:00:09. > :00:11.It's the biggest service run by the Welsh Government -
:00:12. > :00:15.So how are the parties, those asking for your vote,
:00:16. > :00:18.going to find answers to some of the challenges facing
:00:19. > :00:37.Welcome to our first programme of Election Wales 2016.
:00:38. > :00:42.There's just a month to go before the people of Wales elect 60
:00:43. > :00:46.Assembly members and a new Welsh Government.
:00:47. > :00:49.And the issue that will be crucial over the next few weeks
:00:50. > :00:58.With a total budget of ?7.1 billion, employing more than 70,000 people,
:00:59. > :01:02.it's facing increasing demand from an ageing population,
:01:03. > :01:04.with more complex and expensive treatments, and all with
:01:05. > :01:12.So tonight, we will be asking the five main parties how
:01:13. > :01:17.they would respond to these challenges over the next five years.
:01:18. > :01:20.And remember, you too can join the conversation on Twitter -
:01:21. > :01:25.Before we look for some answers, we've been to one A department
:01:26. > :01:27.in Glangwili General Hospital in Carmarthen, to ask people
:01:28. > :01:39.on the frontline the daily challenges they face.
:01:40. > :01:46.This morning I am on an early shift, we were given hand over, the
:01:47. > :01:51.department is full, bar one resuscitation bay. Let us have a
:01:52. > :01:56.look. Because people are living longer, they have complex needs.
:01:57. > :02:01.They have multi-medical problems, and getting sicker with this, and
:02:02. > :02:06.sometimes you know, you cannot sustain their care within the
:02:07. > :02:10.community setting, so hence they end up in the emergency department. It
:02:11. > :02:14.is becoming more normal unfortunately that we have the
:02:15. > :02:18.department quite full. Normally the night doctors would have been able
:02:19. > :02:24.to clear the the. Over the past few months you come in and there are
:02:25. > :02:27.about ten, 11 beds we are occupied by medical patients, surgical
:02:28. > :02:30.patients so we are starting the day on a backlog because the department
:02:31. > :02:35.is full and you have people coming in any way, so it is becoming more
:02:36. > :02:39.common. It didn't used to be like that, we have having full
:02:40. > :02:43.departments first thing in the morning. Every day is different.
:02:44. > :02:47.More recently I found that things are more challenging, mostly because
:02:48. > :02:51.we are not having the patient throw through the department. It is an A
:02:52. > :02:57.department. You expect people to come in, go home, come in, move
:02:58. > :03:00.directly to a superbialty bed. We have the patient staying in because
:03:01. > :03:04.there is nowhere to put them. They come in, they are seen and there is
:03:05. > :03:11.no place to off load them, because there are no beds.
:03:12. > :03:16.From my perspective, one of the main issues that a new Welsh Government
:03:17. > :03:23.should face is the interface between health and social care. Looks
:03:24. > :03:27.intact. There are currently too many patients in hospitals round Wales,
:03:28. > :03:32.who don't require the care that that Acute Hospital is able to provide.
:03:33. > :03:37.Unfortunately, it takes too long to safely get them back into the
:03:38. > :03:42.community, there is then a domino-effect, which often leads to
:03:43. > :03:46.ambulances being parked outside full, emergency units. A new Welsh
:03:47. > :03:49.Government should address this as soon as possible.
:03:50. > :03:53.Views from the A Department at Glangwili Hospital there.
:03:54. > :03:55.Joining me tonight - the health spokespeople for each
:03:56. > :04:00.For Labour, the Health Minister, Mark Drakeford.
:04:01. > :04:01.Darren Millar from the Conservative party.
:04:02. > :04:04.The Liberal Democrats' Kirsty Williams and Caroline Jones
:04:05. > :04:12.There are of course other parties standing in the Assembly elections -
:04:13. > :04:16.there's a full list on the BBC Wales Politics website.
:04:17. > :04:23.After the close of nomination there's will be a full list on the
:04:24. > :04:29.BBC Wales politics website. So thank you all very much for joining us.
