11/11/2015 The Wales Report


The programme discusses the challenges facing the NHS in Wales with the man at the helm, Health Minister Mark Drakeford.

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A special edition from the Senedd in Cardiff Bay.


As we approach an election campaign, in which the state of the NHS


in Wales is sure to be prominent, we talk to the man in charge,


the Health Minister Mark Drakeford, about the challenges that lie ahead.


Hello and welcome once again to the The Wales Report.


This week we're at the Senedd, the home of the National Assembly


for Wales, to talk about the state of the biggest and


most expensive public service in the land - the National Health Service.


These winter months always bring a surge in demand for health care


and this is happening in a climate of acute financial pressure.


So what are the challenges in the months ahead?


In a moment, I'll be talking to the Minister Mark Drakeford.


But first, we asked two health experts for


their analysis and their recommended priorities for the Minister.


The NHS in Wales. A budget of ?5.5 billion a year, implying 70,000


people. Saving lives every day and doing a remarkable job, but


seemingly always facing a crisis. On unlimited demand, but not unlimited


money. For several years the NHS has not had enough money to deal with


the pressures it has. An ageing population, more expensive drugs and


so on. It is experiencing a tight financial situation and health


boards are struggling to balance the books. There is pressure all over


the health service and there is a danger that one we go into the


winter the pressures will increase. Tonight there is a warning that


there could be a crisis on the front line of the medical service in the


GP service. A number of factors is cannot continue to provide services


under the current contracts we have. There is economic austerity,


underinvestment in general practice and our premises. This coupled with


the stress means that many have had to hand their contract back. It


means that these practices are being managed by the health board which is


more costly. Three years ago the health service said that the less


there is major investment, it will collapse. We need to provide more


care in the community, close to people's is. Some progress has been


made, but not enough. This is becoming really quite acute now for


two reasons. One, the current pattern of health care is


inefficient. Secondly, there are question marks over the quality of


care that can be provided. Can we stop all of those hospitals and


departments across the country? There is real concern now that we


cannot do that, so major change is required. And a key part of this


reorganisation will be an effective partnership between health and


social care. It is crucial that health and social care communicate


because so many of the health patients need social care. You can't


support people at home if those two agencies are not coming together. We


are probably wasting a lot of money because of this dislocation of


services. Patients spending too long in hospital, or ending up in


hospital when we could have prevented it. It is a major priority


for the next year. And the problems don't end there. Wales's biggest


help old is being kept in special measures for another two years. We


are now just getting into the winter where demand can stretch the service


to breaking point. Minister, one we spoke a while ago, we spoke about


the challenges you are facing. What things are you pleased about in


terms of progress? I am glad that those people who work writing its


obituary, it turned out to be untrue. The health service today


goes on seeing more people than ever before, more quickly than ever


before, more successfully than ever before. Despite all the pressures,


and they are real, the health service goes on being a modern


miracle, doing things in the lives of people that would have been


unthought of a few years ago. Because of the persistent focus now


on financial pressure, I have noticed more reports about spending


per head. People are saying that spending per head on health in Wales


is less than it is in the UK, even if it is a small amount. That


spending has gone down by about ?100 over the last year. Why is that? We


took a strategic decision to protect spending across the whole of the


system, health and social care together. If you look at them


together, Wales spends 5% more per head than they do in England.


Hospitals in England can't release patients because social care there


has been underfunded. Here, we have emphasised supporting the system in


the round and I think that has been one of our strengths over the last


18 months. The way you are describing it there makes it sound


as if these two components are working smoothly together, but


experts tell us that progress has been disappointing and slow. Is that


fair? We certainly need to do more and we need to do it more quickly


than we have done. People argue that we need service change, and other


reorganisation. That has never been my beer. My view is we have to do


practical things to bring these two services into closer alignment.


There are some very practical things we have done in Wales. We have a


successful intermediary care funds where joint decisions are made. The


new social services act allows me to mandate budgets between the two


services. I do use those powers and there are very practical things we


can do to do some of the things we know need to be done, but because in


Wales we have a planned system, a system that is not fragmented into


lots of competing parts, we have a much better chance of making the


systems work together than they do elsewhere. On the Paul's budget --


on the combined budgets you mentioned, why have you not use


those powers already and to what extent would use them? We have not


had the power up until now. We have the power to bring horses to water,


but not to make them drink. That is what the social services act will


allow us to do. And you will use it straightaway? I will be using it


straightaway, all across Wales. In what circumstances would you use it?


