20/01/2013 The Wales Report


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


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


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


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


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


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


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


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


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


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


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


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


about face significant change because according to experts and


the Welsh government it will improve health care and addressed


the financial pressures weighing down system. There is a


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


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


about rationalising services, or closing local hospitals, provoked


strong emotions from people who feel their local services are under


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


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


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


protesting culminated this week in one final gesture from a small


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


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


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


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


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


proposal to move the neonatal intensive care service to the


hospital near Birkenhead, in England. He was having difficulty


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


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


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


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


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


understandably precious about a service which they hold dear. The


health service in all its forms generates the most passionate of


arguments. Every corner of the services considered worth fighting


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


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


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


campaigners orchestrating the public fight to save it is


Conservative councillor Cheryl Carlisle. She has attended every


consultation meeting called she has come away less than impressed by


the financial arguments put forward by health officials in pursuit of


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


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


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


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


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


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


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


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


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


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


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


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


than 100 people packed into a highly charged atmosphere and it


was not long before individuals were expressing their disquiet.


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


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


snapped when they were formally told that Flint hospital was to


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


still protesting and questioning the validity of the Board's


consultation exercise. What have you heard this morning?


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


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


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


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


neonatal intensive care would be transferred to England. Angry and


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


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


themselves were now resembling a casualty unit for campaigners


trying to reconcile the failed attempts at influencing the


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


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


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


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


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


attempted to justify their decisions. I understand their


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


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


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


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


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


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


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


rightly genuine concern amongst patients, families, children, and


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


what government's pronouncements promises -- pronouncements,


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


by their absence. Surprisingly there is no overarching plan for


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


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


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


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


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


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


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


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


all over Wales are now becoming increasingly concerned about what


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


moving health care into the communities. Winners County Council,


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


including closure of community hospitals. They said the increased


cost would place an intolerable burden on an already overstretched


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


contentious exercise, will have any meaning and whether the government


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


Wales. David Williams reporting. We asked


the Health Minister Lesley Griffiths to appear round tonight's


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


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


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


Confederation which represents senior managers who run the health


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


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


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


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


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


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


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


discussions about the health service and they have really shown


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


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


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


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


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


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


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


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


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


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


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


hospitals. I think that demonstrates that something has to


change and change dramatically. That means shifting the focus of


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


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


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


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


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


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


in effect those people who are making the decision about change


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


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


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


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


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


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


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


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


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


have children and grandchildren. They also have a statutory


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


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


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


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


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


for health is the vision of the Government and it means


transferring and shifting services from hospitals into communities.


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


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


There will be some issues that local communities and local people


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


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


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


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


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


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


local councils by closing community hospitals and cutting back on local


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


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


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


authorities but there are also some fantastic examples where that is


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


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


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


progress that being made and the way the health service is


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


in particular our relationship with Europe. David Cameron has made


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


membership of the European Union. The prime minister postponed a


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


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


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


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


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


any regrets about the terms of our relationship with the European


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


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


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


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


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


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


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


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


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


another �2.8 billion for our farmers, Fisheries and rural


communities. Praise for the European Union from faithful


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


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


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


Government is deeply committed to Wales being an active partner in


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


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


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


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


despite all the investment, West Wales and the baddies remain


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


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


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


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


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


responsible for the Welsh Government's administration of


European funding in Wales, the deputy minister of European


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


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


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


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


European economy and the wider economy which generates jobs and


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


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


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


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


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


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


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


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


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


agricultural and fisheries policies and the new structural fund


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


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


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


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


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


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


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


Wales and used their money to invest in infrastructure and the


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


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


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


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


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


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


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


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


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


industrial decline for the last century. Anybody who believes that


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


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


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


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


and creating new business opportunities. Is that something


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


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


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


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


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


conversation about how we spend this money, the sort of


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


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


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


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


relationship and the future relationship with Europe will be


vital. It is essential. Thank you very much.


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


suffering in the consumer downturn with shoppers keeping their hands


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


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


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


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


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


this new age of cultural globalisation have on one of almost


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


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


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


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


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


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


few independent record shops left across the country. Spillers in


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


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


less as anybody in business. Independent record shops are


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


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


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


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


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


cultural and economic impact. The manic Street Preachers, the


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


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


Way globalisation of popular culture as a real threat to new


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


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


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


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


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


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


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


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


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


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


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


percentage of sales that are physical. Downloads are only still


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


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


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


falling. Sales of online entertainment is going up.


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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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