21/06/2012 Dragon's Eye

It will be another 20 years before the tax payer has finished paying

for Wales'' biggest PFI hospital but there are already plans to move

some of its services elsewhere. Was it a giant waste of money? This is

Good evening. Wales's largest private finance health project,

Neath Port Talbot Hospital, could be about have some services

withdrawn from it despite the fact that taxpayers will be paying for

the building for another 20 years. The university health board that

runs the hospital has indicated that they could be a drop in the

number of beds at the side. It has told us that while some provisions

might be withdrawn, the hospital will become a centre of excellence

for others. It was a public-private partnership

approved by an assembly in its infancy to provide a state-of-the-

art hospital for the Neath Port Talbot area. It opened its doors in

2002 with the health minister It cost �66 million to build

according to the Treasury. The NHS will pay �353 million for the

building and may miss over the course of its life. But now review

is being undertaken into services across the region. The PFI is very

inflexible in terms of its contract. It sucks money in. A we are 10

years into a 30 year contract about that and we'll be paying as a

health board for another 20 years. It makes sense. I am not an

accountant but a surgeon. However it seems pretty obvious we will

want to get the best value at this hospital. So although we are

looking in general and moving services closer to be's homes,

doing more at home, more in the community and or in primary care,

curiously this hospital is probably less likely to see big changes in

the bed numbers. But what it will do is see changes in what goes on,

as were all our hospitals. hospital has 270 beds and provides

a range of in-patient and out- patient services, including dealing

with medical emergencies. It also has a number of operating theatres

including those for orthopaedic surgery and it provides mental

health services, including an acute unit. In a letter to a local AM,

the health board says it needs to save �45 million to break even by

the end of the financial year, confirming that changes are being

proposed to a number of beds and services provided, including some

with a mental health services. concern as an elected

representative is to find best value-for-money bet to ensure that

services are provided as close to people as possible and to make sure

that we do not waste money in these contracts with PFI contractors, and

ensure that the health services are sustained in these areas as opposed

to being taken out of a hospital and move to other places. I have

not had those assurances yet. board says Neath Port Talbot

hospital will become a centre of excellence for some services,

particularly orthopaedic surgery. But problems with finding enough

qualified staff means other divisions may have to go elsewhere.

We have always tried, in the NHS, to provide everything everywhere.

Patients now expect to see consultants at the front door. Bit

by consultants making the decisions. We do not have enough to do that

everywhere, 24/7. The debate about Neath Port Talbot mirrors ones that

are going on across the country. The NHS is launching a wider

consultation about services this summer. The population is growing

more elderly, which is just one of the issues facing the NHS. Obesity

is increasing and the Tappin well- being between the wealthiest and

the poorest in the country is growing. -- the gap in the well-

being. All this comes as NHS budgets are being cut in real terms.

That is why politicians, NHS managers and academics are telling

us we cannot go on doing things the way they have been done the past.

But the board argues that money is not the main driving force behind

the proposed changes. People are always suspicious that change is

about saving money. Let's be clear - we do need to make the NHS's

money go further. But there is never a bad time to try to improve

the quality of what we are doing and luckily, high quality, better

care nearly always translates into cheaper care. If I do run operation

and the patient has a complication, that is bad for the patient but it

is also bad for the Budget. Welsh and UK governments have put a

hold on the PFI contracts that led to the building of this hospital.

For that contractor cost the taxpayer so much when we are

hearing that services may change and when things may need to change

next year, and we are hearing that staff may be moved, these are vital

concerns for the future. We really need to ensure that if the

government are entering into such contracts that these are taken into

regard and I do not think they were at the time. The answer is to go

back to government procurement using property government capital,

which is either raised through borrowing it and itself all through

taxation. But this mechanism whereby the Government is borrowing

from the banks that very high rates of interest is actually

unsustainable. The private financing of public projects was

always controversial. As budgets shrink and Murray becomes tighter,

questions will be asked about ensuring the best possible value. -

- money becomes tighter. During the is a representative of

the University of Glamorgan and the conservative AM Mig- Ramsey. There

was a report last year where the Treasury Select Committee said that

these BFI's were not providing good value for money for the taxpayer.

