26/10/2016 The Wales Report


Huw Edwards takes a look at issues that matter in Wales. Is there a crisis facing GP services in Wales? And Leanne Wood talks about her plans for a post-Brexit Wales.

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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.


Huw Edwards asks the questions that matter to you about your job, your health, your future. Calling to account the decision-makers here in Wales and beyond our borders too, each week the team bring you in-depth reports on pressing issues that matter to the lives of everyone living in Wales.

Is there a crisis facing GP services in Wales? And Plaid Cymru leader Leanne Wood talks about her plans for a post-Brexit Wales.

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