Health The Wales Report


Health

Bethan Rhys Roberts is joined by a panel of politicians from the five main parties in Wales to discuss their plans for the health service.


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Transcript


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It's the biggest service run by the Welsh Government -

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So how are the parties, those asking for your vote,

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going to find answers to some of the challenges facing

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Welcome to our first programme of Election Wales 2016.

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There's just a month to go before the people of Wales elect 60

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Assembly members and a new Welsh Government.

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And the issue that will be crucial over the next few weeks

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With a total budget of ?7.1 billion, employing more than 70,000 people,

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it's facing increasing demand from an ageing population,

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with more complex and expensive treatments, and all with

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So tonight, we will be asking the five main parties how

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they would respond to these challenges over the next five years.

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And remember, you too can join the conversation on Twitter -

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Before we look for some answers, we've been to one A department

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in Glangwili General Hospital in Carmarthen, to ask people

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on the frontline the daily challenges they face.

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This morning I am on an early shift, we were given hand over, the

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department is full, bar one resuscitation bay. Let us have a

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look. Because people are living longer, they have complex needs.

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They have multi-medical problems, and getting sicker with this, and

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sometimes you know, you cannot sustain their care within the

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community setting, so hence they end up in the emergency department. It

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is becoming more normal unfortunately that we have the

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department quite full. Normally the night doctors would have been able

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to clear the the. Over the past few months you come in and there are

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about ten, 11 beds we are occupied by medical patients, surgical

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patients so we are starting the day on a backlog because the department

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is full and you have people coming in any way, so it is becoming more

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common. It didn't used to be like that, we have having full

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departments first thing in the morning. Every day is different.

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More recently I found that things are more challenging, mostly because

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we are not having the patient throw through the department. It is an A

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department. You expect people to come in, go home, come in, move

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directly to a superbialty bed. We have the patient staying in because

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there is nowhere to put them. They come in, they are seen and there is

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no place to off load them, because there are no beds.

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From my perspective, one of the main issues that a new Welsh Government

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should face is the interface between health and social care. Looks

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intact. There are currently too many patients in hospitals round Wales,

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who don't require the care that that Acute Hospital is able to provide.

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Unfortunately, it takes too long to safely get them back into the

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community, there is then a domino-effect, which often leads to

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ambulances being parked outside full, emergency units. A new Welsh

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Government should address this as soon as possible.

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Views from the A Department at Glangwili Hospital there.

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Joining me tonight - the health spokespeople for each

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For Labour, the Health Minister, Mark Drakeford.

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Darren Millar from the Conservative party.

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The Liberal Democrats' Kirsty Williams and Caroline Jones

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There are of course other parties standing in the Assembly elections -

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there's a full list on the BBC Wales Politics website.

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After the close of nomination there's will be a full list on the

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BBC Wales politics website. So thank you all very much for joining us.

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Let us try and start. On a note of consensus this evening. Would you

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all acknowledge that the well NHS is facing erincreasing demands, ever

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decreases resources or finite resources and whoever wins next

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month has to make big choices, and say no to some things. Darren

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Miller? It is important to recognise there are pressures across the whole

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of the United Kingdom and those pressures are also here in Wales,

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but it is not true to say that we need necessarily cut the National

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Health Service budget. My party has maintained a commitment which has

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knots been seen from any of the other parties that with need to

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envest more. What we have seen is a government over the past few years

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which has cut the NHS budget in real terms. But tough decisions to be

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made. Very tough decisions. Caroline Jones would you agree? Yes, but we

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need further investment into the NHS. We know that staff morale on

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the front line services is at an all time low and people are wanting to

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do their jobs, in the best possible way they can. Their care about their

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job but they are unable to because their hands are tied with an ageing

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population. Kirsty Williams, you can promise the earth but there will be

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some things you have to say to the people of we'll, we can't deliver

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that. There are big decisions ahead of us, and how we plan the NHS, to

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service properly for the next 10-20 year, which is why party has been

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saying that job can't be just left to politician, we believe in setting

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up a cross-party, a non-party commission, to engage with the

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staff, and with the people of Wales to decide what Health Service we

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need. Now we persuaded the Welsh Government that commission should be

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set up but unfortunately it failed because of the partieses who didn't

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want to join in. I hope after the election we can create that space

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that allow us to have that conversation about what kind of

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Health Service we want as we go forward. What I am looking for is

