Welsh Health: Special Debate Week In Week Out

Welcome to the Temple of Peace and health in Cardiff. We are joined by

people working on the front line in the NHS. There are patients and

politicians here as well. One thing they all agree on is the fact that

without the NHS we would be lost. It is saving and changing lives every

day, but when things go wrong, our lessons being learned? And how

honest I be about the state of the service? -- how honest are we?

We have seen record cuts, rising waiting lists, and damning reports

that show patients are dying whilst waiting for treatment. In parts of

Wales, things are so bad that we are told that doctors do not want to

work there. The big question is, why is this happening, and when there

are failings, are people too afraid to speak out? We have seen Betsi

Cadwaladr in the headlines again with calls for a corporate

manslaughter and host investigation about the outbreak of C diff. Some

say that too many people are being failed because the system is

gridlocked. We asked the Health Minister to join us for tonight's

debate, but he refused. No one from Welsh Labour wanted to take part.

But this is what Mark Drakeford had to say about the NHS when we spoke

to him last week. Demand is raising your own year and last winter the

real pressure is on the NHS came from people aged 85 and above being

admitted through error and emergency departments. We have worked really

hard over the summer with our colleagues to try to make sure that

the coming winter is not like the last one. The Welsh health service

remains the truest of any of the other four -- of any of the four

offending nations to the principles of Bevan. We are determined on

wheels to continue to provide a National Health Service that his

planned and provided on the basis of clinical need. -- in Wales.. That is

the sort of service that they note in Wales. They will continue to

receive. Ann Clwyd will want the Minister --

warned the Minister not to bury his head in the sand. She warned that

bed and would be turning in his grave. You are surging, is Ann Clwyd

right? My natural inclination is to give reassurance. We have a lot of

highly talented clinicians who are working very hard but another

service that is under duress. We have CVS and genuine concerns.

People are working hard, I could hear about in there, what is that?

The organisation and the way that the system works does not always

work in our favour in getting our patient's treatment in the time

frame in which we would like them to have it. In particular, patients who

have urgent or a life-threatening conditions do not make it on to a

timescale target. These are the patients who are most at risk in

many ways. Are people dying on waiting lists? It is very difficult

to be certain of that, but we have some details from the cardiac

surgery waiting list that people are coming to harm in Wales, which does

not seem to happen in the rest of the UK. There is a suggestion that

outcomes in Wales. . What is arguably union members telling you

about the stresses and strains upon them? We hear it day in, day out.

Short-staffed, stressed, sickness levels. Vacancy management, which

means unfilled posts and so on. But what I would say, is that I work

with the Welsh government and NHS Wales. The government is facing

unprecedented cuts that the Welsh government has had to face in the

past. What are members do understand is that the pressures have not been

brought up on the Welsh NHS by Welsh government, but by the UK coalition

government that is funding the Welsh government, and that cut in funding

to wheels is passed on to the Welsh government and the NHS in Wales. But

it is Welsh Labour that is managing the NHS in Wales. Correct? Yes, but

they can only manage the cake that has been given to them. It is only

so big and it has shrunk your own year. It will continue to shrink if

the current Administration continues to fund Welsh government in the way

that it is. Unison, you are claiming London. They give you the money and

it is up to Labour in Wales to decide how much of that cake is

divided? Absolutely. Oliver members on the front line are finding it

tough, no one is going to run away from that. Those are the discussions

that we have to have day in day out. Nobody is running away from

that difficulty, but we also understand without difficulty

emanates from. How often are people telling you, as the union wreck, I

cannot do this. I cannot live at the service that I am being asked to do?

