26/10/2016 The Wales Report

Tonight on The Wales Report, is there a looming crisis for GP

services in Wales? Will or the evidence from those working on the

front line. The Welsh journey towards Brexit. We will be asking

Plaid Cymru's Leanne Wood about that, and we also talk about trust

in politicians. These days, it is common to hear people say

politicians are all in it for themselves. There is a perception

ins are greedy or corrupt. Are we right to be so suspicious? That is

coming up. Stay with us for The Wales Report. Good evening, and

welcome to The Wales Report. On the night's programme, a subject of

vital importance to all of us, access to our family doctor. There

is growing evidence GP services in Wales are facing something of a

crisis. Figures from a new survey by the BMA in Wales this month show

more than a quarter of GPs who responded are considering leaving

the propeller -- profession. Over 80% are worried about the

sustainability of their practice and more than 60% of respondeds said

they do not have a good work - life balance. Nearly half would not

recommend a career in general practice. Despite a boost for health

spending in the Welsh government project, under the launch of the new

GP campaign, doctors say the concerns of the day's GPs are not

being addressed. In a moment I will discuss all of this with Doctor

Richard Lewis, the man appointed by the Welsh Government you're ago to

help tackle the problems facing primary care. Do not forget you can

join the discussion online. With the hashtag below. First GP Doctor Sue

Fish gives an insight into a surgery in rural Wales. I normally arrive at

the surgery at about half past eight, and I then sit down and

telephone back the people who have called in that morning and the

previous day to see me. Hello, it is Doctor Fish here. Last Tuesday I had

a large number of patients, as you can see, who called up. I had 36

people who phones up that day asking for appointments. -- phoned up. I

will do two hours of face-to-face consultations with patients after

that. The main problem is that we cannot recruit any more GPs. My

partner here was actually on his own for 18 months. Come in... It is

worst in more rural areas than in the cities, but it isn't a career

choice for people coming out of medical school any more. Have you

ever had any trouble with that leg? The lack of GPs means the GPs

currently working are working harder than they were, and working longer

hours than they were. And the pressure and stress of that extra

work is either meaning that they reduce the number of hours they do,

or they are choosing to leave the profession or retire. That is OK.

You are welcome. Some days, I can spend up to an hour signing repeat

prescriptions, as more and more people are on more and more

medication. It takes a lot of time, when our time could be better used

doing something else. This is the box of insurance reports we have got

that probably has several monthss' worth that we just have not had the

time to fill in. We are going off to do my home visits now, so I go to

visit people who are not able to come into the surgery. Hello, Mrs

Richards. How are you today? The patients are getting older, which

means they often have more than one condition, so they are becoming more

complex in the issues they bring to us. I have brought you some new

tablets for the diabetes. So whereas when I first started 25 years ago

someone might just have diabetes and you were dealing with one condition,

in one individual, they will probably have diabetes, heart

disease and may even have some respiratory problems as well. I then

returned to the surgery at four o'clock and I will telephone Triage

again, then do a face-to-face surgery from half past four until

six o'clock. In five years' time the GP practice will look very different

and the public need to be aware that that is going to be the case. I

believe they will get a better service by a new look general

practice that is not reliant just on GPs. Doctor Sue Fish giving a sense

of her working life and I'm joined by a former secretary of the BMA in

Wales, Doctor Richard Lewis, now the primary lead for primary care in

Wales. Thank you for coming in. A few years ago in your BMA 's role,

you use the word impending crisis to talk about GP care. Is that still

the case, are not? I recognised the day Doctor Sue Fish said I am a GP

myself. I will be in practice this week, as I was last week, so I

recognise the challenges in primary care services, not uniquely in Wales

but across the UK, and it is a challenge to recruit people,

particularly GPs into primary care, in Wales, and two and a half years

ago I did warn there was an impending crisis in general

practice, if we didn't take action. The reason I have chosen to take on

this national role is that I recognise the Welsh government, the

health service in Wales, is prepared and committed to take action. It has

outlined a national primary care plan for Wales, which is directed at

a range of initiatives to try to address the very challenges your

film and Doctor Sue Fish's experience and my experience on a

day-to-day basis demonstrates. So you no longer, you are giving the

impression, think there is an impending crisis, because action is

being taken, and we will speak a bit more about that. The extra ?240

million and most recently from the health service in Wales, how much of

that will be spent for example on primary care and GP services?

