Mark's Speeches
Short Debate - Inquiry into physiotherapy services for people living with neurological conditions PDF Print E-mail
Written by Mark Isherwood AM   
Wednesday, 15 May 2013 00:00

 

 

Over 100,000 people are affected by a neurological condition in

Wales.

 

There are a large number of neurological conditions,

including:

 

- conditions that emerge from a traumatic incident

 

- conditions that can be lived with for decades, such as multiple sclerosis – MS

 

- conditions where there is a high prevalence such as Parkinson’s disease, with 1 in 500 affected.

 

- and rarer conditions with a lower prevalence such as Wilson’s disease  with 1 in 30,000 affected.

 

For the majority of neurological conditions, physiotherapy can offer:

 

  • the prospect of maintaining and improving mobility and

independence, for example, in people with spina bifida

 

 – slowing the speed of a progressive condition 

 

- or the prospect of rehabilitation and a return of function – for example incases of stroke or head injury.

 

Physiotherapy services cover a range of specialities, from neonatal care right through to palliative end of life care.

 

They uses physical modalities or treatments, exercise, moving and handling, to advise, assess, treat and enable people to manage their condition.

 

They can make a huge difference to quality of life, yet too many people are either not able to access services or receive only short term rehabilitation.

 

The Assembly Cross Party Group for Neurological Conditions has recently undertaken a review of Neurophysiotherapy services in Wales - and as Cross Party Group Chair I launched its resulting Inquiry into physiotherapy services for people living with neurological conditions in February  at the Physiotherapy Department in Ysbyty Glan Clwyd, Bodelwyddan.

 

It was instructive and  a pleasure  to meet patients and Neurophysiotherapists there – and to discuss the issues highlighted with Betsi Cadwaladr University Health Board’s Head of Therapies, Iain Mitchell.

 

It is almost a decade since I first met Iain Mitchell to discuss his pioneering self-referral model, something I subsequently championed.

 

I therefore welcome the fact that the first recommendation in the Neurophysiotherapy report relates to this – and will say more about this later.

 

The inquiry found that although there is evidence of good practice within physiotherapy services, availability of specialist Neurophysiotherapy services across Wales is inconsistent.

 

Having taken evidence from people who have neurological conditions, the Chartered Society of Physiotherapy  and Local Health Boards, the Neurophysiotherapy report suggests that the Welsh Government should establish a working group to take forward 12 key recommendations.

This report makes serious and well informed recommendations which I now hope will be given full and proper consideration by both the Welsh Government and our Health Boards.

As a contributor to the report, who has Parkinson’s, stated - people with Neurological conditions need access to specialist physiotherapy as soon as possible after diagnosis - but some services miss this, and she therefore calls for “more physiotherapists with specific neurological experience and knowledge”. 

 

The inquiry concluded that most of the 100,000 people living with a neurological condition in Wales could benefit from physiotherapy or from self managed exercise classes with the right support.

There are networks of talented physiotherapists across Wales, who, with the right training, support from specialists, and by working through multidisciplinary teams, could make a positive impact to the lives of people living with neurological conditions.

 

Philippa Ford, Policy Officer for the Chartered Society of Physiotherapy in Wales said,

“The recommendations will provide a focus for the Health Boards to examine current services and address some of the challenges. The setting up of a working group (if Welsh Government agrees to this suggestion) will provide an opportunity for physiotherapy services to learn from each other and share innovative practice."

And the Chair of the Wales Neurological Alliance, Joseph Carter, added:

“Physiotherapy can make a real difference to people living with neurological conditions, but there are still barriers in accessing it. We are calling on the Welsh Government to consider our report and deliver the services that our service users need.”

 

It is in the context that the Cross Party Group on Neurological Conditions would like the Welsh Government to establish a working group to take forward the following 12 recommendations:

 

The report recommends:

 

That Local Health Boards expand self-referral so that anyone with a neurological condition who would benefit from physiotherapy can self-refer to local physiotherapy services.

 

Self-referral is popular with patients. It is a patient-centred

approach that increases ease of use, convenience, portability,

patient influence, choice, engagement and involvement in care,

and promotes self-management.