:04:30. > :04:36.Let us try and start. On a note of consensus this evening. Would you
:04:37. > :04:40.all acknowledge that the well NHS is facing erincreasing demands, ever
:04:41. > :04:46.decreases resources or finite resources and whoever wins next
:04:47. > :04:49.month has to make big choices, and say no to some things. Darren
:04:50. > :04:52.Miller? It is important to recognise there are pressures across the whole
:04:53. > :04:58.of the United Kingdom and those pressures are also here in Wales,
:04:59. > :05:01.but it is not true to say that we need necessarily cut the National
:05:02. > :05:05.Health Service budget. My party has maintained a commitment which has
:05:06. > :05:08.knots been seen from any of the other parties that with need to
:05:09. > :05:12.envest more. What we have seen is a government over the past few years
:05:13. > :05:18.which has cut the NHS budget in real terms. But tough decisions to be
:05:19. > :05:22.made. Very tough decisions. Caroline Jones would you agree? Yes, but we
:05:23. > :05:28.need further investment into the NHS. We know that staff morale on
:05:29. > :05:33.the front line services is at an all time low and people are wanting to
:05:34. > :05:38.do their jobs, in the best possible way they can. Their care about their
:05:39. > :05:43.job but they are unable to because their hands are tied with an ageing
:05:44. > :05:46.population. Kirsty Williams, you can promise the earth but there will be
:05:47. > :05:50.some things you have to say to the people of we'll, we can't deliver
:05:51. > :05:57.that. There are big decisions ahead of us, and how we plan the NHS, to
:05:58. > :06:01.service properly for the next 10-20 year, which is why party has been
:06:02. > :06:05.saying that job can't be just left to politician, we believe in setting
:06:06. > :06:09.up a cross-party, a non-party commission, to engage with the
:06:10. > :06:12.staff, and with the people of Wales to decide what Health Service we
:06:13. > :06:16.need. Now we persuaded the Welsh Government that commission should be
:06:17. > :06:20.set up but unfortunately it failed because of the partieses who didn't
:06:21. > :06:23.want to join in. I hope after the election we can create that space
:06:24. > :06:25.that allow us to have that conversation about what kind of
:06:26. > :06:31.Health Service we want as we go forward. What I am looking for is
:06:32. > :06:34.honesty at the outset, that the NHS in Wales can't do everything, and we
:06:35. > :06:39.have to be straight, and you as politicians have to be straight with
:06:40. > :06:43.the people of Wales about that. Yes, but the NHS also needs to work more
:06:44. > :06:47.effectively and that is the responsibility of the next Welsh
:06:48. > :06:51.Government, it is not to day to day micro manage the NHS but to take the
:06:52. > :06:55.big decisions that Kirstie has alluded to, and that is why I think
:06:56. > :07:00.that the next Government has to start on a major programme of health
:07:01. > :07:05.and social care, integration, and a proper workforce plan for the future
:07:06. > :07:09.generation of NHS workers, if we don't do that, if whoever is in
:07:10. > :07:14.Government doesn't do this, it will let down the NHS in not taking the
:07:15. > :07:17.big decisions it needs. Mark Drakeford you are here as somebody
:07:18. > :07:22.with great experience of running the NHS. There has to be honesty. Of
:07:23. > :07:27.course there has, the pressures in the NHS are real and the product of
:07:28. > :07:30.our great success in people living longer and better, the answer
:07:31. > :07:34.doesn't lie in the hands of the NHS, that is for sure, unless we invest
:07:35. > :07:39.in the round in social care as you heard in ta clip, as well as the
:07:40. > :07:43.NHS, we don't provide people with a service they need, neither is the
:07:44. > :07:45.honesty all about politicians, it is about a conversation with the
:07:46. > :07:50.public, about what the public expect. And how they interact with
:07:51. > :07:54.the Health Service, as well and Kirstie's idea of a forward looking
:07:55. > :07:58.inquiry involving the public, asking them some of these questions is a
:07:59. > :08:04.very important idea. I will come on to that but let us look at hospitals
:08:05. > :08:08.in particular, because we looked there at A Mark Drakeford, the
:08:09. > :08:12.head of the Royal College of Emergency medicine in Wales said in
:08:13. > :08:16.January, that absolutely every emergency department in Wales is on
:08:17. > :08:21.the edge. Now that is quite an indictment, isn't it. Is he right?
:08:22. > :08:24.He wasn't right, because here we are in April and those emergency
:08:25. > :08:28.departments are all still there, all still working and have worked every
:08:29. > :08:33.day since January. Just about. No, no. Much more than just about. It
:08:34. > :08:37.has been a tough winter, the second half has been particularly tough,
:08:38. > :08:41.but no emergency department in Wales has ever closed its doors, we
:08:42. > :08:45.continue to see huge numbers of people, in the month of February,
:08:46. > :08:51.for every single minute of every hour of every day, two people turned
:08:52. > :08:54.up at A departments in Wales. So the demand is enormous, but the
:08:55. > :09:00.system copes. And that is really important for the people who work in
:09:01. > :09:05.it. That is as good as it gets you just cope. The system is just
:09:06. > :09:09.coping, and it is operating on the good will of the doctor, nurses and
:09:10. > :09:14.other staff in the NHS who go above and beyond what I think can be
:09:15. > :09:17.reasonably expected of them on many occasions. The minister is correct.