Currently I think one of the key issues from the film is recruitment

and we are in the process of and have just launched a national and

international recruitment and marketing campaign for doctors to

come to Wales to live and work and train in Wales. As a result of that,

the money is being put directly to support trainees in terms of

incentives. ?20,000 for those trainees who choose to stay and

remain in Wales to work in those difficult to Doctor areas. Uniquely

to Wales, ?2000 for GP registrars to enable them, with their examination

fees, for instance, but beyond that recruiting doctors and health staff

in the Wales, the offering has to be different. The day job has to be

manageable. I am not suggesting for a minute solely measured here is

money, obviously not. There are different ways of doing things. But

in Scotland for example at the moment 11% of the health budget goes

towards primary care. I was given the figure of 7.6% for Wales in 2015

and 2016. If that figure one you recognise, and if that is why is

there such an enormous difference between what for example Scotland

are allocating in this area, and Wales? I think it is important to

remember we are refocusing finances and resources into primary and

community... But is the 7.6% right? 7.6% of the budget in Wales go into

primary care and 11% in Scotland. I think those figures probably are

right. So why the difference? Primary care and community care of

and the health of the population is not just depended on what is

delivered in hell for chronic disease and so on but there are a

huge range of prevention measures and the programme for government

focuses on the determinants of health in terms of the future of the

population. -- what is delivered in health. You also have to create a

healthier population for the future and that depends on housing,

education, employment, the range of other things that we will contribute

to people's ill-health. So the different balance toward health

versus other spending is entirely appropriate when you look at the

whole population and you're looking at the health... The future of that

population come into the future. Doctor Sue Fish said something in

the film that will intrigue many viewers. In five-year five years'

time, it will look totally different, you GP practice. Can you

give us some details on that? The role of the practice nurse, for

instance, people who take blood in practice. When I started in practice

I was often taking blood but that is no longer the case. Using the money

I have alluded to, and that is already developing in Wales. We have

50 clinical pharmacists working in practices in Wales, consulting with

patients who have primarily a medication related problem. Is it a

better service for the patient given lots of patients traditionally want

to see their GP? Increasingly we now have health professionals with an

expertise who can see a range of conditions. For instance, we have

dentists in community care, community pharmacists who have

skills. You would not think of going to go GP for a dental problem. We

have specific skills for the clinical pharmacists I have alluded

to, also optometrists, and we are now seeing a whole range of people

with eye conditions that normally would have gone to their GPs we are

expanding that role. It is also about social care, about harnessing

the community resources and the community resilience. We will speak

again in the future, Doctor. Thank you very much. Thank you. Earlier

this week Carwyn Jones was in Downing Street along with fellow

First Ministers Nicola Sturgeon and Arlene Foster attending in many

late-night meeting chaired by the Prime Minister on the Government

plans for leaving the European Union. They came away with an offer

of a direct line, not to Theresa May, but the David Davis, the Brexit

secretary. An outcome Nicola Sturgeon said left her deeply

disappointed, and this was the reaction of Carwyn Jones. A great

deal of uncertainty on the UK position. We do not know the meat of

the bonds or indeed the general principle for the negotiation. That

said, we welcome the fact there has been a commitment on the part of the

UK Government to move forward with the work problem and also a

commitment of these meetings more frequently, which is absolutely

essential to make sure all nations of the UK have their voices heard.

That was the First Minister in Downing Street after those Cox last

week. So here is the question. How Will Welch national interest be

protected in these negotiations? Here is the Plaid Cymru leader,

Leanne Wood. Had you been in that meeting in Downing Street chaired by

the Prime Minister, what would you be seeing? I think the most

important thing is to articulate clearly what the position in the

Brexit negotiations should be and we have said there should be a four

country approach to the Brexit negotiations, that we should see

very clearly that we want membership of the Single Market, and that when

powers are repatriated, that Wales get additional powers through that

process. Unless you can articulate clearly what the Welsh national

interest is, and I and my team have spent a number of weeks going around

and speaking to the key players in the Welsh economy and getting from

them what the most important key issues are, because... At the front

of it all has to be the economy and the protection of jobs, and that is

what is driving Plaid Cymru's approach to this and I think that is

what should be driving the First Minister's approach as well. Lots of

interesting points there. Let me start with one of them. Membership

of the Single Market, which clearly would involve some kind of

acceptance of freedom of movement. Nobody disputes that. That is the

European Union position, the European Commission position. How do

you square that with the way people voted in Wales at the referendum?

Clearly freedom of movement is something of people do not like.

Yes, freedom of movement was an issue and I am not saying it is the

only issue people voted for, but it was not on the ballot paper. The

question on the ballot paper was about membership of the European

Union and we now have to the kind of Brexit we want. Plaid Cymru

advocates a soft Brexit, which means continuing with the Single Market

because so many of our jobs, 200,000 of them, rely upon our continued

involvement with that single market. Upon membership, not just access,

use a? Everyone has access to the Single Market. America has access.

We want continued membership. We would prefer obviously continued

European Union membership. My party was very strong on the Remain side.