For the commissioning of residential care services, for example. It is


quite wrong in some parts of Wales that different health boards have to


compete with each other. If we had a single budget in which health care


and social Claire could combine their budgets, it would be better


for the people who need it and for the public purse. It is an admission


though that people have been failing to make those decisions on a


constructive basis if you are forcing them. There is more we have


to do to explain to organisations that sometimes doing things in a way


that simply looks good from your perspective may not look right from


the perspective of the system as a whole. Patients flow across the


system as a whole every single day. It's about getting organisations to


rise above their own narrow interests to serve the interests of


the whole system. Last time we met we discussed that you needed to go


into quite a comprehensive range of reorganisation for hospitals. When a


few years ago the First Minister said that the system would collapse


without reorganisation, the alarm bells rang, but nothing has really


happened. Where are you on that? I don't agree that nothing has


happened. When I became health minister in 2013I was asked what


might top priorities would be. One of my top three was to bring the


organisations that were causing anxiety in North West and South


Wales to a proper conclusion. We have succeeded in doing that in all


three places. Though the turmoil we were seeing in parts of West Wales,


I have put those service changes into effect. The South Wales


programme is now agreed and is being implemented, and even in Betsy


Cadwell, changes that have caused local anxiety, people should see


changes in the primary care service. We will see the promises


that have been made, to fruition. We have to deliver on those promises to


gain the confidence of the local population further changes that are


inevitable in our health service. What are those changes?


Alongside that, the concentration of some of our hospital services, the


more special services, in fewer places than we tried to provide them


now. It is a twin track approach. With that approach in mind and given


that you set those goals clearly, how is the Health Board like Betsy


going to achieve these things are given the fact that you have is


extended the period of crisis or a special measures? The first thing it


has to do is regain the trust of its local population, that is where


things went badly wrong in the run-up to the decision to put the


border into special measures. Decisions were being made in a way


that simply alienate it to many people within the local population


and there is a huge effort going on now to regain that trust. Why was it


necessary to extend the period by such a long time? Special measures


are not something that you will be able to turn around in the matter of


100 days. Measures tell you that these processors corner over years.


