16/01/2013 CF99

Hello. Welcome to CF99 live from the Senedd in Cardiff Bay.

On tonight's programme -

What we want to see is standards being raised in the health service,

and naturally changes need to be made.

Health on the earth, or a bed 50 miles away?

The controversial changes to the health service.

And the wizard of Dwyfor.

Does the name David Lloyd George still conjure up magic?

Tonight we are joined by political commentator

Darren Hill from Positif, the Liberal Democrat Aled Roberts,

and Plaid Cymru chairperson, Helen Mary Jones. Welcome.

There are few that disagree that the health service needs to be

changed, but agreeing to the nature of the changes has been

a huge challenge to health managers and politicians for years.

This week, two of Wales's health boards

announced their restructuring plans.

And those plans are very controversial.

James Williams presents the dilemma.

An ideal opportunity to address create a national treasure

- that is how some people regard the changes that are going to

happen to the health service.

A chance to restructure in order to ensure the highest

standards without losing sight of the central principle -

free healthcare for all throughout their lives.

Without these major changes, there is concern that the service will fail.

It is a complex problem but one that needs to be solved.

There are hospitals in England that might become unsafe or are unsafe.

That is our fear,

that services in Wales will become unsafe, unless there is change.

And that is why, of course, these proposals are suggested.

We know that some services which are being offered in some areas

are not of the best quality,

and we also know that there is a shortage of expertise

in several areas of the health service, for instance in Accident

and Emergency, there is a shortage of clinical shortage in that area.

So what we want to see is standards being raised in the health service,

and of course changes have to be made.

The health minister has also insisted that there is no

more money available for the health boards

but the pressure on the service continues.

It is a problem in millions every year as we see that health is

struggling to hit its financial targets.

The Assembly has put more in this year,

for the reason that demands have increasing in a way that they

didn't expect, but we're seeing that people are putting more

pressure on the health service.

There is scarcely another political subject that incenses

people more than the health service, and the parties each have

different ideas about how to cope with the problem.

A number of these changes have scared people, leading to several

protests calling upon the government to protect local services.

Politically, it is impossible to please everybody,

but will there be a price to pay for the politicians?

There are problems.

And the greatest problems are possibly in the Assembly itself.

I'm not a counsellor now, but I was a councillor for 25 years.

You try to help and to accept people's attitudes the whole time,

You try to be a friend to everybody,

perhaps that's the way to describe it.

They are in a difficult situation.

So politicians and health officials have a lot of questions to answer

as they try to piece together the jigsaw to recreate the big picture.

James Williams.

Well, the Betsi Cadwaladr University Health Board

who are responsible for services across north Wales will

announce their plans on Friday.

Earlier on today I popped into one of the BBC's studios to talk

to the chair of the board, Merfyn Jones.

I asked him if shortage of money was the reason for the change.

Obviously the financial climate is one factor.

But I would say that basically, the change is due to

the nature of the population.

We all live to an older age, the population is getting older,

and as that happens, the nature of diseases is changing,

and so an increasing number of people are suffering chronic diseases.

Things like diabetes, dementia, and a number of other diseases.

What we need for these people is, where there is a genuine need,

that they can go to hospital, but what they need is care in the home,

or as close to home as possible.

So we need to change the nature of the provision, so that the

population as it stands, as opposed to how things were 50 years ago.

That is of key importance.

But as you talk about more care in the community,

and more care from GPs and so on,

some of these services are moving further away from people,

that is a lot of centralisation as well.

That is not care in the community.

It might seem as though there's a contrast

between these two extremes,

but I think considering that what we need

is a network of care in the community,

but also then as you mention,

we need specialist centres where there is genuine expertise

with many people working together in order

to ensure that when surgery is necessary,

one is assured that that surgeon is somebody who performs

that work regularly,

is fully trained, and his qualified to do the work.

You can't get that everywhere. You have to have specialist centres.

How do you balance the two things?

Some people say that the health boards in general

are far too willing to listen

to the Royal colleges and the deans and so on

rather than listening to the users and what they feel is needed.

I think we have to listen to users, of course,

and to the profession, and we do so.

And I do hope that at the end of the day,

any decisions we make will be based on that.

But I also think that we have to interpret

the nature of the changes that have been not only in the population,

but also in the workforce of the health service - the doctors

that are required, the specialist nurses that are required.

We are not talking about a general surgeon who could perform

dozens of different operations.

We are looking at people who concentrate on one

type of highly technical and complex work.

So we have two bring those two extremes together -

the care in the community, and the specialised care when it is required.

Professor Merfyn Jones talking from Bangor.

Darren Hill, apart from closing a school perhaps,

a change in the health service

is one of the most difficult things for any government to do.

