19/01/2012 Dragon's Eye


19/01/2012

Felicity Evans examines the war of words over the PIP breast implants drama, plus a discussion about the commission launched to look at the UK's constitutional conundrum.


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Lesley Griffiths and Andrew Lansley have fallen out over breast

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implants. This is Dragon's Eye. Good Evening. The Health Minister

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says she's had to make decisions over how to deal with PIP breast

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implants in Wales without all the evidence. Lesley Griffiths is

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claiming the UK Government didn't share information, including an

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official report, quickly enough as the health crisis unfolded. That's

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denied by her Westminster counterpart, Andrew Lansley, who

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argues that the Welsh Government's policy of replacing the implants

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risks letting the private companies who performed the original surgery

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off the hook. Here's Brian Meechan. It's a health crisis that couldn't

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have been planned for and as a result, it seems politicians and

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the medical profession have been scrambling to keep up with events.

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I'm not sure we have been caught on the hop, but it's rapidly

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increasing and as we know with the internet information spreads

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quickly. Concern can spread quickly, perhaps a bit faster sometimes than

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the reassurance. The advice in the UK is that there is no need for all

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the low-grade silicone PIP breast implants to be removed, only those

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that are causing problems. A different approach emerged between

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London and Cardiff. The Welsh NHS would remove them and replace,

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whilst in England they would only be replaced in exceptional

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circumstances. It's been confusing and even minister worrying for

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women than it had to be. That's because we saw the Government

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position changing both in the UK and in Wales quite significantly.

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Clearly, the regulatory system has failed and the information

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providing to Government has not been reliable. It was a clash at

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First Minister's Questions. Also to replace those implants quite

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frankly is absolutely an appalling decision, which taxpayers clearly

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do not support. I think he'll find it rather different. Are you

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seriously saying you would be happy to see the implants removed, but

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nothing put in place to replace them? Are you seriously saying

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that? If you do, you have very little understanding of human

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nature and you have little understanding of sympathy for

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others. The UK Government says the private medical practises that put

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the implants in should be responsible for the removal and

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replacement. Welsh ministers agree, but critics say their decision has

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made it less likely that that will now happen. I have to say to the

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Shadow secretary, if he commends what the Welsh Government has done,

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he - perhaps he were to do so, to commend it, they have to recognise

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it runs the risk of letting the private providers off the hook.

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Effectively it gives them a get out of jail free card to the private

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clinics who have a duty of care to the patients who they have put

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implants in. I think it's quite wrong of taxpayers to pick up the

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bill. The dispute seems to have highlighted divisions between

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London and Cardiff over their response to the PIP scandal.

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think it speaks to an underlying tension between London and Cardiff,

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on health policy. Theoretically the matters are devolved, but it's not

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as cut and dried in real issues and there's a deGrecian of conned sen

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shun from London to Cardiff. Welsh Government is clear it has no

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idea how many women in Wales have the implants nor how much each

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procedure will cost to replace them and critics say they should have

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found that out before signing off a blank cheque. The Welsh Government

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has made this uncosted commitment at a time when the finances are

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already broken. They are at breaking point and we know local

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health wards will be over budget by the end of the financial year and

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to make another commitment of taxpayers' money towards this sort

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of project is completely barmy. It's a flaw in the whole system in

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Britain that we don't have a proper registry, as we do with orthopaedic

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implants, to know exactly who has got them and how many have got them.

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Ultimately, I have to say, as someone looking after these women,

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I don't really mind. It's a sense of compassion for the women. They

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have paid into the NHS. There is a need for them to have their

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implants removing and in that respect the Welsh government is

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doing no more than it should legally do with women who have got

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something inside them that shouldn't be there. Gl there have

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also been concerns expressed by GPs. Only yesterday the Royal College of

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Surgeons in England, along with my own association and others produced

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some very specific guidance which is really helpful and that's

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available for GPs and patients on the various websites. As I say, the

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Welsh Government will produce shortly even more detail. The NHS

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budget is being cut in real terms and the Health Service coming under

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pressure to deliver more for less. While wards are being closed and

