:00:00. > :00:10.Tonight in a special programme, we consider the state of the NHS in
:00:11. > :00:13.Wales in the dark months of winter with evidence of serious problems
:00:14. > :00:17.frequently in the headlines. We'll be asking the health minister for
:00:18. > :00:20.Wales, Mark Drakeford for his take on what's going on and what he's
:00:21. > :00:23.doing about safety concerns, funding challenges, and changing priorities.
:00:24. > :00:39.Stay with us for The Wales Report. Good evening and welcome to a
:00:40. > :00:44.special edition of the Wales Report. 2013 has been a very challenging
:00:45. > :00:46.year for the NHS in Wales. It's been under intense pressure services are
:00:47. > :00:49.being reorganised financial pressures are acute targets are
:00:50. > :00:53.being missed trust in the service has been dented -- it's a long list
:00:54. > :00:59.of issues to be discussed with the health minister Mark Drakeford. I'll
:01:00. > :01:00.be talking to him in a moment. But first our health correspondent Owain
:01:01. > :01:19.Clarke outlines the main challenges. The health service is not coping in
:01:20. > :01:26.a satisfactory way with emerging here. It is probably tougher now
:01:27. > :01:30.than it has ever been. The health service in Wales is going to find it
:01:31. > :01:36.increasingly difficult to cope with the demand. During 2013, the Welsh
:01:37. > :01:42.NHS has found itself weakened by constant pressure and struggling to
:01:43. > :01:49.find remedies to a long list of ailments. Ambulances queued and
:01:50. > :01:52.hundreds of operations have been postponed as health boards cut
:01:53. > :01:57.millions of pounds from their budgets. The man for Kia has
:01:58. > :02:05.remained high and seems to be increasing. The more Al of front
:02:06. > :02:11.line staff has dwindled, much like the resources they have to work
:02:12. > :02:19.with. -- morale. They do not always have the time they want to deliver
:02:20. > :02:24.the level of care they want. Winter has come around once again, when
:02:25. > :02:29.traditional lay the demands on the health service is at its highest.
:02:30. > :02:34.What is clear is that the pressure facing staff and services across
:02:35. > :02:42.Wales is relentless and not just confined to winter. It is 365 days
:02:43. > :02:48.of pressure nowadays. A few years ago we were talking about winter
:02:49. > :02:53.pressures, but they tend to run into the spring and start in the autumn.
:02:54. > :02:59.When Mark Drakeford took over the health service in March, he
:03:00. > :03:03.inherited a service seemingly lurching from crisis to crisis with
:03:04. > :03:11.targets missed and waiting times soaring. Concerns about standards of
:03:12. > :03:15.care have risen. People have been lulled into a false sense of
:03:16. > :03:23.security. That is not always the case. The health service has not
:03:24. > :03:28.said to the public, this particular department is not good enough. We
:03:29. > :03:32.have to change it because it is fundamentally not the levelling the
:03:33. > :03:37.quality of care. Those concerns still exist with health
:03:38. > :03:42.professionals worried that unless quick changes are made, things could
:03:43. > :03:44.get worse. The health service in Wales is going to find it
:03:45. > :03:53.increasingly difficult to cope with the demand. The health service is
:03:54. > :03:58.going to find that it cannot manage patients in the high-quality way it
:03:59. > :04:04.wants to, and inevitably that could impact on patient safety in the long
:04:05. > :04:08.term. Those fears are wide health boards across Wales are being
:04:09. > :04:14.overhauled and reorganised, to provide effective care for the
:04:15. > :04:19.future. Back in 2011, the Welsh government revealed their plans for
:04:20. > :04:25.all this. 2013 was supposed to be delivery time. During the course of
:04:26. > :04:30.the year, the process has been beset by problems, setbacks and hold-ups.