:09:18. > :09:21.Departments haven't closed but they haven't been able to meet the
:09:22. > :09:24.Government's targets about how long people should wait in an A
:09:25. > :09:28.department and that is because as we heard in the film, there is a lack
:09:29. > :09:32.of flow through our hospital system and alike of beds, and a lack of
:09:33. > :09:37.beds in our community, so people can... Let us look what you are
:09:38. > :09:41.offering instead. Darren Millar how would you fix A departments? We
:09:42. > :09:47.have lost one in five beds in our hospitals and that has caused
:09:48. > :09:51.problems at hospital front doors and it manifests with ambulances cueing
:09:52. > :09:56.up outside. We have seen that this week, in Wales and that is not good
:09:57. > :10:00.enough. What would we do? Invest in Community Hospitals to give extra
:10:01. > :10:04.bed capacity so people can be discharged into them, that is one
:10:05. > :10:08.idea, I think that would make a huge difference, the other thing, is
:10:09. > :10:12.re-invest and re-open a number of minor injury units bah because you
:10:13. > :10:16.can't choose well, which is what patients are being asked to do if
:10:17. > :10:20.you don't have a choice. If you can't get appointments. Nigel Farage
:10:21. > :10:24.a year ago blamed a lot on health tourism in terms of pressures on
:10:25. > :10:30.Britain's hospitals. Was he right, do you agree? We do have an issue
:10:31. > :10:37.with health tourism. It costs the UK almost ?3 billion a year. That is
:10:38. > :10:45.not true. Not the case. Some of that is obviously associated with Wales,
:10:46. > :10:49.what we would like, last year 12333 hours were lost with ambulances
:10:50. > :10:52.waiting outside the A departments. Not because of health tourism.
:10:53. > :10:57.Certainly not. I am not talking about that, that was in three month,
:10:58. > :11:01.we are talking about A as well. I am telling you that 12333 hours were
:11:02. > :11:06.lost with hospitals outside, they couldn't get in because of the bed
:11:07. > :11:09.blogging, because we have closed the cottage hospitals, which are
:11:10. > :11:13.fundamental to our environment. Elin Jones let us hear your solution for
:11:14. > :11:17.A hospitals across Wales. The solutions for A lie in the
:11:18. > :11:21.community, yes, community beds have been closed right throughout Wales
:11:22. > :11:25.and that is putting an extra pressure on A and acute hospitals,
:11:26. > :11:32.there is no doubt about that. I think as was said in by one of the
:11:33. > :11:36.doctors in the film, we have to tackle health and social care
:11:37. > :11:39.integration, that is where many patients get caught in turf war
:11:40. > :11:44.between health and social care, who pays, who is responsible for the
:11:45. > :11:50.care of the elderly, where people are staying on hospital wards for
:11:51. > :11:54.too long. . So we have to integrate that properly, and if we just tinker
:11:55. > :12:02.at the margins we will always continue... You are advocating a
:12:03. > :12:06.huge overhaul, the biggest ever arguably overhaul of the NHS in
:12:07. > :12:09.Wales. Is now really the time to do that? Now is absolutely the time. We
:12:10. > :12:14.have outlined already all the pressures in the NHS. If we carry
:12:15. > :12:20.on, if we carry on the way we are doing, then we will continue to have
:12:21. > :12:24.the... Explain what will happen... How doors haven't closed over
:12:25. > :12:29.winter, that is how bad it is, we have a Health Minister thinking that
:12:30. > :12:34.is a good enough response, because what... Across our border doors have
:12:35. > :12:38.closed this Wales they have not. We need as we started off by saying, we
:12:39. > :12:44.need to take some of the big decisions that fashion the future of
:12:45. > :12:45.the NHS to meet the demands of the 21st century and elderly patients
:12:46. > :12:51.what we need to do, is to integrate 21st century and elderly patients
:12:52. > :12:57.health and social care, break down the barriers between those
:12:58. > :13:02.reorganisation costs. ?10 million seems a cheap ticket. What I would
:13:03. > :13:07.say is that if we carry on as we are doing, we will carry on having the
:13:08. > :13:11.problems into the future it is not... Kirsty Williams... We need
:13:12. > :13:17.another reorganisation of the Health Service like a hole in the head.
:13:18. > :13:22.What we need, what we need, what we need is a relentless focus on
:13:23. > :13:26.service delivery for patients, anything that distracts us from that
:13:27. > :13:30.will let patients and staff down. It is fanciful to suggest a
:13:31. > :13:36.reorganisation is going to cost 10 million. The last one Plaid Cymru
:13:37. > :13:42.undertook in admin costs alone it was 21 million. We need to focus on
:13:43. > :13:47.services. We the need closer working between the NHS and social care,
:13:48. > :13:53.that is crucial, and that is why, that is why we have... Caroline
:13:54. > :13:55.that is crucial, and that is why, Jones Before any planning can be
:13:56. > :14:11.done we need a full scale inquiry. How will that help patients waiting
:14:12. > :14:16.now? This is going to take time but obviously we need to know what is
:14:17. > :14:19.wrong before we can fix it. We do not need another reorganisation. We
:14:20. > :14:24.have had two already and it is not going to be third time lucky for the
:14:25. > :14:27.NHS. We need to be able to focus on service delivery. Plaid Cymru is
:14:28. > :14:28.advocating for a massive reorganisation of local government
:14:29. > :14:32.at the same time which will distract reorganisation of local government
:14:33. > :14:35.them from delivering core services like social services. It is not
:14:36. > :14:40.going to work and it is important we get to grips with the NHS structural
:14:41. > :14:45.reform. Except your party is advocating a directly elected
:14:46. > :14:49.commissioner. That is reorganisation. Do you back more
:14:50. > :14:53.elected commissioners? We do because we want to end the situation at the
:14:54. > :14:56.moment which allows for cronyism to take place, where ministers appoint
:14:57. > :14:59.members to health boards. Instead we want them to be appointed by the
:15:00. > :15:05.people and we think that is the right way. On these health boards at
:15:06. > :15:10.the moment, the people that are appointed, the chairs, the vice
:15:11. > :15:14.chairs, 75% of those people will have a political affiliation with
:15:15. > :15:17.the Labour Party. But briefly, Caroline Jones, how many more
:15:18. > :15:24.elected representatives, how does that help waiting lists? It doesn't.
