17/02/2016 The Wales Report

Tackling the skills shortage in the Welsh NHS.

How can we encourage more doctors to work here?

We ask the Liberal Democrats' Kirsty Williams

how her party would run Wales as we look ahead

to May's national assembly elections.

And sharing cultural snapshots -

do we need to be politically tied to the EU

to form cultural connections with our European cousins?

Good evening and welcome to The Wales Report.

It's forever in the headlines - and last week,

after months of political squabbling,

a major international review found that The NHS in Wales

appears to be performing no better and no worse

But with concerns over staffing numbers in the Welsh NHS,

tonight we hear from one GP practice which has given up

because it just can't recruit enough doctors.

You can join tonight's conversation on social media

An official report into workforce trends

within the Welsh NHS has found a shortage of skills

in many areas, including general practice,

with the current position unsustainable.

Some GP practices are now ending their contracts

Felicity Evans has been to visit one practice which has done

Hazel Drury has been running the Rhuddlan clinic on her own for 13

years. The shortage of GPs has made it difficult to find cover, even for

holidays. Recently, she was taken ill suddenly. From her hospital bed,

she tried and failed to find a locum to replace her. It was the final

straw. Hazel will leave the practice in six weeks' time. It is quite

upsetting. I don't want to leave. I feel selfish looking after myself,

but I don't think I have looked after myself, and I need to do

something for myself and my family now, because I will not be around

for ever otherwise. I need to be here another few years, otherwise

you will be another doctor short in north Wales. General practice is the

cornerstone of the NHS. The majority of what the health service does

happens from places like this, but the problem is that there are not

enough doctors. Even conservative forecasts suggest that Wales will

have to increase GP training places by nearly a third to meet future

demand. But the supply line of people to fill those posts is also

drying up. Junior doctors make up that supply line, and the numbers

deciding they want to become GPs has been dwindling. Patients here at the

Rhuddlan clinic are not alone in seeing their GP today because of

recruitment issues. In Prestatyn, patients face similar uncertainty.

But the health what has assured all of them that their services will not

be affected. And it is not a problem confined to north Wales. Across

Wales, doesn't GP practices have handed sponsored Latif or service

delivery back to their local health board. Two have closed and six have

been identified as being at risk. The Welsh government has tried to

address the shortage by launching a social media campaign designed to

woo junior doctors in England. Thank you for taking the time to listen to

this message. There are many reasons why any doctor in training might

want to work in Wales. Ministers here hope the imposition of an

unpopular new contract there will encourage doctors to cross the

border. But the BMA says there are problems that Wales needs to address

to make it more attractive for junior doctors. There are two key

features with problems Wales faces in recruiting. The first is the

inherent distance of some of our rural practices and some of our

hospitals. The second is the problem created by the North-South divide.

So people are put off applying to Wales if they were living in the

Mersey region, for example, because they might be transferred to

Cardiff, when all their family or spouses are working in the Liverpool

area. Wales is a great place to be, whether you are interested in music,

or sport, you will find it right across Wales. Despite the Welsh

government charm offensive, some junior doctors already working here

say the recent criticism of the Welsh NHS in England has created a

perception problem, even though an international report last week

concluded that there was no difference in quality between the

Welsh and English systems. People who studied in England, Scotland and

Northern Ireland have no idea that the training can be really good

here. I don't feel much is going on to persuade them otherwise. I don't

feel that we sell ourselves very well. I don't people know there are

great opportunities here. Because it takes so long to train doctors, even

if Wales resolved all its recruitment problems tomorrow, we

would still face a shortage in the medium term. But experts say better

strategic planning is key. The NHS generally has been fairly poor at

anticipating how many staff it will need in the future and then training

them. It is odd, because given that the health service is the monopoly

employer and the people responsible for training, that they can get it

right. The key thing about workforce planning is that it needs to follow

this planning. In other words, you need to decide how you want to

deliver services in the future, and only then can you work out how many

and what sort of staff you need. If you do it the other way round, you

carry on doing the same old thing. The problem with the health service

is the connection between those two so that the king about the future

doesn't translate into a rigorous appraisal of how many staff you need

to do it. Back at the Rhuddlan clinic, the health board has now

found a placement for Hazel. While the search continues, her 2000

patients will have to rely on locums.

