04/07/2012 CF99

Good evening and welcome to 30 minutes of discussion.

Tonight, more for less than the health service,

as the amount of money is cut, is it fair to ask surgeries

to lengthen their hours and hospitals offer services in Welsh?

We will speak to a new think-tank.

But is there enough creative thinking in our politics?

The three guest tonight are Plaid Cymru Assembly Member

Alun Ffred Jones,

Dr Tomos Dafydd from Aberystwyth University

and Reverend Aled Edwards, the chief executive of Cytun.

It is more than 60 years since Aneurin Bevan launched the NHS.

His hope was that health care for everybody would lead

to less demand for services as the population's health improved,

but the pressure has increased as funding has decreased.

Demand for improved services and more answerable services

have also increased.

On July 5th, the new National Health Service starts.

Have you chosen your family doctor?

Free health care for everyone from the cradle to the grave,

that was the vision of the National Health Service.

It celebrates its 64th anniversary tomorrow.

Happy birthday to the health service,

but things have changed since it was created.

Around 80,000 people are currently employed in the health service,

it's the biggest employer in Wales.

It claims some 40% of the Welsh Government's budget,

more than £6 billion a year.

But the money will be cut in the future.

There are proposed plans to centralise services

and this has led to concerns that some hospitals will be downgraded.

The Health Minister has denied this although she says

that the present system is unacceptable.

Many people agree.

The way to move forward will be to depend less on hospitals

and carry out more work closer to where the patients live

with the help of GPs or more in the community.

But how can more be offered for patients with less money

such as services in the Welsh language?

This is what the conference in Cardiff discussed.

The response by the BMA to the Government of Wales' consultation

is that the language shouldn't be a priority in a time of recession.

The Government believes that the most important thing

is health care and treatment.

This strategy isn't going against the points we have made.

People need to be able to access services in Welsh.

It should not just be a choice.

This is a priority.

There was another warning from the body representing doctors.

There has been talk of surgeries open later at night

and on the weekends.

Our workload is heavier in Wales than in England.

The percentage of people over 75 in Wales is higher

than in other places.

We are already finding it hard to recruit GPs in Wales.

It would be terrible to try and change the contract just for Wales.

Perhaps doctors would think of going elsewhere.

But in the end, it's views like these that is important.

The doctors and nurses are not to blame,

they are stretched as they are.

We have to do our best to keep our health.

When I had my child in hospital, they were doing their best,

but you could see that they were working so hard,

they really need more staff.

I had a home birth and I used the midwife in the community,

I could not have asked for better.

So there is plenty to celebrate and plenty to think about.

Is it fair to say that perhaps the health service

is the biggest problem for the Welsh Government?

I would argue that we need a strong economy

and that influences people's health.

If people did not work, then it will affect their health.

It is a huge challenge.

But in view of the budget, it is a massive challenge.

There are many things in that report

and one thing mentioned treatment closer to the people,

but before this can be done, the health boards have to explain

how the treatment can be carried out.

The GP contract was a big mistake.

They had more money for doing less work.

We need to integrate GP services with the NHS.

You talked about explaining to the public,

and that is a problem.

Any change in the service will worry people.

It is understandable.

Politicians are not very good at explaining what is happening.

It is very difficult for people to get a hold of the issue

even those who are managers within it.

Explaining any differences will be one of the biggest

challenges for the health service in the next few years.

Tomos Dafydd, things are tight, but our demands are growing.

We want to see a doctor at our convenience.

We want a bilingual service. But something has to give.

The maths don't really add up here, do they?

It is not a case of throwing money at the problem.

The present economic climate means that the Budget

will be tightened in the coming years.

But throwing money isn't the right answer.

We have already seen greater investment in the past decade,

but people in Wales are waiting longer for treatment in Wales

than in England.

Is Andrew Lansley doing a better job?

I believe there is scope to follow England's lead.

We needed to devolve more power to our doctors

and give more independence to those who understand the health service.

We should not centralise so much.

Why is there a civil war by doctors in England, then?

I'm sorry?

There is a lot of opposition to any change to the status quo.

We have seen this when Tony Blair introduced foundation hospitals.

But the truth is the BMA on these changes and on the Welsh language,

they are going against the public.

Changes take place to the health service every five years.

There is no lont-term vision.

It causes chaos and put more pressure on those involved.

If changes are made, then they must be sensible ones.

They must be long-term plans.

The doctors were against the establishment of the BMA

in the first place, what needs to be done?

Should we listen to the doctors or should we just ignore them?

You have to consider professional people.

You cannot run the health service like a business.

But you could use business techniques, couldn't you?

You come to a point, but let us be honest about this,

you have a situation where a former bank manager

can walk away with £30m is laughable.

This idea that we have a lack of money for the NHS is laughable.

Why are we putting so little resources into our NHS?

It is not the situation here, it is global.

Our richest business people are keeping money in offshore accounts

and that is not helping the situation.

But what about GP contracts? Patricia Hewitt introduced them.

Everyone thinks that it was a mistake.