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honesty at the outset, that the NHS in Wales can't do everything, and we

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have to be straight, and you as politicians have to be straight with

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the people of Wales about that. Yes, but the NHS also needs to work more

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effectively and that is the responsibility of the next Welsh

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Government, it is not to day to day micro manage the NHS but to take the

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big decisions that Kirstie has alluded to, and that is why I think

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that the next Government has to start on a major programme of health

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and social care, integration, and a proper workforce plan for the future

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generation of NHS workers, if we don't do that, if whoever is in

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Government doesn't do this, it will let down the NHS in not taking the

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big decisions it needs. Mark Drakeford you are here as somebody

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with great experience of running the NHS. There has to be honesty. Of

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course there has, the pressures in the NHS are real and the product of

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our great success in people living longer and better, the answer

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doesn't lie in the hands of the NHS, that is for sure, unless we invest

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in the round in social care as you heard in ta clip, as well as the

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NHS, we don't provide people with a service they need, neither is the

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honesty all about politicians, it is about a conversation with the

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public, about what the public expect. And how they interact with

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the Health Service, as well and Kirstie's idea of a forward looking

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inquiry involving the public, asking them some of these questions is a

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very important idea. I will come on to that but let us look at hospitals

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in particular, because we looked there at A Mark Drakeford, the

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head of the Royal College of Emergency medicine in Wales said in

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January, that absolutely every emergency department in Wales is on

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the edge. Now that is quite an indictment, isn't it. Is he right?

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He wasn't right, because here we are in April and those emergency

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departments are all still there, all still working and have worked every

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day since January. Just about. No, no. Much more than just about. It

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has been a tough winter, the second half has been particularly tough,

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but no emergency department in Wales has ever closed its doors, we

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continue to see huge numbers of people, in the month of February,

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for every single minute of every hour of every day, two people turned

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up at A departments in Wales. So the demand is enormous, but the

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system copes. And that is really important for the people who work in

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it. That is as good as it gets you just cope. The system is just

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coping, and it is operating on the good will of the doctor, nurses and

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other staff in the NHS who go above and beyond what I think can be

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reasonably expected of them on many occasions. The minister is correct.

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Departments haven't closed but they haven't been able to meet the

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Government's targets about how long people should wait in an A

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department and that is because as we heard in the film, there is a lack

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of flow through our hospital system and alike of beds, and a lack of

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beds in our community, so people can... Let us look what you are

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offering instead. Darren Millar how would you fix A departments? We

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have lost one in five beds in our hospitals and that has caused

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problems at hospital front doors and it manifests with ambulances cueing

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up outside. We have seen that this week, in Wales and that is not good

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enough. What would we do? Invest in Community Hospitals to give extra

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bed capacity so people can be discharged into them, that is one

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idea, I think that would make a huge difference, the other thing, is

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re-invest and re-open a number of minor injury units bah because you

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can't choose well, which is what patients are being asked to do if

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you don't have a choice. If you can't get appointments. Nigel Farage

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a year ago blamed a lot on health tourism in terms of pressures on

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Britain's hospitals. Was he right, do you agree? We do have an issue

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with health tourism. It costs the UK almost ?3 billion a year. That is

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not true. Not the case. Some of that is obviously associated with Wales,

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what we would like, last year 12333 hours were lost with ambulances

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waiting outside the A departments. Not because of health tourism.

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Certainly not. I am not talking about that, that was in three month,

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we are talking about A as well. I am telling you that 12333 hours were

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lost with hospitals outside, they couldn't get in because of the bed

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blogging, because we have closed the cottage hospitals, which are

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fundamental to our environment. Elin Jones let us hear your solution for

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A hospitals across Wales. The solutions for A lie in the

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community, yes, community beds have been closed right throughout Wales

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and that is putting an extra pressure on A and acute hospitals,

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there is no doubt about that. I think as was said in by one of the

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doctors in the film, we have to tackle health and social care

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integration, that is where many patients get caught in turf war

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between health and social care, who pays, who is responsible for the

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care of the elderly, where people are staying on hospital wards for

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too long. . So we have to integrate that properly, and if we just tinker

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at the margins we will always continue... You are advocating a

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huge overhaul, the biggest ever arguably overhaul of the NHS in

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Wales. Is now really the time to do that? Now is absolutely the time. We

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have outlined already all the pressures in the NHS. If we carry