:15:25. > :15:31.At the moment, it isn't helping people. What elections bring our
:15:32. > :15:33.accountability. It brings transparency and accountability.
:15:34. > :15:37.Let's look at hospital reorganisation and where we are at
:15:38. > :15:41.right now. Two and a half years ago, Carwyn Jones said that health
:15:42. > :15:44.services would collapse unless hospitals were reorganised. Where
:15:45. > :15:49.are you on that and are you honestly, with the mood of the
:15:50. > :15:53.night's debate, are you honestly happy with progress? We have had a
:15:54. > :15:57.series of reorganisation is during this assembly term. I have had a
:15:58. > :16:01.series of difficult decisions put on my desk and I have never shied away
:16:02. > :16:05.from them. I have made a decision every time I was asked to do.
:16:06. > :16:12.Undoubtedly there is more to follow. The health service is always in a
:16:13. > :16:15.process of change. More closures? What we don't need is a massive
:16:16. > :16:25.upheaval of the organisation and we do not need elected interference in
:16:26. > :16:27.the decisions that clinicians and people who work in the industry need
:16:28. > :16:34.to do. So more people who work in the industry need
:16:35. > :16:39.not been closures. There is to be a moratorium, so that you -- you do
:16:40. > :16:42.not need a moratorium is that nothing can ever improve. Have you
:16:43. > :16:44.been ambitious and brave enough in your reforms of the NHS? Health
:16:45. > :16:47.service your reforms of the NHS? Health
:16:48. > :16:50.because you have to take the public with youth and the public is often
:16:51. > :16:54.attached to what they know and you were asking people to make a leap of
:16:55. > :16:58.faith into something that will be better in the future. I think we
:16:59. > :17:01.have succeeded in doing that in many parts of Wales. We will have to go
:17:02. > :17:06.on having a discussion. We know that. If you want the very best
:17:07. > :17:08.on having a discussion. We know results for people, particularly in
:17:09. > :17:12.specialist services, sometimes you have to be willing to draw that
:17:13. > :17:16.expertise together into one place where you can offer the very best to
:17:17. > :17:21.people all the time, every day. And you asked for an honest discussion
:17:22. > :17:24.about the challenges facing the health service, and nobody here
:17:25. > :17:27.should pretend to the public that you can simply leave the
:17:28. > :17:30.should pretend to the public that service in our spec where nothing
:17:31. > :17:33.will change because that way is a guarantee, not that things will
:17:34. > :17:38.improve, but that they will go backwards. That is all very credible
:17:39. > :17:44.but the problem with that is that most of the reorganisation proposals
:17:45. > :17:47.that have been put in front of people in our communities have been
:17:48. > :17:53.based on centralisation away from various hospitals on the basis that
:17:54. > :17:57.the staff is not there to run many of those services and there is a
:17:58. > :18:00.recruitment issue in needing to run those services. And herein lies one
:18:01. > :18:05.of the other pressures within the NHS, and that is the fact that we
:18:06. > :18:10.have too few doctors, too few nurses in Wales, certainly the lowest
:18:11. > :18:16.number of doctors in the western EU. More doctors and nurses than ever
:18:17. > :18:19.before. We need to be able to resource the NHS sufficiently, to
:18:20. > :18:24.plan the future of the workforce, to train more of our own doctor and
:18:25. > :18:28.nurses. We need to be able to do that in order to retain hospital
:18:29. > :18:33.services in communities throughout Wales. We will come onto recruitment
:18:34. > :18:37.but in terms of hospital reorganisation, you have to make
:18:38. > :18:41.unpopular decisions as ministers and stick to them. And when the placards
:18:42. > :18:45.come out, you have to stick by that. And you have to follow through on
:18:46. > :18:47.your commitment. One of the reorganisations promised by the
:18:48. > :18:51.government was the building of a new hospital for the south-east of
:18:52. > :18:55.Wales. We have been promised and promised that hospital as part of a
:18:56. > :19:00.reorganisation process. But it is yet to be built. When services
:19:01. > :19:03.change in West Wales, patients were told, we will move your services and
:19:04. > :19:07.when you get to the hospital there will be new facilities available.