GPs and used to work long hours and they could work overnight,

but perhaps they will be called upon to work more hours now.

We have to give them a lot of resources to the health service.

I sometimes believe that if we gave them more resources

then there wouldn't be any pressure on our doctors and nurses.

I think that our expectations of our doctors and nurses are too high.

They all say how busy they are.

We have to talk about the politics of our resources.

I'm not saying that we should privatise the NHS

but I see there is a scope to make more of the private sector.

If we can use the private sector to increase the capacity

of the arts and further education.

It we can use the private sector to increase the capacity

that will release the health service to look after the most needy.

This week I saw service in Neath Port Talbot Hospital being cut.

This is something that the Government said wouldn't happen.

The PFI hospital costs more than £66 million to build.

By the time it would have been finished,

the local health board would have paid £220m for it.

Does is this going against the principle of business

or is it suggesting that those in charge weren't good at contracts?

It is good that we stopped developments like that

but the challenge is massive because of the pressure.

What about the importance of the Welsh language in the service?

Is it affordable?

I do not think economy is what is important.

Numbers and budgets have nothing to do with the Welsh language.

A Welsh-language service is a right.

I am thinking of those under five for example

who can't speak English.

A lot of people would agree, but it does come down to money.

It does not cost more to employ someone who can speak Welsh

as it does to employ someone who speaks English.

They can offer the same service.

-So, only employ those who speak Welsh?

-It is just being pragmatic.

A five-year-old boy may not be able to speak English

or you may have a patient suffering from dementia,

a Welsh-speaking professional may be needed in a circumstance like that.

This is all to do with training. This needs long-term planning.

You cannot do it overnight. Young people have to be trained medically.

People may need to learn the language.

I have family experience,

when someone is ill, they will appreciate having someone

who can speak to them in their first language.

The BMA's opinion belongs in the stone age.

It's a foolish thing to say.

An individual's identity and dignity is linked to the language.

It doesn't conform to our understanding of equality

in society either.

You'd never say that somebody's culture or heritage

is not important.

It's a very foolish thing to say and they should withdraw it.

Thank you.

They pay taxes, they can join the Army and they can marry,

so why can't young people aged 16 vote?

Well, although they don't have the power to change the law,

there were calls from members of all parties here today

to lower the voting age in the Welsh elections.

But would young people welcome that?

These are the views of pupils from Ysgol Bro Myrddin.

You start paying tax at 16 and...

..well, the Assembly gets the money so if we pay,

it's a good idea that we have a say on what they do with the money.

When we're 16 and 17, we start having lessons on politics at school

and we get a lot of information on politics

so I think 14 is a bit young,

especially if they don't understand how the system works,

but I think 16 is the right age.

I think 16 should be the voting age

because, if they get the vote, the government will feel

it needs to do more to win the votes of young people.

I have a voice, why can't I use it?

Young people have plenty of problems

and they have opinions,

so why can't we have a voice?

Tomos Dafydd, they're old enough to be parents, to join the Army,

but they're not old enough to vote.

-Why?

-I'm not keen on the idea of lowering the voting age to 16.

I acknowledge that children of that age have far-reaching rights

but if we're serious about lowering the voting age to 16,

we would surely have to lower the legal age of being an adult

from 18 to 16, and that would raise all kinds of question

in relation to young people's rights in a court of law and so on.

I'm not keen on changing the system.

18 is the international norm, not only in the European Union,

through the members of the EU, but in America and Australia as well.

It's an empty step...

But apathy is a problem and to encourage young people to vote,

isn't this the way to involve them in politics?

I don't accept that argument.

They lowered the voting age to 16 on the Isle of Man a few years ago

and only one in four took advantage of that opportunity to vote

compared to over 60% of the wider electorate.

There must be better ways of cultivating interest.

For example, adopting a primary system, which is used in America.

-Aled?

-Break the monopoly of the political leaders

and give the public a chance to choose parliamentary candidates.

Aled, 18? 16? 14 as Alun Michael has suggested?

I wouldn't go as far as 14 but there are arguments in favour of 16.

But why? We know that what we used to call school-leaving age

is going to rise over the next few years to 18,

but school-leaving age isn't the voting age.

You'd give the vote to anyone who agrees with your views,

but, the truth is, you have to use reasoning,

and that's not very precise.

Where young people can get married and form life-long relationships,

where then can also be guardians, I think young people...

But they can't drink or drive. There are things they can't do.

You have to look at the reasoning

and there are more responsibilities placed on young people these days

and I think they should have more right to make decisions.

If the process was to change, the whole system would have to change.

These young people wouldn't go to the polling stations,

they would vote over Twitter, don't you think, Alun Ffred?

As long as it's safe from being abused, I'm not opposed to that.

But I do think there are questions, if you can vote when you're 16,

why can't you drink or drive when you are 16?

You have to look at the reasons.

The Plaid Cymru policy is that we're in favour of the age being 16.

I'm a little bit more sceptical about it.

-Not that I'm opposed...

-18?

