20/01/2013 The Wales Report


20/01/2013

Is change the best medicine for healthcare in Wales? And as more major retail chains close their doors, what is the cultural importance of independent shops to Welsh high streets?


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Transcript


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Tonight, it is the biggest shake-up of health care in Wales, but is a

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prescription on change on this scale really the best cure for the

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Welsh NHS? In or out? David Cameron wants to re-examine the UK

:00:16.:00:19.

relationship with Europe, but what does it mean for Wales? As another

:00:19.:00:23.

high street giant announces its doors are closing, we examine the

:00:23.:00:28.

mid- the impact of the internet on one of our biggest export, music. A

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:00:38.:00:40.

Good evening and welcome to the programme that looks at the big

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decisions that affect your lives here in Wales and the decision-

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makers behind them. We start tonight with an issue that always

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ranks as the most important to you in any opinion poll. Your NHS. And

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that is undergoing what has been billed as one of the biggest

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changes in its history. The NHS here is about change so good --

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about face significant change because according to experts and

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the Welsh government it will improve health care and addressed

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the financial pressures weighing down system. There is a

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consultation under way and this week we have heard the plans of two

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of Wales' seven health boards. In Mid West and North Wales. Decisions

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about rationalising services, or closing local hospitals, provoked

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strong emotions from people who feel their local services are under

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threat. David Williams has spent the week in North Wales with some

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of those waiting to hear their fate and he has been looking at the

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complex implications for all of us Months of lobbying, arguing that

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protesting culminated this week in one final gesture from a small

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group of parents driven by the most emotive of campaigns. Saving a

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hospital service which had saved the lives of their children. They

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call themselves Cuddles. But they are not here to embrace the health

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authority. On the contrary, they come here to make one last gesture,

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one last plea to the local health board, to think again about six

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proposal to move the neonatal intensive care service to the

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hospital near Birkenhead, in England. He was having difficulty

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breathing so they had to resuscitate him. I don't think he

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would have made it elsewhere. you both feel very strongly that

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this unit should stay in this hospital? We do. Until you have

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been in a predicament where your child is on the line, you don't

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understand what the staff do here. It is unreal. Parents here are

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understandably precious about a service which they hold dear. The

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health service in all its forms generates the most passionate of

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arguments. Every corner of the services considered worth fighting

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for. Not least the Community Hospitals, which are at the heart

:03:15.:03:20.

of the NHS. Community Hospitals like the one at Colwyn Bay, whose

:03:20.:03:27.

minor injuries unit is threatened with closure. One of the leading

:03:27.:03:32.

campaigners orchestrating the public fight to save it is

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Conservative councillor Cheryl Carlisle. She has attended every

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consultation meeting called she has come away less than impressed by

:03:41.:03:47.

the financial arguments put forward by health officials in pursuit of

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their plans. I understand exactly what they are saying, but I do feel

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that the financial problems come from a lot higher up. They come

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from the reorganisation of merging six local health boards. I sat want

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Conwy local health board and we had every bit of budget tied down. We

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knew where every penny was going. Do you think that you have done

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enough to win the argument had saved this money unit, minor

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injuries unit? If it is a true consultation and truly done on

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costings, then yes, I think we have done enough, if they truly listen

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to the people. This week, months of consultation came to an end and a

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health board finally delivered its verdict. It was billed as D-Day,

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decision day. This was technically a board meeting, not a public

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meeting, but by any standards it was an extraordinary affair. More

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than 100 people packed into a highly charged atmosphere and it

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was not long before individuals were expressing their disquiet.

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Although we were not allowed to film it. There were pleas for the

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protesters to stay silent or leave the meeting. One group's patience

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snapped when they were formally told that Flint hospital was to

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close. Angry and frustrated, they spilled out into the corridors

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still protesting and questioning the validity of the Board's

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consultation exercise. What have you heard this morning?

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They are closing Flint. They are giving us one bed at the hospital.

