11/12/2013 The Wales Report


Huw Edwards looks at current affairs in Wales. In a special programme with health minister Mark Drakeford, the challenges facing the NHS in Wales are examined.

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Tonight in a special programme, we consider the state of the NHS in


Wales in the dark months of winter with evidence of serious problems


frequently in the headlines. We'll be asking the health minister for


Wales, Mark Drakeford for his take on what's going on and what he's


doing about safety concerns, funding challenges, and changing priorities.


Stay with us for The Wales Report. Good evening and welcome to a


special edition of the Wales Report. 2013 has been a very challenging


year for the NHS in Wales. It's been under intense pressure services are


being reorganised financial pressures are acute targets are


being missed trust in the service has been dented -- it's a long list


of issues to be discussed with the health minister Mark Drakeford. I'll


be talking to him in a moment. But first our health correspondent Owain


Clarke outlines the main challenges. The health service is not coping in


a satisfactory way with emerging here. It is probably tougher now


than it has ever been. The health service in Wales is going to find it


increasingly difficult to cope with the demand. During 2013, the Welsh


NHS has found itself weakened by constant pressure and struggling to


find remedies to a long list of ailments. Ambulances queued and


hundreds of operations have been postponed as health boards cut


millions of pounds from their budgets. The man for Kia has


remained high and seems to be increasing. The more Al of front


line staff has dwindled, much like the resources they have to work


with. -- morale. They do not always have the time they want to deliver


the level of care they want. Winter has come around once again, when


traditional lay the demands on the health service is at its highest.


What is clear is that the pressure facing staff and services across


Wales is relentless and not just confined to winter. It is 365 days


of pressure nowadays. A few years ago we were talking about winter


pressures, but they tend to run into the spring and start in the autumn.


When Mark Drakeford took over the health service in March, he


inherited a service seemingly lurching from crisis to crisis with


targets missed and waiting times soaring. Concerns about standards of


care have risen. People have been lulled into a false sense of


security. That is not always the case. The health service has not


said to the public, this particular department is not good enough. We


have to change it because it is fundamentally not the levelling the


quality of care. Those concerns still exist with health


professionals worried that unless quick changes are made, things could


get worse. The health service in Wales is going to find it


increasingly difficult to cope with the demand. The health service is


going to find that it cannot manage patients in the high-quality way it


wants to, and inevitably that could impact on patient safety in the long


term. Those fears are wide health boards across Wales are being


overhauled and reorganised, to provide effective care for the


future. Back in 2011, the Welsh government revealed their plans for


all this. 2013 was supposed to be delivery time. During the course of


the year, the process has been beset by problems, setbacks and hold-ups.


In West Wales, the health minister had to step in after the managers


and patients watchdogs find themselves at loggerheads. An outcry


by clinicians and politicians prompted the first Minister to leave


you and revised plans for care for the sickest babies. The final plans


for reconfiguration in South Wales were meant to be unveiled tomorrow


but they have been delayed yet again. We still have not seen the


details for some of these plans that would assure our members that we are


going to address the current needs of the service. The Welsh health


service has become an easy target for politicians hoping to score


points over one another, with the prime minister weighing in on the


performance. They cut the budget by 8.5%, have not met a cancer targets


since 2008, money in the health service in Wales


to the best possible effect. The Welsh NHS is facing similar


pressures two parts of the UK and around the world. For many, it is


what happens on their doorstep that matters most. After what has been


the most difficult period in history for the Welsh NHS, what's next? That


was his analysis of the problems and I am joined now by Mark Drakeford.