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on, if we carry on the way we are doing, then we will continue to have

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the... Explain what will happen... How doors haven't closed over

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winter, that is how bad it is, we have a Health Minister thinking that

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is a good enough response, because what... Across our border doors have

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closed this Wales they have not. We need as we started off by saying, we

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need to take some of the big decisions that fashion the future of

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the NHS to meet the demands of the 21st century and elderly patients

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what we need to do, is to integrate 21st century and elderly patients

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health and social care, break down the barriers between those

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reorganisation costs. ?10 million seems a cheap ticket. What I would

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say is that if we carry on as we are doing, we will carry on having the

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problems into the future it is not... Kirsty Williams... We need

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another reorganisation of the Health Service like a hole in the head.

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What we need, what we need, what we need is a relentless focus on

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service delivery for patients, anything that distracts us from that

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will let patients and staff down. It is fanciful to suggest a

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reorganisation is going to cost 10 million. The last one Plaid Cymru

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undertook in admin costs alone it was 21 million. We need to focus on

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services. We the need closer working between the NHS and social care,

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that is crucial, and that is why, that is why we have... Caroline

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that is crucial, and that is why, Jones Before any planning can be

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done we need a full scale inquiry. How will that help patients waiting

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now? This is going to take time but obviously we need to know what is

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wrong before we can fix it. We do not need another reorganisation. We

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have had two already and it is not going to be third time lucky for the

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NHS. We need to be able to focus on service delivery. Plaid Cymru is

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advocating for a massive reorganisation of local government

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at the same time which will distract reorganisation of local government

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them from delivering core services like social services. It is not

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going to work and it is important we get to grips with the NHS structural

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reform. Except your party is advocating a directly elected

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commissioner. That is reorganisation. Do you back more

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elected commissioners? We do because we want to end the situation at the

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moment which allows for cronyism to take place, where ministers appoint

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members to health boards. Instead we want them to be appointed by the

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people and we think that is the right way. On these health boards at

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the moment, the people that are appointed, the chairs, the vice

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chairs, 75% of those people will have a political affiliation with

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the Labour Party. But briefly, Caroline Jones, how many more

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elected representatives, how does that help waiting lists? It doesn't.

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At the moment, it isn't helping people. What elections bring our

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accountability. It brings transparency and accountability.

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Let's look at hospital reorganisation and where we are at

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right now. Two and a half years ago, Carwyn Jones said that health

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services would collapse unless hospitals were reorganised. Where

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are you on that and are you honestly, with the mood of the

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night's debate, are you honestly happy with progress? We have had a

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series of reorganisation is during this assembly term. I have had a

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series of difficult decisions put on my desk and I have never shied away

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from them. I have made a decision every time I was asked to do.

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Undoubtedly there is more to follow. The health service is always in a

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process of change. More closures? What we don't need is a massive

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upheaval of the organisation and we do not need elected interference in

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the decisions that clinicians and people who work in the industry need

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to do. So more people who work in the industry need

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not been closures. There is to be a moratorium, so that you -- you do

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not need a moratorium is that nothing can ever improve. Have you

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been ambitious and brave enough in your reforms of the NHS? Health

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service your reforms of the NHS? Health

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because you have to take the public with youth and the public is often

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attached to what they know and you were asking people to make a leap of

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faith into something that will be better in the future. I think we

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have succeeded in doing that in many parts of Wales. We will have to go

:16:59.:17:01.

on having a discussion. We know that. If you want the very best

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on having a discussion. We know results for people, particularly in

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specialist services, sometimes you have to be willing to draw that

:17:09.:17:12.

expertise together into one place where you can offer the very best to

:17:13.:17:16.

people all the time, every day. And you asked for an honest discussion

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about the challenges facing the health service, and nobody here

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should pretend to the public that you can simply leave the

:17:25.:17:27.

should pretend to the public that service in our spec where nothing

:17:28.:17:30.

will change because that way is a guarantee, not that things will

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improve, but that they will go backwards. That is all very credible

:17:34.:17:38.

but the problem with that is that most of the reorganisation proposals

:17:39.:17:44.

that have been put in front of people in our communities have been

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based on centralisation away from various hospitals on the basis that

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the staff is not there to run many of those services and there is a

:17:54.:17:57.

recruitment issue in needing to run those services. And herein lies one

:17:58.:18:00.