Joining me now is Professor Malcolm Lewis,

Why do you think there is a problem attracting GPs to Wales? The

fundamental issue is that general practice has become difficult and

unpopular. There was a heyday in the 1980s, when General practice seemed

as popular as anything in terms of recruitment, but that has faded over

the last three decades and we are now in a position where it is not at

all popular. The target, on the basis of intelligence from England,

is that 50% of medical graduates ought to be going into GP training.

That is a numbers issue. In reality, it is nowhere near that and there is

no sign of that happening. And in Wales, we are way behind because the

Welsh government does not even -- did not bother raising the target

for ten years. To be fair to the Welsh government, raising the target

for entry way increasing funding would make little difference,

because we are unable to fill with quality applicants the current

target levels. It is the same in parts of England. We can certainly

feel long parts of the M4corridor and parts of Wales come but we have

difficulty in Pembrokeshire and Carmarthenshire and Ceredigion. So

you don't see a specific reason why people do not want to come to Wales

specifically to be doctors? It is nothing to do with the bad press the

NHS in Wales has had and nothing to do with devolution. Are you

confident it has nothing to do with that? I don't think it is a

political issue, it is more an issue of how it will perceive general

practice. I would not say that if we went to the Welsh government as a

deanery and said, can we have another 10 million to increase the

number of recruits into dinner practice, we would not fill those

places. So when you hear criticism of bad workforce planning, bad

strategy and bad PR, we heard from that junior doctors say we are not

selling it enough, you don't take responsibility for selling Wales as

a good place to be a GP? I think selling Wales is a multi-input

issue. It is not just the Welsh deanery or Welsh government, it is

for NHS Wales as well. Part of it is about good news stories. If we had

good quality training in hospitals and general practice, which I think

we do compared to most of the UK, that surprisingly goes against the

issue. Why is that Mark message not getting out? It does get out, but it

gets out in dribs and drabs and is not a constant message. There is an

issue with scale as well in that Wales is very small compared to

England and Scotland. What about workforce planning? You predict how

many doctors you need. You have explained why there is no point

raising the target, but you also don't know what kind of system you

are planning for, because the Welsh NHS seems to be constantly in flux.

Is that an issue? We have had numerous reports over workforce

issues, the primary care workforce and the general practice workforce

and how things might change in the context of prudent health care, with

skill mix differences and so on. If you take the principle of prudent

health care, which is to only do what you can do, which is a worthy

principle, it is difficult to implement that. You start with

saying 25% of what GPs do could be done by other health care workers.

That is a reasonable assumption but you cannot implement that until you

have the other health care workers who can do it. But now we have

record health spending in Wales and a crisis over the border, with

junior doctors on strike. And you have contracts being imposed. Your

phones must be so hot at the moment, with an influx of doctors coming

across the border? I think there is local anecdotal evidence of Abel

wanted to come across. It is not that easy, of course, for doctors

already in training programmes to just step out and move. There are

processes for transfers. And we also don't know what the impact of the

contract will be on Wales. We can assume that if it looks better in

Wales than England, but in some specialties, it may be better in

England and Wales. If we don't get more doctors, it is going to be a

crisis, isn't it? Yes. We have already seen evidence of practices

not just in north-west, but elsewhere, that are struggling to

manage and are doing what is called handing back the keys, which means

handing back responsibility for running practices to the local

health boroughs. So there is an issue about how these practices

become measured by the health boards. Locums are hard to find, so

the premium goes up and they become almost impossibly expensive, and so

on. So the whole GP structure in Wales is on the edge? I would not

say the whole structure is on edge, but in places, it is on edge, and

different models might be needed to provide for patients in those areas.

There may be something about the culture of young people in these

days who do not want a remote oral lifestyle and want to live in cities

and big towns -- they do not want a remote or rural lifestyle. And we

are seeing this with this generation. Thank you.

There's less than three months to go

until the Assembly Election

and as part of BBC Wales' How Wales Works season,

the main party leaders in Wales to find out how

they would run things if they won power in May.

