25/05/2016 The Wales Report


25/05/2016

Current affairs series. What are the challenges facing the man in charge of the Welsh health service? And what is the impact of European money in Wales? With Bethan Rhys Roberts.


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Tonight on the Wales Report, as business in the Assembly gets

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underway after the election, what are the challenges

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ahead for the new Cabinet Secretary for Health?

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With just a month to go until the referendum on the UK's

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membership of the EU, we look at the impact of European

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Good evening and welcome to The Wales Report.

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After the high drama of the first few weeks of the Assembly, it is

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down to business. Wales have a First Minister and a government in place.

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There are plenty of challenges ahead for the new government - not least

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for the new Cabinet Secretary for Health, Vaughan Gething.

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He will be in charge of spending nearly half the Welsh government

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budget. So what does Mr Gething's

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in-tray look like? And how will the Government tackle

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a radically altered chamber? With fewer AMs and an opposition

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flexing its muscles, the Welsh Labour government is having to find

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new ways of working. I think everyone recognises that it is

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certainly not a case of business as usual, not just because of the

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electoral arithmetic. But also because we have seen a significant

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intervention by the main opposition party, Plaid Cymru, in terms of the

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challenge they pose to Carwyn Jones' election as First Minister and also

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what has happened behind-the-scenes since then, the agreement struck by

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the Liberal Democrats, Kirsty Williams, to come into the cabinet,

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which is a coalition in all but name. There will have to be greater

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occultation before proposals are brought forward. So I think we are

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seeing a spirit of more communication, consultation and

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possibly some brie legislative approaches that are very different

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to those which have existed in the last Assembly. Some of the faces may

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be different but most of the issues are the same. Securing the future of

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the Welsh NHS is still a huge challenge and a man who has to

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tackle it is the new Cabinet Secretary for health, Vaughan

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Gething. Like his predecessors, he faces plenty of pressing and complex

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problems. We note that the health service and our bailout in the last

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Assembly term, and I suspect that will not be the last time it comes

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back with the begging bowl. There are challenges facing the finances

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of health and that is one issue. The second issue is the pace of change.

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The health service, broccoli, knows how it has to change. We need to get

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more care into the community, more preventative work and so on. That is

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not a mystery. The mystery is how the change happens quick enough. The

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third bit is how health and social care works together. Because we know

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that for a lot of people, particularly older people who use

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the health service a lot, they heavily reliant on social care. It

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is about meeting the complete needs of people. Now local government and

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health services are working together, but unfortunately local

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government will go through reorganisation. So that is a big

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challenge, how do we handle that? Earlier, I caught up with the new

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Cabinet Secretary for health, Vaughan Gething, in the Senate. You

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were the Deputy under Mark Drakeford, how will your approach be

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different now that you are in charge. We have a range of different

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challenges confronting us. Every year we need to treat more people in

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the system and every year, the outcomes improve overall. But the

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challenges are not going away, so the pressure is still there. We need

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to decide how best to make use of the system and we need to decide

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what we are doing with the changing context. We have spoken about an

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ageing population and that is still with us. For many years we have

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spoken about the reduction in public finance and that will happen again

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in these next five years. So the way we use our financial resources and

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staffing. But crucially, how we use the resources of the population

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itself, with people making different choices for their own health care,

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being more engaged in discussions with clinicians. And also, we need

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to persuade people to make different choices with eating, drinking and

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exercise. That was prudent health care with Mark Drakeford, taking

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responsibility for your own health. Are you saying that it is more of

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the same or is it a Vaughan Gething vision when it comes to this? We

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have to continue the journey. It has real purchase a cross the service

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but I do not think it is embedded as consistently as it could or should

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be, and that is not surprising. Equally, the public buying into

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that, I am really interested in making sure there is grit in our

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performance. And also we have challenges without the service is

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managed. We have long held ambitions for primary care, and to do more

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locally. But I am really keen to do that over the next few years. What

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I'm trying to get at, will patients notice a difference now that you are

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in charge? Is there something that he wanted to change but you could

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not before as they get -- as a deputy. I am interested in getting

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the best outcome is possible, and understanding the challenges within

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the system, and how we bring staff and the public with us. The

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conversation is always different with health care. Everyone has an

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attitude and an individual experience. That does not

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necessarily reflect their concerns about the service. I have to have

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honesty about the way that we confront those challenges, and then

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I have to make sure that we do not just described the challenges, that

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we have a way of improving the service. I think that is what

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everyone wants us to do. The one thing we know is different is that

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Plaid Cymru have an input into the running of the NHS in Wales. There

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is a compact. How does that work? Well, it is still being worked

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through. There has been an agreement to allow governments to be formed.