of the other pressures within the NHS, and that is the fact that we

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have too few doctors, too few nurses in Wales, certainly the lowest

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number of doctors in the western EU. More doctors and nurses than ever

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before. We need to be able to resource the NHS sufficiently, to

:18:17.:18:19.

plan the future of the workforce, to train more of our own doctor and

:18:20.:18:24.

nurses. We need to be able to do that in order to retain hospital

:18:25.:18:28.

services in communities throughout Wales. We will come onto recruitment

:18:29.:18:33.

but in terms of hospital reorganisation, you have to make

:18:34.:18:37.

unpopular decisions as ministers and stick to them. And when the placards

:18:38.:18:41.

come out, you have to stick by that. And you have to follow through on

:18:42.:18:45.

your commitment. One of the reorganisations promised by the

:18:46.:18:47.

government was the building of a new hospital for the south-east of

:18:48.:18:51.

Wales. We have been promised and promised that hospital as part of a

:18:52.:18:55.

reorganisation process. But it is yet to be built. When services

:18:56.:19:00.

change in West Wales, patients were told, we will move your services and

:19:01.:19:03.

when you get to the hospital there will be new facilities available.

:19:04.:19:07.

But those facilities were not ready at that time. And that undermines

:19:08.:19:12.

faith in the change process, when one of the promises that is made, if

:19:13.:19:19.

they accept the change it is often counterintuitive for people to think

:19:20.:19:22.

that if they travel further away, the service will be better. If the

:19:23.:19:25.

government does not follow through on its promises, it makes further

:19:26.:19:28.

change much more difficult to achieve. It is all very well at

:19:29.:19:32.

tackling the government and its record, but let's look at your

:19:33.:19:36.

record in Westminster. Junior doctors are on strike today over the

:19:37.:19:41.

border. Is that the model that you are offering for Wales? And could

:19:42.:19:45.

you guarantee that you would not tinker with contracts if you win in

:19:46.:19:50.

make that we are certainly not going to be offering cuts, closures and

:19:51.:19:54.

downgrades. But let me deal with the question directly. Let me deal with

:19:55.:20:02.

the question directly. We have no plans whatsoever to change the

:20:03.:20:06.

junior doctor contract here in Wales. But what we want to see... Is

:20:07.:20:13.

it a mistake, what your party is doing in England? What we do want to

:20:14.:20:17.

see is seven week care in our NHS. At the moment, we do not have that.

:20:18.:20:22.

How do we achieve that? Extra investment, more doctors and nurses.

:20:23.:20:26.

We do not have that at the moment. Yes, you are quite right, doctors do

:20:27.:20:30.

work seven days a week, particularly the emergency services, but what we

:20:31.:20:34.

do not see often is elective care over those weekend periods. Let me

:20:35.:20:39.

pin you down here, Darren Millar, on how much you would commit to the NHS

:20:40.:20:45.

in Wales. In terms of overall percentage of the NHS budget, we are

:20:46.:20:48.

looking at 45% going on the budget. What would you put? It is not about

:20:49.:20:53.

percentages, it is about new investment. We know that over the

:20:54.:20:58.

next few years as a result of record investment, there will be ?800

:20:59.:21:00.

million extra at least coming to Wales. People talk in percentages a

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lot of the time, why is it not about percentages? Because it is about

:21:06.:21:10.

money and investment. I will not set an arbitrary percentage as to how

:21:11.:21:13.

much of the gut budget -- how much of the budget will be involved. Why?

:21:14.:21:20.

Because we do not know what the budget will be. But we do know that

:21:21.:21:23.

the Conservatives have given a clear commitment that there will be ?800

:21:24.:21:28.

million more invested. Would it be more or less than the percentage

:21:29.:21:32.

currently spent? And we will have ?800 million more to invest over and

:21:33.:21:35.

above what is there at the moment. So if we look at England, you told

:21:36.:21:41.

us to look at Wales in terms of how Labour run the NHS, look at Wales.

:21:42.:21:45.

Should we look at England for a model of how you would run the NHS

:21:46.:21:49.

year? Let's compare England and Wales. If you look at waiting times,

:21:50.:21:54.