We started last week with Ukip and over the coming weeks,

we'll be speaking to Plaid Cymru,

Tonight, it's the turn of Kirsty Williams, the leader

Her party is gearing up for a campaign which

could see them return fewer AMs than ever before.

Professor Richard Wyn Jones from Cardiff University

takes a look at the challenges ahead

With the best will in the world, looking at all the evidence that we

have both from last year's UK general election, from the polls,

this looks like a possible extinction event for the Welsh Lib

Dems. To form an Assembly group, you need three. Again, that looks hugely

challenging for them. It would require them picking up seats when

you have got the Ukip challenge. It would require them winning

constituencies. That looks difficult. It is not impossible to

imagine them on one, and that would presumably then be the leader,

Kirsty Williams, which would be an extraordinary situation. When Kirsty

took over the leadership, I recall hearing her speak about Project 31.

The aim was to secure 31 liberal AMs. Through no fault of her own,

that just looks like fantasy politics. Hanging onto one or two

would be a good result for them, given where they are.

What I find puzzling about the Welsh Lib Dems is once the federal party

signed up to a coalition deal they were stuck in that position and in a

sense it was quite difficult for them to differentiate themselves

from Nick Clegg and the Liberal Democrat leadership and perhaps

Kirsty Williams did want to differentiate but since the terrible

result they had last May, there doesn't seem to have been any

attempt to change anything. They carry on. The rhetoric is very much

the same. It is almost as if they are caught in the headlights without

any kind of attempt to change the game. Changing the game would be

very difficult and it looks as if the electorate have made up their

minds and there is not a lot they can do. That is a horrible paradox

here in terms of Kirsty Williams' own position because if they

collapse and are down to one or two then presumably the leader who was

elected on the basis of project 31 leading to a majority in the

assembly, it would be hard for that lead to hang on that on the other

hand if you are the only member potentially can you give up the

leadership? Who then takes over the leadership of the Welsh Lib Dems in

such circumstances? It really is a horrible position.

It is a bleak picture he paints but does it feel like possible

extinction to you? Since the general election which was a very difficult

set of results for us, our party membership in Wales has grown. We

have won by-elections and councils, taking seats off Labour in Wrexham

and a seat of the Tories in Powys. We have record numbers of people out

on the streets delivering campaigns. The polls are tab at the moment but

five years ago journalists were predicting we were going to be wiped

out. We defied expectations and returned with a strong liberal

Democrat group and I'm sure we can expectations again. You are not

talking about Project 30 17 years on but are you thinking about five or

ten? What is realistic? I have been in politics long enough to know if

his mug 's game to try and predict election results. What I do know is

that over the past five years with a small assembly team we have punched

above our weight and delivered things for instance our number-1

pledge was more money for education and we have done that. And you have

been in government in Wales and Westminster. What is comfortable for

you as a leader? Is it influencing as an opposition party as you are

doing now or is it in government as a partner? What would be comfortable

for you? What is comfortable for me is getting things done for the

people of Wales. And delivering on the promises we have made. And

getting devolution to work. Someone who has been a proud exponent of

devolving power from Westminster to Cardiff, I also the first person to

acknowledge that for many people it's not working so for me what

would be comfortable is getting a Wales that works for everyone in

Wales and getting devolution to work. Better health services, great

education system and an economy that promotes opportunity. How you going

to do that? Presuming you keep a few seats, would you want to be in

government? I want to be in a position to put into practice the

values and beliefs my party has. For instance, we know that to thrive as

it country we need a great education system. I want to cut class sizes.

