11/12/2013 The Wales Report


11/12/2013

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

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

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

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

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

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

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

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

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being reorganised financial pressures are acute targets are

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

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

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

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

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

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

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

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NHS has found itself weakened by constant pressure and struggling to

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

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hundreds of operations have been postponed as health boards cut

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

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

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

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

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

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

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

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

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

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

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

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inherited a service seemingly lurching from crisis to crisis with

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targets missed and waiting times soaring. Concerns about standards of

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

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

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

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

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quality of care. Those concerns still exist with health

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professionals worried that unless quick changes are made, things could

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

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

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

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

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

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overhauled and reorganised, to provide effective care for the

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

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

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

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

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and patients watchdogs find themselves at loggerheads. An outcry

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by clinicians and politicians prompted the first Minister to leave

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

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for reconfiguration in South Wales were meant to be unveiled tomorrow

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

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

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

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service has become an easy target for politicians hoping to score

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

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

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since 2008, money in the health service in Wales

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

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

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

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

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

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

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

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

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

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

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measure of things slightly differently but when you put it any

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

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

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

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

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

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

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

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think targets by themselves are important in putting a driver into

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

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

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

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

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

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

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

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

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

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

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

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

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

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of extra demand and growth and development in medical technology,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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fundamentally, that they are not financial pressures on the Welsh

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

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

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

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

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people, and including your political opponents, conservatives for example

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

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

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

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

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

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

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

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

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

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

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

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

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

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always recognised that the are some important lessons from Francis that

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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and emergency centre are discharged within two hours of them being

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

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

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that this week is the begin to come into winter.

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

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

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

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

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Hospital. They shouldn't be giving their?

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

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

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

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ways. What do you say to the consultant

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

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is disastrous. One of the pressure points within the casualties

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

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turning up you don't need to be there.

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Write. The link between beds and accident and emergency performance

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

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

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

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question about budget and had recently raided our social care

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

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move people out of hospital to create room for people.

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

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

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

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

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into another area and it is not an answer.

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

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

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

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

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

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

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

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

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

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and emergency departments are sometimes they are frail and it is

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

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receiving trap without substantial packages of care at home --

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receiving substantial packages of care at home.

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Your predecessor recognised that you are not going to tackle these

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

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

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

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

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

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your colleagues seem to have no faith in.

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

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difficulty of having conversations with people about changing people in

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

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

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

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proposal, they left things as they were.

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

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

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

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

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different reaction. Lots of people are questioning

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

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

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

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hospital reorganisation in their own areas.

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

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

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three big reconfiguration exercises going on inside Wales to a

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

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

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

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

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

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even when I know that those decisions will not please

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

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

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

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

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

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

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

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

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

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

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England, those calls are justifiable in Wales?

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

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We have a system of different mechanisms that give us assurance

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

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

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

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

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

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

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

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

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deliver surgeon had been suspended in January and nobody knew anything

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about it. If it important how readily available this information

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is? Not just journalists but patients.

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

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

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

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

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

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

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general hospitals in Wales have higher than expected death rates,

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

:22:59.:23:01.

necessary? In my previous job in the university

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

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

:23:11.:23:16.

11 out of 17? Half above, half below.

:23:17.:23:21.

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

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

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

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

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

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

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

:23:58.:24:00.

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

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

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again, you are saying that she is misinformed?

:24:08.:24:14.

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

:24:15.:24:19.

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

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

:24:24.:24:28.

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

:24:29.:24:31.

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

:24:32.:24:37.

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

:24:38.:24:42.

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

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

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

:24:53.:24:58.

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

:24:59.:25:01.

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

:25:02.:25:07.

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

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

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do it. When will be the time that the NHS

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

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underperforming? People who use the NHS in Wales and

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

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have huge satisfaction levels among patients in the NHS and in

:25:41.:25:46.

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

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

:25:54.:25:55.

and secondary care. You tell me in election time that

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

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satisfaction rate would be telling you something different there. The

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

:26:11.:26:13.

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

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

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

:26:30.:26:32.

into the headlines. Nobody is envious about waiting in

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an ambulance for six hours outside accident and emergency.

:26:38.:26:41.

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

:26:42.:26:51.

wait is and complete exception. Whenever we have exceptional

:26:52.:26:53.

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

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

:26:58.:27:04.

that handover times between ambulances and accident and

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

:27:09.:27:09.

of Haitians. Are you proud of the way Labour has

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handled the health service in Wales?

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

:27:21.:27:23.

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

:27:24.:27:29.

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

:27:30.:27:34.

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

:27:35.:27:38.

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

:27:39.:27:42.

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

:27:43.:27:46.

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

:27:47.:27:51.

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

:27:52.:27:55.

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

:27:56.:28:00.

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

:28:01.:28:06.

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

:28:07.:28:12.

we are on Twitter. Thanks for watching. Merry Christmas

:28:13.:28:17.

and good night.

:28:18.:28:19.

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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