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And there are areas of joint work. We have shared priorities, including

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the manifesto agreement for shared treatment, that is something that

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Plaid Cymru agree with. As a way of making sure that new and emerging

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treatments can be provided in a way that is consistent. Where there is

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evidence that treatment is effective, we want to make sure that

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it is provided immediately across Wales. But you rubbished the Plaid

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Cymru idea during the campaign, didn't you? And that is fine because

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you need the numbers. It is about access to the fund, that is where

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the agreement is. And on that, you said there was no need to change

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things and suddenly, after the election, you need Plaid Cymru

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on-board, so let's change it. You are confusing two things. With the

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new treatment fund, where there is new treatment available, we are

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making sure that is available across the country. Then there is the

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review in the IFPR process, and we have agreed in the past two renewed

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this. We need to see if there is a better way of running the IFPR

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process. But let's be clear, you have a Lib Dem running education,

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Plaid Cymru with some input on health, and you have weekly meetings

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with Plaid Cymru. What is the influence of Plaid Cymru in the

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health service in Wales, or is it limited to that one issue with the

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access to treatment? Within the contract, we set out areas in our

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initial period of engagement. We have five years to run this. Do you

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meet them everyday? How does it work? We will have a series of

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meetings over time and it is about what works. We're looking at having

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a forward-looking Parliamentary review on the National Health

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Service, to look at the future of the service and what it might look

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like in two or decades time. That is about a stocking to Plaid Cymru. It

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is about an ongoing conversation, not just saying that there are only

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two areas where we will talk or discuss. So you will be delivering a

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Labour manifesto with little bits of the Plaid Cymru manifesto? No, we

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have to have an honest conversation. When we have gone through the

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election, we need to talk about what a service really needs in the here

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and now and what we can do with the budgetary pressures that we have got

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and the resources we have got, and how do we make sure that we have a

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properly funded, properly staffed situation that meets the needs of

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our changing population. Let's look at the challenges ahead of you.

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Reorganisation, will it speed up or slow down on you? Any reorganisation

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will have to be about improving the outcomes, improving the service so

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we have better outcomes. We know that these choices are always

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difficult and controversial. And are you going to accelerate it or slow

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it down? I am always going to be guided by the best interests of

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patients. If that means speeding it up, I will do that. The decisions

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were parked by the previous government, when it came to

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sometimes causing a hospital or a ward. I do a man who wants to

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deliver that come what may because you believe it is in the greater

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interest of the patients in Wales? I am interested in doing the right

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thing for the health service and the people. That will mean difficult

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choices. We are spending nearly half of the government's money so it is

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not an easy decision. There are always imperfect choices to make.

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And do you intend to reorganise hospitals in Wales? I will always

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look at what the evidence tells me. I do not feel that a yes or no

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answer is very helpful. But is that not abort doctors and patients want

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to know? But it is not very honest. -- but is that not what doctors and

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patients want to know. Some resources will be reorganised

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because they need to do more in the community. Nobody is saying that is

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a bad thing. The way we describe reorganisation is not always

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controversial. We have reorganised stroke services in some areas, and

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that has not been controversial. There has been a conversation with

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community health leaders and clinical leadership and support. The

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conclusion was that that would benefit outcomes. The service cannot

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look the same in five years' time or ten years' time, so I am prepared to

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make choices to improve the service. Improving the service, your

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counterpart in England, Jeremy Hunt, is in bother with trying to deliver

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what he would say was a seven-day national health service. We have the

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doctors strike but the GPs are not keen. The doctors are not keen

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either. Would you like a seven-day NHS in Wales? We already have a

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seven-day service. People go in and out of health care to receive

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treatment on the weekend as well. The challenge always is to provide a

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better service with the resources we have and the key resources people.