 

The pilots in other parts of the UK showed that people who self-refer to physiotherapy take fewer days off work and are about half as likely to be off work for onemonth, compared with those referred to physiotherapy by a GP.

 

Self-referral to physiotherapy is efficient for other healthcare

providers too, reducing costs, time and resources. Patients often see a GP several times before being referred to physiotherapy, by which time their condition may be more longstanding and difficult to resolve.

 

In May 2012 Abertawe Bro Morgannwg University Health

Board confirmed that in the short time self referral has been in operation for musculoskeletal physiotherapy,  the clinic has resulted in a reduction in waiting lists and an increase in the number of patients seen.

 

This specific service model has been expanded to neurological conditions in Scotland to improve the lives of service users there.

 

Where trialled, self-referral has not led to an increase in demand for physiotherapy, apart from in physiotherapy services that have a history of under-referral. A proportion of people who would normally have seen their GP first simply opt for a more direct route to solve their problem.

 

The report recommends that Local Health Boards establish regular neurological multi-disciplinary teams so that service users can access physiotherapy and other support. These teams must have access to appropriate rehabilitation facilities including the ability to refer to inpatient beds.

 

Across Wales there are emerging examples of best practice

to bring together physiotherapists, occupational therapists, speech and language therapists and other clinicians into conditions specific or neurological clinics.

 

Three multi-disciplinary teams involving a range of

Health and Social Care professionals established across North Wales, have demonstrated benefits for both people living with

motor neurone disease and the professionals providing care

services for such a complex progressive degenerative disease.

 

The report recommendsan expansion in the number of clinical specialist neuro-physiotherapy roles so that every Local Health Board (LHB) has a specialist neuro-physiotherapist for Aquired Brain Injury, Multiple Sclerosis, Parkinson’s disease, neuro muscular disease (NMD), spinal cord injury and stroke - and specialist neuro-physiotherapists to provide support for rarer conditions such as spina bifida or Huntingdon’s disease.

 

 

The report recommendsthat Local Health Boards organise specific neurological skills rehabilitation courses for generic physiotherapists in order to improve skills within the community and within hospitals.

 

The report recommendsthat Local Health Boards review access to all training across professions in order to maximise appropriate professional skills development within limited training budgets.

 

The report recommendsthat the Health and Social Care Committee considers whether the All Wales Medicines Strategies Group should appraise equipment and technology and question whether they are cost effective as part of the upcoming inquiry on access to medical technologies in Wales.

 

The report recommendsthat the Local Health Boards evaluate and standardise the use of specialist equipment for patients with complex needs so a common level of service can be expected when patients transfer closer to home, or to their own home, for continued rehabilitation.

 

The report recommendsthat the Welsh Government considers commissioning a review of hydrotherapy provision across Wales to ensure those people with neurological conditions who might benefit from hydrotherapy are able to access it, both as in-patients and out-patients.

 

The report recommendsthat the Welsh Government continues to work with Local Health Boards to fund an expansion of telemedicine and telecare technology across Wales.

 

The report recommendsthat Heads of Therapies promote the use of validated outcome measures so that physiotherapy for people living with neurological conditions is provided for the appropriate length of time that is commensurate to their needs.

 

The report recommendsthat the National Exercise Referral Scheme be expanded into all neurological conditions to support individuals to self-manage their condition.

 

And the report recommendsthat Local Health Boards review their specialist physiotherapy facilities to determine appropriate access for community use.

 

 

There are definitely some ‘quick-wins’ in relation to these recommendations – on specialist equipment, on training and support and on the expansion of services to meet patients across Wales, which could be incorporated into a new Delivery Plan.

 

It is encouraging that the Welsh Physiotherapy Leaders Advisory Group has been looking at the cross party Inquiry and considering action and response to the recommendations – and that they will be producing a report themselves.

 

 

After all, it is my understanding that  no new money has gone into physiotherapy services since the paediatric neuromuscular post and paediatric palliative care/transitional posts in 2011.

 

A special thanks are due to the Chartered Society of Physiotherapy and all of the individual physiotherapists who assisted in the development into tis Cross Party Report into physiotherapy services for people living with neurological conditions.

