from under it when the Welsh Government removed Betsi Cadwaladr UHB from special measures and opened a new hospital in Cwmbran handily ahead of the last Welsh parliamentary elections. Experts be damned – low politics must win.
The Grange Hospital in Cwmbran is a basket case, and Betsi Cadwaladr UHB had to be returned to special measures. However, the Welsh Government’s unabashed approach to its handling of both suggests a certain institutional blindness.
A secondary aspect of narrow managerialism based on expert advice is that it totally ignores communities’ deep connections to institutions and services. In Pembrokeshire, salami-slicing services away from Withybush, on the say-so of experts and clinicians looking for an easier life for themselves by concentrating services in one location, went down like a bucket of cold sick. The narrow and legalistic language used by Welsh Government ministers when faced with public outrage about Withybush’s fate only served to inflame public sentiment. Managerial rationalism, combined with worthless assurances and weasel words from the Health Board, cost Labour thousands of votes in successive elections.
The implications of this are twofold. First, if it were not for the phenomenon of voting for Reform UK and getting Labour MPs, Pembrokeshire would still be a solidly Conservative seat. Second, as long as Labour in Cardiff Bay is associated with the deeply held grievances of Pembrokeshire’s voters, the Party’s hold on Mid & South Pembrokeshire is tenuous.
COMPLIANCE AND DELUSION
Mr Tufnell’s attempt to deflect blame onto “unelected managers”, thereby placing the responsibility for poor service on Health Board staff instead of considering the whole picture, echoes Eluned Morgan’s approach, both as Health and First Minister.
Unable to hide behind discredited managerialism, the Welsh Government’s rhetoric about the NHS increasingly focuses on health boards being held responsible for systemic failures across the whole of the Welsh NHS. Having shot its own fox over Betsi Cadwaladr and countless other scandals, the Welsh Government has a new stance. Instead of not being responsible for following expert advice, the Welsh Government now cannot be held responsible for what health boards do.
It’s a variation on the argument that the Welsh Government gives money to Wales’s health boards, and its only subsequent role is to monitor performance against targets and compliance with governmental priorities. Failures to reach standards are down to the health boards themselves. The threat of stick and more stick without carrot will force grossly clinically under-resourced health boards into ever more narrow compliance and box-ticking. In compliance culture, it’s not the actual achievement that matters—only achieving compliance.
Perhaps the following anecdote best demonstrates the Welsh Government’s attitude. Some weeks ago, while talking about the local government budget round, I spoke to a prominent member of the Welsh Local Government Association. With bemused disbelief, they told me of a meeting at which a senior Welsh Government minister expressed their conviction that the Welsh NHS was being well run.
Not well run, all things considered. But run well.
Mr Tufnell shares that delusion. As the Welsh government cannot be responsible for the manifold problems of the local NHS, the highly paid managers on six-figure salaries must be to blame – or at least that’s what he says on social media.
On February 14, he will meet with Hywel Dda UHB CEO Phil Kloer. Professor Kloer will doubtless agree that he and every other senior manager on the Health Board should be taken out and shot. Or maybe he’ll share some uncomfortable truths with Mr Tufnell about where the buck actually stops.