0:00:19 > 0:00:23Hello. Welcome to CF99 live from the Senedd in Cardiff Bay.
0:00:23 > 0:00:26On tonight's programme -
0:00:26 > 0:00:30What we want to see is standards being raised in the health service,
0:00:30 > 0:00:33and naturally changes need to be made.
0:00:33 > 0:00:37Health on the earth, or a bed 50 miles away?
0:00:37 > 0:00:40The controversial changes to the health service.
0:00:40 > 0:00:42And the wizard of Dwyfor.
0:00:42 > 0:00:46Does the name David Lloyd George still conjure up magic?
0:00:47 > 0:00:50Tonight we are joined by political commentator
0:00:50 > 0:00:53Darren Hill from Positif, the Liberal Democrat Aled Roberts,
0:00:53 > 0:00:56and Plaid Cymru chairperson, Helen Mary Jones. Welcome.
0:00:56 > 0:01:00There are few that disagree that the health service needs to be
0:01:00 > 0:01:03changed, but agreeing to the nature of the changes has been
0:01:03 > 0:01:07a huge challenge to health managers and politicians for years.
0:01:07 > 0:01:11This week, two of Wales's health boards
0:01:11 > 0:01:14announced their restructuring plans.
0:01:14 > 0:01:18And those plans are very controversial.
0:01:18 > 0:01:20James Williams presents the dilemma.
0:01:23 > 0:01:26An ideal opportunity to address create a national treasure
0:01:26 > 0:01:29- that is how some people regard the changes that are going to
0:01:29 > 0:01:31happen to the health service.
0:01:31 > 0:01:34A chance to restructure in order to ensure the highest
0:01:34 > 0:01:39standards without losing sight of the central principle -
0:01:39 > 0:01:42free healthcare for all throughout their lives.
0:01:42 > 0:01:47Without these major changes, there is concern that the service will fail.
0:01:47 > 0:01:50It is a complex problem but one that needs to be solved.
0:01:50 > 0:01:54There are hospitals in England that might become unsafe or are unsafe.
0:01:54 > 0:01:55That is our fear,
0:01:55 > 0:01:58that services in Wales will become unsafe, unless there is change.
0:01:58 > 0:02:01And that is why, of course, these proposals are suggested.
0:02:01 > 0:02:04We know that some services which are being offered in some areas
0:02:04 > 0:02:08are not of the best quality,
0:02:08 > 0:02:12and we also know that there is a shortage of expertise
0:02:12 > 0:02:17in several areas of the health service, for instance in Accident
0:02:17 > 0:02:22and Emergency, there is a shortage of clinical shortage in that area.
0:02:22 > 0:02:28So what we want to see is standards being raised in the health service,
0:02:28 > 0:02:30and of course changes have to be made.
0:02:30 > 0:02:33The health minister has also insisted that there is no
0:02:33 > 0:02:36more money available for the health boards
0:02:36 > 0:02:39but the pressure on the service continues.
0:02:39 > 0:02:45It is a problem in millions every year as we see that health is
0:02:45 > 0:02:48struggling to hit its financial targets.
0:02:48 > 0:02:53The Assembly has put more in this year,
0:02:53 > 0:02:58for the reason that demands have increasing in a way that they
0:02:58 > 0:03:02didn't expect, but we're seeing that people are putting more
0:03:02 > 0:03:06pressure on the health service.
0:03:06 > 0:03:09There is scarcely another political subject that incenses
0:03:09 > 0:03:12people more than the health service, and the parties each have
0:03:12 > 0:03:16different ideas about how to cope with the problem.
0:03:16 > 0:03:19A number of these changes have scared people, leading to several
0:03:19 > 0:03:24protests calling upon the government to protect local services.
0:03:24 > 0:03:27Politically, it is impossible to please everybody,
0:03:27 > 0:03:29but will there be a price to pay for the politicians?
0:03:29 > 0:03:32There are problems.
0:03:32 > 0:03:37And the greatest problems are possibly in the Assembly itself.
0:03:37 > 0:03:44I'm not a counsellor now, but I was a councillor for 25 years.
0:03:44 > 0:03:52You try to help and to accept people's attitudes the whole time,
0:03:53 > 0:03:56You try to be a friend to everybody,
0:03:56 > 0:03:59perhaps that's the way to describe it.