All of the time. What we have is a front-line service that is under

enormous pressure. Probably the greatest pressure that we have ever

seen in Wales. I think back to the halcyon days, if you like, when we

had unprecedented investment and funding in the NHS and will Wales --

NHS in Wales. I never had any of those concerns raised with me and my

colleagues in those days. This is a new phenomenon that we are dealing

with. You are nurse, you are working on the front line. Does that

register with you? Yes, it does. What is it like being on the front

line and trying to deal with the never-ending tide of people coming

through the front door, expending the best of care. -- expecting. I

you able to cope? It is depressing. Some staff say that there is not

enough hours in the day to complete the paperwork, never mind do the

job. What I am seeing particularly in my brand of nursing, is that

patients are stuck with this for ages, because the resources are not

out there in the community for patients to be discharged. So our

work becomes complex and confused by that factor. Morality is low? Yes,

indeed. Not an exaggeration. Thank you for coming here tonight. Can you

tell us how old you are? 80. And are you now almost completely blind?

Yes. How long did you have to wait for treatment that you did not

receive? 84 days for the first appointment and another five weeks

before I had an injection. So you went blind waiting for treatment?

Yes. So those people who manage those waiting lists, can you tell us

what your life is like now? I cannot read, I cannot do anything. I cannot

read my music, play the keyboard, my guitar. It is all gone. Why? Do you

feel any bitterness? I do. There was no need for it. Two opticians signed

the forms the day I went there to say that my I was bleeding. -- eye.

They would not accept them. You are GP. GPs are also facing hefty

workload. The workload for GPs has gone up by 50% in the last ten

years. People are consulting is much more often, they tend to be older,

they tend to have much more complex problems. They are expectations are

higher. Are debuting out? Do they want to leave the job that they have

given so much of their lives to do? I have heard of areas in Wales where

doctors will not go and work. There are areas where there are

difficulties recruiting GPs. I do not know whether it is to do with

the nature of the job, what we're hearing from from young doctors is

that there is concern for their families not having access to jobs.

Maybe they do not like rural areas. Speaking to my colleagues, morale is

lower than it has been for a long time. Bureaucracy is high,

expectation is high. You are representing the help with

management in Wales. What can you say to Mr Lewis, who went blind

because the waiting list was so long that that was allowed to happen? I

am so sad that you had that experience. It is true to say, and

we have heard tonight already, that the NHS does not get it right all

the time. Patients should be able to expect a certain level of care and

treatment. They should be able to expect safe and quality treatment

and respect when they are receiving that treatment. It makes me very sad

and my members at the NHS Welsh Confederation very sad to hear

this. What is at the heart of this? Is it incompetent management and is

that at the heart of the problem? What this underlines very clearly is

that the NHS in Wales needs to change. It is under unprecedented

pressure. There are 70,000 members of staff directly employed who, we

have already heard, are feeling under pressure. If we are to support

them and help them with their morale, we need to demonstrate that

the NHS must move its services. You are Conservative MP from North

Wales. We have already heard that morale is low. There have been some

major problems. But we have also heard, some people seeing here, our

resources are being starved. It is the Westminster Government, they are

not listening. They are not giving us the money that we need to get the

job done. The reality is spending is increasing and Wales get the funding

to do the same. It is all about the lack of priority. They manage to

find £52 million burning a hole in a unplanned expenditure in

nationalising and airport at a time when the NHS was at its most

critical time, when thousands were having operations cancelled. That is

all about priorities and the Welsh Labour government has got it wrong.

Kirsty Williams, you are a Lib Dem. You show government with the

Conservatives. On their arguments about the share of this cake and the

way it is being shared out? We would like to see the way money flows

changed but ring fencing budgets means the money coming down for NHS

services in the ring fenced. When we are spending 40% of the Welsh budget

on the health service, we are spending more per head on health

services across the border, why are the outcomes worse? Why have we got

a government that does not acknowledge the difficulties the

service is facing and start listening to front line members of

staff who often have the solutions to some of these problems. Why are

we not listening to them and why are we not joining up services so the

resources we have got are used appropriately? I met a family member

whose relative is languishing on a hospital ward. Elin Jones, one of

your MPs has called for a manslaughter enquiry today. I can

hear a lot of politics going on here. This is a difficult thing to

get right. Isn't it easy to sit on the opposition benches? No it is

not, especially when you hear the first Minister question how great

things are in the Welsh NHS and pick a fight with the UK government, pass

blame on. We have to stop this blame game and it works both ways. We have

to have responsibility taken for the Welsh NHS. It is a scandal

politicians are not here tonight. They should be here and they should

be taking responsibility. Let's talk about care. You are the older

Persons Commissioner in Wales and published a report that said you are

not happy with the way older people are treated in hospital. Just

summarise the key issues. The average age of patients is over 80.

