12/07/2012 Dragon's Eye


12/07/2012

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Party politics aside, how should we change the Welsh health service?

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This is Dragon's Eye. Good evening. People across the UK

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are being encouraged to sign up to the Organ Donor Register as part of

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National Transplant Week, but the debate over the Welsh Government's

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plans to introduce an opt-out system continue to be controversial.

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Dragon's Eye has received copies of documents under the Freedom of

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Information Act that show that the UK Government raised concerns over

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whether it was desirable, feasible or necessary to run two different

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systems. The Welsh Government also promised to continue paying for the

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UK organ donation system while it found the money for the new opt-out

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system from its own budget. Here's Brian Meechan. Ultimately everyone

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wants to the same outcome - increasing the number of donors to

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save lives. But how to do that is a source of passionate disagreement.

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The transplant figures for Wales have increased in the last five

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years. The number of donors has risen to 45 in 2007-08 to 67 in

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2011-12. There's been a rise in the number of people on the register,

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by 5% over the same period. The co- ordinators of the organ donation

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system say it is because they've changed the way it operates. Since

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2008 when the team increased to 12 and they were placed as residents

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within hospitals, we have almost reached the 50% increase target set

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down by the task force. Some critics of the presumed consent

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proposals suggest kite damage the successes seen so far. People may

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feel uneasy whether we call it presumed consent or deemed con

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sthaent there is somehow some sort of line being -- consent, that

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there is somehow some sort of line being crossed that their organs or

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bodies are no longer their property. Unfortunately that might leave

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people to take the decision to opt out. Mike Stevens a transplant

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What we are talking about is an opt-out system with safeguards, the

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of the opt-out if you like. There is an opportunity to opt out but

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there'll be a discussion with the family of every potential donor to

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ascertain whether this really was their zifrplt as is the case now,

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at the moment if your name is on the Organ Donor Register legally

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your organs can be used for transplantation. That doesn't mean

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that there's a mandate that they have to be removed. That's still

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going to be the case if we change to this new proposal. Spain was

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widely quoted as the example when presumed consent was proposed in

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Wales. But the Spanish co- ordinators say presumed consent had

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no impact when it was introduced and is no longer used in practise.

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They argue that having specialist medical staff in hospitals and more

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intensive care beds is what organs are deemed to be suitable

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for transplantation purposes, then they must die in a critical care

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environment. I think that research demonstrates that in countries

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abroad where there's been a welcome improvement in levels of organ

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donation that money has been pumped into seeing to it that there is

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plenty of critical care space available. The Royal College of

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Surgeons has raised concerns about operating one system in Wales and

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another in England. It could lead to legal as well as practical

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problems for medics, since surgeons are responsible for ensuring that

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Scotland and England have a slightly different law and they

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make things work without too many difficulties. I believe we will be

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able to do the same. I believe this will be successful, as long as we

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approach it in the right way. Scandal engulfed Alder Hey Hospital

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in Liverpool when it emerged that organs had been removed from

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children without consent. It led to the Human Tissue Act and the Human

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Tissue Authority. The Human Tissue Act is very clear that consent

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should be a positive act. That is simply -- to simply have an option

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of opting out and being deemed to have given consent is concerning. I

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understand why they are doing it but I think it is concerning.

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asked the Welsh government for details of discussions with UK

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ministers on this issue. It continuously refused to release

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Dragon's Eye received documents that showed deep concerns on the

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part of Ministers in London about presumed consent operating only in

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Wales. They said they weren't convinced a separate system was

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feasible, desirable or necessary. think the problem of having two

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systems, the problem of having people who move between

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jurisdiction and the uncertainty of the clinicians and the surgeons,

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clearly says that there is an issue here that has to be addressed. It

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goes back to the starting point - what's the purpose of this is they

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are achieving increased organ donation through education and

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communication? The Welsh Government also told Ministers in London that

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the new register would be funded from the Welsh budget and it would

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be continuing to pay into the UK system too. Supporters say it is

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worth getting behind the presumed consent model. What we'll see is an

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increase in donors and transplants. I think the rest of the UK will be

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looking at us with envy and are likely to change their system. I

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think we'll be the leaders in the UK and around the world as well.