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provisions cut back, some critics say is now the time for the NHS to

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be clearing up a private sector mess? There are fears that the

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waiting lists for plastic surgery in Wales will be tested unless more

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resources are made available to deal with this. We have been

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assured by the Welsh Government and the minister and by Special

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Commission, who are handling this on behalf of the Welsh Government,

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that they will do what is necessary to make sure that this doesn't

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impact on our current waiting lists. To be honest, our lists are already

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long and we are working closely with the health boards in Wales to

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try to get them where they should be and if we were asked to do this

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work on top, that would be a problem. In a year when extra

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funding was being ploughed into the NHS the decision to replace poor-

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quality breast implants may have been less controversial. It's

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perhaps a symptom of the current economic times that it's become so

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now. Brian has been talking to the health minister. We've been told by

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plastic surgeons that we have no idea of the number of women

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involved here. It could be 20, or it could be 2,000. We have no idea

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the cost of each procedure. Isn't this really an uncosted proposal?

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We don't know how much the procedure is going to cost, but

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there is a figure obviously for removing the implants and then to

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replace them is not a great difference. Probably just in the

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hundreds. There is that element. We don't know the numbers and getting

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a firm number is one of the priorities and officials are trying

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to find them out quickly. However, we know that they have not been

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used by NHS in Wales, these implants and they haven't been used

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by private providers in Wales, so we do know that and we think the

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number will be relatively low. problem you have is that you are

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relying on private companies to give you information. They haven't

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been forthcoming so far, so there could be lots of women who don't

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have PIP, who are going to have to be tested anyway? Officials are

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ringing around private providers and we have been getting the

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numbers, so I think they have been telling us this. This isn't letting

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the providers off the hook. I think we are putting pressure on the

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private providers to make sure they recognise their duty of care. That

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is one thing that we are very keen to get over. This is not a blank

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cheque. We are not taking that away. We do expect private providers to

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step up to the plate and really fulfil their duty of care to women.

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If they get a phone call from a woman in Wales they know it's

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already been underwritten by the Welsh Government. They are going to

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shrug their shoulders and carry on? There are legal aspects and duty of

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care and we are putting pressure on them. It's ultimately private

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companies, who have made a mess of this. It's their problem. Surely

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you should be putting pressure on them to fix it, rather than letting

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them off the hook? It's their responsibility and we expect them

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to do it. What we have said is for any woman who is concerned and

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can't get in touch with her provider for a variety of reasons,

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they are not in practice, for example, we are saying they should

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see the surgeon and if they can't, then they should have an assessment

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by the GP. The evidence at the moment is still that they are not

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necessarily having to have these implants removed. Until we know

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that, we'll take the steps forward when we need to. One of the things

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that you have talked about is a clinical need. What do you mean by

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that specifically? Is it a physical need or is there an element of

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mental need about it, because obviously the fact this is in the

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news so much it becomes a sort of mental health issue potentially?

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could potentially and I'm concerned that so many women have this fear

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and I don't think that is too strong a word. That is the message

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I've had. We are wanting to say and get this out very clearly, at the

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moment there is to clinical evidence to say that women who have

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had PIP implants need them removing. However, if they are concerned they

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should see their surgeon or GP. Many of the GPs have said that they

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have not been getting the guidance that they need from the Welsh

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Government. Do you accept that there's been short comings in that

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area? We had to - the initial start of this process was coming from the

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Department of Health and unfortunately we weren't party to a

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lot of information coming. My officials were having great

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difficulty getting information from the Department of Health in the

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first instance about eleven days ago. We couldn't get to see the

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independent report, so we have had to take decisions perhaps that we

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would have preferred to have taken much more firmly, but we had to

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take decisions because we needed things to be taken swiftly. The

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guidance is out there. My officials are working hard and if any woman

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is concerned make an appointment to see the surgeon or the GP, and

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we'll support you all the way. you saying that the Department of

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Health has not been sharing information with the Welsh

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Government? A week last Friday there was a definite lack of

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sharing of information. I have written to the Secretary of State