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Do you think you have lost your fight? No, no. We have lost a

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battle, we haven't lost the war. The Cuddles protest group there

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were hopeful that they had made a case but they were told that

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neonatal intensive care would be transferred to England. Angry and

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emotional, they met with local politicians out to the corridor.

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deliver a lesser service to the people... Their corridors

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themselves were now resembling a casualty unit for campaigners

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trying to reconcile the failed attempts at influencing the

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decisions. How do you feel? Disgusted. They discounted, they

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even had the wrong figures in the consultation. The discounted 1796

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individual letters and still made the decision. It is a farce. After

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one of the most dramatic meetings in which the future of the North

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Wales health service was mapped out, the chief executive of the board

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attempted to justify their decisions. I understand their

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points. I think we can demonstrate we have listened because we have

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made some changes to the decisions we went out with. But the major

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decisions you have made, you have made despite some very strong

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protests, for example the decision on neonatal intensive care. You are

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going ahead anyway. We have considered it. I have to say it has

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been a very difficult decision for all of us around the border and we

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have had to weigh up the balance of what is very emotional and quite

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rightly genuine concern amongst patients, families, children, and

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also our staff, if I might add, against the weight of evidence that

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is given to us by the Betis Association of perinatal Medicine,

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the national clinical Forum and the Royal Colleges. We have had some

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way that heavily in the ballots. Can I ask you a fundamental

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question. At the end of all this how well patient care be improved?

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I believe patient care will be improved in terms of better access,

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reliability, safety of services and outcomes and we are very clear we

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need to measure the outcomes, in other words quality of life and

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what sort of return people have had in terms of their treatment. Soak

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in a word, people, patients, will benefit as a consequence of the

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decisions you have made today? The Welsh government's five-year

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plan or vision for the NHS in Wales is called together for help. The

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problem is, as we have said on this programme before, the people of

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Wales are not together or agreed about the way to bring about change.

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Certainly there seems to be a compelling argument for it but that

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message does not seem to have been conveyed very well. Despite the

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what government's pronouncements promises -- pronouncements,

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promises even, to show leadership, they have been largely conspicuous

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by their absence. Surprisingly there is no overarching plan for

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change. The local health boards have been left to drop their own

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plans, put them out consultation and as we have seen in the last

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week, lay them before suspicious and critical public. Many would go

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along with the need to upgrade and modernise Wales' creaking health

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service. There is a clear need for improved clinical delivery. However,

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there are serious doubts about the way that the Welsh government has

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gone about the task. In particular, there is concern that the whole

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exercise is not -- has not been properly costed. Local authorities

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all over Wales are now becoming increasingly concerned about what

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they say is cost shifting. That is the increased financial burden of

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moving health care into the communities. Winners County Council,

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based in in Caernarfon, last year called for a halt to the proposals,

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including closure of community hospitals. They said the increased

:09:31.:09:34.

cost would place an intolerable burden on an already overstretched

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budget. Other authorities in Wales are saying much the same thing.

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They simply cannot afford the extra bill. They see it as moving rather

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than solving the problem and they are becoming more vocal about it.

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The point that is coming across from some parts of local government

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is to lead to make sure that any proposals that come forward are

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properly costed, so that we know the cost envelope we are all

:09:58.:10:01.

working in. The key thing for both sectors is to make sure that we

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have enough money to deal with the service pressures but we have got

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and to make sure that over a period of time the services we both

:10:10.:10:13.

deliver a sustainable. The problem we have got is that we know that

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there is worse to come in terms of public expenditure cuts. We know

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that things are going to get tougher and there is only a limited

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amount of money to go around so I think working together and making

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sure that we are not shunting costs but actually pooling our budgets

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will be a key feature for the public services and the next period.