 

The report’s findings are based on responses from service users, information from Local Health Boards and oral evidence from professionals.

 

They provide a legitimate basis for discussion and action.

 

The Cross-Party Group for Neurological Conditions would support further research undertaken by Local Health Boards or the Welsh Government to examine the issues raised further –

 

but above all we would welcome a commitment from the Minister that he will establish a working group to take forward the 12 recommendations.

 

 

 

 
 
Welsh Conservative Debate ‘Delivery Unit’ PDF Print E-mail
Written by Mark Isherwood AM   
Wednesday, 15 May 2013 00:00

 

 

 

The Welsh Government has too often favoured political targets masking inaction over delivery targets that are clear and measurable.

 

Housing is key to Health, Wellbeing, and Community Regeneration, yet Welsh Government Housing targets have been limited to loosely defined “Affordable Housing” only – when their Stats Wales website shows that Labour led Welsh Government slashed the supply of new Social Housing by 70% in the first three Assembly terms, as waiting lists, overcrowding and hidden homelessness ballooned.

 

Whereas 25,676 new social dwellings were built in Wales in the last decade of UK Conservative Government to 1997, only 7,492 new social dwellings were built during the first 12 post devolution years in 1999.  

 

For them now to complain now about the shortage of Social Housing to meet current need is sick making.  

 

The present Welsh Labour Government has again limited its target to affordable homes, side stepping the Whole Market approach it claimed to support and failing to deliver the overall house building target called for in the Communities, Equality and Local Government Committee Inquiry into the provision of affordable housing in Wales.

The Principality Building Society had said that there had not been sufficient emphasis on whole-of-market housing and, in particular, working with house builders.

The Home Builders‘ Federation called for a whole-market solution to providing housing in general, rather than just affordable housing. By increasing overall supply, they argued, more housing would be made affordable to more people.

Yet this Welsh Government failed to listen.

By excluding the Whole Market from their targets, they failed to acknowledge that only by increasing overall supply will more housing be made available to more people.

In 2012, witnesses to the Communities, Equality and Local Government Committee Report into the provision of affordable housing in Wales stated “the housing crisis is with us now”.

 

The Welsh Labour Government can’t say they weren’t warned.

In 2004 the Welsh Consumer Council stated “Unless house-building and renovation of existing homes is stepped up, Wales could face a housing crisis in coming years”.

House Building in Wales is at its lowest level since the Second World War.

 

Although the European Commission has recommended that we implement a comprehensive housing reform programme to increase supply and alleviate affordability - the Group Chair of a North Wales-based construction company told me that building homes in Wales is no longer profitable and they cannot continue to spend money unless the end product at least covers the cost”.

 

Only this week, the CBI stated “The construction industry across the UK is finding it tough but here in Wales undoubtedly it is even worse” – blaming the absence of the pump-priming mechanisms seen at UK Government level, and additional regulations which put house builders in Wales at a disadvantage to those in England - and calling on the Welsh Government to reform and actually spend wisely.

Labour led Welsh Government has subsidised rather than tackled the deep rooted causes of poverty, worklessness and dependency.

 

 

Wales, remains the poorest part of the UK, with the lowest levels of economic activity and wealth creation per head of all the devolved countries and English regions - despite a doubling of devolved budgets and billions in European regeneration funding.

In fact, Wales has been bottom since 1998.

 

The Welsh Government has failed to deliver for the most economically deprived parts of Wales as West Wales and the Valleys - which includes four of the six North Wales counties’ is still the poorest in the UK.

 

Workless households across the UK rose by 200,000 under the previous UK Labour Government, and one in three working-age people in Wales were workless under Welsh Labour Government prior to the change of the UK Government, double the UK average.

 

Since 1999, the poverty gap in Wales has widened and social mobility stalled.

 

The UK is once again the top destination for inward investment in the European Union – but Wales has slipped from top to bottom destination amongst the 12 UK nations and regions.