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When matters of life and death are involved it is no surprise they

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motions run high. As everyone aims for the ultimate goal of increasing

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the number of donors. As it's National Transplant Week,

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we asked the Health Minister, Lesley Griffiths, for an interview

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on the Government's plans for organ donation. She said no, but she did

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give us a statement. It says that the freedom of information request

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related to issues relevant to a previous attempt to bring in an

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opt-out system in the last Assembly. And that the Welsh Government is

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"maintaining dialogue" with the UK Government to address their

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concerns. It also denies that the Welsh Government will be funding

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two systems of organ donation. Joining me now is Professor John

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Saunders, chair of the Royal College of Physicians' Ethics

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Committee, and the chair of Kidney Wales Foundation, Roy Thomas. You

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are a keen supporter of the new proposals. What do you make of the

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argument that says we are getting where we want to be anyway.

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Donation rates are going up, the number of people signing the

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register is going up. It looks as if the Government is going to hit

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the target that it set itself by 2013. It is working, don't Tam we

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are with? First of all the Government in the UK won't reach

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its target in 2013. No, I'm talking about in a Wales. In Wales we will.

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We've been debating this for six or seven years. The people of Wales

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understand the issues. We understand we have a good

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transplant unit, a world-class transplant unit in Cardiff, and

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they understand the issues. They have through campaigns over the

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last three or four campaigns increased the Organ Donor Register.

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But that system is outdated. It hasn't achieved what it should

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achieve and we need a new system. Professor, do you agree with that,

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is the current system outdated? it is not. It doesn't work as well

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as it should, but the rising number of people on the Organ Donor

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Register is in Wales, that's terrific news. The percentage is

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going up. Wales has always been ahead of the rest of the UK in this

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respect. With respect to England, there is enormous variation in

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English regions. None of emare quite up to Wales but one or two

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are close to it. What are your concerns about an opt-out system?

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It is cheerful the impact of people's choices of how many people

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will opt out because they don't like the idea of organs being taken.

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I don't think there's a primary ethical objection. So are you

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concerned that perhaps the progressed that in Wales will be

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jeopardised by an opt-out system? That's the angzifplt There is no

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evidence of that. You talked in your clip about Spain. We've been

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highly successful. They have more intensive care beds. We hopeful

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will do that. It has increased donation in place like Belgium,

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where they introduced this in 1986. The fears of people on the opt-out

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register. They are there and I can understand that. John has a good

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point on that. I'm clear this Wales, the BBC poll in March showed a 62%

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support. We've only got 33% on the Organ Donor Register. It is

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fantastic to see more people on that. I do say it is outdated.

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about some of the concerns around safeguards and that sort of thing?

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I know the Royal College of surgeons has been expressing

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concerns, because legally it's the obligation of the surgeon

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performing the transplant to ensure that proper core sent has been

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given. What about mental capacity issues? You do have concerns about

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how that will be dealt with, in terms of people with learning

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disabilities, perhaps people with dementia, the mentally ill?

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sensitivities that we have in the NHS, and Alder Hey was mentioned.

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Alder Hey was historic. It was a very sad episode in NHS Stu, but

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the human tissue Act dealt with that. It should be consigned to the

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history books, now doctors are aware of consent. They do look at

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the immediate family for guidance. Naz your clip, the organ donor co-

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ordinators are experts all of this. What about that, that ultimately

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because the families will still be consulted and their weres will be

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taken into account you have the ultimate safeguard? I rather

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support Roy's views on this. It doesn't worry me, I think it has

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been taken care of. Roy is right to emphasise that some of these issues

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over consent belong to pleasant experiences in the past. Gentlemen,

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thank you. Unless you've been away all week,

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you'll know there's been a blazing row over changes to the health

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service. More specifically, a report into the changes. Or more

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specifically still, e-mails between the author of the report and senior

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Government officials. In all the political mudslinging, it's easy

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enough to forget the real issue - the far-reaching changes to the NHS

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in Wales. We know it's difficult, we're told it's necessary, but is

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it achievable? Arwyn Jones reports. Since taking the job just over a

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year ago the Health Minister has said on several occasions she will

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have to face some flak over influence restructure hospitals in

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Wales. This week she saw exactly what that flak can look like.