:19:08. > :19:12.But those facilities were not ready at that time. And that undermines
:19:13. > :19:19.faith in the change process, when one of the promises that is made, if
:19:20. > :19:22.they accept the change it is often counterintuitive for people to think
:19:23. > :19:25.that if they travel further away, the service will be better. If the
:19:26. > :19:28.government does not follow through on its promises, it makes further
:19:29. > :19:32.change much more difficult to achieve. It is all very well at
:19:33. > :19:36.tackling the government and its record, but let's look at your
:19:37. > :19:41.record in Westminster. Junior doctors are on strike today over the
:19:42. > :19:45.border. Is that the model that you are offering for Wales? And could
:19:46. > :19:50.you guarantee that you would not tinker with contracts if you win in
:19:51. > :19:54.make that we are certainly not going to be offering cuts, closures and
:19:55. > :20:02.downgrades. But let me deal with the question directly. Let me deal with
:20:03. > :20:06.the question directly. We have no plans whatsoever to change the
:20:07. > :20:13.junior doctor contract here in Wales. But what we want to see... Is
:20:14. > :20:17.it a mistake, what your party is doing in England? What we do want to
:20:18. > :20:22.see is seven week care in our NHS. At the moment, we do not have that.
:20:23. > :20:26.How do we achieve that? Extra investment, more doctors and nurses.
:20:27. > :20:30.We do not have that at the moment. Yes, you are quite right, doctors do
:20:31. > :20:34.work seven days a week, particularly the emergency services, but what we
:20:35. > :20:39.do not see often is elective care over those weekend periods. Let me
:20:40. > :20:45.pin you down here, Darren Millar, on how much you would commit to the NHS
:20:46. > :20:48.in Wales. In terms of overall percentage of the NHS budget, we are
:20:49. > :20:53.looking at 45% going on the budget. What would you put? It is not about
:20:54. > :20:58.percentages, it is about new investment. We know that over the
:20:59. > :21:00.next few years as a result of record investment, there will be ?800
:21:01. > :21:05.million extra at least coming to Wales. People talk in percentages a
:21:06. > :21:10.lot of the time, why is it not about percentages? Because it is about
:21:11. > :21:13.money and investment. I will not set an arbitrary percentage as to how
:21:14. > :21:20.much of the gut budget -- how much of the budget will be involved. Why?
:21:21. > :21:23.Because we do not know what the budget will be. But we do know that
:21:24. > :21:28.the Conservatives have given a clear commitment that there will be ?800
:21:29. > :21:32.million more invested. Would it be more or less than the percentage
:21:33. > :21:35.currently spent? And we will have ?800 million more to invest over and
:21:36. > :21:41.above what is there at the moment. So if we look at England, you told
:21:42. > :21:45.us to look at Wales in terms of how Labour run the NHS, look at Wales.
:21:46. > :21:49.Should we look at England for a model of how you would run the NHS
:21:50. > :21:54.year? Let's compare England and Wales. If you look at waiting times,
:21:55. > :21:58.Wales lags behind. If you look at patient outcomes for cancer and
:21:59. > :22:03.stroke, Wales lags behind. Absolutely untrue. We need to make
:22:04. > :22:06.sure we level playing field. Look at cancer drugs and you are seven times
:22:07. > :22:11.less likely to get access to cancer drugs if you are Welsh than if you
:22:12. > :22:16.were English. Give us your vision, just your vision. To make it clear,
:22:17. > :22:21.we would invest money, extra money, each and every year at least at the
:22:22. > :22:24.rate of inflation into the Welsh NHS. That would mean that over the
:22:25. > :22:34.next assembly, over the next fortnight years, ?800 million more
:22:35. > :22:37.would go into the NHS. So we should not look at England as an example?
:22:38. > :22:43.We have different policies here than in England. Caroline Jones, give us
:22:44. > :22:50.a flavour of what the NHS would look like in the UK. More privatisation?
:22:51. > :22:55.Absolutely not. But that is what Nigel Farage said. He didn't. I
:22:56. > :22:58.would not support any party that believed in privatisation. Nine
:22:59. > :23:03.years ago I suffered from cancer and so I would not support any party.
:23:04. > :23:06.The other parties like to say that we would privatise but we wouldn't.
:23:07. > :23:11.Although we have a pretty good example at the moment of issues that
:23:12. > :23:18.are privatised. We have agency nurses, and the cost of agency
:23:19. > :23:28.nurses is, we could employ over 200,000 full-time nurses. How much
:23:29. > :23:33.would you spend on the NHS? It is about managing the budget. Of course
:23:34. > :23:38.we would spend more. Let's reinvent hospitals to prevent a bed lock in.
:23:39. > :23:50.I think there would be a major incentive to prevent bed blocking.
:23:51. > :23:54.Man-hours lost every month by ambulances locked outside. That is
:23:55. > :23:58.not good use of time. That money would be reinvested. In terms of
:23:59. > :24:02.looking ahead, would it be more of the same from Labour or are you
:24:03. > :24:06.offering something very new in this election? We offer a combination of
:24:07. > :24:14.stability, because we will not have reorganisation, but reform as well.
