In its research and publications Nova Cambria will address the full range of policy questions and challenges that Wales faces. Undoubtedly, however, three areas will predominate – the economy, health and education. The following notes provide an outline sketch of Nova Cambria’s approach and priorities.
Key themes are:
- Infrastructure – laying the foundations for a flourishing economy
- Shared prosperity – Developing the economy for every corner of Wales
- Global Wales – Selling Wales to the World and bringing the World to Wales
- The Digital Economy – Making Wales the Digital Destination
- Wales Means Business – Making Wales the best place to do business.
In developing new thinking around these themes we will address the following fundamental problems of the Welsh economy:
- The productivity gap: a function of low investment and low skills.
- The ownership gap: the relative absence of Welsh-owned firms and institutions.
- The infrastructure gap: the result of years of under-investment.
- The age gap: the effects of the Brain Drain on our long-term prospects.
Undoubtedly, the main problem facing our economy is persistently low levels of productivity which, in turn, are reflected in low Gross Value Added (GVA) per capita and low earnings. Productivity in Wales is approximately 80 per cent of the UK level which in turn is about 80 per cent of the level across the Group of Seven (G7) advanced countries.
Productivity is vitally important because it is the principal determinant of pay levels and job sustainability. In addition, we have the highest relative poverty rates in the United Kingdom, with nearly 200,000 children – that’s approaching one in three – living in poverty. Our goal, therefore, should be to develop an economic plan that will help generate and then share prosperity throughout Wales.
Wales invests around £6 billion and 40 per cent of its budget on health and social services, much of it directed to the Health Boards and Trusts. Due to this dominance, health spending inevitably impacts on every other area of policy-making.
The NHS is currently in the most financially challenging period of its history. Demand and costs pressures are rising every year and in 2014 the Nuffield Trust estimated that pressures in Wales were rising by around 3.2% before accounting for efficiency growth. Despite UK Government increases health spending and the Barnet-driven consequential for Wales, all the signs are that pressure are mounting.
In July 2018 the Welsh Government published its Plan for Health and Social Care Wales. This recognizes that we no longer live in the world in which the NHS was originally designed. People live longer, medicine can do much more, technology is transforming the way we live, life styles and expectations have changed, and treating people in hospitals is only a small part of modern health and social care. There is also a recognition that a public health approach is key to a healthy society. However, and crucially, it avoids the issue of integrating health and social care services into a national service which, given the interdependency associated with multi co-morbidities associated with an aging population, is an urgent policy imperative
A background consideration is the need to tackle wasteful spending on health. The OECD has observed that around one fifth of health expenditure makes no or minimal contribution to good health outcomes. Not only that, but data from many countries including Wales show that about one in ten patients are harmed by hospital admission.
Health policy priorities include:
- Integration of health and social care into one national service for Wales.
- Development of an inclusive, contributed Welsh insurance scheme for care home provision for older people.
- A shift in emphasis from hospital-based to GP-led primary care health provision in the community.
Nova Cambria is also concerned with addressing four compromises made by Aneurin Bevan when he established the NHS in 1948:
- Continued private practice by consultant specialists.
- Continued status of GPs as private operators of a public service.
- Isolation and subordination of some functions (mainly Public Health) from the otherwise comprehensive NHS.
- Absence of democratic local accountability at all levels of the NHS.
Once renowned for its education performance, in recent decades Wales has been falling behind. This has been most evident in our declining position in the OECD’s Programme for International Student Assessment (PISA) rankings for children between 11 and 14 at Key Stage 3. These show Wales to be performing less well than England, Northern Ireland, and Scotland, and to be below the OECD average.
A problem with policy development in this field is that experience has shown that good practice travels badly. A major challenge is to discover how practices in high performing schools can be transferred to those performing less well. This also applies within schools.
Existing research has demonstrated that school improvement depends on:
- Leadership, self-evaluation and external support.
- The ethos and atmosphere within schools.
- Innovation in teaching and learning.
- Data gathering and use.
- Addressing under-achievement and basic skills deficits.
- Enhancing the role and status of teachers
While it is relatively easy to list these requirements it is harder to ensure good practice is implemented. Areas where policy attention should be focused include the following
- Methods for building upon existing initiatives with early years.
- Identifying weakness in development across age-groups, for example the transition from primary to secondary, and from secondary into tertiary and higher education.
- The role of Welsh-medium education and its interface with English-medium schools: how can the binary linguistic nature of Welsh education be minimised?
- What is needed in terms of curriculum development. For instance, how should the Welsh Baccalaureate initiative be progressed?
- The need to address the underlying problems of the Welsh economy arising from educational under-performance and low skills, in terms of literacy and numeracy and vocational skills more generally.