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The challenge in England has been running a seven-day service with the

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same numbers of staff. I am interested in seeing a resolution to

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the junior doctors strike in England. It is not in our interest

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in Wales to see that the dispute continue. I look forward with

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interest to the BMA ballot of the members and then we will have

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choices to make here in Wales about how we want to run our own services,

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and the choice of attracting and retaining staff in Wales as well,

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not just doctors and nurses but a range of health care professionals.

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When you look at the challenges facing you, they are massive. An

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ageing population, as you have mentioned a lot, we are expecting

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more over-65s, the number will double in Wales over the next 20

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years, and how do you tackle that? Is there a panacea? Would return to

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the private sector for example, as a consideration, or are you

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ideological the opposed to that? I'm interested in what the challenges

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mean to us. It is not about just living longer, it is our day

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healthier when they are living longer? There are challenges with

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emergency admissions, the number of over 85 is coming into hospitals

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after emergency treatments. In the private sector, would we see a

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growing influence of the private sector under Vaughan Gething? Or are

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you ruling that out? I do not see the need for a growing influence

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because it is about what works best for the patients. But if that works

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best, would you consider it? I am not persuaded that the private model

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works in the best interest of patients. I am interested, for

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example, in making sure that there are different choices available in

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housing, health and public services to make sure that people do not need

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to go into hospital. That is almost always a better experience and

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normally a better outcome for the individual. Can we ever get on top

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of the problem? Will supply ever meet demand or is your job just like

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rolling a block up a hill with no real answer? Part of the challenge

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is how we meet demand in a different place, instead of simply putting

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more capacity into the system. That will not work in terms of the

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financial or human resources. There has to be remodelling and that is

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why the shift into primary care matters and also why the health has

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to work more progressively and persistently with other partners,

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housing in particular, as well as integrating with social care. We

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need to change the nature of demand and a number of demand, and not

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simply look at capacity measures. That is consistent with what

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happened last time around. It is about making sure that those models

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are delivered at a consistent basis around the country. And I am

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encouraged that there is huge goodwill within the service, and

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real passion from the staff. I think we can approach a difficult

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challenges with optimism about the future. Thank you.

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There's just a month to go to the referendum on the

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Here on the Wales Report we'll spend the next few weeks looking at

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Tonight , we're looking at the impact of European

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Structural funding is Brussels' way of trying to boost

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the poorest parts of the EU, so Wales which has

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some of the most deprived areas in Western Europe

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has been a big recipient; between 2000 and 2020

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we'll have received over ?5 billion, which has been

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distributed in three tranches of funding.

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Felicity Evans has been to Blaenau Ffestiniog,

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which received funding between 2000 and 2013, to

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find out how effective it's been in the area.

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The drug and tens of beautiful but not necessarily restful. -- the

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rugged Snowdonia. In fact, they provide a bracing challenge from

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mountain bikers who want to test their skills against some of the

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best downhill trails in Europe. Riders come to enjoy the bike tracks

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from all over the UK. Without aid money from the EU, these courses

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might never have been built. The EU gives a financial aid to some of its

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poorest areas, called structural funding. Qualify the GDP of the

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area, the economic value everything it produces, must be three quarters

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or less of the EU average. Wales has qualified for this structural

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funding three times. Between 2000 and 2020 it will have received more

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than ?5 billion worth. When mountain bikers come here to enjoy the

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thrills of the annual courses, they might not notice the signs that note

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the EU financial contribution, but it's not lost on those who helped

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develop the project, like Simon Williams. Without the money which we

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got with would never have got off the ground, I believe that it was a

:16:42.:16:45.

considerable amount of money, ?1.2 million, and from that we have these

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five trails, a visitors centre, car parking etc, it's been a great

:16:52.:16:55.

success. Testament to this would be that we've had the British downhill

:16:56.:17:02.

championships here on two occasions. Two years back-to-back, we have our

:17:03.:17:06.