:24:15. > :24:18.Reform alongside investment. And reform alongside partnership with
:24:19. > :24:24.the staff who work in the NHS. The Tory recipe is privatisation and
:24:25. > :24:30.confrontation. Absolutely rubbish. Our recipe would be partnership with
:24:31. > :24:34.staff. That is why we do not have strikes in the Welsh NHS. Continuing
:24:35. > :24:38.investment and reform alongside it. We have to do something differently
:24:39. > :24:41.in the NHS if we want it to be able to go on doing the things that it
:24:42. > :24:45.does that are so valuable. That is the recipe we offer, a combination
:24:46. > :24:48.of making sure that we keep the ship steady as it goes, because that is
:24:49. > :24:52.really important in difficult times, and also that we do things
:24:53. > :24:54.differently so we are fit for the future. Thank you all very much for
:24:55. > :24:55.now. Let's pause there a moment and take
:24:56. > :24:59.a quick visit to a GP surgery to get a sense of some of the pressures
:25:00. > :25:05.in primary care. Where are the challenges confronted
:25:06. > :25:11.here? We have been to is Beech
:25:12. > :25:25.House Surgery in Denbigh. I'm working increasingly harked here
:25:26. > :25:28.in Beech House to look after my patience. And I feel that this is
:25:29. > :25:33.getting increasingly difficult overtime. I think the difficulty is
:25:34. > :25:38.that if you have 50 patients to see in a day, which can happen here on a
:25:39. > :25:43.busy day, especially in the middle of winter, it is very difficult to
:25:44. > :25:45.be able to give the care that you want to to every patient sat in
:25:46. > :25:51.front of you, because of time pressure. At this practice, it is
:25:52. > :25:57.very good. You get an appointment very quickly, without a problem. My
:25:58. > :26:01.sister lives not far from here. If she needs an appointment and she
:26:02. > :26:06.cannot get an appointment, it might not be for three weeks. So it is
:26:07. > :26:09.variable. Some of the main difficulties are problems with
:26:10. > :26:14.recruitment and retention of GPs. In certain parts of North Wales, we
:26:15. > :26:19.cannot deny that there is a crisis in general practice. The changes
:26:20. > :26:23.that I would like to see in the NHS in Wales over the next five years is
:26:24. > :26:31.to put a greater focus on primary care. We all know that we are seeing
:26:32. > :26:37.90% of patients contracts getting only 80% of the budget -- 8% of the
:26:38. > :26:41.budget. It is important for patients to get primary care in their
:26:42. > :26:49.community, close to their homes, but this has to be properly funded in
:26:50. > :26:56.order to do an excellent job. Dr Fiona Godlee is there. Let's look at
:26:57. > :27:02.GP recruitment specifically. Elin Jones, one of your manifesto pledges
:27:03. > :27:06.was 1000 extra doctors. Where will they come from? 1000 extra doctors
:27:07. > :27:11.over the next ten years because we have too few doctors are head of
:27:12. > :27:17.population compared to most of the European Union. That is why we need
:27:18. > :27:24.to recruit more doctors. Perhaps we need to look at financially
:27:25. > :27:30.incentivising rural areas where it is difficult to recruit doctors. But
:27:31. > :27:34.where are you getting them from? Fundamentally, we have to trained
:27:35. > :27:38.more doctors in Wales. There are too few young people able to access
:27:39. > :27:41.Welsh medical schools at this point. We need to increase places in Welsh
:27:42. > :27:45.medical schools and make sure that more younger people are able to
:27:46. > :27:51.train to be doctors in Wales and that means that they will end up
:27:52. > :27:57.more likely to serve the NHS in Wales rather than leaving Wales to
:27:58. > :28:01.have to go to get medical education and possibly never returning. We
:28:02. > :28:05.fundamentally need to start from day one of the next government
:28:06. > :28:08.increasing the training places for doctors in Wales. And Kirsty
:28:09. > :28:13.Williams, it is particularly an issue in rural areas. How would your
:28:14. > :28:16.party persuaded doctors to go and work in rural Wales? We need to look
:28:17. > :28:22.at incentive schemes but we also need to make several places
:28:23. > :28:26.attractive places to do medicine. I think we can create innovative
:28:27. > :28:28.careers were GPs can mix their time between general practice and
:28:29. > :28:34.hospital medicine, making it an attractive job to do. We also have
:28:35. > :28:38.to recognise that GPs are a precious resource. It is not unusual for
:28:39. > :28:45.people to wait three weeks to get a GP appointment in many rural parts.