My report looked at 12 areas. There was improvement across Wales and

there was a lot of activity going on, but there is still a long way to

go. Not getting the basics right for older people in hospitals, care for

people with dementia and basic communication for people. Do you

have an issue with the way people are looked after? Aren't they all

Angels and what is the experience for some elderly people in hospital?

Elderly people tell me how extant in -- outstanding their care has been

and I do not want elderly people to go into hospital because for many

their care will be great but they also tell me how we failed to get

the basics right. Martin, you are from the Royal College of nursing.

Not everybody gets it right. We have seen some of that evidence from the

film and the people in this room. When you have the appropriate number

of resources, outcomes are definitely better. One of the

challenges is that people who work in the health service get up, do a

good job when frequently they cannot do that good job, morale drops and

we have evidence since 2011, 30% of people in the service said morale

was so low they fight like leaving the service. This year this has gone

to 60%. The impact of not doing your job properly does have an impact on

patients and those delivering the service. Peter Walsh, you have

published a report today in which you said that it was a shocking

report, showing health boards across Wales are not listening to the

warnings about patient safety. This was the third time we published this

research. Each time there has been a worrying lack of implementation of

patient safety alerts. These are life and death actions designed to

protect patients from things that commonly go wrong and killed and

seriously harm people. This year there was an increase in compliance

but there were two health boards with multiple numbers of which

alerts that they had not implemented, 15 of them going past

the deadline that was said and health Inspectorate Wales could not

provide one shred of evidence that they had taken any serious action.

We have the chief executive of the health Inspectorate of Wales. Where

have you been throughout all this? The point I would make to the

patient safety alerts is we have been following up, we build those

through into the inspections we undertake. The issue we find is one

of consistency. Things can be done very well in one part of a

particular health board and yet that learning is not consistently spread.

That is an issue that needs to be followed through by each of the

organisations, to make sure these things are picked up and implemented

consistently. How can it be left over five years and for the

regulator not to be able to evidence they have given a warning to one of

these health boards about things that are designed to save people's

lives? We have fed back on these as part of our reviews. We have not fed

back on them explicitly in the context of patient safety alerts and

that is one of the areas of learning we would want to take away. Let's

turn to our opinion poll which we commissioned across Wales and it

asked 750 people how confident they are that they will receive a good

standard of care in the Welsh NHS? It turns out 72% said they were

confident. But more than a quarter, 25% said they were not. You are

happy, aren't you, with the service you have been getting? My wife

suffered with chest pain back in August and I took her down to the

accident and emergency department, triage saw her straightaway, they

took her into the accident and emergency department. It seemed as

though they will all concentrating on Heather. Kind people doing a good

job? yes, there was a nurse reassuring us at all times,

communicating well. The doctors telling us the results of the blood

tests, they then kept her in because they thought she had a heart attack

and again the care, the doctors... He wanted to say it is not all bad

out there. There are lots of people in the NHS who care about people. I

think so. We get these horror stories... If it was all the same.

Unfortunately, there has been a 290% increase in complaints about our

service in the Welsh NHS. One of the key problems is, it takes too long

to get a response to a complaint. You complain and it can be months,

years sometimes before the system response. Dorothy Wilson, you

complained, didn't you? After your partner died. Yes, I did. How did

you get on with your complaint? I try to do it on my own, try to find

out what had happened. When I moved on from that and wanted to know why

things had gone wrong, that was when the health board and the Trust

actually turned against me and it became very bitter. Were you

distressed, unhappy, frustrated at the? I am afraid it was much worse

than that. I was grieving for a partner I had lost but on top of

that, to be treated in the way I was, it pushed me to the limit. As a

lawyer you deal with a lot of complaints. It is a typical story.