0:03:59 > 0:04:01They are in a difficult situation.
0:04:01 > 0:04:07So politicians and health officials have a lot of questions to answer
0:04:07 > 0:04:10as they try to piece together the jigsaw to recreate the big picture.
0:04:12 > 0:04:14James Williams.
0:04:14 > 0:04:17Well, the Betsi Cadwaladr University Health Board
0:04:17 > 0:04:19who are responsible for services across north Wales will
0:04:19 > 0:04:21announce their plans on Friday.
0:04:21 > 0:04:25Earlier on today I popped into one of the BBC's studios to talk
0:04:25 > 0:04:27to the chair of the board, Merfyn Jones.
0:04:27 > 0:04:32I asked him if shortage of money was the reason for the change.
0:04:32 > 0:04:35Obviously the financial climate is one factor.
0:04:35 > 0:04:38But I would say that basically, the change is due to
0:04:38 > 0:04:40the nature of the population.
0:04:40 > 0:04:45We all live to an older age, the population is getting older,
0:04:45 > 0:04:49and as that happens, the nature of diseases is changing,
0:04:49 > 0:04:56and so an increasing number of people are suffering chronic diseases.
0:04:56 > 0:05:03Things like diabetes, dementia, and a number of other diseases.
0:05:04 > 0:05:11What we need for these people is, where there is a genuine need,
0:05:11 > 0:05:14that they can go to hospital, but what they need is care in the home,
0:05:14 > 0:05:17or as close to home as possible.
0:05:18 > 0:05:24So we need to change the nature of the provision, so that the
0:05:24 > 0:05:29population as it stands, as opposed to how things were 50 years ago.
0:05:29 > 0:05:33That is of key importance.
0:05:33 > 0:05:37But as you talk about more care in the community,
0:05:37 > 0:05:39and more care from GPs and so on,
0:05:39 > 0:05:43some of these services are moving further away from people,
0:05:43 > 0:05:46that is a lot of centralisation as well.
0:05:46 > 0:05:48That is not care in the community.
0:05:48 > 0:05:51It might seem as though there's a contrast
0:05:51 > 0:05:53between these two extremes,
0:05:53 > 0:05:56but I think considering that what we need
0:05:56 > 0:06:00is a network of care in the community,
0:06:00 > 0:06:02but also then as you mention,
0:06:02 > 0:06:09we need specialist centres where there is genuine expertise
0:06:09 > 0:06:12with many people working together in order
0:06:12 > 0:06:16to ensure that when surgery is necessary,
0:06:16 > 0:06:20one is assured that that surgeon is somebody who performs
0:06:20 > 0:06:22that work regularly,
0:06:22 > 0:06:27is fully trained, and his qualified to do the work.
0:06:27 > 0:06:31You can't get that everywhere. You have to have specialist centres.
0:06:31 > 0:06:33How do you balance the two things?
0:06:33 > 0:06:37Some people say that the health boards in general
0:06:37 > 0:06:39are far too willing to listen
0:06:39 > 0:06:41to the Royal colleges and the deans and so on
0:06:41 > 0:06:47rather than listening to the users and what they feel is needed.
0:06:47 > 0:06:51I think we have to listen to users, of course,
0:06:51 > 0:06:55and to the profession, and we do so.
0:06:55 > 0:06:58And I do hope that at the end of the day,
0:06:58 > 0:07:02any decisions we make will be based on that.
0:07:02 > 0:07:06But I also think that we have to interpret
0:07:06 > 0:07:11the nature of the changes that have been not only in the population,
0:07:11 > 0:07:15but also in the workforce of the health service - the doctors
0:07:15 > 0:07:19that are required, the specialist nurses that are required.
0:07:19 > 0:07:24We are not talking about a general surgeon who could perform
0:07:24 > 0:07:27dozens of different operations.
0:07:27 > 0:07:30We are looking at people who concentrate on one
0:07:30 > 0:07:35type of highly technical and complex work.
0:07:35 > 0:07:39So we have two bring those two extremes together -
0:07:39 > 0:07:45the care in the community, and the specialised care when it is required.
0:07:45 > 0:07:48Professor Merfyn Jones talking from Bangor.
0:07:48 > 0:07:52Darren Hill, apart from closing a school perhaps,
0:07:52 > 0:07:54a change in the health service
0:07:54 > 0:07:56is one of the most difficult things for any government to do.