Wales lags behind. If you look at patient outcomes for cancer and

:21:55.:21:58.

stroke, Wales lags behind. Absolutely untrue. We need to make

:21:59.:22:03.

sure we level playing field. Look at cancer drugs and you are seven times

:22:04.:22:06.

less likely to get access to cancer drugs if you are Welsh than if you

:22:07.:22:11.

were English. Give us your vision, just your vision. To make it clear,

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we would invest money, extra money, each and every year at least at the

:22:17.:22:21.

rate of inflation into the Welsh NHS. That would mean that over the

:22:22.:22:24.

next assembly, over the next fortnight years, ?800 million more

:22:25.:22:34.

would go into the NHS. So we should not look at England as an example?

:22:35.:22:37.

We have different policies here than in England. Caroline Jones, give us

:22:38.:22:43.

a flavour of what the NHS would look like in the UK. More privatisation?

:22:44.:22:50.

Absolutely not. But that is what Nigel Farage said. He didn't. I

:22:51.:22:55.

would not support any party that believed in privatisation. Nine

:22:56.:22:58.

years ago I suffered from cancer and so I would not support any party.

:22:59.:23:03.

The other parties like to say that we would privatise but we wouldn't.

:23:04.:23:06.

Although we have a pretty good example at the moment of issues that

:23:07.:23:11.

are privatised. We have agency nurses, and the cost of agency

:23:12.:23:18.

nurses is, we could employ over 200,000 full-time nurses. How much

:23:19.:23:28.

would you spend on the NHS? It is about managing the budget. Of course

:23:29.:23:33.

we would spend more. Let's reinvent hospitals to prevent a bed lock in.

:23:34.:23:38.

I think there would be a major incentive to prevent bed blocking.

:23:39.:23:50.

Man-hours lost every month by ambulances locked outside. That is

:23:51.:23:54.

not good use of time. That money would be reinvested. In terms of

:23:55.:23:58.

looking ahead, would it be more of the same from Labour or are you

:23:59.:24:02.

offering something very new in this election? We offer a combination of

:24:03.:24:06.

stability, because we will not have reorganisation, but reform as well.

:24:07.:24:14.

Reform alongside investment. And reform alongside partnership with

:24:15.:24:18.

the staff who work in the NHS. The Tory recipe is privatisation and

:24:19.:24:24.

confrontation. Absolutely rubbish. Our recipe would be partnership with

:24:25.:24:30.

staff. That is why we do not have strikes in the Welsh NHS. Continuing

:24:31.:24:34.

investment and reform alongside it. We have to do something differently

:24:35.:24:38.

in the NHS if we want it to be able to go on doing the things that it

:24:39.:24:41.

does that are so valuable. That is the recipe we offer, a combination

:24:42.:24:45.

of making sure that we keep the ship steady as it goes, because that is

:24:46.:24:48.

really important in difficult times, and also that we do things

:24:49.:24:52.

differently so we are fit for the future. Thank you all very much for

:24:53.:24:54.

now. Let's pause there a moment and take

:24:55.:24:55.

a quick visit to a GP surgery to get a sense of some of the pressures

:24:56.:24:59.

in primary care. Where are the challenges confronted

:25:00.:25:05.

here? We have been to is Beech

:25:06.:25:11.

House Surgery in Denbigh. I'm working increasingly harked here

:25:12.:25:25.

in Beech House to look after my patience. And I feel that this is

:25:26.:25:28.

getting increasingly difficult overtime. I think the difficulty is

:25:29.:25:33.

that if you have 50 patients to see in a day, which can happen here on a

:25:34.:25:38.

busy day, especially in the middle of winter, it is very difficult to

:25:39.:25:43.

be able to give the care that you want to to every patient sat in

:25:44.:25:45.

front of you, because of time pressure. At this practice, it is

:25:46.:25:51.

very good. You get an appointment very quickly, without a problem. My

:25:52.:25:57.

sister lives not far from here. If she needs an appointment and she

:25:58.:26:01.

cannot get an appointment, it might not be for three weeks. So it is

:26:02.:26:06.

variable. Some of the main difficulties are problems with

:26:07.:26:09.

recruitment and retention of GPs. In certain parts of North Wales, we

:26:10.:26:14.

cannot deny that there is a crisis in general practice. The changes

:26:15.:26:19.

that I would like to see in the NHS in Wales over the next five years is

:26:20.:26:23.

to put a greater focus on primary care. We all know that we are seeing

:26:24.:26:31.