Do you think there is still a role for the private sector? There is,

but it is true to say that the early PFI projects were not well

managed. Beryl all sorts of disaster stories about how they

were originally set up. -- there are. But at this point, for us to

say there is no role at all for the private sector, as there was

government seems to repeatedly tried to say, that is nonsense. I

don't think people cared whether the funding is coming from the

private sector or the public sector. But they care whether they are

getting good value for money. do, and day care whether they are

getting the service they won. If it is necessary to rely on a PPI to

provide those services, I don't think we should cut off our noses

to spite our face. I think they are historical mistake, the way they

have been constructed. Their only merit was that they brought forward

capital investment that would not have been possible otherwise, but

that it huge cost. If we are to use private capital in future, we have

to find a new way of doing it. In the next few years, the banks are

not going to have a lot of money to spare anyway. We will park that all

the moment and talk about the in flexibilities you were mentioning.

The taxpayer is in a long-term contract for this hospital and they

rather the 20 years ago. Does that mean that any Port Talbot is, in

fact, protected weather comes to decisions being made? And if so it

does it mean that clinical decision-making is being skewed by

such inflexible contracts? That is certainly possible. That hospital

is further away from the exit and some of the others because of the

cost of coming out of the contracts. It is quite possible, however, in

that part of Wales that those beds are going to be needed and if they

can be used in different ways, we may have a happy ending to the

story. But it is an inflexibility and in the overall pattern of

health care, that sort of rigidity is not a good idea. I think that

the NHS will change. It has to change. But I am deeply unhappy

with the way there was government are approaching this by simply

thinking reconfiguration is the answer. In certain areas, an amount

of reconfiguration will be helpful but it has got to address local

needs. There are deep concerns amongst people across certain parts

of Wales about where these services are being threatened with

withdrawal, and his reconfiguration the answer? You can reconfigure and

reconfigure like we have done with local government. The big problem

for the NHS in Wales is that it was government is cutting its budget

far more than it should be. Even if it was not, do you accept that

demand would still be rising with end elderly population, and the NHS

cannot continue in the way it has? Yes, the NHS has to change. Anyone

who denied that would be mad but what I am saying is that that

change has to be responsible stop it is not a one size fits all

imposed by Cardiff. It has got to listen to local people. People

attending the Prince Philip Hospital in Llanelli are worried

about losing their services. Does the poor are not wrong. The whole

point of as having a Welsh assembly is to listen to the concerns of

local people. People are concerned when they hear about

reconfiguration of services and that services may be moved further

away from them - what is your position on that? The problem is

that we have had a very poor public debate on these issues. A lot of

the bin in Wales who are worried and are labouring under a lack of

information I have not had a grown- up debate that they need to have.

Solutions must be locally relevant and people must be persuaded that

they are necessary. At the moment, people simply do not know the facts.

Do you think reconfiguration is necessary? Or we are going to see

some major changes. It is about saving people's lies in reducing

the amount of disability people suffer. -- saving people's lives.

We need to have this intelligent debate otherwise the whole thing is

shrouded in suspicion. We only found doubt yesterday that Cardiff

Ebbw Vale the trust had been bailed out by a loan. We do not know when

that was. Let's have a transparent debate but let snow from the

government what the facts are first otherwise we are trying to make

policy in the dark. A people want hot for hospitals at a safe,

effective and efficient, don't they? However you achieve that,

that is what people want. Yes, and hospitals have to meet a certain

standard. What I am saying is that there was Government's policy

should not simply be to speak, "we think this will see Duke". It has

to address local needs and concerns. -- this will suit you.

Somewhat parents are having to make more than seven years for children

with autism to be diagnosed. One in 100 children is born with the

condition, a lifelong develop mental difficulty that affect how

people communicate with others. There was government says it has

only world-leading strategy that it published in 2008 but we can reveal

that a commission -- a report published by the government

revealed a number of witnesses. am going to take you into my world.