own event annually calls downhill fast that draws people from all over

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the UK. Simon believes the success also gives a boost the local

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economy. We employ full-time and part-time staff, 17 members of

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staff, and the accommodation providers down in the town as well

:17:21.:17:23.

obviously benefit from the numbers that come here. On any given weekend

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we have hundreds of people from all over the UK. Attracting tourists to

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enjoy the mountain biking is not the same as getting them into it to

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visit the restaurants and shops. Here Arnie has been spent on making

:17:42.:17:45.

the town centre more attractive so the tourists already visiting other

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nearby attractions like the Mountain bike trails will be tempted to come

:17:49.:17:55.

into town and spend. The town centre still isn't a thriving economy.

:17:56.:17:59.

Shawn Roberts has been running his family's shop for decades and

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successfully applied for some of the EU funding for repairs had a

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face-lift for the shop front. He is in courage by the money that has

:18:08.:18:11.

been spent on the area but says getting people who visit places like

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this into town to splash the cash is still a challenge. People are more

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positive about the future, the problem is the major tourism

:18:22.:18:25.

sections are outside the town, so trying to get them into town and

:18:26.:18:32.

stay in town is that there is global. Even with the EU funded

:18:33.:18:36.

project has been a magnet for tourism, spreading the wealth to the

:18:37.:18:40.

town remains problematic. The aim of this EU aid money is to haul

:18:41.:18:44.

struggling economies out of the doldrums. The economists Calvin

:18:45.:18:50.

Jones is sceptical about how effective it can be. It's probably

:18:51.:18:56.

true is made a difference in the Pacific places and would have been

:18:57.:19:01.

worse without structural funds? In the short-term, yes. The answer in

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the long-term is to change the structure of the economy. In the

:19:06.:19:12.

short-term, I think we need to change our reels -- emotional

:19:13.:19:15.

listenership, need to start thinking about how we can encourage activity

:19:16.:19:23.

in rails that will affect the subsidy, much like the things that

:19:24.:19:27.

have been attempted in the past. These are imposed from the top down

:19:28.:19:32.

and the Welsh economy will transform when you come from the ground up.

:19:33.:19:37.

Vast areas of Wales qualify for structural funding. If you keep your

:19:38.:19:41.

eyes peeled in West Wales and the valleys you will probably notice

:19:42.:19:45.

lots of signs marking the EU contribution to new buildings and

:19:46.:19:48.

committee projects. Arguably, these plaques were not intended to

:19:49.:19:53.

proliferate the way they have. Structural funding is not supposed

:19:54.:19:58.

to be running tap. After all, everyone's ideal would be for Wales

:19:59.:20:02.

to be prosperous enough not to qualify for any of these aid money.

:20:03.:20:06.

When we first qualify for this level of funding back in 2000 the First

:20:07.:20:11.

Minister Rhodri Morgan called it a once-in-a-lifetime opportunity.

:20:12.:20:14.

Clearly he wasn't expecting Wales qualify for a second set of funding

:20:15.:20:19.

and certainly not a third. Calvin Jones argues the age could never be

:20:20.:20:24.

significant enough to trigger the metamorphosis the Welsh economy that

:20:25.:20:27.

some hope for. Problems in Wales are so intractable, so long for

:20:28.:20:32.

generations, that this level of talking, a few hundred million

:20:33.:20:37.

pounds a year is not much in the context of a 50 billion economy, it

:20:38.:20:42.

is not enough to make the fundamental transformative changes

:20:43.:20:45.

that will push wolves are part of a more prosperous future. Close rotors

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will think about the economy when they vote on the 23rd of June. --

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Welsh voters. But there are unresolved questions, how important

:20:56.:20:57.

are the funds to the future of the Welsh economy? If Britain votes out

:20:58.:21:03.

with extra support be divided by the UK Government? If Britain votes in,

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will will still receive the same levels of funding if new, poorer

:21:10.:21:11.

countries join the EU? I'm joined now by Dr Mark Lang -

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a regeneration expert and economics Thank you for coming in. Doctor

:21:14.:21:26.

line, you are at remainder, but the fact with us qualify to three times

:21:27.:21:32.

shows they are not working? No, it is symptomatic of the nature of Isle

:21:33.:21:37.

economy, thing we've been pursuing a questionable economic policy in

:21:38.:21:42.