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do accept that you do not have a grip on your department? We can

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have no trust in the Welsh Government now. The people of Wales,

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Llanelli and Mid and West Wales will feel they've been sold a pig

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in a poke. Let's see what led to such a tumultuous week in Wales

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politics. The report was to articulate the reasons why health

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boards need to change services. And to help health boards in engaging

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with their communities about the future of hospital services in

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Wales. The report published in the spring said mortality rates for

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general surgery, trauma and oorth pedics, general medicine and stroke

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services are higher in Wales than in England. It said there is

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evidence that centralising emergency surgery brings mortality

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rates up to the English average, and mortality for heart attacks,

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stroke and major trauma are improved when services are

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centralised. It also said that outcomes improved significantly if

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patients receive the right care and treatments within the first golden

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hour of falling ill or getting injured. So what's caused this

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debate? Well this, week BBC Wales highlighted e-mail correspondence

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between the author of the report, Professor Marcus Longley, and

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senior Welsh Government officials. In one e-mail exchange, Professor

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Longley asks the medical director of the NHS in Wales, Dr Chris Jones,

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for more killer facts. And expresses concerns that the

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evidence as presented does not seem to be as incisive as we might have

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hoped. Who, asked the opposition, is we? In another, he asks for more

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evidence to Sian up the document and its impact in supporting the

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case for change Return Dr Jones advises the Professor That the

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document needs to be more positive if possible, and set out a more

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persuasive vision of how things could be better. So a showdown was

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set for First Minister's Questions on Tuesday, with accusations and

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counter accusations. First out, the First Minister. It is cowardice to

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attack the reputation of an academic, to try to suggest he is

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independent, to ruin his reputation in the academic world, without

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there being any comeback The correspondence, the Government says,

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was no more than sharing information.. There has been

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nothing in this process which has lacked in transparency. I have

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neither lived nor connived with anyone. But that wasn't enough to

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silence the opposition, who decided to come out in force. Will you

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apologise for mislead this Assembly and the people of Wales about the

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fact that it was not an independent report in if you didn't know, you

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do accept thaw do not have a grip on your department? And that it is

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time for you to resign? This is another case of the Labour Party

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sex up a document to try to prove their case. People across Wales are

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really frightened about the future of their local hospitals. They can

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have no trust in the Welsh Next week, she will go before the

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health committee on the eve of a vote of no confidence in her. It is

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clearly an issue which will dominate the political landscape in

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Wales for the foreseeable future. If we can leave aside the political

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cut-and-thrust, at its heart this debate is about the future of the

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NHS, the next direction for our hospitals and so on. Professor

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Marcus Longley's report was supposed to feed into that. The

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health minister has said that the status quo, no change, is no longer

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an option. But changing away from the status quo, not just for this

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government, but for others, too, has proven more easily said than

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done. Because this is what you get when you talk about restructuring

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health services. Locals out in force to oppose plans. This man

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used to be a top official at the UK Government's Department of Health,

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and he says it is clear why the NHS has trouble convincing locals.

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the same locality, the NHS bureaucracy offer the same

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unpopular choice, get rebuffed and come back five years later with it

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again, get rebuffed and come back five years later again. The people

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pushing it might have only just got the job, might be newly elected,

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but the people rejecting it have seen it four times. They did not

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like at the last three times and do not like it this time. But it is

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not just from the public. It tends to fracture because the retail

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constituency members understand they cannot travel with this. So

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although it is the official party line, the locals understand this is

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not a pathway to re-election, so they peel off. So you get cross-

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party tension and Intra party tension. So the consensus breaks

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down. That might not be the only problem. Today, the Auditor-General

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for Wales said although current health services are not affordable,

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it might not have enough funds to pay for major reforms either.

