20/01/2013 The Wales Report

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