0:07:56 > 0:08:00This government has introduced this new system where the
0:08:00 > 0:08:04process is out of the hands of the politicians until the end.
0:08:04 > 0:08:08How is that meant to work, and does it work in your opinion?
0:08:08 > 0:08:13The way it's meant to work is to give the local boards
0:08:13 > 0:08:20the chance to restructure services following a clinical mindset,
0:08:20 > 0:08:24and put that before political considerations.
0:08:24 > 0:08:29I think it's a brave step, to be honest, to make this kind of change.
0:08:29 > 0:08:33Because one thing that is not acknowledged within that
0:08:33 > 0:08:39package is that there are too many hospital beds
0:08:39 > 0:08:43in Wales per head of population,
0:08:43 > 0:08:46so we also have to do something.
0:08:46 > 0:08:50Now this is the problem. There are two elements, clearly.
0:08:50 > 0:08:52First of all, a matter of style.
0:08:52 > 0:08:55And as Lesley Griffiths's style is completely
0:08:55 > 0:08:58different from Edwina Hart's style,
0:08:58 > 0:09:03that has caused an internal shake-up within the health service.
0:09:03 > 0:09:07Where Edwina was a lot more prepared to interrupt, Lesley is not.
0:09:07 > 0:09:11She works through the local port in a different way.
0:09:11 > 0:09:15But there is a basic problem.
0:09:15 > 0:09:20In order to change things and carry the public with you,
0:09:20 > 0:09:24you have to communicate and have a dialogue, and definitely,
0:09:24 > 0:09:30at Hywel Dda, and to an extent at Betsi Cadwaladr, that has not happened.
0:09:30 > 0:09:33Helen Mary, do you agree with that analysis, that this
0:09:33 > 0:09:36message is not being sold - the message that Merfyn Jones
0:09:36 > 0:09:39was trying to explain there to the public?
0:09:40 > 0:09:43The problem is that people are trying to sell a message
0:09:43 > 0:09:47rather than sharing the problems with the public on a local
0:09:47 > 0:09:50level, explaining what the challenge of the featureless,
0:09:50 > 0:09:52and looking for answers that are going to
0:09:52 > 0:09:55answer our needs in West Wales and in the North.
0:09:55 > 0:09:58They are taking a pattern of services that work well
0:09:58 > 0:10:02in the big cities of England and to an extent in South Wales
0:10:02 > 0:10:03where the population is bigger,
0:10:05 > 0:10:08but there have not looked beyond to Scotland or Canada
0:10:08 > 0:10:11where they have created different answers,
0:10:12 > 0:10:16for instance moving the doctors and nurses, and keep the patients local.
0:10:16 > 0:10:19There's a good example of that in Hywel Dda,
0:10:19 > 0:10:22in fact, the breast cancer service in Llanelli -
0:10:22 > 0:10:24surgery is performed in Llanelli,
0:10:24 > 0:10:27but surgeons go out to Bronglais, Withybush,
0:10:29 > 0:10:31so that people do not have to travel.
0:10:31 > 0:10:35You need to some imagination, and also to explain the problems
0:10:35 > 0:10:37to people and take them with you.
0:10:35 > 0:10:36Darren is right.
0:10:36 > 0:10:40They are trying to force changes and people without listening to them,
0:10:40 > 0:10:43and that is not going to work.
0:10:43 > 0:10:46But Aled, the members of these boards are not malicious people
0:10:46 > 0:10:50who want to provide the public with a poor service.
0:10:50 > 0:10:55They are trying to do the best they can on the profession's council.
0:10:55 > 0:10:57Why do you think things are going wrong?
0:10:57 > 0:11:00Because they have not convinced local leaders,
0:11:00 > 0:11:02to an extent, that there plans make sense.
0:11:04 > 0:11:07I think people are ready to change,
0:11:07 > 0:11:12people feel that the present system is not sustainable,
0:11:12 > 0:11:16but they have not been convinced about the details of the packages,
0:11:16 > 0:11:17especially in the north.
0:11:19 > 0:11:21I think the schemes regarding maternity units
0:11:21 > 0:11:24which are being transferred to Merseyside,
0:11:28 > 0:11:32people are asking questions about how that is going to work.