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It is not over yet. Health boards in South Wales still have to

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deliver their verdict The Witches expected later this year. In the

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meantime, if any of the community health councils decide to exercise

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their right, as they might well do, to block any of these proposals, it

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will act as an effective veto. The decision will then have to be

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referred to the health minister, Lesley Griffiths, for her to make a

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decision. Only then will we know if the Welsh government's promise of

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showing strong leadership in what has been a long and disjointed and

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contentious exercise, will have any meaning and whether the government

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will actually be able to deliver their grand plan for health in

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Wales. David Williams reporting. We asked

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the Health Minister Lesley Griffiths to appear round tonight's

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programme, but she declined because she says she has acquired at -- a

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Krays side judicial role in the final decision-making process. But

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joining me as Helen Birtwistle, the director of the Welsh NHS

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Confederation which represents senior managers who run the health

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service. -- on a day-to-day basis. Thank you for coming in. You spend

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a long time working in public relations before you did this job.

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How do you find positive spin on what we have just heard? I don't do

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spin. I think the issue is that there are real discussions to be

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had with the public about how services need to change and the

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fact is that if we are looking for positives, it is that the members

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of the public, clinicians, are extremely engaged in decisions and

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discussions about the health service and they have really shown

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what an interest they have in the health service and how passionately

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they feel about the health service. That is something that in the NHS

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we need to maximise. We need to to take their views on board and we

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have. The trouble is people are building barricades, they are

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storming into meetings, they are angry. The NHS sits at the heart of

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the community in Wales and so many people now feel that it all seems

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to be creaking and groaning and even falling apart, that the

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mission is not clear, there is no overall strategy, costings have not

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been done. It is a mess, frankly, isn't it? The Health Service is

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under incredible strain and we have seen better over the Christmas and

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New Year period with some others of people who have been going into our

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hospitals. I think that demonstrates that something has to

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change and change dramatically. That means shifting the focus of

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services from hospitals into the community. Are you saying an effect

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that the burner -- the burden on the NHS in Wales is such now, the

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financial burden, is such that change is inevitable? You may not

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like it but it is going to have to come. One understands that that may

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be the case, but we have also got to have confidence in the people

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who are making the decisions aren't there seems to be drift there, but

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in effect those people who are making the decision about change

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have not really worked the costings out and haven't taken into account

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the emotion that comes out of these communities at the same time. They

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:14:00.:14:00.

are not explaining the message very This is driven by safety and

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quality of care and changing the type of care and services we offer

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and shifting from hospitals to the community. The second point I would

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bring up is about the passion and emotion. That is quite right. As

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patients, we have a vested interest self-service but so do the people

:14:19.:14:23.

making the decisions. The members of our health boards have not been

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beamed down from outer space, they live in those communities. They

:14:30.:14:33.

have children and grandchildren. They also have a statutory

:14:33.:14:39.

responsibility to provide safe care. Part of the issue here might be

:14:39.:14:43.

that the health boards are being left to come up with their own plan.

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There is no umbrella. Is there enough guidance from the Welsh

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Government to the local health board about what needs to be done

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or are they just letting your members get on with it? Together

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for health is the vision of the Government and it means

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transferring and shifting services from hospitals into communities.

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That is the overall vision. Local health boards are charged with

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coming up with a response to that vision for their local communities.

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There will be some issues that local communities and local people

:15:19.:15:29.
:15:29.:15:31.

don't like. In North Wales, we understand that. But health boards

:15:31.:15:37.

have to weigh up a range of issues. Public views but also views from

:15:37.:15:43.

staff, clinicians, the Royal Colleges, from experts and from a

:15:43.:15:47.

wealth of information and they have to balance the decisions they make

:15:47.:15:51.

based on the best and safe care. One thing you are going to face

:15:51.:15:57.

opposition on is the fact you are shifting the cost from the NHS to

:15:57.:16:02.

local councils by closing community hospitals and cutting back on local

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support, you are shifting care to them and they don't have the money

:16:06.:16:11.

to deal with it either. It is a shared problem. We recognise that.

:16:11.:16:16.