Let's say one thing straightaway, there is a lot of excellent health


care in Wales and the lot of doctors and nurses doing a good job. There


are however pressures on problems at the prime minister says your meeting


-- missing a lot of key targets. He is not right to say that. Cancer


performance in Wales is almost identical to that in England. We


measure of things slightly differently but when you put it any


comparable way, the performances are practically the same, and with


cancer targets in particular, we regularly meet the 31 the target,


because far more people are treated in 31 days and we have had an


improving picture in relation to the 30 today targets. -- 32. Can I say


this, one of the things I have been struck by is the number of senior


clinicians who is said to me that our targets do not measure of the


things that really matter to patients. Why have them then? I


think targets by themselves are important in putting a driver into


the system, but whether we have the right targets to make sure they are


driving the best outcomes for patients is a more open question. I


have had clinicians say to me, I could treat the patient in 62 days


but it would be the wrong thing for that patient. It could be a complex


are cancer and the clinician could say, I want to carry it eight series


of tests to make sure I know exactly what to do. -- complex or rare. That


would take me past the 62 days and that is the right thing to do. You


are not saying the question of resources is not related to missing


a target? We are like all services living under the strain of the age


of austerity. The there's less money available to provide public services


in Wales and there will be less money again next year than the year


after that even less. By 2015, we will be trying to provide public


services with the same money we had in 2005, so that is a decade's worth


of extra demand and growth and development in medical technology,


and a budget we had ten years earlier. I wonder how we square that


with the decision your government took back in 2011 to put through


record-breaking cuts. Today you are looking for more cash, are we now


saying it was right in 2010 to make the kind of ambitious cuts you


decided on? There were no cuts in 2010. The plan was announced. The


plan was for the Welsh NHS to continue receiving 43% of the budget


and it has done so ever since. Since 2010 there has been an 8% growth in


health spending across the UK and an 8% rise in the Welsh NHS. In real


terms? And 8% cash growth which is what the UK has had as well, so the


idea at the Welsh NHS has been uniquely penalised is not true. What


we did was to make sure that those services on which the NHS depends


but are not directly provided by the NHS where not the cornea late cut.


-- draconially. We have tried to have a more balanced approach in


Wales. It is difficult to balance that with the independent report in


2011 projecting 8.3% cuts over three years, 3.3 in Scotland and 2.2


Northern Ireland, and 0.9 in England. The more recent analysis


says things have not come about the way they projected. What is the


figure? The figure there's the one I have given. You go back to 2010 a


look at rates of growth in health spending. Does that mean, more


fundamentally, that they are not financial pressures on the Welsh


NHS? Certainly not. They are very real financial pressures which is


why in the budget passed this week, there are ?570 million extra over


three years. Even with that, the health service will continue to feel


the pressures of austerity. Just wondering again, why do you think


people, and including your political opponents, conservatives for example


seeing in the last week that if you look at the cumulative effect, some


?800 million will have come out of NHS budgets over that time. You are


saying that is made up? I am saying there are real financial pressures


and NHS has done well to allow us to come in on budget. They are living


within its means. The pressure for the need to put more nurses on the


wards and make sure we are able to do important things to guarantee


quality and safety, and an extra injection of money was needed. We


feel the decisions allow us to have a balanced approach. A balanced


approach which means you are now looking for half a billion extra


over and above what you planned. Either you planned badly or the


crisis is bigger than you admitted? New pressures have merged and the


Francis review is a game changer. I spent the summer working with the


finance minister on what lessons they are for the Welsh NHS. We have


always recognised that the are some important lessons from Francis that


we need to apply in Wales and they come with the price tag attached to


them. What is the biggest lesson? The biggest lesson is that in order


to be sure that we are providing standards of care on our local


wards, we need to have the number of people there to do it with the right


skill mixed to match the needs of the patients under their care, and


in order to do that you have to invest in staff. That is why we made


an early announcement of ?10 million extra for nurses and that underpins


the plans going forward. How will that affect the crisis in accident


and emergency right now? When I became health minister in March, we


were coming to the end of the longest and hardest winter since


1963. I was acutely aware of the very real pressures in our accident


and emergency departments. I feel be going to this winter with planning


and performance better. Andy Lynch targets were met last month and half


the people who go to... Over half the people who go to our accident


and emergency centre are discharged within two hours of them being


there. Does that mean there would be difficult days this winter? It


doesn't mean that at all. The system will come under pressure and we seen


that this week is the begin to come into winter.