This government has introduced this new system where the

process is out of the hands of the politicians until the end.

How is that meant to work, and does it work in your opinion?

The way it's meant to work is to give the local boards

the chance to restructure services following a clinical mindset,

and put that before political considerations.

I think it's a brave step, to be honest, to make this kind of change.

Because one thing that is not acknowledged within that

package is that there are too many hospital beds

in Wales per head of population,

so we also have to do something.

Now this is the problem. There are two elements, clearly.

First of all, a matter of style.

And as Lesley Griffiths's style is completely

different from Edwina Hart's style,

that has caused an internal shake-up within the health service.

Where Edwina was a lot more prepared to interrupt, Lesley is not.

She works through the local port in a different way.

But there is a basic problem.

In order to change things and carry the public with you,

you have to communicate and have a dialogue, and definitely,

at Hywel Dda, and to an extent at Betsi Cadwaladr, that has not happened.

Helen Mary, do you agree with that analysis, that this

message is not being sold - the message that Merfyn Jones

was trying to explain there to the public?

The problem is that people are trying to sell a message

rather than sharing the problems with the public on a local

level, explaining what the challenge of the featureless,

and looking for answers that are going to

answer our needs in West Wales and in the North.

They are taking a pattern of services that work well

in the big cities of England and to an extent in South Wales

where the population is bigger,

but there have not looked beyond to Scotland or Canada

where they have created different answers,

for instance moving the doctors and nurses, and keep the patients local.

There's a good example of that in Hywel Dda,

in fact, the breast cancer service in Llanelli -

surgery is performed in Llanelli,

but surgeons go out to Bronglais, Withybush,

so that people do not have to travel.

You need to some imagination, and also to explain the problems

to people and take them with you.

Darren is right.

They are trying to force changes and people without listening to them,

and that is not going to work.

But Aled, the members of these boards are not malicious people

who want to provide the public with a poor service.

They are trying to do the best they can on the profession's council.

Why do you think things are going wrong?

Because they have not convinced local leaders,

to an extent, that there plans make sense.

I think people are ready to change,

people feel that the present system is not sustainable,

but they have not been convinced about the details of the packages,

especially in the north.

I think the schemes regarding maternity units

which are being transferred to Merseyside,

people are asking questions about how that is going to work.

From your point of view as a politician

in one of the opposition parties,

wouldn't your arguments have more credibility

if you occasionally said, "Look, this decision is unpopular,

but we think the board is right in this instance".

Why can't you say, "this is where we think they're wrong,

and we're prepared to support them with unpopular decisions,

where we think..."

Some of us have responded to the consultation with Betsi Cadwaladr,

and have said fine, if you're going to implement services locally,

perhaps we need to admit that we have to close, for example,

a 100-year-old hospital.

But questions do arise about some of the proposals,

and above all, about the minister's unwillingness to discuss things

on a political level.

We accept that she has a status where it's difficult,

but to some extent, political leadership is needed as well.

And that has not been given by the government.

But Helen, we have seen some hospitals in Wales

that have been political footballs for years.

-I'm referring in particular to Llandudno and Prince Philip.

More than one party have kicked that football around.

That is true, of course.

And if you're responding as the councillor says,

you're responding to the concerns of those who elect you.

But I remember examples when the health board had convinced me

and other people, local leaders, the service needed to be changed,

and that we could then help them to sell these changes,

even if they were unpopular, if they had put their case forward properly.

But we are not in a situation where all the doctors

and nurses agree this is the right way forward.

We're also in a situation where they are setting a pattern of services,

which do not work for a rural area.

I am also concerned that there isn't a sense of leadership

coming from the centre.

This is something that is supposed to be a national service.

It is not good for the Minister to say

the Health Board should make all the decisions.

Let's go back to Lesley Griffiths. These plans could be made,

but only if the local community health council opposes.

What should she do?

What are you expecting her to do? Is this already rubber stamped?

I think some plans, in West Wales and North Wales,

will arrive at the Minister's desk at that time,

she will have to be politically answerable to the plans put forward.

She may have to intervene with some of these plans.

She will be expected to do something, especially to communicate

in a better way with the Health Boards haven't managed to do so.

This is definitely the case in North Wales

where she represents Wrexham.

She will be under a great deal of pressure there, I think.

Do you believe, there is a weakness in the health service

with the Health Minister, that she cannot communicate the messages?

As a politician of the same area? You know her well.

She has taken the decision that her style is completely different

to Edwina, the previous Health Minister.

The system in Wales needs to change so much

that you need strong leadership from the centre.

I know it seems a mistake has been made when it comes to strategy.

And the appointment? What about her as a Health Minister?