There is a lot of work to do with the social care sector and local

:16:16.:16:19.

authorities but there are also some fantastic examples where that is

:16:19.:16:24.

working really well in Wales. In the heat of all this discussion

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about what is closing and what is being perceived as being taken away,

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at our peril we forget the good work that is being done and the

:16:31.:16:35.

progress that being made and the way the health service is

:16:35.:16:42.

developing. Thank you very much. It's time to talk relationships and

:16:42.:16:45.

in particular our relationship with Europe. David Cameron has made

:16:45.:16:50.

clear that Britain should look again at what it gets out of the

:16:50.:16:53.

membership of the European Union. The prime minister postponed a

:16:53.:16:57.

speech last week on the UK's relationship with Europe to respond

:16:57.:17:01.

to the hostage crisis in Algeria than its thought hits -- is likely

:17:01.:17:06.

to warn that the UK could drift towards a divorce from the European

:17:06.:17:13.

Union if problems are not addressed. So is it all give on our part and

:17:13.:17:23.
:17:23.:17:37.

little take or is it an arrangement So do we like David Cameron have

:17:37.:17:41.

any regrets about the terms of our relationship with the European

:17:41.:17:46.

Union? Have we been putting up with an ungrateful, extravagant and

:17:46.:17:51.

expensive partner for far too long? Certainly, the Bill is pretty eye-

:17:51.:17:59.

watering. In 2011, the UK's match - - national contribution was �9.5

:17:59.:18:05.

billion and we got more than 3 billion back in rebates. Isn't it

:18:05.:18:10.

about time we to be good look at what we in Wales get out of this

:18:10.:18:18.

partnership? Between 2007 and 2013 �1.8 billion was allocated for

:18:18.:18:25.

regeneration, training and job creation, roads and buildings. So

:18:25.:18:32.

far, 753 million of that total has actually been paid out. But there

:18:32.:18:39.

is more time available to spend the rest. On top of that, we've had

:18:39.:18:42.

another �2.8 billion for our farmers, Fisheries and rural

:18:42.:18:46.

communities. Praise for the European Union from faithful

:18:46.:18:50.

admirers reads like a love letter. Carwyn Jones thinks we're on to a

:18:50.:18:54.

good thing, saying of our relationship, being in Europe is

:18:54.:18:59.

good for Wales. It's good for jobs, good for our economy. The Welsh

:18:59.:19:03.

Government is deeply committed to Wales being an active partner in

:19:03.:19:07.

the European Union to help us build our economy and to help create

:19:07.:19:14.

sustainable prosperity. But critics say we might as well drop some of

:19:14.:19:18.

Our European Union millions into the water, saying we've wasted on

:19:18.:19:22.

the wrong things or not claimed it because of bureaucracy. After all,

:19:22.:19:26.

despite all the investment, West Wales and the baddies remain

:19:26.:19:32.

economically poor. Is this relationship stake in a rat or can

:19:32.:19:35.

we change? Now is the time for you to tell the Welsh Government what

:19:35.:19:39.

you want the money to be spent on and had to ensure it makes it

:19:39.:19:44.

across the water here to Wales. Has won funding round ends and another

:19:44.:19:54.
:19:54.:20:00.

begins, is it now time for all of Joining me now is the man

:20:00.:20:02.

responsible for the Welsh Government's administration of

:20:02.:20:06.

European funding in Wales, the deputy minister of European

:20:06.:20:13.

programmes, Alun Davies. Let's begin by making it very clear. How

:20:13.:20:18.

disastrous did you say it would be if Wales was to pull out of Europe?

:20:18.:20:25.

It would be catastrophic for the economy of Wales. There are

:20:25.:20:30.

financial benefits but also our economy is linked in to the wider

:20:30.:20:37.

European economy and the wider economy which generates jobs and

:20:37.:20:42.

income for people up and down the country. I know how important it is

:20:42.:20:48.

to the economy of Wales. I hope we will continue to be a positive part

:20:48.:20:57.

of European Union. David Cameron has got a problem with Europe and

:20:57.:21:03.

he is suggesting he wants to create a distance between us and Europe.