Too many children are being taught in packed class sizes. We want the

correct number of nurses and an economy that allows people the

dignity of a well-paid job to allow them to buy their first home. You

can do that in many ways. Which way because the electorate needs to

know? How are the Lib Dems going to influence? Will they strike a

bargain with Labour? Would you strike a bargain with the Tories or

Ukip? Give us a flavour of who you do a deal with. It's not about doing

a deal, it's about getting things done and getting a government that

works for people in a way that for the last 17 years it hasn't. Wales

had high hopes of this institution was going to transform our education

and health service and economy but it has not happened for the VAT

majority of people. I am trying to get out -- get that how would you

influence a future government? We won't be on the sidelines shouting

because that doesn't achieve smaller class sizes or more nurses on a

hospital ward or an economy that works. We have done it for the last

five years in using our influence to get things changed. We would use

that same approach again, working with other political parties who see

the merit of having the correct them of nurses in our health service, the

party that recognises you cannot ask a teacher to produce excellent

results when you have 32 youngsters in your classroom. If you have a

young couple who are desperate to get on that housing ladder but they

can save up the deposit to buy that first home. If I can just pin this

town and I don't expect you to say this evening yes we will do it deal

but what am trying to say is deal have any yellow lines? Plaid Cymru

have said they will never do a deal with the Conservatives. If you vote

for the Lib Dems you could put Ukip in power because you are not ruling

that out. When it comes to working whether the parties you have to find

a point of agreement. I cant see any circumstances and I've not heard any

policies by Ukip but something I could agree with. Our values are so

file a prat. -- so far apart. Sometimes politics is a strange

thing. Who would have thought you would see Labour and the

Conservatives working together against the Liberal Democrat lands

end 50 minute care calls, to restrict the use of zero our

contracts in the health service. All doors are open and yet last week

there was talk of some kind of pre-election deal between you, Plaid

Cymru and the Green party. Did you pull the plug on those talks? We

were approached informally by another political party about a

pre-election pact but we didn't think it was the right way to go.

Did those talks tap -- start at all? There were some informal meetings

but we didn't think it was the right approach. But it could have

safeguarded a few seats for you. That is the whole point. My approach

is not doing what's best in the narrow party political interests of

my party, my job is to say that devolution hasn't worked and we want

a Wales that works for everyone and to do that we need a new approach in

that National Assembly and we are putting forward policies that will

deliver. We have listened to people and we are coming forward with

policies to answer the problems. So no pre-election deals but

post-election your door is open to everyone? After the election was the

people of spoken we will do our best to deliver on the promises we were

made to those people. You are still to the left. You are centre-left. It

is a crowded area, especially in Wales. What is making you

distinctive these days? People might say they want to improve public

services. The Labour Party has had 17 years to do it and yet people are

dissatisfied with the state of education and the health service and

the economy. We have demonstrated that when we make promises in Wales

we can deliver on them. We are still different from the other parties.

For instance, recently we had an opportunity to vote on Assembly

Members pay. We were the only party in the assembly willing to stand up

and say a massive pay rise for Assembly Members is not appropriate.

We want to stop this from happening. The other parties made noises about

that. But they didn't do what they could have done and voted against it

which demonstrates that we are very different. We might be small but

when it comes to challenging the system, we are the only party

prepared to do that. You were talking some years ago the project

31 and a majority in the assembly and a lot has happened since then.

When you look in the mirror do you think, have eyed and anything wrong

as a leader? Of course, any human being would question, could we have

done things differently? But when I look at myself in the mirror I know

that as the leaders of the smallest group in the assembly over the last

five years there are children getting additional money for the

education that would not have happened if we hadn't of been there.

The Bell have been treated with state-of-the-art radiotherapy

machines in Wales which would have had that treatment if we had not

secured additional resources. The iron people in an apprenticeship

today that would not have been there if Labour had had their way. When I

looked out what we have delivered as a small group, I am proud. This

election must be the most challenging you have ever faced.

What keeps you going? It is really challenging and it would be great to

be at the top of the polls but what keeps me going is that I know there

are no political parties in this coming election committed to

ensuring the rather like right number of nurses in our hospitals.

We had to drag the Labour Party to induce a system which put money into

the education of our poorest children and it's working. When I

see that and talk to teachers that tell me those kids are doing better

than it's all worthwhile. Thank you very much.

Tomorrow, EU leaders meet in Brussels

for a crucial summit, where Prime Minister David Cameron

is hoping to secure a deal on the UK's relationship

If he does, a referendum on Britain's membership

of the European Union could be held as early as June.

So what impact will the vote have on culture in Wales?

Do we need to be part of a political union

to share and exchange cultural connections with other countries?

Clementine Schneidermann is an award-winning

French photographer whose photos have been published

including in the pages of the New York Times.

Originally from Paris, she's currently living

and working in Abertillery as part of a residency

documenting life in Blaenau Gwent, an area

that continues to receive a large portion of EU funding.