We accept we have lost that augment and people have spoken. The question

now is the kind of Brexit we have, and a soft Brexit with perhaps an

element of free movement of people continued is in the best interest of

Wales. Let me give the example of the health service. 30% of our

doctors are trained overseas and we have a shortage of doctors right

throughout the Welsh health service, particularly GPs in the valleys and

other places. We would be cutting off our nose to spite our face if we

did not allow some means for people with key skills for our economy and

our public services to be allowed in.

I am just wondering on this key issue, no one is seriously

suggesting that the pattern of Brexit will involve membership of

the single market. No one is thinking that that is even our

possibility, so why are you saying that would be part of your

negotiation stance? It is not going to happen. But it is in the best

interest of wheels. But if it is unrealistic, why are you pursuing a?

Some would say that the deep two macro is going to access to the

market because that is possible. I am not seeing a clear path being

indicated by the UK Government or by the Welsh Government. What Plaid

Cymru has done is set out a clear set of criteria as to what we should

do to proceed as soft Brexit option. Carwyn Jones and the others in the

Assembly voted with the Tories and Ukip for a hard Brexit position. Our

argument is that that is better than the against the best interests of

this country in terms of the economy and jobs. Our economy is already

weakened by the system that we are in already. We get 10% less than

other parts of the UK. We can take further steps to weaken our economy.

Read need to put steps in place to be the real success that we know we

can be. Picture have voter at home listening to your statement, you

believe Carwyn Jones is getting it wrong, not strengthening the Welsh

economy, but in the next bet you're supporting his government in terms

of the budget plans. The core issue of any governing administration. How

do people make sense of that? I wonder at this point people want a

constitutional crisis in the Assembly whether government can get

the budget through. We are trying to be responsible opposition. We

secured secured the biggest deal of any opposition party since

devolution that focuses on our key priorities that benefit people

throughout the country. We are taking responsibility very

seriously. We are continuing to oppose the government, particularly

on Brexit, scrutinising the decisions and lack of action and

holding them to account. I think we have the best of both worlds by

taking this oppositional approach which is responsible and careful,

but effective opposition. Going back to my viewer at home, our data see

Plaid Cymru as an official opposition, or a party that wants to

see itself in opposition terms, or a party that is, in effect, in a kind

of unofficial coalition? I say that because if you are in a position of

supporting a party's spending plans, traditionally, maybe this is a

different battle than Westminster, but traditionally he would be seen

to be very closely allied to that party if you are following back

course. You seem to be wanting to have it both ways. I would like to

see our political tradition more in line with the European level rather

than the Westminster level. What we are doing is perhaps a different

approach to what you're used to sing in Westminster are admittedly, but

we are holding the government to account and we can't just leave

their job to the far right and the right, we need to take a responsible

position in doing that. At the same time we are using the opportunities

that we have got in a hung parliament situation to win games

around our programme of opposition, which we are very pleased

with our. It is full of great ideas to turn this country around and we

can't afford to wait another five years before putting that plan into

operation. We are going to use every opportunity we can to win real gains

for people in our community. Leanne, thank you very much. We had the

trust in our politicians Nathan Hart democratic institutions is at a low

ebb, that came out in the referendum campaign. Can we trust those elected

to serve our best interests? Journalist Martin Williams has spent

the last year investigating the financial interests of politicians

to see if there is any conflict with the Parliamentary duties. This is

his personal take. These days it is common to hear

people say that politicians are all in it for themselves. There is a

perception that MPs are greedy or even corrupt, but are we right to be

so suspicious? At the moment the rules allow politicians to take

lucrative second jobs. Instead of serving the communities full times,

many slip quietly to work for banks and even businesses. But don't

worry, they tell us, financial interests will corrupt democracy

because this system is transparent. They say they are open and honest

about their moneymaking affairs and if we have a problem with that we

can just put them out of the next election. Simple. But even when they

do have to declare their financial interests does anyone in Parliament

checked this to make sure they are telling the truth? Not really. There

is an official register of interests which is published online, but it is

not properly audited. Not only that it is published in such an out of

date way that it is impossible for data analysts to scrutinising

properly. So it is hardly surprising that when I investigated all this I

discovered hundreds of jobs that had never been declared, some of them

aren't controversial, but others have the potential to distort

politics and distort democracy. Parliament is not taking it

seriously, this problem. What should be done? Clearly there will always

be some politician to do things we don't like, but Parliament's

pathetic transparency is nothing more than an embarrassment. It

doesn't matter what your politics are, it doesn't matter what your

views are on MPs who have second jobs, the very least we should be

entitled to a system that is transparent and honest so we can

hold people to account and find out what is really going on. At the

moment, Parliament is denying us that right.