That's what I would say, but my party says differently.

-Have you told them?

-I haven't dared say anything.

They were very keen on 16 this afternoon and I'm with them.

I think I even voted with them.

So is it going to happen, Tomos? Is it inevitable?

-Will it happen sooner or later?

-I don't think so.

There isn't a consensus on this issue, as far as I can see.

I sense the status quo will remain in the long term.

The established international norm is that the voting age should be 18

and I don't see a scientific argument in favour of changing that.

Right, we'll leave that there.

Education, the economy, houses, bilingualism -

some of the subjects Gorwel, a new think tank, will discuss

over the next few months.

The Conservative and deputy presiding officer, David Melding,

established it, and its aim is to encourage creative cross-party debate

on policy issues in Wales.

Aled Edwards, is there enough broad thinking,

what they call blue sky thinking, happening in Wales?

No. There's room to improve.

I asked a prominent politician when I started working with the Assembly,

what makes a good politician?

The answer I got,

when you think you've had a good idea, you know it's not.

I think that's pretty accurate.

You have to know what effect your decisions will have

on a variety of people.

I welcome this. Anything that encourages discussion and debate,

and encourages new ideas in the Welsh context is to be welcomed.

That is a problem, Alun Ffred,

We have the Institute of Welsh Affairs,

which tends to feed every party.

Maybe those parties need individual think tanks.

Well, I agree.

And to break up the consensus on the left, which tends to develop,

because that's where Plaid is, generally, that's where Labour is,

that's where the Welsh Lib Dems are as well, I'd say,

so having a think tank which is to the rights,

although David Melding's not to the right, of course, is a good idea.

And what Wales needs is an open discussion

on issues like our status, on devolution,

rather than the party political arguments

that run along these lines.

Tomos, Gorwel has parked, I think that's the term,

the constitutional question by saying,

"We want to welcome people who believe in independence

"but are right wing."

Is it possible? Doesn't almost every subject raise questions

in relation to the role of this place

compared to other governing bodies?

There will be tensions on the constitutional question

between those who are involved in Gorwel,

but I'd say the priority is to reform public services,

develop a sustainable green economy in the long term,

and to promote a bilingual Wales.

There must be scope for cross-party co-operation on those issues.

Alun Ffred, politicians always want us to think that you're very busy...

I am busy!

..thinking about the next speech and the next conference.

Do you have time to think? You've been in government.

Do you think strategically about the long term?

One of the main problems of being in government

is the lack of time to think.

I'm amazed that we have Ministers in Wales

who have been on the front bench for 12 years.

I'm surprised they have time to visit the toilet.

Having institutions like this is a good thing

-but I'd like to know who's paying for it.

-That's always a clue...

Who is paying, Tomos?

That's beyond my pay grade. I'm not going to reveal anything.

But it's encouraging to see so many people across the political spectrum

taking part in this.

There are nationalists - Cynog Dafis was at the launch,

there were Tories

and many people who haven't been involved in formal politics.

That's very encouraging.

The launch was very positive, on the whole.

Ieuan Wyn Jones said he intends to establish a think tank too.

Have you heard anything about that?

Recently? The party think about establishing one every three years.

We haven't managed it yet.

I don't think the party should do it

but someone's who's at arm's length from the party.

The Labour Party has one

How important is it that it isn't too party orientated?

It's vital.

We want to be able to decide what sort of people we want to be.

In the modern Wales, that has to be complex

and we need the ability to be more than one thing

and to see outside the conventional patterns.

To be more, if you like, than we used to be as a culture.

But the IWA has been extremely successful and influential

and has brought people who aren't political in to debate all kinds...

But there is a danger that there's only one of those.

Definitely. In a small country, that's always a danger.

That's why I welcome any body that has an independent voice.

There are at least five in Scotland.

Is this another sign of the process maturing in Wales?

I think it's very beneficial.

The saddest aspect of our politics

has been the political and creative monopoly of the left

over the last few decades.

Any development which encourages pluralism in our democracy

and challenges the status quo and the cosy system in Cardiff Bay,

is a positive development.

But, as Alun Ffred suggested, when we talk about the right wing here,

we're talking about the right wing in terms of Wales.

It's nothing like the right wing

that exists in the TaxPayers' Allience and so on.

We're talking about the right of centre here.

There's room for those in the middle ground to take part in this.

It was very encouraging to see a broad cross-section of people.

Andrew RT Davies should have a think tank. That would be out on the right.

But as a former member of the All-Wales Convention,

what's vitally important so that we confirm our legislative powers

is that we define the principles which form our laws,

rather than them being administrative items.

And thinking it out in a principled way is very important

as we develop our legislative tradition.

It won't happen until we have financial responsibility.

That's when the true politics will start.

And as a member of Gorwel, Tomos, where will you do your thinking?

There's a welcome for people from all parties

and those who are not formally involved in politics to take part.

The man on the horizon!

That's right. Thank you very much to the three of you.

That's it for tonight. We'll be back at the same time next Wednesday.

-Until then, good night.

-Good night.