Wales. And we have done so, it's not necessarily because of devolution,

:21:43.:21:46.

we've done so for 35 years and it's the same economic policy we have

:21:47.:21:50.

pursued across the UK in that time and it is neoliberalism. That fight

:21:51.:21:54.

against the principle of redistribution. Let's focus on

:21:55.:21:57.

Brussels on the money coming from there, is that a good thing for

:21:58.:22:01.

Wales? Definitely, the structural funding body redistribution. You

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could argue about if we spend them on the right things, I think clearly

:22:05.:22:09.

in the case of the film, there are some very good examples of how we

:22:10.:22:12.

spend the money, but some of those for things that we spent are not

:22:13.:22:18.

necessary. So the money coming in is good but you would argue the way it

:22:19.:22:26.

spent. A reporter yesterday suggested that Wales is a

:22:27.:22:31.

beneficiary to the tune of about ?79 per head. ?151 per head across the

:22:32.:22:40.

UK is the amount, we lose. It is a different story in Wales, do

:22:41.:22:43.

acknowledge that as someone who wants to withdraw from the EU? The

:22:44.:22:48.

difficulty is trying to figure out what the counterfactual is? If we

:22:49.:22:53.

were not in the EU at all, what kind of support would Westminster and

:22:54.:22:58.

Cardiff Bay gift to Wales in terms of the funds they get? What we don't

:22:59.:23:03.

know is what we would have got then? Circulate Wales is a net

:23:04.:23:06.

beneficiary, but that beneficiary comes in terms of the cost for the

:23:07.:23:11.

rest of the UK. When you look at something

:23:12.:23:22.

like Blaenau Ffestiniog with that have happened anyway, we don't know,

:23:23.:23:27.

was based on regional development grants and each of those would be

:23:28.:23:31.

them trying to get the funds from the Westminster Government and that

:23:32.:23:35.

would be based on a cost benefit, we heard about neoliberalism. I think

:23:36.:23:40.

there is a lack of liberalism in here that is insufficient use of

:23:41.:23:46.

market forces, much more use of top-down, as the Calvin Jones say.

:23:47.:23:51.

Are you suggesting these grants coming from Europe are causing a

:23:52.:23:56.

culture of dependency? That is what I'm saying. Any kind of Grant leads

:23:57.:24:01.

to a sense of dependency and the fact we are getting it three times

:24:02.:24:06.

in a row is only representing that. Is that a fair point? No, ultimately

:24:07.:24:12.

if you look at where UK in the structural funds have been spent,

:24:13.:24:15.

they are predominantly over the last 35 years in London and the

:24:16.:24:19.

south-east, building things like this seven tunnel, high-speed one,

:24:20.:24:23.

Crosswell, etc. That is enormous amount of money being concentrated

:24:24.:24:26.

in London and the south-east that is not fair and not democratic. I would

:24:27.:24:30.

also say it is clear in this neoliberal mantra that actually what

:24:31.:24:34.

we really want to speak about is drawing regional aid completely,

:24:35.:24:41.

whether it is European or any other because it interrupts the market.

:24:42.:24:45.

Could it be stifling the private sector? If you know you're getting

:24:46.:24:49.

the grant, does it stifle enterprise? Were not playing a level

:24:50.:24:54.

playing field. What you effectively have its public service subsidy of

:24:55.:24:57.

large businesses in London and the south-east. One would argue that in

:24:58.:25:00.

fact if there is a public sector fund that has got to be done on a

:25:01.:25:07.

cost benefit basis, where there aren't political constraints, we are

:25:08.:25:11.

in a UK, we are one country and democracy and it has to be some

:25:12.:25:15.

disbursement of funds, but there has to be a balance in terms of what the

:25:16.:25:18.

returns are. You don't want to throw money places that won't have any

:25:19.:25:24.

return just to sustain them. Let's say that the vote goes your way in

:25:25.:25:29.