It is a very old and isolated place and it can be inspiring for people

because it's something you can't find anywhere else. I know people

who are from the valleys and to take pictures and it is really different.

You really see it in a different way. I suffer from the lack of light

here whereas some people who are from the don't really see it as a

problem. He really bring a different touch when you are not from the

place. It doesn't mean it's more interesting it's just different.

This is the exhibition. We are having their necks of vision of

young Georgian photographers. I met during the opening of photography in

Cardiff and we found we were both living in Abertillery. I was living

in a war so and Italy before moving to Wales and when I moved to Wales

three and a half years ago I missed being able to go to exhibitions and

to see art. Our idea was to organise an exhibition of international

photography first in our town and then in the towns in the area. What

effect do you think leaving the European Union could have on running

the exhibitions? It would be difficult to cooperate with artists

and to invite them. In the past we have worked with people who come

from EU countries and it was easier to cooperate with them and invite

them to the exhibitions. What effect do you think leaving the EE you

could have on the Welsh culture? Cultural diversity is really

important and leaving the year would mean artists would not be able to

come here freely and many people would have to leave. Also it would

be more difficult to cooperate with other European projects and it will

be difficult to access funding. It would be a shame if an artist is not

able any more to work in Wales because I think Wales benefits a lot

from the art. If you don't have that any more wheels will lose something

very important. The photographer Clementine

Schneidermann there. I'm joined now by Sophie Lewis,

the Chief Executive of Sinfonia Cymru and cultural

commentator Richard Fitzwilliams. Richard, I will start with that

final thought from Clementine. Do you think England and Wales would

lose something important culturally if we were to lose the EU? I don't,

because although naturally, there is a certain amount of benefit in

grants to areas with regeneration projects and some to various

countries in the EU, there is no question that there are subsidiary

benefits, but if you consider the fact that we are the leaders in

Britain and culturally in the world, it is a kaleidoscope of creativity.

And if we were to leave, I think matters would remain the same.

Sophie, we don't need to stay in the EU to punch above our weight? I

think we very much do need to stay in the EU. Some of the examples

Richard has whited Maasai Mara of those areas are -- some of the areas

Richard has cited are directly supported by the EU. If you take the

film industry, some of the bigger films that have made a major

contribution to British exports started with development funding

from the EU. Films like Brooklyn, which has been nominated for a

number of Oscars, had development funding from the EU. So is it all

about money? No, it is bigger than that. The grants are very strategic

and they are supporting the fantastic creative industries sector

that we have. But beyond that, it is about freedom of movement as well.

Richard, you are talking about big and expensive projects which are

well funded, but what about the photographer, like Clementine, who

are not funded by the EU, but so many come because of help from the

EU and that would all disappear. We don't know that it would disappear.

I am unconvinced that freedom of movement or freedom of objectivity

think about museums and our creative industry as a whole, would be

adversely affected by what would happen if we were to leave the EU.

What I do think would happen would be possibly an outpouring of some

form of creativity, because even most liberal figures would consider

it an adverse situation if we had a lot of plays and films about a

parochial decision. Sophie is mentioning grants, and they do

indeed exist with reference to the film, but if you are thinking

overall about our creative industries, they employ 1.7 million

people, something like 9% of exports, over 17 billion. That is

linked to talent so particularly. Sophie, we have talked about the

funding and free movement. What about the psyche, the identity, the

impact of leaving on the Welsh identity? For Wales in particular,

we are at an interesting point culturally. We are becoming far more

innovative. We are taking more risks, and the Welsh government will

be looking very seriously at this issue of the in-out referendum in

terms of what that will mean for the Welsh identity. If we then decide

the best thing to do is not be a member of the EU, I think we would

seriously jeopardise the ambition and our identity. Richard? It is a

tremendously significant point that throughout history, the arts here

and in particular in recent decades, have been so enriched by

international and national links and by a cross-cultural

internationalism. So whether or not we are in or out, I think this will

continue, because the talent here is so massive. Thank you both. We will

leave it there. If you'd like to get

in touch with us, email us at [email protected],

or follow us on social media - We'll be back next week -

thanks for watching.