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because obviously I think the regulation of these implants and

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perhaps other surgical devices needs to be much closely inspected

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and regulated and I think there is a concern here about this. You may

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be aware, we have a surgical materials testing lab in Bridgend,

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and we are the only country in the UK to have this and I have written

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to the Secretary of State asking him and the other devolved

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administration health ministers to see if they would like to use it,

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because we are leading the way in this. At a time when NHS budgets

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are being squeezed and we are seeing closures of wards, why is

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this a priority? It's not going to be an urgent treatment. If a woman

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is found to need the breast implant removed and replaced I don't think

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from the evidence I've been given it will be urgent. They will go on

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a list and the process will be followed through. Are you not

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concerned that this sets a precedent whereby very poor

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practice on part of private companies and NHS are having to

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pick up the tab? No, I don't think so. Well, a Department of Health

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spokesperson has told this programme - "The allegations are

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simply untrue" and that the Chief Medical Officer had shared "all

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available information". They go on to say that "The Welsh Government

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did not inform us prior to their announcement on PIP implants."

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Setting up a Commission can mean one of two things - a Government

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wants to do something or a Government doesn't want to do

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something. This week the UK Government announced it was setting

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up a Commission to look at whether Welsh, Scottish and Northern Irish

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MPs should be prevented from voting on matters affecting England only.

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Pressure has been growing on the UK Government to address concerns that

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English voters being sidelined in post devolution Britain. The

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Commission consists of a panel of experts and will report in May 2013.

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Our Parliamentary Correspondent, David Cornock, reports. It was

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launched with a minimum of fuss. Not even a ministerial photo call

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or interview, but the Commission on the couldn't quepbss of devolution

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for the House of Commons could have a big impact on the way this place

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is run -- consequences. It's a Westminster-focused commission. It

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will look at issues of Parliamentary and legislative

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practice and procedure. It's going to find it quite hard to look at

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wider issues of how England is governed, although there is

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increasing evidence that the English are getting really quite

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anxious about the wider issues and they need to be addressed somehow.

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That evidence appears to be growing. One of the things we wanted to look

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at was English attitudes to the West Lothian question and we asked

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English people whether they think that Scottish MPs should be barred

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from voting on English matters and 79% of people said they should.

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Political parties used to target Worcester woman, the floating voter

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in middle England. This Worcester woman has been trying to change the

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law to answer the question. It's something in the coalition

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programme for Government to set up a commission to look into these

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issues and I think as an MP who represents an English constituency,

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a lot of my constituents say to me that they are concerned that

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English-only legislation is voted through potentially by MPs who

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don't represent England. Here's one of those MPs who doesn't represent

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England. Paul Murphy represents a Welsh seat, but has sat in the UK

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One of his predecessors, the Conservative John Redwood, says

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England feels hard done by and needs a stronger voice in the union.

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He wants English votes on English issue, but there is another

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question posed by this week's announcement, why now? With Alex

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Salmond pushing for an independent Scotland, and David Cameron trying

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to keep it together, why risk it? The timing is unfortunate. The

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inevitable conclusion of the commission will be that Scottish

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MPs are not allowed to vote on English-only legislation or are

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restricted in voting, and that, arguably, weakens the United

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Kingdom Parliament and therefore weakens the United Kingdom.

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Alex Salmond's high-profile campaigning is helping fuel English

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resentment? I wouldn't say resentment, but I find English

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people saying you have Welsh people in the Cabinet and Scottish people

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in the Cabinet. Who is representing us? You have your Assembly, they

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say. The Scots have their Parliament. Where's ours? There is

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a build-up. We know there are several English-based parties now

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who are looking at a Parliament for England. Which could be one answer

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to the West Lothian question. Already three answer to the West

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Lothian question - one is reduce the number of MPs from Scotland and

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Northern Ireland, Wales from Westminster which mean that is

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continue to vote on all business, but they have less influence

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because there are fewer of them. The second is what is called an

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English Parliament. That would mean creating a separate distinct

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institution to represent England. The third answer which has been

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constituent policy at the recent elections is English votes for

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English laws. That's a vote Harriet Harman hopes

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will be delivered. The Speaker can certify certain pieces of

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legislation that are England only and through the standing orders, as

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they're called, we can decide situation where the majority of

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English MPs is also required. conceivable you could also have a

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Labour UK Government that didn't have the majority of seats within

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England. That would create questions about how you implement

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English votes for English laws. one said it would be easy. Perhaps

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the West Lothian question is rath really an English question.