0:11:32 > 0:11:35From your point of view as a politician
0:11:35 > 0:11:36in one of the opposition parties,
0:11:36 > 0:11:39wouldn't your arguments have more credibility
0:11:39 > 0:11:43if you occasionally said, "Look, this decision is unpopular,
0:11:43 > 0:11:46but we think the board is right in this instance".
0:11:48 > 0:11:51Why can't you say, "this is where we think they're wrong,
0:11:51 > 0:11:55and we're prepared to support them with unpopular decisions,
0:11:55 > 0:11:56where we think..."
0:11:55 > 0:12:00Some of us have responded to the consultation with Betsi Cadwaladr,
0:12:00 > 0:12:08and have said fine, if you're going to implement services locally,
0:12:08 > 0:12:11perhaps we need to admit that we have to close, for example,
0:12:11 > 0:12:13a 100-year-old hospital.
0:12:14 > 0:12:19But questions do arise about some of the proposals,
0:12:19 > 0:12:23and above all, about the minister's unwillingness to discuss things
0:12:23 > 0:12:24on a political level.
0:12:25 > 0:12:28We accept that she has a status where it's difficult,
0:12:28 > 0:12:32but to some extent, political leadership is needed as well.
0:12:32 > 0:12:34And that has not been given by the government.
0:12:34 > 0:12:36But Helen, we have seen some hospitals in Wales
0:12:36 > 0:12:39that have been political footballs for years.
0:12:39 > 0:12:44- I'm referring in particular to Llandudno and Prince Philip.
0:12:44 > 0:12:48More than one party have kicked that football around.
0:12:48 > 0:12:50That is true, of course.
0:12:50 > 0:12:53And if you're responding as the councillor says,
0:12:53 > 0:12:56you're responding to the concerns of those who elect you.
0:12:56 > 0:13:00But I remember examples when the health board had convinced me
0:13:00 > 0:13:04and other people, local leaders, the service needed to be changed,
0:13:03 > 0:13:07and that we could then help them to sell these changes,
0:13:09 > 0:13:13even if they were unpopular, if they had put their case forward properly.
0:13:13 > 0:13:16But we are not in a situation where all the doctors
0:13:16 > 0:13:20and nurses agree this is the right way forward.
0:13:20 > 0:13:26We're also in a situation where they are setting a pattern of services,
0:13:26 > 0:13:31which do not work for a rural area.
0:13:31 > 0:13:35I am also concerned that there isn't a sense of leadership
0:13:35 > 0:13:38coming from the centre.
0:13:38 > 0:13:42This is something that is supposed to be a national service.
0:13:42 > 0:13:46It is not good for the Minister to say
0:13:46 > 0:13:49the Health Board should make all the decisions.
0:13:49 > 0:13:54Let's go back to Lesley Griffiths. These plans could be made,
0:13:54 > 0:13:59but only if the local community health council opposes.
0:13:59 > 0:14:02What should she do?
0:14:02 > 0:14:07What are you expecting her to do? Is this already rubber stamped?
0:14:07 > 0:14:13I think some plans, in West Wales and North Wales,
0:14:13 > 0:14:17will arrive at the Minister's desk at that time,
0:14:17 > 0:14:23she will have to be politically answerable to the plans put forward.
0:14:23 > 0:14:28She may have to intervene with some of these plans.
0:14:28 > 0:14:34She will be expected to do something, especially to communicate
0:14:34 > 0:14:39in a better way with the Health Boards haven't managed to do so.
0:14:39 > 0:14:43This is definitely the case in North Wales
0:14:43 > 0:14:48where she represents Wrexham.
0:14:48 > 0:14:52She will be under a great deal of pressure there, I think.
0:14:52 > 0:14:59Do you believe, there is a weakness in the health service
0:14:59 > 0:15:05with the Health Minister, that she cannot communicate the messages?
0:15:05 > 0:15:09As a politician of the same area? You know her well.
0:15:09 > 0:15:13She has taken the decision that her style is completely different
0:15:13 > 0:15:16to Edwina, the previous Health Minister.
0:15:16 > 0:15:22The system in Wales needs to change so much
0:15:22 > 0:15:26that you need strong leadership from the centre.
0:15:26 > 0:15:31I know it seems a mistake has been made when it comes to strategy.