Imagination. I will show you how autism affects kids in different

ways. The BBC recently run at a series about autism on the

children's Channel CBBC. It discussed issues around autism and

young people. For some people on the orders and Spectrum, life can

be confusing but the parents of children showing symptoms of autism

spectrum disorder, life can be very frustrating. We have heard of

parents having to wait seven years for a diagnosis. Often until they

get it, there is little help on offer. The government says its

waters and strategy is world- leading but the parents we have

spoken with do not quite agree with that. Lisa from Pembrokeshire had

to wait over two years for a diagnosis. A I was more or less

begging for a referral to an educational psychologist to because

I could see that there was something unusual about my child

that I could not see in other children of the same age. She has

since set up a Facebook support group for parents like her. Collins

I have heard this as a lot - that we have a world-leading autism

strategy. That sounds fantastic. Aren't we lucky in Wales, to have

this were leading strategy? That is all very well but we are not seeing

the benefits in Pembrokeshire. If Pembrokeshire is world-leading,

then I dread to think what the rest of the world must be like! We are

floundering. Parents are desperate. One parent whose child had had to

wait five years for a diagnosis did not want to be identified but told

us about the experience. My child is of very high intelligence but it

is getting worse by the day as far as their anxiety levels go. Her

adverse are more and more frequent and violent. We have nobody to turn

to, no help and no support. I don't know how I can maintain my job as I

have been called to the school on a daily basis. Jonathan was diagnosed

with autism at 21 and says that having an diagnosis made all the

difference. I think it is crucial. The younger Tilda is diagnosed, the

better it is for them because going through the education system not

being understood is extremely to challenging. I think parents a need

that time to get to grips with the 18 months ago, they commissioned a

report, looking specifically at young people, crucially, it sought

the views of clinicians. Their Last night, the National autism

society was celebrating 50 years of service. It was attended by the

deputy minister responsible for social services. It is the largest

orders and charity in Wales and it says the situation here is not as

good as it should be. More people in Wales are waiting three years or

more for nought as an diagnosis. 47 % of people in Wales said they had

waited three years or longer. In England, that figure was 34 %. It

indicates that people are waiting longer for a diagnosis in Wales.

Other charities and Wales to spit that although they were not

available to be interviewed. In April this year, the debt to the

minister for social services was asked about the government's

strategy. So since we published our world-leading autistic spectrum

action plan, much has been achieved. We have developed and there -- and

infrastructure, facilitated awareness and raising training for

professionals and supported projects. Despite being very proud

of the world-leading orders and strategy, the deputy minister

declined our invitation for an interview on the subject but she

did give us a statement and says she fully recognises the importance

to parents and children of receiving a timely diagnosis. She

goes on to say that workers on going to improve diagnosis in

children and adults while ensuring greater consistency throughout

Wales and finishes by saying that access to services is not always

dependent on completion of a formal diagnosis or assessment. She expect

professionals to ensure that families receive appropriate

support at all times. Autism is in grave. One in 100 people artistic

and it comes in all shapes and sizes. For any child with autism,

receiving the right support at the right time can make the world of

difference to their development but the longer they have to wait for

that support, the more difficult it becomes.

Arwyn Jones reporting. Mark Isherwood is the chair of the

Assembly's cross party group on autism. I asked him for his

assessment of the effectiveness of diagnostic services in Wales.

are many questions that have been raised by reports and surveys. The

fact that Wales has and daughters and strategy is a great achievement.

-- has an autism strategy. It also has cross-party support. The focus

must be now on the delivery of that strategy and part of that his

diagnosis so that proper support can be put into people. We have now

had the 50th birthday survey and 40 % said they had to wait more than

three years to be diagnosed which is Wellow -- well above the UK

average. That was a relatively small sample but alongside that we

have got an official report, dated December 2010. In March or April

this year, the deputy minister answered a question in the chamber,

saying she was now in 20th April 12 asking the authors to carry out an

evaluation of children's diagnostic services. But we find out now this

report was published in 20th December 10. So the strategy is not

all it's cracked up to be? strategy is fine but the delivery

is the problem. Most Assembly Members can give you examples

involving parents telling them their own horror stories. Nearly

half reported waiting more than three years is worrying. Services

will intervene to support a child ever there needs but in reality,

too often, we find that children and young adults are being denied

access to speech and language therapy services and early

intervention services because of delays in being diagnosed. Do you

accept that this is something the Welsh government is taking

seriously? There is a strategy, there have ring-fenced or than �7

million over format years for autism diagnosis and treatment,

they have commissioned a study themselves to assess how things are

going. Aren't those the sides -- the signs of a government trying to

get to grips with the problem? problem is we now discover we have

a report 18 months ago with evidence from conditions --

clinicians themselves, talking about postcode lottery diagnosis.