Fuel Poverty targets have been missed and the 2013 UK Fuel Poverty Monitor calls for a detailed action plan setting out how and when Fuel Poverty will be eradicated in Wales - involving real partnership with the private, voluntary and Community sectors.

 

Wales has the highest Child Poverty in the UK - rising since 2004 - and record youth unemployment - rising since 2005.

 

All too often money has washed over communities rather than watering their roots.

 

As Oscar Wilde said “ideals are dangerous things. Realities are better”.

 

 

 
 
Welsh Conservative Debate on Wales as part of the UK PDF Print E-mail
Written by Mark Isherwood AM   
Wednesday, 08 May 2013 00:00

 

We call on the National Assembly for Wales to recognise the benefits of Wales being part of the United Kingdom and the importance of ensuring the future of Wales within a strong and evolving United Kingdom.

We support Amendment 1 regarding the Part 1 Report by the Commission on Devolution in Wales, but will be opposing Amendment 2.

Wales and the United Kingdom have a massively mutually beneficial relationship.

 

“The global reputation of the United Kingdom is a powerful lever in attracting jobs and investment to Wales, while Wales’ continued presence in the union serves to enrich the entire UK.

 

But the evolution of devolution is taking us to a crossroads.

 

One direction could take us to separation, the other to a proud and confident Wales within a more federalised UK.

 

Our cousins across the globe from Australia to North America are proud Unionists, but equally proud of their own individual State legislatures-  each with unique law making and tax raising powers, separation of power between legislature and executive – and, in most cases a bicameral system with upper and lower Chambers.  

 

Except when it comes to sport the people of Wales are proud to be both Welsh and British - and support for independence remains below 10%.

 

The people of the UK share a history, culture and experience, within which the Romano - Britons of the West played a key role.

 

Wales within the UK shares a strong position on the international stage and permanent membership of the UN Security Council, as well as being represented by 270 UK Embassies across the globe.

 

The UK’s single Market with shared currency-  Tax and regulatory regime - allows Welsh businesses to trade freely in the second largest European economy and the 6th largest economy in the world.

 

The pensions of almost 650,000 people in Wales are guaranteed by the UK Welfare System, 85% of private sector employees in Wales are employed by UK owned companies and 138 Million journeys take place each year across the border between England and Wales.

 

Two thirds of the population of Wales live within 50 miles of that border.

The Mersey Dee Alliance area shares a £17 Billion economy and the Mersey Dee Alliance  has highlighted the interdependence between North East Wales and North West England, the only part of the UK with a contiguous urban area divided by a  National Boundary.

When the Assembly Social Justice and Regeneration Committee reviewed the Structure of Policing in 2005, our Report noted “that criminal activity does not recognise National or Regional boundaries and that cross border partnerships must reflect operational reality”.

 

 

As I stated in May 2009 during the Welsh Conservative Debate on Cross  Border issues. “The border between England and Wales is long and porous and as a result, cross-border movements in health and education services are a long established fact of life- reflecting geographic and demographic realities … Devolution provides an opportunity for Wales to do things differently and for different approaches to be road-tested on either side of the border –But the objective must be to do things better rather than being different just for the sake of it. We must avoid at all costs a slate curtain in services between these two British Nations.

Our long and porous border should be a cause for celebration and cooperation rather than an obstacle to efficiency and effectiveness”.

 

One of the tragedies of the Dark Ages is that so much of the history of the Britons and their intimate connection with the Britons of the West was lost.

We are all Britons, Cymry our fellow countrymen and women, Welsh or Waelisc the term of derision used to describe us by the invader, daring to describe us as foreigners in our own land.

Our legacy and destiny was always to reclaim the lost lands, reunite the tribes of Britain and rebuild Albion as a global symbol of hope and justice.

 

If we succumb to the seductive poison of those who would destroy Britain and betray the inheritance of Millennia, our shared Islands would at last fall beneath the shadow, betrayed and dismembered at home, emasculated and controlled overseas .

We must refuse to cast aside the very principles which have become the foundational truths of our Greater Britain, which so many of our best citizens have given their lives to defend.

 

As a constituent emailed yesterday: “I utterly despise separatists in Britain.  They wish people to prosper or suffer to a line on a 16th Century map. The people either side of this line are part of the same families and lead the same way of life.”