Brexit, the money stops for Wales and the Welsh tournament says that

:25:30.:25:35.

37,000 jobs have been created in Wales since 2007 and 12,000

:25:36.:25:39.

enterprises have benefited from that money, can you guarantee the UK

:25:40.:25:43.

Government would step in and fill that gap? Hold on, I don't think any

:25:44.:25:47.

Government will stop the money as soon as we leave the U. The way the

:25:48.:25:53.

monies disbursed is the way that order exists. It would go in 2020.

:25:54.:25:58.

No one can guarantee where it will be in 2020 but we know that in the

:25:59.:26:03.

short-term funding will continue for our agriculture for the regions in

:26:04.:26:07.

the way that it has been disbursed. There is a formula that works. We

:26:08.:26:11.

cannot be outside of the EU and still take the money, that what you

:26:12.:26:15.

want? No, you leave Europe you can keep the money, there is a

:26:16.:26:19.

well-known precept in economics were if the losers are compensated by the

:26:20.:26:27.

gainers, that will be a net benefit. That is possible. What I'm saying is

:26:28.:26:32.

it might be that Wales will get more under a new regime, what we don't

:26:33.:26:37.

know is how it will be spent. Doctor line, the argument is this is Welsh

:26:38.:26:42.

money anyway and UK money, just going via Brussels for what about

:26:43.:26:47.

that argument? To be honest, I care more fundamentally about the

:26:48.:26:51.

principle of redistribution. Kent has spoken about... Does it need go

:26:52.:26:56.

via Brussels? Just now, going via London is not helping. We have this

:26:57.:27:00.

notion that the principle that we should be putting money into areas

:27:01.:27:05.

of opportunity not need, why? We have huge poverty? What motivates me

:27:06.:27:09.

is to best tackle that poverty from what I'm asking is the current

:27:10.:27:12.

formula where money goes from the UK to Brussels and is redistributed,

:27:13.:27:18.

much of it to Wales, is that a good system? Well, yes. Because clearly

:27:19.:27:22.

we benefit from it. And if Brussels were taken out of the equation you

:27:23.:27:26.

don't trust Westminster of whatever colour to step in? No, we've seen

:27:27.:27:32.

it. We live in a democracy it in a democracy if you don't like the

:27:33.:27:35.

Government you have as you don't like the benefits you get from it,

:27:36.:27:39.

change the Government. Two economists, this debate will rage

:27:40.:27:44.

for a month, what do you make of the tour of the debate? Lots of

:27:45.:27:47.

criticism and scaremongering, Boris Johnson ranting about the none is

:27:48.:27:53.

and the remainder is predicting all sorts of doom and gloom. What you

:27:54.:27:57.

make of it on? Are people getting the facts they need? I think the

:27:58.:28:01.

facts are there but they are hidden because of the motion of the debate.

:28:02.:28:05.

The temperature is rising a lot and people need to be dispassionate and

:28:06.:28:09.

step back. There is a very good economic argument for leaving the U

:28:10.:28:13.

but it's one of a long-term and a lot of the stuff we hear from the

:28:14.:28:21.

remain camped -- Remain camp is short-term. How is it going? There

:28:22.:28:24.

is far too much raw emotion just now. It is easy to lower the level

:28:25.:28:29.

of debate ultimately, economically it is good for us to sit Remain. We

:28:30.:28:35.

have a report today that says that the ISS is now saying it will be bad

:28:36.:28:39.

for Britain, the OECD previously etc, the economic orthodoxy actually

:28:40.:28:45.

says this would be bad. Both agreed the head has to really hard on this

:28:46.:28:49.

one? Indeed. Indeed. Thank you both for joining us.

:28:50.:28:54.

We will hold a special debatably before the vote and if you want to

:28:55.:28:59.

be new orders or have a question you can e-mail us or follow us on social

:29:00.:29:07.

media. We will be back next week, thank you for joining us. Good

:29:08.:29:08.

night.

:29:09.:29:11.

As business in the Assembly gets under way after the election, what are the challenges facing the man in charge of the Welsh health service?

Includes a look at the impact of European money in Wales.

With Bethan Rhys Roberts.


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