26/10/2016 The Wales Report


26/10/2016

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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Transcript


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

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

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

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

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

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

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

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

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

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

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

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

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more than a quarter of GPs who responded are considering leaving

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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in one individual, they will probably have diabetes, heart

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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ago I did warn there was an impending crisis in general

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

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

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

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

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

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

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

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

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

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

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

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

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

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international recruitment and marketing campaign for doctors to

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

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

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

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

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

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

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

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

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

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

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

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

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there such an enormous difference between what for example Scotland

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

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remember we are refocusing finances and resources into primary and

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

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

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

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

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

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huge range of prevention measures and the programme for government

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

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

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healthier population for the future and that depends on housing,

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

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

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versus other spending is entirely appropriate when you look at the

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

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

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

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

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

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

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

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

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50 clinical pharmacists working in practices in Wales, consulting with

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

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better service for the patient given lots of patients traditionally want

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

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

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dentists in community care, community pharmacists who have

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

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have specific skills for the clinical pharmacists I have alluded

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

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

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

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the community resources and the community resilience. We will speak

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

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this week Carwyn Jones was in Downing Street along with fellow

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First Ministers Nicola Sturgeon and Arlene Foster attending in many

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

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

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

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secretary. An outcome Nicola Sturgeon said left her deeply

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

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

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

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

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

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commitment of these meetings more frequently, which is absolutely

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

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

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

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

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

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

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important thing is to articulate clearly what the position in the

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

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country approach to the Brexit negotiations, that we should see

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

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powers are repatriated, that Wales get additional powers through that

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process. Unless you can articulate clearly what the Welsh national

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

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

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

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

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

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

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

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

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

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European Union position, the European Commission position. How do

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

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

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

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

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question on the ballot paper was about membership of the European

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

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

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

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

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

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We want continued membership. We would prefer obviously continued

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

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

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

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

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

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

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

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

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

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our public services to be allowed in.

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

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suggesting that the pattern of Brexit will involve membership of

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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constitutional crisis in the Assembly whether government can get

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

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secured secured the biggest deal of any opposition party since

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devolution that focuses on our key priorities that benefit people

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throughout the country. We are taking responsibility very

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seriously. We are continuing to oppose the government, particularly

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on Brexit, scrutinising the decisions and lack of action and

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

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taking this oppositional approach which is responsible and careful,

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

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

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

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

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

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different battle than Westminster, but traditionally he would be seen

:18:59.:19:03.

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

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

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

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

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

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

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

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

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

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around our programme of opposition, which we are very pleased

:19:42.:19:56.

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

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

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

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

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

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

:20:13.:20:17.

to serve our best interests? Journalist Martin Williams has spent

:20:18.:20:22.

the last year investigating the financial interests of politicians

:20:23.:20:26.

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

:20:27.:20:27.

his personal take. These days it is common to hear

:20:28.:20:39.

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

:20:40.:20:43.

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

:20:44.:20:48.

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

:20:49.:20:52.

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

:20:53.:20:57.

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

:20:58.:21:02.

worry, they tell us, financial interests will corrupt democracy

:21:03.:21:06.

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

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

:21:10.:21:13.

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

:21:14.:21:17.

do have to declare their financial interests does anyone in Parliament

:21:18.:21:20.

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

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

:21:27.:21:30.

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

:21:31.:21:35.

date way that it is impossible for data analysts to scrutinising

:21:36.:21:40.

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

:21:41.:21:43.

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

:21:44.:21:48.

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

:21:49.:21:53.

politics and distort democracy. Parliament is not taking it

:21:54.:21:58.

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

:21:59.:22:02.

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

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pathetic transparency is nothing more than an embarrassment. It

:22:07.:22:09.

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

:22:10.:22:14.

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

:22:15.:22:18.

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

:22:19.:22:21.

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

:22:22.:22:25.

moment, Parliament is denying us that right.

:22:26.:22:31.

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

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

:22:43.:22:47.

Parliamentary standards authority, and Laura McAllister from Cardiff

:22:48.:22:51.

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

:22:52.:22:56.

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

:22:57.:23:00.

things have improved immeasurably since the MPs expenses scandal. In

:23:01.:23:06.

fairness to politicians beyond Westminster, things were always

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

:23:12.:23:15.

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

:23:16.:23:19.

things like declarations of business interests. And around expenses

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

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

:23:31.:23:33.

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

:23:34.:23:40.

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

:23:41.:23:47.

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

:23:48.:23:51.

business costs associated with Members of Parliament, the fact that

:23:52.:23:56.

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

:23:57.:24:01.

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

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

:24:07.:24:11.

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

:24:12.:24:15.

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

:24:16.:24:19.

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

:24:20.:24:23.

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

:24:24.:24:28.

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

:24:29.:24:32.

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

:24:33.:24:36.

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

:24:37.:24:42.

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

:24:43.:24:45.

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

:24:46.:24:51.

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

:24:52.:24:54.

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

:24:55.:24:58.

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

:24:59.:25:02.

apologist for badly behaved Leticia because there are some in every

:25:03.:25:06.

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

:25:07.:25:12.

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

:25:13.:25:15.

Accusations could come from any quarter and some of them are

:25:16.:25:21.

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

:25:22.:25:25.

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

:25:26.:25:34.

differences between the Westminster context and the Wales context in

:25:35.:25:39.

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

:25:40.:25:46.

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

:25:47.:25:51.

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

:25:52.:25:55.

in terms of introducing greater transparency around expenses claims

:25:56.:26:00.

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

:26:01.:26:05.

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

:26:06.:26:09.

there will always be some rogue politicians in every institution,

:26:10.:26:12.

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

:26:13.:26:16.

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

:26:17.:26:28.

do have issues over quality of politicians and diversity of types

:26:29.:26:30.

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

:26:31.:26:32.

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

:26:33.:26:35.

less trusts in political institutions these days. During the

:26:36.:26:43.

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

:26:44.:26:48.

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

:26:49.:26:54.

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

:26:55.:26:57.

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

:26:58.:27:03.

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

:27:04.:27:07.

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

:27:08.:27:11.

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

:27:12.:27:15.

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

:27:16.:27:21.

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

:27:22.:27:26.

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

:27:27.:27:30.

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

:27:31.:27:33.

the institutions because that is quite damaging. It is really

:27:34.:27:42.

important that we have a transparency in our political

:27:43.:27:44.

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

:27:45.:27:49.

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

:27:50.:27:53.

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

:27:54.:27:57.

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

:27:58.:28:02.

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

:28:03.:28:06.

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

:28:07.:28:15.

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

:28:16.:28:20.

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

:28:21.:28:24.

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

:28:25.:28:28.

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

:28:29.:28:33.

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

:28:34.:28:37.

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

:28:38.:28:40.

politicians trust the public enough to give them the quality of

:28:41.:28:44.

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

:28:45.:28:49.

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

:28:50.:28:54.

quality and integrity of information. You can argue whether

:28:55.:28:57.

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

:28:58.:29:03.

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

:29:04.:29:07.

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

:29:08.:29:11.

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

:29:12.:29:15.

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

:29:16.:29:19.

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

:29:20.:29:25.

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

:29:26.:29:30.

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

:29:31.:29:34.

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

:29:35.:29:39.

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

:29:40.:29:43.

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

:29:44.:29:50.

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

:29:51.:29:55.

the #walesreport. Good night.

:29:56.:29:58.

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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