Were you surprised when they said in Swansea that they shouldn't turn up


in accident and emergency and less they have a serious problem. What


does that tell us? We need to get a different message


over to members of the public and to many people turn up at Morriston


Hospital. They shouldn't be giving their?


Quite a lot of those people don't need to be in accident and emergency


department at all. They will be sent home without any treatment and they


will have a simple advice, which they could have got in and easier


ways. What do you say to the consultant


who said to me if you cut the number of beds, the domino effect of that


is disastrous. One of the pressure points within the casualties


Department. You can't separate those problems. It isn't all about people


turning up you don't need to be there.


Write. The link between beds and accident and emergency performance


is very real. It is about our ability to move people into hospital


beds when they are needed and our ability to move the ball out of


hospital beds, back home, when we need to do that. Back to your first


question about budget and had recently raided our social care


budget to put the money into the NHS, we would be even less able to


move people out of hospital to create room for people.


There have been a lot of talk about caring for people at home and in the


community. One GP I spoke to who works in the Glamorgan area said,


that is great and in principle that is fine but the infrastructure isn't


there, GPs are under pressure and you are simply moving one problem


into another area and it is not an answer.


I think your GP was underselling the success that they and their


colleagues have had in recent years. Despite the fact we have an


ageing nation and we are a net importer of older people and we have


the vast as growing number of older people over the age of 85, the


number of older people going into residential care in Wales has fallen


in each of the last ten years and is likely to go on falling. How have we


managed to do that? We have been listening to what people tell us


they want and providing a great deal more care for them in their own


homes. It means that when people come through the door of accident


and emergency departments are sometimes they are frail and it is


not always easy to see what you could do because they are already


receiving trap without substantial packages of care at home --


receiving substantial packages of care at home.


Your predecessor recognised that you are not going to tackle these


fundamental issues without major reform of the shape of the NHS in


Wales. I spoke to your predecessor over a year ago and she used words


like urgent and absolutely essential to move quickly. You are still


talking about it and I'm just wondering when are you going to be


in a position to change things, rather than bring up appraisals that


your colleagues seem to have no faith in.


I think you are right to point to the sometimes intractable seeming


difficulty of having conversations with people about changing people in


the health service. One of the ways the conversation has moved on in the


last five years is five years ago, when you went out to people and


said, we need to change the way things are, if you didn't like your


proposal, they left things as they were.


They are still saying that? Now when you go out, there is a


recognition of the need to change and nobody wants to leave things as


they are. When you come down to move from the general, everybody agrees


change is necessary, to whether that means change for you here, you get a


different reaction. Lots of people are questioning


whether you are the government have the political strings or even the


political drive to force through the changes which lots of your Labour


colleagues clearly think are too sensitive. They don't want to sell


hospital reorganisation in their own areas.


You can understand that but I tried to say that there are three


priorities for me in my first year and one was to try to bring the


three big reconfiguration exercises going on inside Wales to a


conclusion. The one in North Wales is concluded and it has been agreed


with the committee health Council and we are pushing ahead with those


changes. I said when things land on my desk, I will make the necessary


decisions. I will look at them carefully and do a proper job of


weighing up the evidence but I will not hold back from making decisions,


even when I know that those decisions will not please


everybody. I have recently had to decisions on my desk and I have made


one in relation to services in Llanelli. I know they are not


popular there but the decision is made and when I meet people in


Llanelli, I say I'm not coming here to talk to you about the decision


because I have made the decision. I have come to talk to you about how


to implement the decision. That is how I intend to carry on.


There are concerns when you look at shape and performance of the health


service in Wales about safety and patient safety. We had an incident


yesterday about a senior surgeon at the University Hospital of Wales. Do


you think the calls for a more thorough review, as they have had in


England, those calls are justifiable in Wales?


When I'm asked my question I say this, we have questioned in Wales.