We are currently dealing with 160 complaints. The timescales that the

government, the Welsh government legislation has put in place, the

timescale targets were in exceptional circumstances up to six

months. It should be a 30 day response. None of our complaints

have been within a six-month period. We have received that 72% of people

said they are broadly happy with the system as it is working, so we have

to remind ourselves of that, that it is not all dysfunctional and that

would be a distortion to say that. Absolutely. I only see the cases of

people who come to me with grievances. When the outcomes are

poor... The signposting has improved in relation to advising patients

where they need to go if they do have a complaint. 72% of people said

they do not know where to complain. I think it has improved

significantly since the previous procedure, however, I have a concern

about the current procedure insofar as to aspects of it, the delays

patients are experiencing and the independence of the procedure. It

seems like a good point to bring in new, Julie Bailey, because you have

been there as far as complaints are concerned. You are well known across

the country for being the person who brought the major issues at mid

Staffordshire to the nation's tension. But you prayed a price. --

paid a price. Not everyone in your town was delighted by your

response. From what you hear hear, is this all depressingly familiar

and how do you go about complaining? Can you encourage

people in any way? People contact me from all over the country and the

first thing I tell them is the NHS complaints procedure is a torture.

It is not the procedure itself, it is the people within it, the

behaviours of the people within it. The NHS is renowned for denial, it's

why your minister is not here tonight. They will not say there is

a problem. We have not got that learning environment within the NHS.

Complaints should be a rich source of information. Alan Birtwistle,

there is a culture of denial. I know that NHS managers and leaders in

Wales are working extremely hard to get an open and transparent culture

and to be able to respond properly to complaints and learn lessons and

really learn lessons is important, but what I would say is in our

hospitals, surgeries and clinics, it is important that people are able to

raise concerns as well as complaints. What we are talking

about are some of the eager issues which clearly have to be addressed.

We have to be really patient focused and patient centred. Professor, you

listened very patiently and attentively to this. You had

something to say in the phone earlier about the way the system is

working. I am concerned about the complaints procedure in England. We

had a good complaints procedure, there are about 14,000 complaints

that are not resolved and had to go further. They were looked at by an

independent panel. That panel was got rid of. It ended up in only one

in the 375 complaints being properly investigated. That is very worrying.

Professor, you lead the outbreak into the C diff -- investigation

into the C diff outbreak. I you concerned about the culture of

denial? I was concerned that they did not know what was going on. They

were not denying, they did not know the figures that were on the wards.

It was not going to the board itself. What about whistle-blowing?

There had been an attempt by some of the infection-control staff. It took

six months foreign emergency meeting to be held. From July to January.

Should there be more whistle-blowing? Should we give

people the protection to blow the whistle, in the interest of the

patients and everyone else working? It has to go into the system and be

acted upon very quickly. Some NHS staff have tried to do that and have

been knocked back and knocked back by senior management and then in the

end they give up and leave the organisation. When we tried to look

at some of the figures, here in Cardiff we saw lots of cases that

were not coded properly. We do not have the data to reassure ourselves

that if something was going on then we would know about it, and if we

did not abated that alarms would be raised. -- if we did know about it.