:04:31. > :04:36.In West Wales, the health minister had to step in after the managers
:04:37. > :04:43.and patients watchdogs find themselves at loggerheads. An outcry
:04:44. > :04:48.by clinicians and politicians prompted the first Minister to leave
:04:49. > :04:53.you and revised plans for care for the sickest babies. The final plans
:04:54. > :04:56.for reconfiguration in South Wales were meant to be unveiled tomorrow
:04:57. > :05:05.but they have been delayed yet again. We still have not seen the
:05:06. > :05:11.details for some of these plans that would assure our members that we are
:05:12. > :05:18.going to address the current needs of the service. The Welsh health
:05:19. > :05:22.service has become an easy target for politicians hoping to score
:05:23. > :05:31.points over one another, with the prime minister weighing in on the
:05:32. > :05:34.performance. They cut the budget by 8.5%, have not met a cancer targets
:05:35. > :06:15.since 2008, money in the health service in Wales
:06:16. > :06:18.to the best possible effect. The Welsh NHS is facing similar
:06:19. > :06:25.pressures two parts of the UK and around the world. For many, it is
:06:26. > :06:30.what happens on their doorstep that matters most. After what has been
:06:31. > :06:40.the most difficult period in history for the Welsh NHS, what's next? That
:06:41. > :06:47.was his analysis of the problems and I am joined now by Mark Drakeford.
:06:48. > :06:51.Let's say one thing straightaway, there is a lot of excellent health
:06:52. > :06:59.care in Wales and the lot of doctors and nurses doing a good job. There
:07:00. > :07:07.are however pressures on problems at the prime minister says your meeting
:07:08. > :07:13.-- missing a lot of key targets. He is not right to say that. Cancer
:07:14. > :07:17.performance in Wales is almost identical to that in England. We
:07:18. > :07:22.measure of things slightly differently but when you put it any
:07:23. > :07:29.comparable way, the performances are practically the same, and with
:07:30. > :07:34.cancer targets in particular, we regularly meet the 31 the target,
:07:35. > :07:40.because far more people are treated in 31 days and we have had an
:07:41. > :07:52.improving picture in relation to the 30 today targets. -- 32. Can I say
:07:53. > :07:56.this, one of the things I have been struck by is the number of senior
:07:57. > :08:00.clinicians who is said to me that our targets do not measure of the
:08:01. > :08:08.things that really matter to patients. Why have them then? I
:08:09. > :08:12.think targets by themselves are important in putting a driver into
:08:13. > :08:17.the system, but whether we have the right targets to make sure they are
:08:18. > :08:24.driving the best outcomes for patients is a more open question. I
:08:25. > :08:28.have had clinicians say to me, I could treat the patient in 62 days
:08:29. > :08:35.but it would be the wrong thing for that patient. It could be a complex
:08:36. > :08:41.are cancer and the clinician could say, I want to carry it eight series
:08:42. > :08:48.of tests to make sure I know exactly what to do. -- complex or rare. That
:08:49. > :08:57.would take me past the 62 days and that is the right thing to do. You
:08:58. > :09:05.are not saying the question of resources is not related to missing
:09:06. > :09:10.a target? We are like all services living under the strain of the age
:09:11. > :09:14.of austerity. The there's less money available to provide public services
:09:15. > :09:21.in Wales and there will be less money again next year than the year
:09:22. > :09:24.after that even less. By 2015, we will be trying to provide public
:09:25. > :09:32.services with the same money we had in 2005, so that is a decade's worth
:09:33. > :09:37.of extra demand and growth and development in medical technology,
:09:38. > :09:43.and a budget we had ten years earlier. I wonder how we square that
:09:44. > :09:49.with the decision your government took back in 2011 to put through
:09:50. > :09:55.record-breaking cuts. Today you are looking for more cash, are we now
:09:56. > :09:59.saying it was right in 2010 to make the kind of ambitious cuts you
:10:00. > :10:06.decided on? There were no cuts in 2010. The plan was announced. The
:10:07. > :10:15.plan was for the Welsh NHS to continue receiving 43% of the budget
:10:16. > :10:20.and it has done so ever since. Since 2010 there has been an 8% growth in
:10:21. > :10:28.health spending across the UK and an 8% rise in the Welsh NHS. In real
:10:29. > :10:34.terms? And 8% cash growth which is what the UK has had as well, so the
:10:35. > :10:39.idea at the Welsh NHS has been uniquely penalised is not true. What
:10:40. > :10:43.we did was to make sure that those services on which the NHS depends
:10:44. > :10:56.but are not directly provided by the NHS where not the cornea late cut.