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are waiting for the Government proposals as to how they are going

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to react to the ideas the boards are going to bring forward over the

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next year, in terms of changing the pattern of services. Those have to

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stay within the budgets available in Wales. That is the challenge.

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Because if you move from current provision to future provision, you

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need to spend money. And as I said, money is very tight. What exactly

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the new plans are will be revealed over the next few weeks and months.

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One thing is for sure - in politics, health always gets the pulse racing.

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Let's discuss some of that. With me, the chair of the Assembly's health

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committee, Mark Drakeford, Plaid Cymru's health spokesperson Elin

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Jones, and the former Conservative AM of Jonathan Morgan, also a

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former chair of the health committee. Well come. Do any of you

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think that the status quo is the way forward for the Welsh Health

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Service? Well, the health service is continually evolving. It changes

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all the time. I have been the Assembly Member for Ceredigion for

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13 years. It has changed during my time and will continue to change,

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especially with new technology that offers new opportunities of

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delivering a service. But they are fundamental services in a district

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general hospital that need to be there to save lives and provide the

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ability of babies to be born in that community, and for services to

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care for the elderly. So is it your position that services at district

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general hospitals should never be up for discussion, that what is

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there must remain for ever and a day? That is not what I said. I

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accept that change will happen, technology will change and afford

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new opportunities, but there are basic services that a community

:19:13.:19:20.

will require within a distance, within a timely intervention...

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you consider those untouchable? From my perspective, in

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representing Ceredigion and the hospital we saw in some of those

:19:28.:19:34.

pictures, that access to emergency surgery that can save lives, access

:19:34.:19:39.

to emergency Caesarean that can deliver babies safely and save the

:19:39.:19:45.

lives of mothers, those are pretty fundamental. If those are removed

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from a community where there is then no ability to have those

:19:48.:19:55.

services within reach of life saving opportunities, that is not

:19:55.:19:59.

acceptable to those communities and no politician could sell that.

:19:59.:20:04.

are pulling a face. We have to be realistic about where we are in

:20:04.:20:09.

delivering health services in Wales. Since devolution in 1999, we have

:20:09.:20:13.

been told by independent experts, clinicians, by people working in

:20:14.:20:17.

the Wales Audit Office and others, not just by politicians or

:20:17.:20:20.

Government ministers, that the NHS and the way we deliver services,

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how we deliver them, the localities, what services we deliver, has to

:20:25.:20:30.

change. Because if you keep thinking that the NHS of the 1950s

:20:30.:20:34.

is something you can deliver today, we are kidding ourselves. The

:20:34.:20:38.

health service has become much more expensive to deliver. There are

:20:38.:20:41.

examples throughout the world where services are delivered more closely

:20:41.:20:44.

to people and become far more effective and efficient. We know

:20:44.:20:49.

that closer collaboration between health and social services is

:20:49.:20:53.

needed to make sure we spend money more wisely. I think some of the

:20:53.:20:56.

health service provision we have had in Wales, although that has

:20:56.:20:59.

been very good, there have been poor examples. Some community

:20:59.:21:03.

hospitals, frankly, should have closed years ago. We spent months,

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if not years, talking about when neurosurgery ought to be located in

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South Wales. The problem in Wales is that very often we are good at

:21:12.:21:16.

analysing the problem, at sick -- accepting that what we have will

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not work, and taking forever and a day to provide a solution. We are

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now hitting the buffers because we are running out of money and the

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local health boards, which have tried to do a very difficult job in

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difficult circumstances, are now facing the biggest challenge of

:21:30.:21:35.

their lives. Mark Drakeford, how do you go about trying to build

:21:35.:21:37.

political consensus for what is obviously very difficult change,

:21:37.:21:41.

given that everyone seems to have a different concept of what change

:21:41.:21:47.

means for the NHS? Change is very difficult in the NHS. Not just in

:21:47.:21:52.