I think we need a strong politician, whoever it may be.

Lesley Griffiths is a strong politician.

I agree, if you look at the government's front benches,

yes, perhaps this is a decision for the Government,

perhaps they're trying to give the decision to the health boards

in order to avoid the political reaction.

Like they are doing with schools.

Tomorrow, will be the 150th anniversary

of the of birth of David Lloyd George.

An exhibition at the Pierhead Building in Cardiff Bay marks this.

I went there earlier to speak to Richard Elfyn who played the part

of The Wizard, the Goat and the Man Who Won the War.

Richard, you were part of this production from the start,

how did this production come to light?

I and the author worked at a creative writing centre

in Ty Newydd in Llanystumdwy

at the former home of David Lloyd George.

We were developing scripts.

At the end of the process, actors came in to work on new plays.

While we were there, we were talking about Lloyd George,

in the room where he died.

We had the idea of writing a play about his life.

Why is his personality so attractive to playwrights?

A lot of things have been written about him,

hardly anything has been written about politicians at the same time.

People always know things about his love life.

You don't remember the good things he did while he was Chancellor,

you think of the bad things.

I don't think any Chancellor has had such an influential time.

He was very influential with points such as national insurance

and changing the house of Lords and The Parliament Act.

He was involved with the people's budget. He had so much influence.

When you talk to people, they will say, he did these good things,

but there is a lot of things that aren't so good?

That is where the drama comes in.

There is this vision of a split personality

which is amazing considering that he was so influential.

He was able to hide so much of his life

and we only heard about this after he died.

He had been married for 50 years, as we play him in this play,

but he had an affair for 25 years.

Richard, thank you very much.

A radio version of the play was played on Radio Wales

last Sunday, can you find it on iPlayer.

I have to start with the Liberal Democrat.

Aled, was he your idol?

I was brought up by my grandmother

singing songs about Lloyd George giving the pension to old people.

He was a great influence on liberal life in Wales.

In England, to some extent,

but he came from the radical Welsh background.

I think Saunders Lewis said that it is possible to live too long.

Perhaps people see something romantic in the young Lloyd George,

but then get disappointed that he seemed to lose his way?

Yes, right at the end of his career.

That seems to happen to politicians. We don't know when to stop.

It's important we remember the positive things,

such as the pension.

I liked the young Lloyd George, who was a nationalist,

as well as a liberal.

He was the Prime Minister when women got the vote for the first time.

He wasn't very keen, but he had to do it.

If he had finished after the war, then everyone would have remembered

the positive things, and maybe not so much of the negative things.

I agree with you. There is a time when a politician should step down.

What hits me is, perhaps, we do not realise how much he did

because some of the problems he solved are now forgotten.

If you look at Cymru Fydd, everyone thinks that it was a programme

of self-government.

You had other questions which were just as important at the time,

but they've moved on?

He was the Prime Minister after the Irish uprising.

He managed to reach a compromise to solve one of the most basic problems

in British politics for the past 50 years.

He managed to solve a few things.

In the last two or three years, when he was leading the government,

a coalition government, which is always difficult,

as I'm sure everyone recognises now, especially you Aled,

when he was leading that coalition government.

A few decisions he made, such as selling seats in the House of Lords

has taken the shine off his achievements.

And split the liberal party at the same time.

It is interesting that this 150th anniversary has come.

He was a believer in universal benefit,

he believed that everyone was entitled to benefits.

We can see your members voting to cut back on that in some fields,

perhaps it is down to compromise?

To what extent are you wearing Lloyd George's cloak nowadays?

We're living in a different world now.

A number of radical things are being introduced to benefit schemes.

Last week's announcement that pensioners will be earning

a lot more and taking the level of pensions a up a level.

Pensioners will earn £650 a year more

by the time the changes are put through.

There are changes underway and things are going to change.

Lloyd George showed he was ready to take these radical decisions

when it came to Ireland or votes for women.

They were not popular at the time.

Are you in Plaid Cymru, the illegitimate children

of Lloyd George?

I don't know about that.

It is interesting to see there are no liberals

left in Lloyd George's patch.

But we have inherited the radical aspect that he had.

Even though the present Government are doing some good things,

I don't think Lloyd George would be impressed

with things as the bedroom tax and cutting back on child benefit.

This is a question for you.

Which party would Lloyd George be today?

I think he would be sitting as a leader,

either with the Liberal Democrats or with Plaid Cymru in the Assembly.

I'm sure he would try to get some sort of compromise

between the two parties that you are part of.

He was one of the figures that could merge the different elements.

Thank you very much to all three of you. That is all for today.

We will be back at the same time next week.

Thanks for watching, good night.