:21:03.:21:08.

If there is a referendum in the future and England votes to decide

:21:08.:21:11.

against and Wales foot four, that is a problem for the last

:21:11.:21:15.

Government. It is an enormous problem for Wales and the whole of

:21:15.:21:22.

the UK. I have watched this debate playing out in the London media and

:21:22.:21:30.

I spent my time talking to people in the European Union about the new

:21:30.:21:34.

agricultural and fisheries policies and the new structural fund

:21:34.:21:42.

policies. But what would we do if England voted for and they voted

:21:42.:21:51.

against? Foreign affairs has always been a UK power. The interests of

:21:51.:21:57.

Wales line not only in being in the heart of Europe but being an active

:21:57.:22:00.

but this event in the debate that currently taking place about the

:22:00.:22:03.

new programmes that are being developed. Let's examine some of

:22:04.:22:07.

those programmes because we have not been very good at using Europe

:22:07.:22:12.

than in many in Wales. Cornwell had special funding status just like

:22:12.:22:16.

Wales and used their money to invest in infrastructure and the

:22:16.:22:20.

economy is doing well as a result. But here, it's a different story.

:22:20.:22:26.

We have wasted so much European money over the years. If you look

:22:26.:22:30.

at the economic story of Wales over the last decade, you will see that

:22:30.:22:35.

we have been catching up with other parts of the UK and the investment

:22:35.:22:39.

that has been made has had an enormous impact not only in terms

:22:39.:22:45.

of dry statistics but also in people's lives. They've had

:22:45.:22:48.

opportunities they wouldn't have had without this funding. We have

:22:48.:22:53.

invested in things we could not have invested in so we are having

:22:53.:23:00.

an impact. The valleys of South Wales have seemed economic and

:23:00.:23:03.

industrial decline for the last century. Anybody who believes that

:23:03.:23:09.

you can turn that around in less than 10 years does not live in the

:23:09.:23:14.

reality that I live in. That is what they're doing in Cornwall. We

:23:14.:23:21.

need to invest in jobs and not social schemes. They got the

:23:21.:23:26.

message early on. The money needs to go on infrastructure and jobs

:23:26.:23:31.

and creating new business opportunities. Is that something

:23:31.:23:38.

you're going to learn from in the future? When you actually look at

:23:38.:23:48.

the investments that have taken place, you will see that Wales is

:23:48.:23:53.

seen as an exemplar territory which has used the money well but is also

:23:53.:24:00.

continuing to plan to use it better. The announcement I made last week,

:24:00.:24:05.

the consultation starts in the next few words, it's about having this

:24:05.:24:08.

conversation about how we spend this money, the sort of

:24:08.:24:14.

relationship we want with the European Union. I hope we can have

:24:14.:24:19.

a relationship which is based on Wales taking the lead in some ways,

:24:19.:24:23.

Wales as an example part of the Union and Wales investing in

:24:23.:24:28.

further economic growth and jobs. The Crusoe message is that the

:24:28.:24:31.

relationship and the future relationship with Europe will be

:24:31.:24:37.

vital. It is essential. Thank you very much.

:24:37.:24:41.

Now onto a different kind of free market. Other high street has been

:24:41.:24:44.

suffering in the consumer downturn with shoppers keeping their hands

:24:44.:24:49.

out of the pockets and on their keyboards. Buying entertainment on

:24:49.:24:53.

the internet and not in a high- street store is having a major

:24:53.:24:59.

impact. Among the latest casualties is the music retail chain, HMV.

:24:59.:25:04.

With such giants of the high streets disappearing, what is the

:25:04.:25:09.

outlook for independent music shops left in Wales and what effect will

:25:09.:25:12.

this new age of cultural globalisation have on one of almost

:25:12.:25:22.
:25:22.:25:26.

Time was when you could find a record shop on every high street in

:25:26.:25:30.