They talk about the failure and a lack of understanding among senior

managers. That was 18 months ago. Why is the minister being briefed

to answer questions only in April? Does she know she has got that

report? What has been done on the recommendations given to the Welsh

government? So when that report complains of a postcode lottery,

that is precisely the sort of inconsistency that they Wales wide

strategy is supposed to prevent? is. These things involve a big

change. They involve a lot of services working together in

communities and a lot of money is going into this. I think you

mentioned �7 million. The priority is to ensure that funding goes to

frontline services and this makes sure that the people need the

support I getting it. These reports are suggesting otherwise. The fact

we got the funding and the strategy means we are far better off than we

were but it also indicates there are still problems at delivery

level which the Welsh government must take responsibility for.

you for joining us. Badges have received a lot of

attention over the last few days after it emerged that the First

Minister approved a plan to buy a new one for the Counsel General,

Theodore Huckle. It's costing thousands of pounds but we're told

that the Welsh Government's senior legal adviser needs the silver

bullion insignia to "distinguish" him during ceremonial events. Our

reporter, Carl Roberts, is a thrifty chap and also, it turns out,

a frustrated Blue Peter presenter. So he made me a cheaper version.

Frankly, I'm insulted. The trouble is, once he got out his sticky back

plastic, there was no stopping him. Here's one he prepared earlier.

As I'm sure you know, this is Theodore Huckle QC, the Council

general for Wales. His duties include holding meetings and

discussions with other law officers and in the future, he could be

sporting what one Assembly member has been -- has described as a

shiny badge. It gave me an idea. I have got my badge. I am waiting for

the Council general who was answering questions over there.

We're waiting for him to come over through that door and will see

whether he will accept this badge. -- and we will see. This is my

badge. What about this decision to buy a UA new badge? I am the lawyer

in all of this. Into your new batch arrives, we have made you one. Will

you accept it? Have a nice day. The Council general did not seem too

impressed with my badge but the politician who discovered the

information in the first place is not impressed either. Decisions

like this, they do bring politicians into disrepute. It

gives people the opportunity to say that politicians are all out of

touch. Decisions like this, you can understand why people say that. It

makes me angry when things like this happen and the people making

the decisions don't understand that ordinary people just would not

spend �5,000 of public money on a piece of jewellery. Business case

recommends appears to peace with silver bullion which will cost

�5,382 including VAT. It is sure to be a busier for staff here at the

Royal Mint, because they have won prestigious commission that will

raise their profile. They're making the Olympic medals here as well!

this day and age, I would have thought that many is wasted. Other

people might think differently. What does it matter? It's what

comes out through his mouth that matters. That badge want making any

better. It sounds like a good position to being and if that is

what it's worth, fair enough. Welsh government confirmed that the

Royal Mint had been commissioned by the First Minister to produce and

signed the insignia and that the cost had yet to be finalised. He

has already got one badge and soon he will have another one.

Our Welsh Affairs Editor, Vaughan Roderick, is here. You're here to

talk about the GCSE row because in England, they are planning to bring

back a O-levels. A leaked document said this morning the government in

England was considering bringing back a 2 level exam process,

something like O-levels. That did not impress the Liberal Democrats

because they had not been consulted. The Welsh Education Minister said

it was bonkers to launch something like that without any consultation.

It has erupted from nowhere, that story. The there is a review of

GCSEs going on in Wales at the moment. There are concerns about

grade inflation and the Daily Telegraph to covered last year what

appeared to be exam boards competing with each other. GCSEs

are England, Wales and Northern Ireland exam and a jointly-owned by

those three administrations. They are not owned by Michael Gove. Any

change should have been discussed between the three administrations.

Has Leighton Andrews ruled out his return to levels? He has absolutely