 

Abraham Lincoln was proud of his Welsh Heritage. As he said - “Above all And Beyond All the Union must survive”. As he also said “separation would be a backward step”. Let what he said in the context of the United States also apply to our United Kingdom.   

 

It remains the enduring duty of we Britons of the West, East, North and South to safeguard our shared  sovereignty - celebrating our diversity, languages and cultures, embracing our commonality , defending our Unity. 
 
Debate on Public Service Reform PDF Print E-mail
Written by Mark Isherwood AM   
Tuesday, 07 May 2013 00:00

 

Effective Public Sector Reform is about giving power to the people.

 

As Cultural Historian Peter Stead has said “We need to completely redefine the nature of Public life in Wales so that people are doing things other than administering the lives of others or, as is more often the case, recommending ways in which lives should be administered”.

 

We must encourage everyone who wishes to leave their community a better place within a Welsh Big Society – even if this does present a challenge to Wales’ Political Leaders.

 

After all, the Big Society concept is in many senses more Welsh than English.

 

As Dan Boucher states in his book “the Big Society in a Small Country” -

 

“Given that  perhaps the most important feature of the Big Society is an approach to problem solving which is bottom- up and rooted in the local community, rather than top-down and dependant on the state, the most striking cultural point of connection between Wales and the Big Society is the Nation’s long-term identification of itself as a community of communities”.

 

In our communities, there are individuals, enterprises and charities that are better placed to tackle many of the problems our nation faces.

 

Transferring power from Government to them, can help us provide better services more efficiently –

benefitting the most vulnerable by turning the power thing upside down.

 

I am a Director of the Wales Participatory Budgeting Unit, a Social Enterprise which gives people choice, bringing real community participation - ensuring that limited funds go where they are most needed.

 

When the Wales Participatory Budgeting Unit ran workshops for the Social Services Improvement Agency Wales on the potential for participatory budgeting to devolve portions of respite care budgets, Staff from 14 Local Authorities were impressed at how solutions identified by carers themselves could really work and were relatively inexpensive in comparison with larger Council – introduced services.

 

When I attended a Round Table meeting with the Wales Council for Voluntary Action, and partner organisations –

The professionals present highlighted the need to involve the Voluntary Sector in the development of Primary Care Services across Wales.

 

They championed co-design and co-delivery in public services, bringing together the independent third sector and the public sector with the citizen and the community at the centre, reducing demand on other services.

 

They feared that the move to community care would be more expensive when it needn’t be if we change the way we do things -

 

Unleashing Third Sector expertise that the state sector does not have –

 

 Allowing it to play a strategic role with Government, delivering a whole service approach that puts people in communities rather than service deliverers at the centre.

 

Transition Networks are starting to take root in Wales, connecting, supporting and training communities as they self-organise and rebuild resilience – with neighbours working together in places such as Holywell to make their communities stronger and happier through local projects.

 

Personal budgets were rolled out in England in 2008 under Labour – and Scotland’s Self-directed Support Act places a requirement on Local Authorities to offer individuals four choices on how they can obtain social care, direct payment, or the person directs the available support, or the local authority arranges the support - or a mix of these - and a requirement to point people towards available advice and support.

However, as MS Society Cymru state: “local authorities in Wales are currently required to offer direct payments as one option for social care, but it is limited as it does not offer the freedom that Personal Budgets in self-directed support could do”.

 

Local Area Coordination and Asset Based Community Development is working in Wales to restore power in respect of Social Welfare to individuals, families and communities, with Swansea hosting their next study group.  

 

Credit Unions serve the community – despite Welsh Credit Unions signing up to the UK Government’s Credit Union expansion project to deliver sustainability.

 

The WCVA called for real community ownership in the future of Communities First – but new arrangements for Communities First clusters fail to ensure that the Community is involved by right in decisions that affect it.

 

Our charitable Hospices can help the NHS and Social Services in Wales  deliver more – but are struggling to get more than one year’s service level agreement- and some have none.

 

Public services are Commissioned from the Private Sector in Wales, but the lack of smart Commissioning means they cost more.