Wales, but anywhere that change is trying to be brought about. Let me

:21:52.:21:56.

give three reasons for optimism about what can be achieved. First,

:21:56.:22:01.

inside the Assembly Chamber, not universally, but I think across a

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considerable majority of members, there is a shared understanding of

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what the problem is. You have heard some of it already this evening.

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Lots of what they have said, I would agree with in understanding

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what the problem is. That is a good starting-point. Second, we have

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managed to bring about change in places. We have actually succeeded

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in it. I was recently in a fantastic new hospital. Three old

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community hospitals had to be closed to make that happen and it

:22:30.:22:33.

was done with the agreement of the local population. We can make this

:22:33.:22:37.

happen. Third, and maybe slightly strangely, that again in the way

:22:37.:22:40.

that Jonathan Stead, the pressures from funding are such that the

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choice about change is no longer, shall we think about it, when will

:22:44.:22:50.

we do it? It is an urgent thing on our doorstep. Is that what makes

:22:50.:22:53.

people suspicious when it comes to establishing the agreement of the

:22:53.:22:57.

local population? People think, this is actually about saving money,

:22:57.:23:02.

not giving me better services. And as Elin Jones was saying, even if

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they had to travel that little bit further when they are about to give

:23:05.:23:09.

birth to their baby, or an emergency, that could compromise

:23:09.:23:14.

their chances of a successful outcome. They are a couple of

:23:14.:23:17.

issues. People become suspicious when politicians and health boards

:23:17.:23:22.

talk about changing local services. Automatically, they think they will

:23:22.:23:25.

end up with something worse than what they have. The problem with

:23:25.:23:32.

where we Arnaud, and I know it is being retrospective, but we had

:23:32.:23:36.

year on year significant increases in health expenditure between 1999

:23:36.:23:41.

and 2005-2006. At no point in that period was there an attempt to

:23:41.:23:46.

radically reform the delivery of health services. The Government

:23:46.:23:49.

spent time restructuring health boards and Trusts. It was

:23:49.:23:53.

bureaucratic. It was not about service delivery, but about

:23:53.:23:57.

shifting the chairs in the local health board structures. That is a

:23:57.:24:02.

challenge. A we have to do much to take the public with us. Local

:24:02.:24:07.

health boards should consult with the public. If push has come to

:24:07.:24:10.

shove, and you have expressed there are grounds for optimism, do you

:24:10.:24:14.

believe that in the course of this Assembly political consensus can be

:24:14.:24:17.

established, voters can be brought along with the proposals the

:24:18.:24:22.

Government is about to make? certainly think that in the process

:24:22.:24:26.

of change you have to think of the patients as assets. The reason we

:24:26.:24:29.

sometimes have difficulties is because people feel passionately

:24:29.:24:33.

about the NHS and their services. If you regard people as the enemy,

:24:33.:24:37.

you will never bring about change. You have to harness enthusiasm for

:24:37.:24:43.

the NHS and turn it into an asset. Thank you for joining us.

:24:43.:24:46.

Cardiff council employees are planning to use the Olympics in

:24:46.:24:49.

Cardiff as a platform to protest against plans to appoint a team of

:24:49.:24:53.

senior managers. With the eyes of the world on the capital city as

:24:53.:24:56.

the Games kick-off, the GMB union says it will target Olympic

:24:56.:25:03.

football events which are being played at the Millennium Stadium.

:25:03.:25:06.

The Rings are up, we have seen the Olympic torch in the capital, and

:25:06.:25:10.

in less than two weeks, thousands will be in the Millennium Stadium

:25:10.:25:13.

to watch Great Britain take on New Zealand in the women's football.

:25:13.:25:17.