:10:57. > :11:02.-- draconially. We have tried to have a more balanced approach in
:11:03. > :11:10.Wales. It is difficult to balance that with the independent report in
:11:11. > :11:19.2011 projecting 8.3% cuts over three years, 3.3 in Scotland and 2.2
:11:20. > :11:27.Northern Ireland, and 0.9 in England. The more recent analysis
:11:28. > :11:33.says things have not come about the way they projected. What is the
:11:34. > :11:38.figure? The figure there's the one I have given. You go back to 2010 a
:11:39. > :11:46.look at rates of growth in health spending. Does that mean, more
:11:47. > :11:52.fundamentally, that they are not financial pressures on the Welsh
:11:53. > :11:59.NHS? Certainly not. They are very real financial pressures which is
:12:00. > :12:04.why in the budget passed this week, there are ?570 million extra over
:12:05. > :12:09.three years. Even with that, the health service will continue to feel
:12:10. > :12:14.the pressures of austerity. Just wondering again, why do you think
:12:15. > :12:20.people, and including your political opponents, conservatives for example
:12:21. > :12:26.seeing in the last week that if you look at the cumulative effect, some
:12:27. > :12:38.?800 million will have come out of NHS budgets over that time. You are
:12:39. > :12:42.saying that is made up? I am saying there are real financial pressures
:12:43. > :12:51.and NHS has done well to allow us to come in on budget. They are living
:12:52. > :12:58.within its means. The pressure for the need to put more nurses on the
:12:59. > :13:05.wards and make sure we are able to do important things to guarantee
:13:06. > :13:10.quality and safety, and an extra injection of money was needed. We
:13:11. > :13:14.feel the decisions allow us to have a balanced approach. A balanced
:13:15. > :13:22.approach which means you are now looking for half a billion extra
:13:23. > :13:26.over and above what you planned. Either you planned badly or the
:13:27. > :13:34.crisis is bigger than you admitted? New pressures have merged and the
:13:35. > :13:38.Francis review is a game changer. I spent the summer working with the
:13:39. > :13:46.finance minister on what lessons they are for the Welsh NHS. We have
:13:47. > :13:53.always recognised that the are some important lessons from Francis that
:13:54. > :13:59.we need to apply in Wales and they come with the price tag attached to
:14:00. > :14:03.them. What is the biggest lesson? The biggest lesson is that in order
:14:04. > :14:09.to be sure that we are providing standards of care on our local
:14:10. > :14:13.wards, we need to have the number of people there to do it with the right
:14:14. > :14:18.skill mixed to match the needs of the patients under their care, and
:14:19. > :14:22.in order to do that you have to invest in staff. That is why we made
:14:23. > :14:28.an early announcement of ?10 million extra for nurses and that underpins
:14:29. > :14:33.the plans going forward. How will that affect the crisis in accident
:14:34. > :14:36.and emergency right now? When I became health minister in March, we
:14:37. > :14:43.were coming to the end of the longest and hardest winter since
:14:44. > :14:49.1963. I was acutely aware of the very real pressures in our accident
:14:50. > :14:57.and emergency departments. I feel be going to this winter with planning
:14:58. > :15:01.and performance better. Andy Lynch targets were met last month and half
:15:02. > :15:05.the people who go to... Over half the people who go to our accident
:15:06. > :15:12.and emergency centre are discharged within two hours of them being
:15:13. > :15:15.there. Does that mean there would be difficult days this winter? It
:15:16. > :15:20.doesn't mean that at all. The system will come under pressure and we seen
:15:21. > :15:24.that this week is the begin to come into winter.
:15:25. > :15:28.Were you surprised when they said in Swansea that they shouldn't turn up
:15:29. > :15:32.in accident and emergency and less they have a serious problem. What
:15:33. > :15:35.does that tell us? We need to get a different message
:15:36. > :15:39.over to members of the public and to many people turn up at Morriston
:15:40. > :15:44.Hospital. They shouldn't be giving their?