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Whatever the academic answer are to all of this, the political reality

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is such if we start weakening the role of Welsh Members of Parliament

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together, reducing their numbers, that is actually playing into the

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hands of the people who want to see the breakup of this country.

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Conservative-led coalition won't like that solution, so will the

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commission achieve anything? ever, it's the Government feeling

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they have to appear to be doing something to answer a question that

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was first asked by in the 1970s and has been asked ever since. It needs

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panel of experts because it's a very tricky question, and it

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probably doesn't have a tidy answer, but if anyone is going to have a

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way of coming up with squaring the circle, it's this body of expert

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opinion. If Westminster does become more of an English Parliament, that

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could throw up new questions. If Welsh MPs are banned from voting on

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English issues, then could an MP with an English seat still be

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appointed Secretary of State for Wales? The question perhaps for

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another commission. David Cornock reporting on the

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commission looking at voting rights of MPs from the devolved nations.

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The body will begin its review against a background of shifting

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currents across the UK. Here in Wales, the Silk Commission is

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looking at the way Wales is funded, and the Scottish Government is

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preparing to publish its plans for an independence referendum. Its

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First Minister, Alex Salmond, has already had a war of words with

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David Cameron over that. BBC Scotland's Political Editor Brian

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Taylor gave me the latest. It's important to talk about the process

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and the rules determining a referendum. Some people may think

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it's rather arcane, but it matters that we get the rules and the

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regulations correct for the referendum. We are, after all,

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dealing with the future of the union that's lasted 300 years. It

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might be a reasonable idea to get it right, so where we are at the

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present moment is we have a dispute between the Scottish and UK

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governments on absolute fundamental issues with regard to the

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referendum. We have a dispute on timing. The UK Government want it

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eerily. The Scottish Government says 2014. We have a dispute on

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legality. The UK Government says Scotland can't hold a referendum

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unless it gets further powers. Alex Salmond says no. We can order a

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consultation. We have a dispute above all about the question or

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questions to be asked. Alex Salmond wants the flexibility to ask a

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second question on devolution maxed. Rather than Holyrood independence -

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it must be a yes or no on independence. We hear lat of

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discussion about devo-Max as a possible option. What does Alex

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Salmond mean? Alex Salmond says it's up to others

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- perhaps civic Scotland, perhaps the intellectuals who might be

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tempted to come up with this in detail, but of course the

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Government in February 2010 publishes a draft bill. They define

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it as being full control of all tax revenues and spending in Scotland

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with the exception of defence, Foreign Affairs, currency and the

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currency itself. They say it's up to others to

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define what they mean. Broadly, it's full control on spending.

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see a full consultation paper. What can we see there? Alex Salmond will

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state the details on his thinking of the referendum. We have only had

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a consultation paper from the UK Government. We'll have this

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consultation paper from the Scottish Government on the

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questions, the timing - just these issues that divide. Really, what we

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have here are the two governments seeking to assert their control of

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the referendum, their influence over the referendum. Alex Salmond

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has gone from a situation where he was telling the Prime Minister to

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butt out of the debate to a situation where he is open to

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negotiation and discussion as long as he says the primacy of the

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question - the primacy of the referendum is recognised as being

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in Scotland's hands, which means - the Scottish Parliament's hands

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which means the Scottish government's hands. It's early days

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to be taking about opinion polling and voter intentions. What with

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they telling us these days? Most polls tend to suggest a lead for

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union over independence. If they ask the extra question on devo-max

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or enhanced powers that seems to be the more popular. You're right. It

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is far, far too early to say the referendum details haven't been

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fixed, let alone the date or the campaign. Thank you very much.

