11/11/2015 The Wales Report

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.