0:15:31 > 0:15:36And the appointment? What about her as a Health Minister?
0:15:36 > 0:15:41I think we need a strong politician, whoever it may be.
0:15:41 > 0:15:45Lesley Griffiths is a strong politician.
0:15:45 > 0:15:49I agree, if you look at the government's front benches,
0:15:49 > 0:15:54yes, perhaps this is a decision for the Government,
0:15:54 > 0:15:59perhaps they're trying to give the decision to the health boards
0:15:59 > 0:16:03in order to avoid the political reaction.
0:16:03 > 0:16:06Like they are doing with schools.
0:16:06 > 0:16:09Tomorrow, will be the 150th anniversary
0:16:09 > 0:16:13of the of birth of David Lloyd George.
0:16:13 > 0:16:19An exhibition at the Pierhead Building in Cardiff Bay marks this.
0:16:19 > 0:16:25I went there earlier to speak to Richard Elfyn who played the part
0:16:25 > 0:16:31of The Wizard, the Goat and the Man Who Won the War.
0:16:31 > 0:16:36Richard, you were part of this production from the start,
0:16:36 > 0:16:41how did this production come to light?
0:16:41 > 0:16:49I and the author worked at a creative writing centre
0:16:49 > 0:16:52in Ty Newydd in Llanystumdwy
0:16:52 > 0:16:55at the former home of David Lloyd George.
0:16:55 > 0:16:58We were developing scripts.
0:16:58 > 0:17:02At the end of the process, actors came in to work on new plays.
0:17:02 > 0:17:05While we were there, we were talking about Lloyd George,
0:17:05 > 0:17:08in the room where he died.
0:17:08 > 0:17:13We had the idea of writing a play about his life.
0:17:13 > 0:17:17Why is his personality so attractive to playwrights?
0:17:17 > 0:17:20A lot of things have been written about him,
0:17:20 > 0:17:24hardly anything has been written about politicians at the same time.
0:17:24 > 0:17:30People always know things about his love life.
0:17:30 > 0:17:35You don't remember the good things he did while he was Chancellor,
0:17:35 > 0:17:39you think of the bad things.
0:17:39 > 0:17:43I don't think any Chancellor has had such an influential time.
0:17:43 > 0:17:50He was very influential with points such as national insurance
0:17:50 > 0:17:55and changing the house of Lords and The Parliament Act.
0:17:55 > 0:18:00He was involved with the people's budget. He had so much influence.
0:18:00 > 0:18:06When you talk to people, they will say, he did these good things,
0:18:06 > 0:18:10but there is a lot of things that aren't so good?
0:18:10 > 0:18:12That is where the drama comes in.
0:18:12 > 0:18:17There is this vision of a split personality
0:18:17 > 0:18:23which is amazing considering that he was so influential.
0:18:23 > 0:18:26He was able to hide so much of his life
0:18:26 > 0:18:30and we only heard about this after he died.
0:18:30 > 0:18:36He had been married for 50 years, as we play him in this play,
0:18:36 > 0:18:41but he had an affair for 25 years.
0:18:41 > 0:18:45Richard, thank you very much.
0:18:45 > 0:18:48A radio version of the play was played on Radio Wales
0:18:48 > 0:18:51last Sunday, can you find it on iPlayer.
0:18:53 > 0:18:57I have to start with the Liberal Democrat.
0:18:57 > 0:19:00Aled, was he your idol?
0:19:00 > 0:19:05I was brought up by my grandmother
0:19:05 > 0:19:11singing songs about Lloyd George giving the pension to old people.
0:19:11 > 0:19:14He was a great influence on liberal life in Wales.
0:19:14 > 0:19:18In England, to some extent,
0:19:18 > 0:19:23but he came from the radical Welsh background.
0:19:23 > 0:19:29I think Saunders Lewis said that it is possible to live too long.
0:19:29 > 0:19:36Perhaps people see something romantic in the young Lloyd George,
0:19:36 > 0:19:43but then get disappointed that he seemed to lose his way?
0:19:43 > 0:19:45Yes, right at the end of his career.
0:19:45 > 0:19:50That seems to happen to politicians. We don't know when to stop.
0:19:50 > 0:19:54It's important we remember the positive things,
0:19:54 > 0:19:58such as the pension.
