25/05/2016 The Wales Report


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


underway after the election, what are the challenges


ahead for the new Cabinet Secretary for Health?


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


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


Good evening and welcome to The Wales Report.


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


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


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


for the new Cabinet Secretary for Health, Vaughan Gething.


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


budget. So what does Mr Gething's


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


a radically altered chamber? With fewer AMs and an opposition


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


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


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


electoral arithmetic. But also because we have seen a significant


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


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


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


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


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


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


seeing a spirit of more communication, consultation and


possibly some brie legislative approaches that are very different


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


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


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


tackle it is the new Cabinet Secretary for health, Vaughan


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


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


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


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


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


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


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


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


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


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


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


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


health services are working together, but unfortunately local


government will go through reorganisation. So that is a big


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


performance. And also we have challenges without the service is


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


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


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


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


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


the best outcome is possible, and understanding the challenges within


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


conversation is always different with health care. Everyone has an


attitude and an individual experience. That does not


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


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


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


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


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


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


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


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


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


the manifesto agreement for shared treatment, that is something that


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


a forward-looking Parliamentary review on the National Health


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


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


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


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


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


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


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


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


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


properly funded, properly staffed situation that meets the needs of


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


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


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


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


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


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


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


were parked by the previous government, when it came to


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


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


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


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


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


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


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


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


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


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


patients want to know. Some resources will be reorganised


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


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


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


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


community health leaders and clinical leadership and support. The


conclusion was that that would benefit outcomes. The service cannot


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


healthier when they are living longer? There are challenges with


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


to work more progressively and persistently with other partners,


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


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


simply look at capacity measures. That is consistent with what


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


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


encouraged that there is huge goodwill within the service, and


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


challenges with optimism about the future. Thank you.


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


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


Tonight , we're looking at the impact of European


Structural funding is Brussels' way of trying to boost


the poorest parts of the EU, so Wales which has


some of the most deprived areas in Western Europe


has been a big recipient; between 2000 and 2020


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


distributed in three tranches of funding.


Felicity Evans has been to Blaenau Ffestiniog,


which received funding between 2000 and 2013, to


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


the town centre more attractive so the tourists already visiting other


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


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


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


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


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


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


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


positive about the future, the problem is the major tourism


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


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


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


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


struggling economies out of the doldrums. The economists Calvin


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


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


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


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


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


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


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


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


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


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


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


lots of signs marking the EU contribution to new buildings and


committee projects. Arguably, these plaques were not intended to


proliferate the way they have. Structural funding is not supposed


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


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


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


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


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


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


significant enough to trigger the metamorphosis the Welsh economy that


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


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


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


is not enough to make the fundamental transformative changes


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


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


Welsh voters. But there are unresolved questions, how important


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


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


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


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


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


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


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


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


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


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


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


against the principle of redistribution. Let's focus on


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


Wales? Definitely, the structural funding body redistribution. You


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


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


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


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


spent. A reporter yesterday suggested that Wales is a


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


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


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


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


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


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


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


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


rest of the UK. When you look at something


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


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


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


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


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


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


Are you suggesting these grants coming from Europe are causing a


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


change the Government. Two economists, this debate will rage


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


criticism and scaremongering, Boris Johnson ranting about the none is


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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




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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