:15:45. > :15:47.Quite a lot of those people don't need to be in accident and emergency
:15:48. > :15:51.department at all. They will be sent home without any treatment and they
:15:52. > :15:55.will have a simple advice, which they could have got in and easier
:15:56. > :15:59.ways. What do you say to the consultant
:16:00. > :16:04.who said to me if you cut the number of beds, the domino effect of that
:16:05. > :16:09.is disastrous. One of the pressure points within the casualties
:16:10. > :16:12.Department. You can't separate those problems. It isn't all about people
:16:13. > :16:18.turning up you don't need to be there.
:16:19. > :16:22.Write. The link between beds and accident and emergency performance
:16:23. > :16:25.is very real. It is about our ability to move people into hospital
:16:26. > :16:30.beds when they are needed and our ability to move the ball out of
:16:31. > :16:35.hospital beds, back home, when we need to do that. Back to your first
:16:36. > :16:39.question about budget and had recently raided our social care
:16:40. > :16:44.budget to put the money into the NHS, we would be even less able to
:16:45. > :16:48.move people out of hospital to create room for people.
:16:49. > :16:54.There have been a lot of talk about caring for people at home and in the
:16:55. > :16:57.community. One GP I spoke to who works in the Glamorgan area said,
:16:58. > :17:03.that is great and in principle that is fine but the infrastructure isn't
:17:04. > :17:06.there, GPs are under pressure and you are simply moving one problem
:17:07. > :17:13.into another area and it is not an answer.
:17:14. > :17:18.I think your GP was underselling the success that they and their
:17:19. > :17:23.colleagues have had in recent years. Despite the fact we have an
:17:24. > :17:30.ageing nation and we are a net importer of older people and we have
:17:31. > :17:34.the vast as growing number of older people over the age of 85, the
:17:35. > :17:38.number of older people going into residential care in Wales has fallen
:17:39. > :17:44.in each of the last ten years and is likely to go on falling. How have we
:17:45. > :17:47.managed to do that? We have been listening to what people tell us
:17:48. > :17:51.they want and providing a great deal more care for them in their own
:17:52. > :17:54.homes. It means that when people come through the door of accident
:17:55. > :17:59.and emergency departments are sometimes they are frail and it is
:18:00. > :18:03.not always easy to see what you could do because they are already
:18:04. > :18:11.receiving trap without substantial packages of care at home --
:18:12. > :18:14.receiving substantial packages of care at home.
:18:15. > :18:19.Your predecessor recognised that you are not going to tackle these
:18:20. > :18:24.fundamental issues without major reform of the shape of the NHS in
:18:25. > :18:28.Wales. I spoke to your predecessor over a year ago and she used words
:18:29. > :18:33.like urgent and absolutely essential to move quickly. You are still
:18:34. > :18:36.talking about it and I'm just wondering when are you going to be
:18:37. > :18:41.in a position to change things, rather than bring up appraisals that
:18:42. > :18:46.your colleagues seem to have no faith in.
:18:47. > :18:51.I think you are right to point to the sometimes intractable seeming
:18:52. > :18:55.difficulty of having conversations with people about changing people in
:18:56. > :18:58.the health service. One of the ways the conversation has moved on in the
:18:59. > :19:02.last five years is five years ago, when you went out to people and
:19:03. > :19:06.said, we need to change the way things are, if you didn't like your
:19:07. > :19:10.proposal, they left things as they were.
:19:11. > :19:15.They are still saying that? Now when you go out, there is a
:19:16. > :19:20.recognition of the need to change and nobody wants to leave things as
:19:21. > :19:23.they are. When you come down to move from the general, everybody agrees
:19:24. > :19:30.change is necessary, to whether that means change for you here, you get a
:19:31. > :19:32.different reaction. Lots of people are questioning
:19:33. > :19:36.whether you are the government have the political strings or even the
:19:37. > :19:40.political drive to force through the changes which lots of your Labour
:19:41. > :19:44.colleagues clearly think are too sensitive. They don't want to sell
:19:45. > :19:49.hospital reorganisation in their own areas.