And as the eyes of the world focus on Cardiff, they could see some in

:25:17.:25:21.

the crowd wearing T-shirts protesting against plans for the

:25:21.:25:28.

council to employee up to 24 senior managers on salaries of up to

:25:28.:25:32.

�120,000. The plans have been drawn up by the council has no chief

:25:32.:25:37.

executive, and the proposal is to appoint a team of senior managers

:25:37.:25:41.

to support the council's cabinet. The aim is to put the Cabinet at

:25:41.:25:47.

the heart of decision-making. The plans will cost �1.7 million a year

:25:47.:25:53.

in wages. And that is spending that the trade unions' call obscene.

:25:53.:25:57.

have �55 million to save them the next three years. We understand

:25:57.:26:03.

that we are in economic meltdown. This is obscene and immoral.

:26:03.:26:06.

Earlier this month, Cardiff Council announce that lowest paid workers

:26:06.:26:12.

will receive a wage increase of around 1500 pounds per year if, as

:26:12.:26:15.

the authority claims to be the first in Wales to introduce a

:26:15.:26:19.

living wage. On the same day, staff at the council were informed of

:26:19.:26:22.

plans to change the management structure. One former Cabinet

:26:22.:26:26.

member is sceptical of the reasoning for the appointments.

:26:26.:26:32.

as they say in the paper there goes the full Cabinet, if they want to

:26:32.:26:41.

make a truly member-led administration, they are talking

:26:41.:26:45.

about not responding birdie at a supplementary meeting two questions.

:26:45.:26:49.

Why would a Cabinet member be afraid to answer my supplementary

:26:49.:26:53.

question verbally if they had the ability? Unions say many staff had

:26:53.:26:59.

seen wages reduced by up to �8,000 following job evaluation. They are

:26:59.:27:02.

actively discussing ways to vent their opposition to the proposals.

:27:02.:27:07.

At the end of the day, some of our members have said that they have

:27:07.:27:11.

already bought tickets for the Olympic venues. And they may well

:27:11.:27:15.

be wearing T-shirts to say how ludicrous it what is currently

:27:15.:27:19.

being proposed by this establishment. The council says

:27:19.:27:23.

that they are investing now in order to save money on consultant

:27:23.:27:27.

fees in future. Cabinet members are meeting this evening and are

:27:27.:27:31.

expected to rubber-stamp the senior management model and approve a 30

:27:31.:27:35.

day consultation process. In the meantime, council employees in

:27:35.:27:39.

unison and the GMB unions could be making an Olympian effort to oppose

:27:39.:27:44.

the plans. Betsan Powys is here. Let's return

:27:44.:27:48.

to the health row. It has been a difficult week for the health

:27:48.:27:51.

minister and she faces another difficult week. Yes, super

:27:51.:27:55.

Wednesday. In the morning, the Health Committee, where she will

:27:55.:27:59.

appear with Marcus Longley and Dr Chris Jones. That is where the

:27:59.:28:03.

opposition want answers. If they do not get them, they will be a motion

:28:03.:28:08.

of no confidence in the afternoon. She was regarded as one of the

:28:08.:28:12.

weakest links in the Cabinet. After all this, if she survives, she is

:28:12.:28:16.

bound to be the safest number of the Cabinet. How could Carwyn Jones

:28:16.:28:21.

get rid of her? We have come to the end of the road on Dragon's Eye I.

:28:21.:28:26.

At this point, it has been customary to do this. Vicky for

:28:26.:28:33.

watching, have a good summer, good night. Take care and good night.

:28:33.:28:39.

Join Felicity Evans as she takes a fresh look at politics through the Dragon's Eye.

Whether it is your local council, the National Assembly, Westminster or Europe, Dragon's Eye will be probing, scrutinising and shedding light on our democratic institutions.

In national transplant week, we look at the Welsh government's plans to change the way organs are donated in Wales and a former top health official says reforming the NHS is 'too difficult for Wales'.


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