Two years we think is what it will take in order to rebuild some of the


capacity of that board, some of the trust with its local population and


to make some of the important decisions that will be necessary to


put that board on an even keel for the future. When the initial period


started there was a suggestion that's there were some painful


decisions to be made which could be made within months and then things


could return to what you might call normality, we are not in that


position so what does it tell us about the stewardship and the


oversight here in Cardiff -- Cardiff Bay? What it tells us is that when


things go wrong in a Health Board, the cliff that health boards might


be going out to be steep indeed and the movement from being in control


and having a decent relationship with your local population can


evaporate very quickly. The repair of that takes a lot longer than its


loss. That is what we are learning in that contacts. I am wondering


whether a double edge thing. You want important decisions to be taken


and you do not think the system is working as it is clearly, are you


then created a problem because lots of doctors are saying to me, levels


of recruitment in some areas are in a pretty bad state and if you put a


pretty bad state and if you put aboard to be a very attractive place


to work in a pretty bad state and if you put aboard into special


measures, it is not going to be a very attractive place to work again


and damage you can end with people not deciding to invest their futures


in that part of Wales, it is a con recession I have had in the past in


South West Wales where I say if you want people to come and work in your


hospital what you do not want is someone who does not know the area


well but might be looking at an advert to put that hospital's name


into Google and all they see as turmoil around the future of our


hospital. We know from our experience elsewhere that you can


repair that damage, you can turn the corner, you can gain reputation as


well. There are wonderful things that go on in Betsi Cadwaladr


everyday, it's cancer services are the best in Wales, some of its


primary care is among the most innovative that we have in Wales. We


have to find a way of getting past the immediate problems to find that


meant as opportunities there are forever anyone wanting to invest


their future in that part of our health service. It is important to


underline recruitment is not just a problem there, there is a


recruitment problem for nurses and GPs across Wales and what is the


reason? Why is Wales unattractive for some health professionals? What


are you picking up? We need a little bit of context. There are more


people working in the Welsh NHS than ever before, more doctors, 2000


GPs... We have a recruitment problem in some parts of Wales but we have


22,000 nurses for the first time ever, the highest number we have


ever had. We have a plan for dealing with our recruitment problems in


primary care in particular. It is this. That the future of primary


care will not look like it has in the past, the role of the GP remains


absolutely pivotal. We have to do more to free up the time of the GPs


we have to do the things that only GPs are able to do, lots of what GPs


do today can just as clinically and competently and successfully be done


with an advanced practice nurse, a clinical pharmacist, and advanced


practice paramedic... We have to think of primary care in the future


as using the talents and abilities of the whole primary care team and


allowing GPs them to concentrate on those complex cases were only


someone with the training and ability to weigh up the case in


around like the GP has. I think we have had a great deal of success


working with the GP community in Wales to recognise that way forward


and as a result we have in parts of North Wales now teams of people


working in primary care in a way that we have never seen before. I


was chatting to one GP outside Cardiff recently, here's my age, he


is looking at retirement eventually, his message was a bit depressing


because he is a committed GP and he was saying lots of GPs of his


generation feel that they have been under intense pressure, they are not


valued, partly by the Welsh Government and they feel they are


under a lot of pressure and they are looking to take early retirement and


on top of that, it is then difficult to get young GPs in. That is not the


constructive picture that you seemed to be painting. I absolutely


recognise the pressures that GPs feel every day with a number of


people coming through their door and it is true that the new generation


of people coming into general medicine are not necessarily


attracted to the sort of models of primary care, the contractor model


that we have had in the past. I am very keen to do all we can to help


people who do not want to go on working full-time in the way that


they have bought 30 years or more to continue to make a contribution to


the Welsh NHS, maybe working part-time on a part of the job that


is particularly interesting to them, to take up a diabetes specialism, we


have huge numbers of people who need primary care medicine in diabetes


and we have people who worked for a long time who may be willing to go


on working if they can make a particular contribution in that sort


of medicine or training, the future generation of GPs and the other


thing we have to do is to help the profession to generate new models of


employment. More salaried GPs in future, I am sure, more GP practices


working together in federations, some very interesting models in


parts of Wales of GPs coming together to form social enterprises,


collectives, where they shared some of this burden over a wider number


of practices and individuals, there are things we can do, we are very


committed to doing that and we are very lucky that although individuals


think these pressures very much, our relationship with our profession and


the general practitioner community in Wales is genuinely constructive


and I think we share ambitions and we have discussions about means


towards those ends, but in Wales, in comparison with other parts of


England in particular, my aim as Health Minister is to tell our


people how much they are valued, how much the solution to the future lies


in dialogue and discussion, rather than confrontation. One final point,


I must mention junior doctors because they have been on the


headlines, a lot of people have been making the distinction between how


junior doctors are dealt with in Wales and in England where it has


been hugely controversial with the new contract, what is your message


to junior doctors in Wales and are you telling them that they have a


better run in Wales? My message to junior doctors, outside Wales as


well as in Wales, is that we want you to make your future part of our


future. We see you as a tremendous asset, we see you as people we want


to invest in, we see you as people who we want to have a dialogue


with, to shape the future which cannot be the same as the past,


change is inevitable, but our way of bringing about change is through


discussion and dialogue. I absolutely do not want to be in a


position where our staff in Wales, in which they feel that my attitude


to them is one of dictation and confrontation. That is absolutely


not the way we do things in Wales. Hopefully we will have another


update in a few months but thank you for talking to us.


Well, if the debate about health provision in Wales is


familiar, the state of another vital public service is not so prominent.


The state of the media in Wales, broadcasting, print and online, is


not a cause for national celebration if you look at the latest analysis.


Yes, we all know about Dr Who and Sherlock and Casualty,


all made in Wales, but we're talking about coverage of Welsh life


and what kind of voice the people of Wales have in the media.


A report by the Institute of Welsh Affairs released today has found


that coverage of Wales is shrinking, both on screen and in print.


The Welsh Government says it's a cause for deep concern.


It was the BBC to spend more money on English and which programmes in


Wales and in a moment I will be talking to James Purnell. Before


that, Angela Graham who chairs the Media Policy Group for the Institute


of Welsh Affairs offers her analysis. I start every day with


Radio Wales Sport. I read the western mail at breakfast and then


check out Wales online, I use iPlayer to give me the options and


the eye player it gives me the ITV Wales many as well. Despite all


these choices, we face a future of many media in Wales, but less media


contents about Wales. In commercial radio, as digital audio broadcasting


spreads, local news could disappear from the airwaves as big groups take


over. Newspaper sales are declining and there are fewer journalists. Is


this a brave new world driven by the potential of social media or a


weakened press sector, less able to keep as well informed and hold power


to account. Surely in broadcasting, especially television, Wales is


doing really well, making big network shows like Sherlock,


Casualty and Dr Who. But look for Wales itself on the network and you


find very little. In the Ingush language, drama arts and


entertainment made for Wales about Wales are disappearing from the


schedules for BBC Wales. It means the people of Wales are becoming


harder to see and harder to hear. ITV Wales has been cut to its lowest


output ever at just 90 minutes a week of non-news programming. S4C's


funding has been cut by a quarter. In the last five years, the BBC in


Wales has been cut of more heavily than in Scotland and in Northern


Ireland. Under the current license the deal, all the BBC is promising


is that Wales will be cut less than anywhere else. As a strategy, that


is not good enough. The BBC centrally must show that it has a


plan to deal with the media circumstances particular to Wales.