:19:50. > :19:54.You can understand that but I tried to say that there are three
:19:55. > :19:57.priorities for me in my first year and one was to try to bring the
:19:58. > :20:02.three big reconfiguration exercises going on inside Wales to a
:20:03. > :20:08.conclusion. The one in North Wales is concluded and it has been agreed
:20:09. > :20:14.with the committee health Council and we are pushing ahead with those
:20:15. > :20:19.changes. I said when things land on my desk, I will make the necessary
:20:20. > :20:23.decisions. I will look at them carefully and do a proper job of
:20:24. > :20:27.weighing up the evidence but I will not hold back from making decisions,
:20:28. > :20:31.even when I know that those decisions will not please
:20:32. > :20:34.everybody. I have recently had to decisions on my desk and I have made
:20:35. > :20:40.one in relation to services in Llanelli. I know they are not
:20:41. > :20:43.popular there but the decision is made and when I meet people in
:20:44. > :20:48.Llanelli, I say I'm not coming here to talk to you about the decision
:20:49. > :20:52.because I have made the decision. I have come to talk to you about how
:20:53. > :20:57.to implement the decision. That is how I intend to carry on.
:20:58. > :21:00.There are concerns when you look at shape and performance of the health
:21:01. > :21:06.service in Wales about safety and patient safety. We had an incident
:21:07. > :21:10.yesterday about a senior surgeon at the University Hospital of Wales. Do
:21:11. > :21:15.you think the calls for a more thorough review, as they have had in
:21:16. > :21:19.England, those calls are justifiable in Wales?
:21:20. > :21:26.When I'm asked my question I say this, we have questioned in Wales.
:21:27. > :21:31.We have a system of different mechanisms that give us assurance
:21:32. > :21:36.that things are as they should be and throw up an early warning
:21:37. > :21:39.signals when they are not. At the moment, I am satisfied that those
:21:40. > :21:47.different strands are operating in an effective way and we don't need
:21:48. > :21:52.to go beyond that. When things arise where I do feel that there is a need
:21:53. > :21:56.for an independent outside look at what is going on in order to provide
:21:57. > :22:01.public assurance, I will do that. I have already done that. Can people
:22:02. > :22:09.have confidence that the information is readily available with Mac I was
:22:10. > :22:14.shocked yesterday -- available? I was shocked to find yesterday that
:22:15. > :22:17.deliver surgeon had been suspended in January and nobody knew anything
:22:18. > :22:22.about it. If it important how readily available this information
:22:23. > :22:25.is? Not just journalists but patients.
:22:26. > :22:31.We understand better than we did in the past that making information
:22:32. > :22:38.available to patients in a more open way will be part of the future. It
:22:39. > :22:40.is half of the story, I think. Information is one thing and
:22:41. > :22:45.understanding that information is another so we have to work harder to
:22:46. > :22:49.put information into the public domain in a way that allows patients
:22:50. > :22:52.to make sense of it. When I say 11 out of 17 district
:22:53. > :22:58.general hospitals in Wales have higher than expected death rates,
:22:59. > :23:01.does that concern you? With that convincing a wider review was
:23:02. > :23:05.necessary? In my previous job in the university
:23:06. > :23:10.in Cardiff and working with statistics, I would say that in any
:23:11. > :23:16.system, some are going to be above and some below.
:23:17. > :23:21.11 out of 17? Half above, half below.
:23:22. > :23:28.Out of what? 11 is half of 22. 11 out of 17. I think the figures
:23:29. > :23:33.that I have are that half hour hospitals in Wales have figures
:23:34. > :23:36.above a hundred and half below. When you next quarter of published, a
:23:37. > :23:43.different mix will be above and below. These are not figures. Sir
:23:44. > :23:50.Bruce Keogh himself said it would be academically reckless to draw a
:23:51. > :23:57.conclusion to say that in hospital above 100 is a cause for alarm and a
:23:58. > :24:00.hospital below 100 is clear water. When your Labour colleague says
:24:01. > :24:03.there are significant problems in some Welsh hospitals, that they need
:24:04. > :24:07.to be reviewed and there are concerns about standards of care,
:24:08. > :24:14.again, you are saying that she is misinformed?