:28:46. > :28:48.We have to recognise that they are a precious resource and it takes a
:28:49. > :28:51.long time to get them working. We need to recognise that GPs are
:28:52. > :28:55.working as part of the team and that is why we want to see more nurses in
:28:56. > :29:00.our community and we also want to have direct funding for GPs, to
:29:01. > :29:05.allow them -- allow them to employ more nurses or pharmacists,
:29:06. > :29:09.physiotherapists, councillors. One in four Welsh people suffer from a
:29:10. > :29:13.mental illness and that takes up a lot of time. Often they do not have
:29:14. > :29:17.services to refer people onto. Actually, we want to create a fund
:29:18. > :29:21.that will allow surgeries to expand my meaning that GPs see the people
:29:22. > :29:23.that need to see them. Other health care professionals are able to help
:29:24. > :29:35.solve people's problems. I wouldn't disagree with anything
:29:36. > :29:39.that has been said about incentivising people to come to work
:29:40. > :29:43.in Wales. We, we do have problems, it is not just confined the rural
:29:44. > :29:48.areas, we have problems in urban area, we have seen in Prestatyn and
:29:49. > :29:53.Wrexham and North Wales, as was features in the film, there are real
:29:54. > :29:56.pockets of pressure and frankly the Welsh Government has been burying
:29:57. > :30:00.its head in the sand too long, it has be a number of years that the
:30:01. > :30:03.Royal College has be a number of years that the
:30:04. > :30:07.immediate to train more doctor, there is a crisis merging, that is
:30:08. > :30:10.upon us and frankly, the Welsh Government hasn't done enough to
:30:11. > :30:13.address it. Training takes a long time, where would you get more
:30:14. > :30:17.doctors tomorrow, where would your party get them? We would offer
:30:18. > :30:22.incentives for people to come to Wales, we would say how wonderful
:30:23. > :30:28.Wales is, what it has to offer, and we would hope that people would be
:30:29. > :30:34.encouraged enough... Financial incentives? I don't know about that.
:30:35. > :30:39.I don't think so. Tell them it is a nice place to do other stuff? Yes,
:30:40. > :30:42.we have to promote our country. It is beautiful. Would you attract
:30:43. > :30:47.doctors from abroad? As well as recruitment, we have to look at
:30:48. > :30:50.retention and at the moment... Would you attract doctors from abroad?
:30:51. > :30:56.Well, where would they come from? Because we would be depleting other
:30:57. > :31:00.areas, maybe of these service, that are very much needed in their own
:31:01. > :31:05.country, having trained in their country and you know, those services
:31:06. > :31:06.are required there, are we completing, ethical about taking
:31:07. > :31:09.doctors from other countries? completing, ethical about taking
:31:10. > :31:14.are the type of thing that we have to look at. You have acknowledged
:31:15. > :31:20.that recruitment is a huge issue, why do you think so few want to work
:31:21. > :31:23.in Wales? Let us get the record strange straight, we have more
:31:24. > :31:28.doctors working in Wales than any other time in our history. That is
:31:29. > :31:31.have a a very low base. It is not from a low
:31:32. > :31:34.have a a very low base. It is not more consultants working in
:31:35. > :31:35.hospitals and the number of GPs we have in the workforce in
:31:36. > :31:38.hospitals and the number of GPs we year went up again.
:31:39. > :31:44.hospitals and the number of GPs we level. But you know that the NHS,
:31:45. > :31:51.OK, if you are challenging that, the NHS Wales workforce would say that
:31:52. > :31:59.you need to, 30% more GPs just to catch up with England. That is not
:32:00. > :32:04.the case at all. You asked for a sensible discussion, in Wales we
:32:05. > :32:08.have 6.5 GPs for every 10,000 of the population, in England they have
:32:09. > :32:11.6.6. So it is nonsense to say there is a 30% difference. Difference. It
:32:12. > :32:15.is nothing like it whatsoever. What we have to do, because every year,
:32:16. > :32:19.there are 3% more appointments with GPs in Wales than the year before,
:32:20. > :32:24.over a single assembly term, that means you have nearly a fifth
:32:25. > :32:26.increase in the demand for GP appoints so we have to
:32:27. > :32:32.increase in the demand for GP but Kirstie got the answer right.
:32:33. > :32:38.You asked for consensus, Kirstie got the answer right. What we have to do
:32:39. > :32:46.is diversity -- diversify a primary care team.