90% of patients contracts getting only 80% of the budget -- 8% of the

:26:32.:26:37.

budget. It is important for patients to get primary care in their

:26:38.:26:41.

community, close to their homes, but this has to be properly funded in

:26:42.:26:49.

order to do an excellent job. Dr Fiona Godlee is there. Let's look at

:26:50.:26:56.

GP recruitment specifically. Elin Jones, one of your manifesto pledges

:26:57.:27:02.

was 1000 extra doctors. Where will they come from? 1000 extra doctors

:27:03.:27:06.

over the next ten years because we have too few doctors are head of

:27:07.:27:11.

population compared to most of the European Union. That is why we need

:27:12.:27:17.

to recruit more doctors. Perhaps we need to look at financially

:27:18.:27:24.

incentivising rural areas where it is difficult to recruit doctors. But

:27:25.:27:30.

where are you getting them from? Fundamentally, we have to trained

:27:31.:27:34.

more doctors in Wales. There are too few young people able to access

:27:35.:27:38.

Welsh medical schools at this point. We need to increase places in Welsh

:27:39.:27:41.

medical schools and make sure that more younger people are able to

:27:42.:27:45.

train to be doctors in Wales and that means that they will end up

:27:46.:27:51.

more likely to serve the NHS in Wales rather than leaving Wales to

:27:52.:27:57.

have to go to get medical education and possibly never returning. We

:27:58.:28:01.

fundamentally need to start from day one of the next government

:28:02.:28:05.

increasing the training places for doctors in Wales. And Kirsty

:28:06.:28:08.

Williams, it is particularly an issue in rural areas. How would your

:28:09.:28:13.

party persuaded doctors to go and work in rural Wales? We need to look

:28:14.:28:16.

at incentive schemes but we also need to make several places

:28:17.:28:22.

attractive places to do medicine. I think we can create innovative

:28:23.:28:26.

careers were GPs can mix their time between general practice and

:28:27.:28:28.

hospital medicine, making it an attractive job to do. We also have

:28:29.:28:34.

to recognise that GPs are a precious resource. It is not unusual for

:28:35.:28:38.

people to wait three weeks to get a GP appointment in many rural parts.

:28:39.:28:45.

We have to recognise that they are a precious resource and it takes a

:28:46.:28:48.

long time to get them working. We need to recognise that GPs are

:28:49.:28:51.

working as part of the team and that is why we want to see more nurses in

:28:52.:28:55.

our community and we also want to have direct funding for GPs, to

:28:56.:29:00.

allow them -- allow them to employ more nurses or pharmacists,

:29:01.:29:05.

physiotherapists, councillors. One in four Welsh people suffer from a

:29:06.:29:09.

mental illness and that takes up a lot of time. Often they do not have

:29:10.:29:13.

services to refer people onto. Actually, we want to create a fund

:29:14.:29:17.

that will allow surgeries to expand my meaning that GPs see the people

:29:18.:29:21.

that need to see them. Other health care professionals are able to help

:29:22.:29:23.

solve people's problems. I wouldn't disagree with anything

:29:24.:29:35.

that has been said about incentivising people to come to work

:29:36.:29:39.

in Wales. We, we do have problems, it is not just confined the rural

:29:40.:29:43.

areas, we have problems in urban area, we have seen in Prestatyn and

:29:44.:29:48.

Wrexham and North Wales, as was features in the film, there are real

:29:49.:29:53.

pockets of pressure and frankly the Welsh Government has been burying

:29:54.:29:56.

its head in the sand too long, it has be a number of years that the

:29:57.:30:00.

Royal College has be a number of years that the

:30:01.:30:03.

immediate to train more doctor, there is a crisis merging, that is

:30:04.:30:07.

upon us and frankly, the Welsh Government hasn't done enough to

:30:08.:30:10.

address it. Training takes a long time, where would you get more

:30:11.:30:13.

doctors tomorrow, where would your party get them? We would offer

:30:14.:30:17.

incentives for people to come to Wales, we would say how wonderful

:30:18.:30:22.

Wales is, what it has to offer, and we would hope that people would be

:30:23.:30:28.

encouraged enough... Financial incentives? I don't know about that.

:30:29.:30:34.

I don't think so. Tell them it is a nice place to do other stuff? Yes,

:30:35.:30:39.

we have to promote our country. It is beautiful. Would you attract

:30:40.:30:42.

doctors from abroad? As well as recruitment, we have to look at

:30:43.:30:47.

retention and at the moment... Would you attract doctors from abroad?