0:19:58 > 0:20:02I liked the young Lloyd George, who was a nationalist,
0:20:02 > 0:20:06as well as a liberal.
0:20:06 > 0:20:12He was the Prime Minister when women got the vote for the first time.
0:20:12 > 0:20:15He wasn't very keen, but he had to do it.
0:20:15 > 0:20:20If he had finished after the war, then everyone would have remembered
0:20:20 > 0:20:27the positive things, and maybe not so much of the negative things.
0:20:27 > 0:20:32I agree with you. There is a time when a politician should step down.
0:20:32 > 0:20:37What hits me is, perhaps, we do not realise how much he did
0:20:37 > 0:20:43because some of the problems he solved are now forgotten.
0:20:43 > 0:20:48If you look at Cymru Fydd, everyone thinks that it was a programme
0:20:48 > 0:20:50of self-government.
0:20:50 > 0:20:54You had other questions which were just as important at the time,
0:20:54 > 0:20:59but they've moved on?
0:20:59 > 0:21:03He was the Prime Minister after the Irish uprising.
0:21:03 > 0:21:09He managed to reach a compromise to solve one of the most basic problems
0:21:09 > 0:21:15in British politics for the past 50 years.
0:21:15 > 0:21:20He managed to solve a few things.
0:21:20 > 0:21:25In the last two or three years, when he was leading the government,
0:21:25 > 0:21:29a coalition government, which is always difficult,
0:21:29 > 0:21:32as I'm sure everyone recognises now, especially you Aled,
0:21:32 > 0:21:36when he was leading that coalition government.
0:21:36 > 0:21:42A few decisions he made, such as selling seats in the House of Lords
0:21:42 > 0:21:46has taken the shine off his achievements.
0:21:46 > 0:21:50And split the liberal party at the same time.
0:21:50 > 0:21:54It is interesting that this 150th anniversary has come.
0:21:54 > 0:21:56He was a believer in universal benefit,
0:21:56 > 0:22:01he believed that everyone was entitled to benefits.
0:22:01 > 0:22:08We can see your members voting to cut back on that in some fields,
0:22:08 > 0:22:11perhaps it is down to compromise?
0:22:11 > 0:22:16To what extent are you wearing Lloyd George's cloak nowadays?
0:22:16 > 0:22:18We're living in a different world now.
0:22:18 > 0:22:24A number of radical things are being introduced to benefit schemes.
0:22:24 > 0:22:29Last week's announcement that pensioners will be earning
0:22:29 > 0:22:33a lot more and taking the level of pensions a up a level.
0:22:33 > 0:22:35Pensioners will earn £650 a year more
0:22:35 > 0:22:38by the time the changes are put through.
0:22:38 > 0:22:42There are changes underway and things are going to change.
0:22:42 > 0:22:46Lloyd George showed he was ready to take these radical decisions
0:22:46 > 0:22:52when it came to Ireland or votes for women.
0:22:52 > 0:22:54They were not popular at the time.
0:22:54 > 0:22:58Are you in Plaid Cymru, the illegitimate children
0:22:58 > 0:22:59of Lloyd George?
0:22:59 > 0:23:02I don't know about that.
0:23:02 > 0:23:05It is interesting to see there are no liberals
0:23:05 > 0:23:09left in Lloyd George's patch.
0:23:09 > 0:23:13But we have inherited the radical aspect that he had.
0:23:13 > 0:23:18Even though the present Government are doing some good things,
0:23:18 > 0:23:21I don't think Lloyd George would be impressed
0:23:21 > 0:23:25with things as the bedroom tax and cutting back on child benefit.
0:23:25 > 0:23:29This is a question for you.
0:23:29 > 0:23:32Which party would Lloyd George be today?
0:23:32 > 0:23:36I think he would be sitting as a leader,
0:23:36 > 0:23:42either with the Liberal Democrats or with Plaid Cymru in the Assembly.
0:23:42 > 0:23:46I'm sure he would try to get some sort of compromise
0:23:46 > 0:23:50between the two parties that you are part of.
0:23:50 > 0:23:57He was one of the figures that could merge the different elements.
0:23:57 > 0:24:01Thank you very much to all three of you. That is all for today.
0:24:01 > 0:24:04We will be back at the same time next week.
0:24:04 > 0:24:07Thanks for watching, good night.