25/05/2016 The Wales Report

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

night.