We have a system of different mechanisms that give us assurance


that things are as they should be and throw up an early warning


signals when they are not. At the moment, I am satisfied that those


different strands are operating in an effective way and we don't need


to go beyond that. When things arise where I do feel that there is a need


for an independent outside look at what is going on in order to provide


public assurance, I will do that. I have already done that. Can people


have confidence that the information is readily available with Mac I was


shocked yesterday -- available? I was shocked to find yesterday that


deliver surgeon had been suspended in January and nobody knew anything


about it. If it important how readily available this information


is? Not just journalists but patients.


We understand better than we did in the past that making information


available to patients in a more open way will be part of the future. It


is half of the story, I think. Information is one thing and


understanding that information is another so we have to work harder to


put information into the public domain in a way that allows patients


to make sense of it. When I say 11 out of 17 district


general hospitals in Wales have higher than expected death rates,


does that concern you? With that convincing a wider review was


necessary? In my previous job in the university


in Cardiff and working with statistics, I would say that in any


system, some are going to be above and some below.


11 out of 17? Half above, half below.


Out of what? 11 is half of 22. 11 out of 17. I think the figures


that I have are that half hour hospitals in Wales have figures


above a hundred and half below. When you next quarter of published, a


different mix will be above and below. These are not figures. Sir


Bruce Keogh himself said it would be academically reckless to draw a


conclusion to say that in hospital above 100 is a cause for alarm and a


hospital below 100 is clear water. When your Labour colleague says


there are significant problems in some Welsh hospitals, that they need


to be reviewed and there are concerns about standards of care,


again, you are saying that she is misinformed?


I say two things. I read and Clwyd's report into the system of


complaints in England and I have a chance to talk to her about it. It


is a valuable report and there are lessons to be learned in Wales from


its. There are things that she says which strike a chord with me about


the way patient experience in Wales pans out. She is right on many of


those things that I don't agree with her in the conclusion she draws


about the scores. The mortality index? Yes. I simply


think that there is a difference of interpretation and I don't think an


independent review of these things makes best sense for the NHS in


Wales. When we have figures that we are all confident tell us something


significant about Welsh hospitals and is then -- and if they're in a


Welsh hospital is above the level where we think dependent view of


what goes on in was Matt -- what goes on is necessary, then we will


do it. When will be the time that the NHS


is held up as an example, rather than being held up for


underperforming? People who use the NHS in Wales and


see what it is day in day out know we are in that position already. We


have huge satisfaction levels among patients in the NHS and in


independent surveys. We commissioned by people who come and do them for


us. We have satisfaction levels of 95% and above in our primary care


and secondary care. You tell me in election time that


opinion polls count for nothing. Any political party with a 95%


satisfaction rate would be telling you something different there. The


truth of the matter is fantastic work goes on in the Welsh health


service every single day. The Assembly has a legislature to push


the boundaries in other ways that are looked at in envy. There are so


many good things that happened in Wales, the difficulty is to get that


into the headlines. Nobody is envious about waiting in


an ambulance for six hours outside accident and emergency.


No. The average waiting time in Wales is 20 minutes. That six hour


wait is and complete exception. Whenever we have exceptional


circumstances, we have an individual report on it. There will be


circumstances and clinical reasons why that weight happened. I am clear


that handover times between ambulances and accident and


emergency have to be done in a timely way and in the best interest


of Haitians. Are you proud of the way Labour has


handled the health service in Wales?


I am proud of our record. We wouldn't have the health service we


have without the Labour Party and without a Labour government. What I


am proudest of all is of the people who work in our health service, who


go in their everyday. That is not the question. Are you


proud of your handling of it? Without our handling, we wouldn't


have people doing the jobs that they do in the way that they do. I am


immensely proud of the people who write to me every week to say, don't


you know, they say to me, what fantastic care I had when I went


into a Welsh hospital. Why don't we hear more about that?


Thank you very much. That is it from tonight's programme. We will be back


in January. If you have any comments, please get in touch. And


we are on Twitter. Thanks for watching. Merry Christmas


and good night.


Huw Edwards presents a current affairs series taking a look at issues that matter in Wales. In a special programme with health minister Mark Drakeford, the challenges facing the NHS in Wales are examined.

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