:32:47. > :32:48.is diversity -- diversify a primary A physiotherapist and so on, so what
:32:49. > :32:55.we have to do, is to broaden the base of people who are able to offer
:32:56. > :32:58.appointments at primary care, those people are available today, not
:32:59. > :33:05.being trained so they become available in ten years' time. That
:33:06. > :33:09.way... In Prestatyn which I think Darren Millar mentioned, we have a
:33:10. > :33:13.new service opened which does this. Just to be clear, are you saying
:33:14. > :33:17.that patients, are you saying that patients are doing to the wrong
:33:18. > :33:24.place? No, what I am saying is that when patients go to the right place,
:33:25. > :33:27.to primary care, 90% of contacts are in primary care, insped of ex
:33:28. > :33:33.pegging that the GP will be your first port of call there are others
:33:34. > :33:36.who we can just as clinically deploy, those people will be under
:33:37. > :33:40.the oversight of a GP. Why isn't that happen something if you are
:33:41. > :33:46.saying they are ready, it is not, clearly we saw the pressures on A
:33:47. > :33:51.earlier. A year ago we had no clinical pharmacists in Wales, today
:33:52. > :33:55.we have a 50 because we have put money into clusters a. Is more money
:33:56. > :34:01.for primary care, is that the answer? You are talking about
:34:02. > :34:05.cutting 300 million. Making sure that the primary care get their fair
:34:06. > :34:08.share of the totality of the NHS budget is, because the Royal College
:34:09. > :34:14.of GPs have said clearly the amount of money that, the share of money
:34:15. > :34:20.going to the primary sector has been reducing in the past few years. To
:34:21. > :34:26.be clear, on your manifesto would you cut the health budget? No. ?300
:34:27. > :34:30.million savings. We have said that the additional funding for the NHS
:34:31. > :34:34.and social care that comes into Wales from the UK Treasury will be
:34:35. > :34:39.completely ring-fenced for the purposes of the NHS. Where will you
:34:40. > :34:45.make the savings? Of course there are savings. This Health Minister
:34:46. > :34:53.had to make savings in the NHS, and any Health Minster will have to do
:34:54. > :34:57.that. Where does the money come from? Where there is waist in the
:34:58. > :35:06.NHS and we all hear of it all the time, we know it is there. Where
:35:07. > :35:14.will it come from? From within the NHS on inefficient practise, better
:35:15. > :35:19.precurement of... Why have we waited until there is a crisis, whys was
:35:20. > :35:23.there no forward planning? You were in Government for five years. All of
:35:24. > :35:28.it will be ring-fenced and put to front line service, that is the
:35:29. > :35:34.priority that Plaid Cymru has put in its manifesto. Our time is nearly
:35:35. > :35:39.up. Let us close back where we began. Is there an acknowledgement
:35:40. > :35:43.we have to be more grown up when it comes to this debate and this
:35:44. > :35:46.campaign and that being straight with the people is absolutely key
:35:47. > :35:51.throughout this campaign? If you were to do that, how would you be
:35:52. > :35:56.straight with the people, and their responsibility to towards the NHS,
:35:57. > :36:00.Caroline Jones? Their responsibility towards the NHS, I find that the
:36:01. > :36:06.current Government is very sensitive to any form of criticism. What would
:36:07. > :36:11.you do? What would I do? I think we need to go back to basics, to have
:36:12. > :36:15.transparency by asking doctors and nurse what they feel the failures
:36:16. > :36:18.are and them not being afraid to answer the question, because at the
:36:19. > :36:23.moment is survey shows that 60% of those that are raising concerns are
:36:24. > :36:27.bullied and harassed after, so they are in fear of reprisals and can't
:36:28. > :36:31.speak their mind. Darn your message to patients. We have had enough
:36:32. > :36:34.broken promises from previous Governments and they have included
:36:35. > :36:37.junior partners with the Liberal Democrats and Plaid Cymru in the
:36:38. > :36:40.past. What we need is better resourced NHS which is more
:36:41. > :36:44.accountable to the people, where patients are more responsible for
:36:45. > :36:47.their own care and the way they use NHS resources, I think that is
:36:48. > :36:51.something that can be delivered and we can work with other parties to
:36:52. > :36:54.deliver that. We have worked with them on mental Health Services, and
:36:55. > :36:59.I think that shows that we have opportunities to do that in future.
:37:00. > :37:03.Kirsty Williams. We have to get President Obamary care right. If we
:37:04. > :37:07.don't get it right we will continue to see those pressures in our
:37:08. > :37:11.hospital service, so we need better access to GP, we need to ensure that
:37:12. > :37:14.there are more nurses working in Wales, we have had tremendous
:37:15. > :37:17.success, the first part of Europe introducing a law to ensure there is
:37:18. > :37:22.the right number of nurse, we want to have that in our community and we
:37:23. > :37:28.immediate to address the issue of the disparity between how we treat
:37:29. > :37:33.fiscal health and mental health. Plaid Cymru is to take the
:37:34. > :37:38.decisions, that means proper workforce planning for the NHS and
:37:39. > :37:42.social care workforce but full health and social care integration
:37:43. > :37:48.so that we break down the barriers and we put the patients back at the
:37:49. > :37:52.centre of NHS planning. We need a new bargain between the
:37:53. > :37:56.system and the patient, the system has to be more open to people, to
:37:57. > :38:01.hear their views, to take their views seriously to regard people as
:38:02. > :38:04.equal partners in the business of bringing about improvement, and at
:38:05. > :38:06.the same time patients have responsibilities, a huge amount of
:38:07. > :38:11.what the Health Service does today is to deal with harms that need
:38:12. > :38:14.never have happened and that includes type 2 diabetes in many
:38:15. > :38:18.cases, we all have a responsibility to do more, to look after our own
:38:19. > :38:23.health, if we want the NHS to be there for us, when things happen to
:38:24. > :38:27.us, over which we have no control at all.
:38:28. > :38:34.In our next Election Wales 2016 I'll be travelling Wales to ask
:38:35. > :38:38.the Leaders of each of the five main parties their vision for Wales.
:38:39. > :38:41.But in two weeks' time we'll be looking in detail at another big
:38:42. > :38:43.issue in this election - education and what the parties
:38:44. > :38:45.have to offer pupils, parents and students.
:38:46. > :38:48.If you'd like to get in touch ahead of that or you'd like to be
:38:49. > :38:50.in the audience for our special debate with the Welsh Party leaders