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Plaid Cymru's been undergoing a period of soul searching since its

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disappointing performance in the Assembly elections last May. Its

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leadership contest will be concluded in March, and this week

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the party published a review examining where it's been going

0:21:390:21:43

wrong and making recommendations about how it can get back on track.

0:21:430:21:46

The review was lead by Eurfyl ap Gwilym, Plaid's Chief Economic

0:21:460:21:49

Adviser. One of the themes emerging from the review is the need for

0:21:490:21:58

clarity in agreeing and communicating policy. I asked him

0:21:580:22:01

Mr ap Gwilym whether the number of recommendations - 95 in total -

0:22:010:22:04

jeopardised that goal. That's a good question. What we did

0:22:040:22:10

as part of this exercise - we came up with 95 detailed recommendations

0:22:100:22:13

- we got five principle recommendations. The other thing to

0:22:130:22:17

bear in mind - this report now goes to the party at large. It is to be

0:22:170:22:22

the basis for a lot of debate within the party, then from within

0:22:220:22:27

that debate, it's a matter for the party to decide if they accept this

0:22:270:22:31

recommendation or reject it. Following on from that is to bring

0:22:310:22:33

in an implementation plan and implement it over several years, so

0:22:330:22:37

this is a part of the process, not the final end product. Would it be

0:22:370:22:42

fair, then, to describe the long list of recommendations as a menu

0:22:420:22:46

rather than a plan? You pick the ones you like? I wouldn't say that

0:22:460:22:50

we believe the recommendations have validity and should be accepted by

0:22:500:22:53

the pardy, but ultimately it's a matter for the party whether they

0:22:530:22:59

accept them or not. As we worked our way through, this sounds

0:22:590:23:03

paradoxIcal, but clearly Plyd Cymru hasn't been doing well in electoral

0:23:030:23:06

terms. In my business experience if I have ever gone into a company

0:23:060:23:08

which is having difficulties in terms of being successful, if you

0:23:080:23:13

went and looked at the mechanisms of that company, you would find

0:23:130:23:18

they all are working perfectly well, you have a problem. Paradoxically,

0:23:180:23:22

in Plyd Cymru, lots of things we can improve on. That's why we have

0:23:220:23:25

come up with so many recommendations. Lots about

0:23:250:23:29

structure, but some are very basic - this in particular surprised me -

0:23:290:23:33

in the case of official spokespersons it should be a

0:23:330:23:36

precondition they develop a sound understanding of their own brief.

0:23:360:23:40

It does beg the question of what sort of candidates the party has

0:23:400:23:43

been picking up until this point if you have to say something that

0:23:430:23:48

basic, is that right? Quite right. I am very critical of some we have

0:23:480:23:52

seen, weak performances by some of our people on some subjects. Do you

0:23:530:23:58

want to name names? No. They all know who they are. I mentioned they

0:23:580:24:03

all need to pull up their socks, get a lot smarter, or they

0:24:030:24:05

shouldn't be candidates or spokespeople. Do you think that is

0:24:050:24:09

the sort of message they'll be willing to accept and other party

0:24:090:24:13

members will be? I think the party membership will, and I hope most of

0:24:130:24:16

our senior people will as well. We have not been doing well enough.