Wales. Remember those hours spent looking for the latest release on

:25:30.:25:36.

vinyl and then CDs. How the world has changed. The internet

:25:36.:25:40.

revolution has had a huge impact on our consumption of music and the

:25:40.:25:45.

look of our shopping centres. If the once-mighty record giant HMV

:25:45.:25:51.

does disappear from our high street that will mean they will only be a

:25:51.:25:57.

few independent record shops left across the country. Spillers in

:25:57.:26:01.

Cardiff is the oldest independent record store in at the world. It is

:26:01.:26:07.

battling on. By no means Athens rosy for this. It is as tough or

:26:07.:26:11.

less as anybody in business. Independent record shops are

:26:11.:26:16.

integral to the local music scene. They are part of the landscape. We

:26:16.:26:20.

stop a lot of up-and-coming band so put out their own music and they

:26:20.:26:26.

can come in here and it will sit alongside established bands. A lot

:26:26.:26:30.

of them sell more copies than we will have something that everybody

:26:30.:26:36.

will have heard of. Music from Wales through the 90s had a huge

:26:36.:26:40.

cultural and economic impact. The manic Street Preachers, the

:26:40.:26:46.

Stereophonics, Tom Jones and many more were part of a cool Wales

:26:46.:26:50.

which changed the perception of wells across the world. But many.

:26:50.:26:54.

Way globalisation of popular culture as a real threat to new

:26:54.:26:59.

music in both languages in Wales. So in the 21st century, will we

:26:59.:27:07.

still be the land of song? Joining the now is the radio 1 DJ,

:27:07.:27:16.

Hugh Stephens. There was a time when some of us who would go down

:27:16.:27:21.

to a shops on the Saturday and come back with a 45 but what has

:27:21.:27:27.

happened? It is an ever changing world. I still go into town on a

:27:27.:27:31.

Saturday to buy a seven-inch single. Music has changed thanks to the

:27:31.:27:37.

internet. Music is at the click of a button. People think music is

:27:37.:27:44.

free. That whole role of going in to restore and buying something and

:27:44.:27:50.

holding it and taking it home, it still does happen, there are still

:27:50.:27:55.

some great shots out there and HMV is still going so it's not over yet

:27:55.:27:58.

and I don't think it will be for a long time. There is still a high

:27:59.:28:03.

percentage of sales that are physical. Downloads are only still

:28:03.:28:06.

a small part of it but everyone can see the internet taking more and

:28:06.:28:12.

more sales from the high street. you look at the statistics, it all

:28:12.:28:18.

seems to be going the way of online sales. A high streets sales are

:28:18.:28:24.

falling. Sales of online entertainment is going up.

:28:24.:28:31.

Eventually, it will overtake physical purchases. That is the way

:28:31.:28:35.

it looks like it's going. But there is still an appetite for people to

:28:35.:28:41.

own things. The whole culture of downloading will be a shock to our

:28:41.:28:46.

generation when they get to an old age and they want to pass their

:28:46.:28:51.

collection on to somebody else.Not allowed to do that because you have

:28:51.:28:55.

bought it and it has been downloaded in your name. There is a

:28:55.:28:58.

whole array of corporate -- complications that will hit us over

:28:58.:29:03.

the next decade. But how do people make a living out of this in the

:29:03.:29:08.

future? It is really tough for musicians of all sorts. From jazz

:29:08.:29:14.

and classical to rock and folk, it is really tough. People have day

:29:14.:29:18.

jobs. Not many people do it as a full-time living apart from those

:29:18.:29:22.

who do it very successfully. The live experience is something you

:29:22.:29:32.
:29:32.:29:36.

can't download. Those shops that we saw like Spillers are also vital in

:29:36.:29:42.

keeping the scene five -- vibrant and interesting. We do have a rich

:29:42.:29:46.

culture of venues in Wales and they play an important part as does the

:29:46.:29:51.

Is change really the best medicine for healthcare in Wales? And as more major retail chains close their doors this programme examines the cultural importance of independent shops to Welsh high streets.


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