That was Martin Williams with some strong opinions. Let's get some more

opinions. He is Jenny Willet, former Lib Dem MP, a member of the

Parliamentary standards authority, and Laura McAllister from Cardiff

University. Laura, the main charge there is that there is pathetic

transparency, is that a charge that sticks? I don't agree. I think

things have improved immeasurably since the MPs expenses scandal. In

fairness to politicians beyond Westminster, things were always

better in Wales. The work of the remuneration board has improved

things considerably. I think there is a level of transparency over

things like declarations of business interests. And around expenses

claims. I don't recognise all of that, though I can see where Martin

is coming from in terms of the improvements that still need to be

made, certainly in Westminster. It doesn't reflect the behaviour of

politicians, certainly not in Wales. Jenny, for you, where have the main

improvements being? The fact that all the pay and the expenses and

business costs associated with Members of Parliament, the fact that

this dealt with separately and the public and trust that it is being

overseen by an independent body, that helps give the bit of

confidence that MPs are not able to twist the system in any way, which

means that you can have faith that it is being handled properly. His

main point was that it was often in the form that you couldn't access

easily, in the form that you needed some expert skills to drill down

into the detail. Is that the case? That is the second jobs, the

register of interests that all MPs have to comply with. In terms of the

expenses and the business costs, that is done in a way that is easy

to access. On the business interests, there are issues with how

easily accessible that is. If you don't register an interest that you

have, that is a serious offence and you will get in a lot of trouble as

a member of Parliament. I can't comment on his particular

allegations, but they are very seriously taken and you would be in

a lot of trouble if you didn't register your interests. I am not an

apologist for badly behaved Leticia because there are some in every

institution, but you also have to be fair to people here. Politicians do

have very difficult job. They need some protection, as well.

Accusations could come from any quarter and some of them are

unfounded. Not all of them, but some are. There needs to be some

protection for politician to aren't misbehaving. Just the main

differences between the Westminster context and the Wales context in

Cardiff Bay. What are they? The obvious one is this size of the two

institutions. We only have 60 AMs in Wales, so the activities are very

visible. In fairness to them I think we were ahead of the game in Wales

in terms of introducing greater transparency around expenses claims

and so on. I think all of this goes down to a kind of perception that

the public as of politicians. My experience of politicians is that

there will always be some rogue politicians in every institution,

but by and large I think most politicians are in it for the right

reasons. They are there to serve the public and to the best they can. We

do have issues over quality of politicians and diversity of types

of politicians, but, that said, most politicians are therefore honourable

reasons, I think. People frequently talk about the fact that people have

less trusts in political institutions these days. During the

referendum, there seemed to be a bigger kick back against the system.

Lots of people thought that was to do with projecting patterns of

political support. It is interesting that you can see patterns of

changing behaviour across the world at the moment. If you look at the

rise of Donald Trump in America, the rise of you, the results in the

referendum you can see a pattern of people wanting to kick back against

what is seen as the political establishment. In some ways that is

quite healthy. Making sure that the establishment can take itself too

seriously and just assumed that people are going to both of them

that is very healthy. Where I have some slight concerns as if it is

based on a feeling that you can't trust people and you can't rely on

the institutions because that is quite damaging. It is really

important that we have a transparency in our political

structures so that people feel that they can trust. They can kick off

against the establishment and vote for the ever they want, but they are

doing it now and they can trust that the system is clean and that people

are not in it for themselves. I think that is really important. What

is your reading of the changing patterns of buildings we have seen

in recent years, and does it reflect a clear disconnect between the

establishment politics as we have known it, and voters who are

disgruntled about lots of things, the economy, the quality-of-life and

all the rest of it. What is your reading of that? I don't think you

can read too much into the individual turnouts that we have had

in referenda and elections. For me it will stun into a very basic issue

of trust. Trust has to be reciprocal. I don't think

politicians trust the public enough to give them the quality of

information that allows them to make decisions. We saw that in the EU

referendum. It was an appalling campaign on both sides in terms of

quality and integrity of information. You can argue whether

the result reflected that or whether it was just an outcome of a whole

series of events that led to this dislocation between the public on

what the leaders were telling them. You can't have trust on one side

without reciprocal trust on the other. I think that would require a

real culture change in the way that politicians go out there and talk to

people. People said to be half to the EU referendum, people who voted

Bremain said they didn't know anybody who voted Leave. I am

shocked by that because most of us plenty of people that were going to

vote Leave and they were not the people resented by the way some

politicians talk to them. Thank you for coming in. That is all we have

time for tonight. If you want to get in touch you can e-mail us, or

follow us on social media. The discussion continues, you can get

the #walesreport. Good night.