Rhetoric about making money work harder or guilt tripping us that


network quality will suffer if Wales gets more funding simply is not


enough. The market has not delivered what Wales need from its broadcast


media, robust public service broadcasting is essential and the


BBC is the cornerstone of that in Wales. That was Angela Graham with


her thoughts on where we are an James Purnell is with me now. Thanks


for talking to us. You have come to Cardiff for people want you to say


that the BBC is committed to spending more money on


English-language programmes and what is the answer? We recognise that


there is a need and we agree with Angela that people in Wales want to


see more Welsh content going on all of our services and they want to see


more content about Wales as well. The context is difficult, the BBC's


finances were cut, we have had to find 40% savings in the last ten


years and we will have to find another 20%, there is not a magical


part where we can find the money so we will have to work really


creatively with everyone in Wales, look at the money we spend on our


network services, on BBC One and BBC Two to address those needs in a way


that we can do within the reduced funding. Let us be clear when the


first Minister of Wales want ?30 million spent on English-language


programmes, you're basically saying that is not possible? We have said


that we will cut Wales less than anywhere, we are having to cut our


money quite significantly. I think it is good but very hard to find an


net increase of ?30 million but what we do totally agree with is to say


it is right that Wales needs to have its culture and politics reflected


within Wales and to the whole of the UK and we want to look at our


money, see how we can spend more efficiently and creatively to


achieve that. One example would be, there has been a huge success story


in Wales in the last ten years with Who, Sherlock, if some of those


programmes could be covering and betraying Wales as well, like Gavin


Andrews a seeded, that would be a way of hitting both birds with one


stone, so we need creative solutions. That is piggybacking


other stuff, it is not creating new streams of programming which are to


do with innovative ways of betraying Wales within Wales and beyond Wales.


That is what was achieved in the past, we are not in a position any


more. In the past we had growing money and now we do not, our funding


is going down significantly. You made the point clearly on money, I


am wondering whether the BBC is really understanding the kind of


ecology that we have, which is different to Scotland, if we make


that comparison. The BBC is shouldering a heavy burden. Other


parts of the media in Wales, print and with ITV are considerably weaker


than elsewhere, shouldn't the BBC be stepping up and making an exception


of Wales? I think that is right. There is less plural media in Wales,


whereas 20 years ago, there would have been quite a lot of people


playing in this area and it is now mainly the BBC, I do agree that we


have a responsibility to address this need and I guess what I am


saying is we have to do it in a way which is created, but I would love


us to have another ?30 million from the funding settlement, but we do


not have that. We are sitting down with everyone, all of our partners


to see if our money can work harder. On the other side of the coin, that


media ecology is working incredibly well. Wales now has one of the


world-class centres for drama production. It has not been all bad


news, there has been a lot of good news in the last few years. Now we


need to make sure that in the next few years we address this need of


covering Wales. To what extent are you able to say, are replaying the


right role. Our ITV doing enough, are you being assertive in that


way, accepting that people are having a go at their level of


spending. I think it is right that we face a greater scrutiny than


others. It is true that ITV used to do 12 hours a week and that is now


down to five hours a week. If they did more, if Channel 4 did more, if


we could have other new entrants into the market, as has happened in


Scotland, that would help as well, but that would not remove the need


for the BBC to play its role in addressing that.


On that point, there is a strong view that says your licence payers


in Wales are not getting a fair deal. If you look at the level of


English-language rogue ramming, they are not getting the provision they


were getting before. Really, despite the financial pressure that you talk


about, even within that, you have a duty to do more than you are doing?


That is a fair point about English-language programming, but


the BBC is now the main player and it may have gone down, but we are


providing most of the content. More widely, if you look at what Welsh


audiences think about the BBC, they are the most positive in the whole


of the UK. Welsh audiences watch more BBC, listen to more radio than


anywhere in the BB is -- in the UK. We spend more per head in Wales than


we do anywhere else in the country. We are committed to Wales, we spend


more per capita, but there is this need about English-language


programming and we are to talking people about how we can address it


next time round. If you'd like to get


in touch with us, email us or follow us on social media -


the hashtag is TheWalesReport. We'll be back next week, but


until then, thanks for watching.


Huw Edwards asks the questions that matter to you about your job, your health, your future. Calling to account the decision-makers here in Wales and beyond our borders too, each week the team bring you in-depth reports on pressing issues that matter to the lives of everyone living in Wales.

The programme discusses the challenges facing the NHS in Wales with the man at the helm, Health Minister Mark Drakeford.

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