We are not getting the truth out, it is your job as the inspectorate to

get the truth out. We are part of the system which is responsible for

providing assurance in the way that Enzo working. The health board are

managing things themselves, then we go and test that things are

happening correctly. What about whistle-blowers? Would that be

helpful? There are already fossil blowing policies. I think that by

the time you get to something which is called whistle-blowing it is

possibly a step too late. I would like to think that we develop a

culture where people are raising concerns long before that. Can I

just ask you, we have spoken to some of the members of the BMA, which

have told us some shocking stories and are far too nervous to come

forward and speak. Is that a common experience? Welsh NHS employers have

just been trying to introduce a whistle-blowing policy which till

has a punitive element to it, rather than openness. We have had to

campaign to maintain the free speech of doctors. Do they feel

intimidated? Very much so. In terms of whistle-blowing, we had a staff

survey recently amongst NHS staff in Wales, and it showed that staff are

more inclined to be open and to report complaints and concerns than

they ever have been in the past. So that kind of cultural thing that you

are talking about is not there yet, but it is living in the right

direction. In terms of the whistle-blowing policy, it is an

interim policy at the moment which is being reviewed with a view to

taking on board... I have to interrupt, where either

whistle-blowers? There is a clear indication from the staff survey

that people are prepared to come forward. They say they will, but I

be doing it? They say that they will. The policy that we have at the

moment is an interim one which will be reviewed in March to take on

board the issues that came out of the Mid Staffordshire inquiry. I

have to go back to you, we do not have a government minister to

respond to this. This issue of whistle-blowing. People in many

cases blow the whistle because they care and because they want things to

work. Do you accept that we have to back off a bit, because there are

suggestions that the culture is too oppressive and allow people to play

a more active role in running their own NHS? I would want to challenge

the idea that it is oppressive. There is a move towards more

transparency. I would agree that by the time it gets to

whistle-blowing, and whistle-blowers should be treated properly and be

supported, actually, because we should use complaints of any sort at

any level as an opportunity to improve services. That is the point

that the professor wanted to make, complaints can be useful. System

should be in place to monitor patient safety, standards of case,

-- carer, infection rates. Loan from complaints. I would agree with that.

If all of this information was available to the public, rather than

head and in papers are only available after Freedom of

Information request, then all of this information on mortality rates

and infection rates being available with mean that people could see how

things were improving or what needed to be done. There is a lot of big

news on the horizon for the NHS in Wales. We have been talking a lot

about reconfiguration on the landscape. Hamish, you lead the

case. You think that the case for change is a good thing? I think that

the NHS in Wales, as it is across the UK and more widely, is in -- is

under huge pressure. We have to change. The NHS has changed hugely

in what we are trying to do over the last 50 years, but we have not

changed much in the way that we try to do it. We have to change so that

we provide better care. 300 clinicians did not get in the ring

and come forward with a proposal for the new programme because they

wanted to save money, they did it because they wanted to improve care

and have better standards. Is change necessary? PS. But the staff in

Battersea do care about their patients and they work extremely

hard under extreme pressures. We see union members coming to us because

they want to get the carer. They give exceptionally high carer, but

when they see in the media the onslaught of complaints about them,

they take it very personally. Is it the media's fault? Mistakes have

been made, but the front line staff work extremely hard. There will be a

lot of people cheering you right across Wales, because staff to work

hard. What we are talking about tonight is how we can make the

system work better. You are an economist, you cat health matters.

-- you look at health matters. Is the ideal one of centralisation.

That we cannot have the NHS that we are all used to on our doorstep for

any more time. That we need to change the system? The system does

need changed. We have heard enough evidence just in this room to change

that. One thing which has not been mentioned as our own individual

responsibility. Public health has not featured in this debate at all.

There are some aspects of health that cannot be prevented. The NHS is

there to fix the problem is there to fix the problems to which we as a

population have caused. I think that our expectations as to what the NHS

can do for us also need to change as a population. The system does need

to change, it is completely fragmented. We have integrated

health board in Wales and yet they are not integrated. We still talk

about hospitals and we talk about primary care. There is a thought

that this is all about the carer of the patient, the individual. The

care of the patient. You have terminal cancer. There is a

treatment that could help you. Tell us about that. It is called

selective internal radiotherapy treatment. And it involves pitting

radioactive series through the artery, into the liver, and the

attack the cancer without actually touching the liver. It is expensive

though. It is very expensive. And therefore they will not give it to

you? They will not fund me. I have had to fund it myself at a cost of

£18,000. Yearly savings? Yes. I have had to borrow money as well to fit

the bill. What do you say to those at the top, to remind them about the

patient? I feel that I have been kicked into touch. Is this NHS good

enough, or do you want it to be better? I think that in my case the

NHS could have gone partway to funding my treatment, even if they

cannot do it all. We will stop beer and remained ourselves that there

are many people who are looking for this NHS to work. This debate could

go on night. We hope that it is as open and transparent as everyone

agrees that it needs to be in the future. I would like to thank

everyone here at the Temple of Peace, and to you for watching. Good

night.