12/07/2012 Dragon's Eye


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


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


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


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


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


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


Information Act that show that the UK Government raised concerns over


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


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


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


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


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


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


The transplant figures for Wales have increased in the last five


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


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


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


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


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


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


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


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


feel uneasy whether we call it presumed consent or deemed con


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


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


bodies are no longer their property. Unfortunately that might leave


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


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


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


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


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


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


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


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


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


widely quoted as the example when presumed consent was proposed in


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


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


They argue that having specialist medical staff in hospitals and more


intensive care beds is what organs are deemed to be suitable


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


environment. I think that research demonstrates that in countries


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


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


plenty of critical care space available. The Royal College of


Surgeons has raised concerns about operating one system in Wales and


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


problems for medics, since surgeons are responsible for ensuring that


Scotland and England have a slightly different law and they


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


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


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


in Liverpool when it emerged that organs had been removed from


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


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


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


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


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


asked the Welsh government for details of discussions with UK


ministers on this issue. It continuously refused to release


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


part of Ministers in London about presumed consent operating only in


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


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


systems, the problem of having people who move between


jurisdiction and the uncertainty of the clinicians and the surgeons,


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


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


are achieving increased organ donation through education and


communication? The Welsh Government also told Ministers in London that


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


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


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


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


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


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


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


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


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


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


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


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


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


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


"maintaining dialogue" with the UK Government to address their


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


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


Saunders, chair of the Royal College of Physicians' Ethics


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


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


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


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


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


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


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


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


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


understand the issues. We understand we have a good


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


they understand the issues. They have through campaigns over the


last three or four campaigns increased the Organ Donor Register.


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


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


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


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


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


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


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


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


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


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


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


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


concerned that perhaps the progressed that in Wales will be


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


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


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


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


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


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


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


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


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


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


I know the Royal College of surgeons has been expressing


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


performing the transplant to ensure that proper core sent has been


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


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


disabilities, perhaps people with dementia, the mentally ill?


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


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


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


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


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


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


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


taken into account you have the ultimate safeguard? I rather


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


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


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


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


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


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


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


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


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


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


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


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


have to face some flak over influence restructure hospitals in


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


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


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


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


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


politics. The report was to articulate the reasons why health


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


with their communities about the future of hospital services in


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


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


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


evidence that centralising emergency surgery brings mortality


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


stroke and major trauma are improved when services are


centralised. It also said that outcomes improved significantly if


patients receive the right care and treatments within the first golden


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


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


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


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


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


for more killer facts. And expresses concerns that the


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


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


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


case for change Return Dr Jones advises the Professor That the


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


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


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


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


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


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


there being any comeback The correspondence, the Government says,


was no more than sharing information.. There has been


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


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


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


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


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


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


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


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


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


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


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


clearly an issue which will dominate the political landscape in


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


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


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


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


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


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


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


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


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


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


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


the same locality, the NHS bureaucracy offer the same


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


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


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


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


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


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


constituency members understand they cannot travel with this. So


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


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


party tension and Intra party tension. So the consensus breaks


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


for Wales said although current health services are not affordable,


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


especially with new technology that offers new opportunities of


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


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


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


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


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


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


accept that change will happen, technology will change and afford


new opportunities, but there are basic services that a community


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


you consider those untouchable? From my perspective, in


representing Ceredigion and the hospital we saw in some of those


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


to emergency Caesarean that can deliver babies safely and save the


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


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


services within reach of life saving opportunities, that is not


acceptable to those communities and no politician could sell that.


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


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


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


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


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


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


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


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


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


examples throughout the world where services are delivered more closely


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


that closer collaboration between health and social services is


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


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


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


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


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


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


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


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


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


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


difficult circumstances, are now facing the biggest challenge of


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


political consensus for what is obviously very difficult change,


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


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


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


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


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


considerable majority of members, there is a shared understanding of


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


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


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


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


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


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


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


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


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


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


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


people suspicious when it comes to establishing the agreement of the


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


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


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


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


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


issues. People become suspicious when politicians and health boards


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


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


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


year on year significant increases in health expenditure between 1999


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


radically reform the delivery of health services. The Government


spent time restructuring health boards and Trusts. It was


bureaucratic. It was not about service delivery, but about


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


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


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


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


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


established, voters can be brought along with the proposals the


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


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


sometimes have difficulties is because people feel passionately


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


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


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


Cardiff council employees are planning to use the Olympics in


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


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


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


football events which are being played at the Millennium Stadium.


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


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


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


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


the crowd wearing T-shirts protesting against plans for the


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


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


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


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


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


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


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


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


Earlier this month, Cardiff Council announce that lowest paid workers


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


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


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


plans to change the management structure. One former Cabinet


member is sceptical of the reasoning for the appointments.


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


make a truly member-led administration, they are talking


about not responding birdie at a supplementary meeting two questions.


Why would a Cabinet member be afraid to answer my supplementary


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


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


actively discussing ways to vent their opposition to the proposals.


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


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


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


being proposed by this establishment. The council says


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


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


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


day consultation process. In the meantime, council employees in


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


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


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


minister and she faces another difficult week. Yes, super


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


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


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


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


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


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


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


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


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


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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