:30:48.:30:50.

Well, where would they come from? Because we would be depleting other

:30:51.:30:56.

areas, maybe of these service, that are very much needed in their own

:30:57.:31:00.

country, having trained in their country and you know, those services

:31:01.:31:05.

are required there, are we completing, ethical about taking

:31:06.:31:06.

doctors from other countries? completing, ethical about taking

:31:07.:31:09.

are the type of thing that we have to look at. You have acknowledged

:31:10.:31:14.

that recruitment is a huge issue, why do you think so few want to work

:31:15.:31:20.

in Wales? Let us get the record strange straight, we have more

:31:21.:31:23.

doctors working in Wales than any other time in our history. That is

:31:24.:31:28.

have a a very low base. It is not from a low

:31:29.:31:31.

have a a very low base. It is not more consultants working in

:31:32.:31:34.

hospitals and the number of GPs we have in the workforce in

:31:35.:31:35.

hospitals and the number of GPs we year went up again.

:31:36.:31:38.

hospitals and the number of GPs we level. But you know that the NHS,

:31:39.:31:44.

OK, if you are challenging that, the NHS Wales workforce would say that

:31:45.:31:51.

you need to, 30% more GPs just to catch up with England. That is not

:31:52.:31:59.

the case at all. You asked for a sensible discussion, in Wales we

:32:00.:32:04.

have 6.5 GPs for every 10,000 of the population, in England they have

:32:05.:32:08.

6.6. So it is nonsense to say there is a 30% difference. Difference. It

:32:09.:32:11.

is nothing like it whatsoever. What we have to do, because every year,

:32:12.:32:15.

there are 3% more appointments with GPs in Wales than the year before,

:32:16.:32:19.

over a single assembly term, that means you have nearly a fifth

:32:20.:32:24.

increase in the demand for GP appoints so we have to

:32:25.:32:26.

increase in the demand for GP but Kirstie got the answer right.

:32:27.:32:32.

You asked for consensus, Kirstie got the answer right. What we have to do

:32:33.:32:38.

is diversity -- diversify a primary care team.

:32:39.:32:46.

is diversity -- diversify a primary A physiotherapist and so on, so what

:32:47.:32:48.

we have to do, is to broaden the base of people who are able to offer

:32:49.:32:55.

appointments at primary care, those people are available today, not

:32:56.:32:58.

being trained so they become available in ten years' time. That

:32:59.:33:05.

way... In Prestatyn which I think Darren Millar mentioned, we have a

:33:06.:33:09.

new service opened which does this. Just to be clear, are you saying

:33:10.:33:13.

that patients, are you saying that patients are doing to the wrong

:33:14.:33:17.

place? No, what I am saying is that when patients go to the right place,

:33:18.:33:24.

to primary care, 90% of contacts are in primary care, insped of ex

:33:25.:33:27.

pegging that the GP will be your first port of call there are others

:33:28.:33:33.

who we can just as clinically deploy, those people will be under

:33:34.:33:36.

the oversight of a GP. Why isn't that happen something if you are

:33:37.:33:40.

saying they are ready, it is not, clearly we saw the pressures on A

:33:41.:33:46.

earlier. A year ago we had no clinical pharmacists in Wales, today

:33:47.:33:51.

we have a 50 because we have put money into clusters a. Is more money

:33:52.:33:55.

for primary care, is that the answer? You are talking about

:33:56.:34:01.

cutting 300 million. Making sure that the primary care get their fair

:34:02.:34:05.

share of the totality of the NHS budget is, because the Royal College

:34:06.:34:08.

of GPs have said clearly the amount of money that, the share of money

:34:09.:34:14.

going to the primary sector has been reducing in the past few years. To

:34:15.:34:20.

be clear, on your manifesto would you cut the health budget? No. ?300

:34:21.:34:26.

million savings. We have said that the additional funding for the NHS

:34:27.:34:30.

and social care that comes into Wales from the UK Treasury will be

:34:31.:34:34.

completely ring-fenced for the purposes of the NHS. Where will you

:34:35.:34:39.

make the savings? Of course there are savings. This Health Minister

:34:40.:34:45.

had to make savings in the NHS, and any Health Minster will have to do

:34:46.:34:53.

that. Where does the money come from? Where there is waist in the

:34:54.:34:57.

