17/02/2016 The Wales Report


Bethan Rhys Roberts looks at tackling the skills shortage in the Welsh NHS. What can be done to recruit more doctors? Plus an interview with the Liberal Democrats' Kirsty Williams.

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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.


Bethan Rhys Roberts looks at tackling the skills shortage in the Welsh NHS. What can be done to recruit more doctors to Wales? And the second in a series of interviews with the main party leaders in Wales, this time with the Liberal Democrats' Kirsty Williams.

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