0:24:160:24:23

It's as clear as that. And we have to up our game. This is why this is

0:24:230:24:27

quite a hard-hitting report. Indeed. Are you talking about exceptions

0:24:270:24:31

here in terms of underperformance, or would you say that then a

0:24:310:24:34

general problem of underperformance among the party's elected

0:24:340:24:38

representatives? I wouldn't say a general problem, but I think it's

0:24:380:24:43

patchy. Somewhere I use the term "varied quality". Therefore, we

0:24:430:24:48

need to get those that aren't performing as well to perform as

0:24:480:24:52

well as some of our good performers. You talk about the changing

0:24:520:24:57

perception of the party. You say Plyd Cymru is regarded as a party

0:24:580:25:02

of Welsh speakers and talk about the need to change that. Other than

0:25:020:25:06

the suggestion that the party should change its English name, you

0:25:060:25:09

don't offer any guidance how to achieve that? We do in part. If you

0:25:090:25:14

look at the report, a very basic thing - in quite large areas of

0:25:140:25:21

Wales, we conduct a lot of our - in Welsh only. We are saying we must

0:25:210:25:26

train our people to do simultaneous translation and get that as the

0:25:260:25:30

norm. A lot of countries, including Europe, are multilingual. People

0:25:300:25:34

are used to working in one language, but clearly, where we have meetings,

0:25:340:25:39

it's very difficult unless you're a Welsh speaker that naturally is

0:25:390:25:44

going to make us appear to be not only for Welsh speakers, but

0:25:440:25:48

discourage non-Welsh speakers from joining us. Can I ask about

0:25:480:25:55

independence. You have a call for clarity. Are you saying

0:25:550:25:59

independence should be the banner behind which Plyd Cymru marches?

0:25:590:26:03

Our constitutional aim - and unique to Plyd Cymru is we want

0:26:030:26:07

independence for Wales within the European Union. Until last year we

0:26:070:26:13

didn't actually have that spelt out in our stution. That's caused us --

0:26:130:26:17

constitution. That's caused us some difficulties. While we have been

0:26:180:26:24

reluctant... But the party is still divided on that issue. Look at your

0:26:240:26:28

five leadership candidates... have four. Forgive me. That's all

0:26:280:26:32

right, but let's just check this. Another thing we say - several

0:26:320:26:39

years ago, as a member, we had an internal meeting on our policy, and

0:26:390:26:42

the committee didn't publish that report. If we want unity around

0:26:420:26:45

policies, you have to first of all afford the membership the

0:26:450:26:49

opportunity to debate them, hammer them out, and then when you have

0:26:490:26:52

done that then it's reasonable to call your membership right now.

0:26:520:26:57

This is the policy we have agreed as a party collectively. Now

0:26:570:27:02

support it. I am grateful for joining us. Thank you very much.

0:27:020:27:07

If you have any suggestions as to who that mystery fifth candidate I

0:27:070:27:11

invented might be, answer on a postcard. Maybe our Welsh affairs

0:27:110:27:14

correspondent Vaughan sawn can help out.

0:27:140:27:19

What are you hearing... Nominations haven't stopped. There could be a

0:27:190:27:22

fifth. Maybe many members wish there were. It seems from the early

0:27:220:27:29

stains of this contest - and it's quite a long contest - the

0:27:290:27:35

candidates who -- the candidate who has gone up like a rocket is Leanne

0:27:350:27:41

Wood. She seems to attract more attention Somme would have expected.

0:27:410:27:46

Another of the candidates suggests that the race could be very close

0:27:460:27:52

between the two women candidates - Ellen Jones and Leanne Wood, with

0:27:520:27:56

the two male candidates lagging a little bit at the moment, but an

0:27:560:27:59

awful lot of undecided's out there. Remember, this is one of those

0:27:590:28:03

alternative vote candidates where people go one, two, three, four,

0:28:030:28:06

and an awful lot will depend on the second and third preferences and

0:28:060:28:12

who gets knocked out in the early stages. Remind us when it will be

0:28:120:28:16

resolved. We're going to go through weeks and weeks of this, and when

0:28:160:28:20

you get an announcement, you're then going to have the whole

0:28:200:28:26

question of how that person will lead because one of the things that

0:28:260:28:31

comes up in that report that Eurfyl ap Gwilym was talking about is the

0:28:310:28:36

need for a leadership team. That to me suggests there may be a lack of

0:28:360:28:41

confidence in the four candidates that they feel whichever one wins

0:28:410:28:45

there are weaknesses there and they need people around them, perhaps

0:28:450:28:51

the thought was that Jones had a little bit too much power over the

0:28:510:28:59

On Dragon's Eye this week, a war of words between UK and Welsh Health Ministers over PIP breast implants, and we discuss the commission launched to look at the UK's contentious constitutional conundrum.


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