NHS and we all hear of it all the time, we know it is there. Where

:34:58.:35:06.

will it come from? From within the NHS on inefficient practise, better

:35:07.:35:14.

precurement of... Why have we waited until there is a crisis, whys was

:35:15.:35:19.

there no forward planning? You were in Government for five years. All of

:35:20.:35:23.

it will be ring-fenced and put to front line service, that is the

:35:24.:35:28.

priority that Plaid Cymru has put in its manifesto. Our time is nearly

:35:29.:35:34.

up. Let us close back where we began. Is there an acknowledgement

:35:35.:35:39.

we have to be more grown up when it comes to this debate and this

:35:40.:35:43.

campaign and that being straight with the people is absolutely key

:35:44.:35:46.

throughout this campaign? If you were to do that, how would you be

:35:47.:35:51.

straight with the people, and their responsibility to towards the NHS,

:35:52.:35:56.

Caroline Jones? Their responsibility towards the NHS, I find that the

:35:57.:36:00.

current Government is very sensitive to any form of criticism. What would

:36:01.:36:06.

you do? What would I do? I think we need to go back to basics, to have

:36:07.:36:11.

transparency by asking doctors and nurse what they feel the failures

:36:12.:36:15.

are and them not being afraid to answer the question, because at the

:36:16.:36:18.

moment is survey shows that 60% of those that are raising concerns are

:36:19.:36:23.

bullied and harassed after, so they are in fear of reprisals and can't

:36:24.:36:27.

speak their mind. Darn your message to patients. We have had enough

:36:28.:36:31.

broken promises from previous Governments and they have included

:36:32.:36:34.

junior partners with the Liberal Democrats and Plaid Cymru in the

:36:35.:36:37.

past. What we need is better resourced NHS which is more

:36:38.:36:40.

accountable to the people, where patients are more responsible for

:36:41.:36:44.

their own care and the way they use NHS resources, I think that is

:36:45.:36:47.

something that can be delivered and we can work with other parties to

:36:48.:36:51.

deliver that. We have worked with them on mental Health Services, and

:36:52.:36:54.

I think that shows that we have opportunities to do that in future.

:36:55.:36:59.

Kirsty Williams. We have to get President Obamary care right. If we

:37:00.:37:03.

don't get it right we will continue to see those pressures in our

:37:04.:37:07.

hospital service, so we need better access to GP, we need to ensure that

:37:08.:37:11.

there are more nurses working in Wales, we have had tremendous

:37:12.:37:14.

success, the first part of Europe introducing a law to ensure there is

:37:15.:37:17.

the right number of nurse, we want to have that in our community and we

:37:18.:37:22.

immediate to address the issue of the disparity between how we treat

:37:23.:37:28.

fiscal health and mental health. Plaid Cymru is to take the

:37:29.:37:33.

decisions, that means proper workforce planning for the NHS and

:37:34.:37:38.

social care workforce but full health and social care integration

:37:39.:37:42.

so that we break down the barriers and we put the patients back at the

:37:43.:37:48.

centre of NHS planning. We need a new bargain between the

:37:49.:37:52.

system and the patient, the system has to be more open to people, to

:37:53.:37:56.

hear their views, to take their views seriously to regard people as

:37:57.:38:01.

equal partners in the business of bringing about improvement, and at

:38:02.:38:04.

the same time patients have responsibilities, a huge amount of

:38:05.:38:06.

what the Health Service does today is to deal with harms that need

:38:07.:38:11.

never have happened and that includes type 2 diabetes in many

:38:12.:38:14.

cases, we all have a responsibility to do more, to look after our own

:38:15.:38:18.

health, if we want the NHS to be there for us, when things happen to

:38:19.:38:23.

us, over which we have no control at all.

:38:24.:38:27.

In our next Election Wales 2016 I'll be travelling Wales to ask

:38:28.:38:34.

the Leaders of each of the five main parties their vision for Wales.

:38:35.:38:38.

But in two weeks' time we'll be looking in detail at another big

:38:39.:38:41.

issue in this election - education and what the parties

:38:42.:38:43.

have to offer pupils, parents and students.

:38:44.:38:45.

If you'd like to get in touch ahead of that or you'd like to be

:38:46.:38:48.

in the audience for our special debate with the Welsh Party leaders

:38:49.:38:50.

With a month to go until polling day, Bethan Rhys Roberts is joined by a panel of politicians from the five main parties in Wales to discuss their plans for the health service.


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