:24:15. > :24:19.I say two things. I read and Clwyd's report into the system of
:24:20. > :24:23.complaints in England and I have a chance to talk to her about it. It
:24:24. > :24:28.is a valuable report and there are lessons to be learned in Wales from
:24:29. > :24:31.its. There are things that she says which strike a chord with me about
:24:32. > :24:37.the way patient experience in Wales pans out. She is right on many of
:24:38. > :24:42.those things that I don't agree with her in the conclusion she draws
:24:43. > :24:48.about the scores. The mortality index? Yes. I simply
:24:49. > :24:52.think that there is a difference of interpretation and I don't think an
:24:53. > :24:58.independent review of these things makes best sense for the NHS in
:24:59. > :25:01.Wales. When we have figures that we are all confident tell us something
:25:02. > :25:07.significant about Welsh hospitals and is then -- and if they're in a
:25:08. > :25:15.Welsh hospital is above the level where we think dependent view of
:25:16. > :25:17.what goes on in was Matt -- what goes on is necessary, then we will
:25:18. > :25:27.do it. When will be the time that the NHS
:25:28. > :25:30.is held up as an example, rather than being held up for
:25:31. > :25:35.underperforming? People who use the NHS in Wales and
:25:36. > :25:40.see what it is day in day out know we are in that position already. We
:25:41. > :25:46.have huge satisfaction levels among patients in the NHS and in
:25:47. > :25:53.independent surveys. We commissioned by people who come and do them for
:25:54. > :25:55.us. We have satisfaction levels of 95% and above in our primary care
:25:56. > :26:01.and secondary care. You tell me in election time that
:26:02. > :26:05.opinion polls count for nothing. Any political party with a 95%
:26:06. > :26:10.satisfaction rate would be telling you something different there. The
:26:11. > :26:13.truth of the matter is fantastic work goes on in the Welsh health
:26:14. > :26:23.service every single day. The Assembly has a legislature to push
:26:24. > :26:29.the boundaries in other ways that are looked at in envy. There are so
:26:30. > :26:32.many good things that happened in Wales, the difficulty is to get that
:26:33. > :26:37.into the headlines. Nobody is envious about waiting in
:26:38. > :26:41.an ambulance for six hours outside accident and emergency.
:26:42. > :26:51.No. The average waiting time in Wales is 20 minutes. That six hour
:26:52. > :26:53.wait is and complete exception. Whenever we have exceptional
:26:54. > :26:57.circumstances, we have an individual report on it. There will be
:26:58. > :27:04.circumstances and clinical reasons why that weight happened. I am clear
:27:05. > :27:08.that handover times between ambulances and accident and
:27:09. > :27:09.emergency have to be done in a timely way and in the best interest
:27:10. > :27:15.of Haitians. Are you proud of the way Labour has
:27:16. > :27:20.handled the health service in Wales?
:27:21. > :27:23.I am proud of our record. We wouldn't have the health service we
:27:24. > :27:29.have without the Labour Party and without a Labour government. What I
:27:30. > :27:34.am proudest of all is of the people who work in our health service, who
:27:35. > :27:38.go in their everyday. That is not the question. Are you
:27:39. > :27:42.proud of your handling of it? Without our handling, we wouldn't
:27:43. > :27:46.have people doing the jobs that they do in the way that they do. I am
:27:47. > :27:51.immensely proud of the people who write to me every week to say, don't
:27:52. > :27:55.you know, they say to me, what fantastic care I had when I went
:27:56. > :28:00.into a Welsh hospital. Why don't we hear more about that?
:28:01. > :28:06.Thank you very much. That is it from tonight's programme. We will be back
:28:07. > :28:12.in January. If you have any comments, please get in touch. And
:28:13. > :28:17.we are on Twitter. Thanks for watching. Merry Christmas
:28:18. > :28:19.and good night.