Health and Social Care

The political paradox of devolved healthcare

The Welsh Labour Government enjoys wielding the power of devolved healthcare but consistently deflects the blame for its failings writes Rob Sutton.

The concept of devolved healthcare is something of a dream for a health wonk. The idea of allowing 4 nations with similar population demographics to run divergent healthcare systems should have been a grand experiment for testing and comparing the best possible standard of care for UK citizens.

Instead, what lessons which might have been learned were muddled by unsystematic and politically contrarian policies. This has been best demonstrated throughout the course of the pandemic. Where the UK government has zigged, the Welsh Government has zagged.

No-one dares risk being caught too blatantly “playing politics” with a matter as serious as the Covid-19 pandemic. But that is inevitably what is going on. The UK and Welsh Governments are involved in a perpetual game of one-upmanship (they say “lockdown,” we say “firebreak.”) And as far as public opinion goes, this is a battle the Welsh Government in the Senedd are winning.

After peaking at 72% in late March last year, approval of the UK government’s handling of the pandemic has precipitously fallen to 37% in January. Meanwhile, the Welsh Government has enjoyed consistently higher public approval, ranging in the 70s throughout most of 2020, and it has only recently dipped to (a still very respectable) 58%.

Never mind that our policy approaches have been (branding contrarianism aside) largely identical. Or that the Welsh Government trails behind the other nations of the UK in death ratesinfection rates and vaccine rollout. The polling indicates support for the Welsh Government’s handling of the pandemic has remained consistently higher than that of Westminster.

This is something of a paradox. A polling lead of over 20% would suggest a radically different approach with markedly better outcomes. Yet despite the impression given that the devolved administrations are treading their own paths, political constraints have required each government stick close to that set out by Westminster. The risk associated with deviating are large and the benefits are slim. Better safe and unexceptional than independent and risky.

So why has the Welsh Government’s mediocre performance during the pandemic not impacted it in the same way the UK Government has suffered? And how, after 20 years of running the NHS in Wales, during which time health inequalities have gone unaddressed and waiting lists have bloated, have Welsh Labour managed to avoid the blame for the failures of their health policies?

The first reason is that devolution provides an effective bully pulpit. No-one utilises this more effectively that the Scottish First Minister, but Mark Drakeford has taken every opportunity to turn Welsh Government announcements into party political broadcasts. The Welsh Government hold an effective monopoly on messaging, and with the Senedd closed, the avenues for opposition have narrowed.

Where the Welsh Government’s policies are popular, Drakeford flaunts it as justification for his contrarian approach. When his administration misfires, blame is redirected quickly and without rebuttal. Mark’s menagerie of excuses has expanded to include his advisersthe Welsh publicthe English publicthe sale of alcoholthe sale of children’s toys, and bad weather.

The second is what we might call the “second-mover advantage.” The UK Government generally takes the role of “first-mover” when steering the nation’s approach to Covid (for the reasons of political precautiousness outlined above.) This gives the devolved administrations time to better shape their own policies, learning what does and does not work before implementing it themselves. The devolved administrations use public opinion of Westminster as a canary in a coal mine.

The third reason stems from the unbalanced power dynamic between the UK government and the devolved assemblies. Devolution has always been seen a compromise, aiming to appease secessionists by giving the UK’s constituent nations a sense of agency.

Yet the tendency remains to expect the UK to flex its economic and administrative might and lead the way when the Union faces crises. Constantly having one foot out the door makes for an unstable relationship, and when the situation deteriorates, the default is to blame Westminster, regardless of whether the specific policy area was actually within the purview of the devolved assembly.

The combined effect of these is that devolved nations are in a better position to cherry-pick policy ideas while escaping blame for their own mistakes. Therein lies the challenge for the UK government. The Welsh Government is lauded when it succeeds but manages to offload any failure onto Westminster.

This is not just a challenge for the UK Parliament. It is a challenge for Conservatives throughout the UK. How do we make a positive case for devolution, particularly for devolved healthcare during the current pandemic, when it is so politically unwieldy? Even when Welsh Labour is left in complete control of a policy, the blame has a habit of boomeranging back to the Westminster Tories.

How do we break Labour’s grip on the Senedd when the chips seem so overwhelmingly stacked in their favour? The best approach right now would require a focused programme of opposition to the most egregious of the Labour Government’s shortfalls and a positive vision for an alternative.

The Welsh Conservatives 5-point plan for the vaccine rollout is an excellent example at a time when the Labour administration’s languid approach is causing much frustration. We have a duty to hold them to account and to argue the case for a Welsh Conservative Government in 2021.