So much good is happening in Wales, despite a “Big State”  Welsh Government which fails to engage.

As the former Arch Bishop of Canterbury said “Community must push back against managerial and functional approache- preparing people to understand themselves and the Society they inhabit, not to be cogs in the wheel”.


 

 
 
Welsh Conservative Conference Speech PDF Print E-mail
Written by Mark Isherwood AM   
Saturday, 27 April 2013 00:00

 

Protecting the public is paramount but complex.

The Labour Welsh Government believes that a devolved Criminal Justice system should form part of the long term vision of Welsh Governance – and Plaid Cymru believe there should be a transfer of powers over justice as a whole, including Police, Prosecution, Probation, Prison, and Young Justice.

 

Welsh Conservatives believe that the introduction of Police and Crime Commissioners marked an act of real devolution, empowering local communities to have their say on Policing priorities and to hold an elected representative to account.

 

We have not seen any evidence which leads us to support the devolution of Policing or Criminal Justice and we are concerned that the devolution of Policing could compromise cross-border working between Police forces.

When the Assembly Social Justice and Regeneration Committee reviewed the Structure of Policing in 2005, our Report noted “that criminal activity does not recognise National or Regional boundaries and that cross border partnerships must reflect operational reality”.

AND frankly, the thought of a Welsh Police Force under the state Socialist control of the First Minister of Blame, Carwyn Jones, or Loony Leanne Wood, absolutely terrifies me.

Their Socialist Parties have spent the last 14 years subsidising rather than tackling the deep rooted problems which are holding Wales back.

 

Labour and Plaid Cymru Welsh Government Ministers - abstained and Labour and Plaid Cymru backbenchers - voted down the Assembly Legislative Consent Motion relating to Police and Crime Panels in February 2011.

 

In a prior letter to Assembly Members, the UK Minister had said that rejecting the Legislative Consent Motion would not stop Police and Crime Commissioners from being introduced; it would merely prevent the special arrangements for Wales, which allow a Welsh Government representative on the new police and crime panels, from taking effect.

 

Once again these nasty Socialist Muppets had put their knee-jerk political protest against everything the Conservative led UK Government does before the interest of the people of Wales.

As Former AM Baroness Randerson subsequently said in the House of Lords: “there is something rather foolish in the Minister concerned – Carl Sargent - negotiating a solution, putting it to the Assembly and then abstaining on his own solution—which he had agreed with Ministers in Westminster”.

Labour and Plaid Cymru have said that UK Police Reforms and Budget Reductions would mean higher crime, but recorded crime is down more than 10% under this UK Government and people’s experience of crime has fallen to its lowest level since the Crime Survey for England and Wales began.

Crime in Wales fell 9% last year, with the biggest drop in Gwent, down 17%, followed by drops of 8% in North Wales, 6% in Dyfed Powys and 5% in South Wales.

 

However, only this month a Labour AM responded to new figures showing a 10% fall in crime in Wrexham by warning that this fall in crime could be short lived if planned Budget cuts go ahead, even though the budget cuts were implemented from 2010.

 

Shadow UK Policing Minister David Hanson has criticised police budget reductions, despite Labour backing equivalent cuts.

Labour planned cuts of around 12%, and Labour’s March 2010 UK budget had included police funding reductions of £545 million by 2014.

But Labour has also supported savings proposed by Her Majesty’s Inspectorate Constabulary (HMIC) and the Police Arbitration Tribunal which essentially match the UK Government’s own plans to make savings from police budgets over this parliament.

 

This month the UK Peace Index reported that rates of Murder and Violent Crime had fallen more rapidly in the UK than many other Western European Countries and that South Wales is the most peaceful urban area in the UK.

 

AND a Cardiff University study suggests the number of people treated in hospital in England and Wales after violent incidents fell by 14% last year.

The congenital malcontents in Cardiff Bay should check their facts before carping –

  • But as Carwyn Jones’ namesake, “CJ”, said in “the Fall and Rise of Reginald Perrin” :

 “He didn’t get where he is today by serving Welsh people”.

 
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