08/02/2017 The Wales Report


08/02/2017

Huw Edwards presents a special report on the huge challenge facing social care in Wales and discusses Labour's divisions over Brexit with former leadership challenger Owen Smith.


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Transcript


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We talk about the state of social care in Wales -

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faced with rising demand and increasing costs.

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The Brexit journey for Wales, and its effect on Labour.

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We'll be talking to the former leadership contender Owen Smith.

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And, the rising rate of suicide among men.

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We'll be talking about tackling isolation and stigma.

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Good evening, and welcome to The Wales Report.

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First tonight, the cost of social care in Wales is set to double,

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more or less, over the next 15 years as the population grows older.

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The question is, how will that growing demand be met?

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Remember, you can join in the discussion tonight ?

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As we approach local government elections in May,

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one of the questions is how care services provided at home,

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as well as in residential care homes, are funded.

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The Welsh Local Government Association says this is the biggest

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problem faced not just by them but by all decision-makers

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In a moment, Bethan Rhys Roberts will be asking the Minister

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for Social Services, Rebecca Evans AM, how she intends

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to deal with the increasing pressure on the system.

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Deciding you need support from social services isn't easy for

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anyone. Margaret Morgan and her husband, Malcolm, always thought

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they'd be able to stay in their own home, but Malcolm has dementia and

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he now needs round-the-clock care in a residential home. It hasn't turned

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out as it was planned. We'd spoken about this quite often and we bought

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we might be able to live at home and stay at home, but the condition that

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Malcolm has now, I couldn't look after him at home. I did for as long

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as I could, and it would have been impossible. Nursing in care homes

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like this are a vital part of the social care system. They provide

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around 23,000 beds across Wales, doubled the amount available in the

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Welsh NHS, so it's clear that homes like this do help to ease the

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pressure on hospitals. There are concerns that, despite fewer cuts to

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social care here than in England over the last few years, the care

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market in Wales is fragile, and that makes the system unsustainable. For

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Margaret, Malcolm and many others, it's an uncomfortable truth. I worry

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what I'm going to do and what is going to happen. I don't know what's

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going to happen. If they haven't got any money now and there are going to

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be many more older people, it's not a problem that's going to diminish.

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It's to get worse. It's a great problem. The county of Conwy offers

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a glimpse of the future. Across Wales, one in five people are over

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65 but, dear, it's oh -- it's one in four. The proportion in the rest of

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Wales is opposed to reach that by 2032. Cared -- care providers say

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that while demand is growing the number of community beds available

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is shrinking, which in turn is putting more pressure on the health

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service. Recently we have had seven care homes closing in the county

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with the loss of 133 beds, 8.4% of local provision, and that's been on

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top of the homes that have closed in recent years. We've lost around 20%

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of our provision. We can't meet the current demand, so we are seeing

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problems in the local hospitals, where there is delayed transfer of

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care. The deputy manager of the home says the care needs of residents are

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becoming more and more complex. The needs of clients coming in are

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increasing. We seem to be getting a lot more residents with quite

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chronic conditions, sometimes quite acute illnesses that we are looking

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after their in the homes, rather than, I would imagine in the past,

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they would have been hospitalised. They are becoming more dependent. In

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contrast to England, most Welsh care homes are run by small, independent

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providers meaning that, when costs go up, they are more vulnerable. The

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pressure is so great now that are having to provide more hours of care

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than they are being paid for. We are currently funded to provide 23 care

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hours per resident per week, but we are actually delivering 25, so the

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two hours per resident per week shortfall we are having to make

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ourselves from our own funding. These are the most vulnerable people

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in society we are looking -- we are looking after and we have to make

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sure we deliver care that they need, and those needs are increasing. They

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have increased significantly. Funding hasn't kept up. Local

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government in Wales has called for the funding crisis in social care,

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including residential care and care at home, to be addressed urgently,

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but it's the long-term pressures that cause real concern. The health

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foundation recently published a report which shows the current cost

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of social care in Wales is 2.3 billion. By 2030, it nearly doubles.

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The question is, if local authority budgets have gone back in recent

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years to levels that we had in 2004, 2005, no growth in those benefits,

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how are we going to meet at anticipated growth in social care?

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It is clear that social care and health care depend on each other, so

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local health boards, local authorities and care providers need

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to work more closely together to deliver a joined up service. I think

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that's starting to occur in many places. We are starting to see the

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integrated care fund, ?50 million, where local authorities work closely

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with authorities, great schemes like extra care schemes, a range of

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strategies around learning disabilities, but we need to up our

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game and make sure that those are not isolated examples of good

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practice, but that good practice travels across Wales. Others believe

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that poor planning and a lack of political leadership are to blame

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for the situation. I think we are seeing, in a relatively mild winter,

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huge pressures and not just in Wales but across the UK, and this is no

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surprise. This should be no surprise to anybody. The fact that we still

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don't have an integrated independent care sector of ring step-down

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respite beds, that is able to care for people with dementia in crisis

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situations, there is not any cohesive structure to do that, and

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we should have that by now. The reality is that we are 1 million

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miles away from where we need to be, where we could have been, and we

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need a wake-up call. Is that, as Wales's population continues to grow

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older, demand on both health and social services services will

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continue to rise. So the difficult question politicians need to address

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now is, just how will that demand be met?

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Bethan Rhys Roberts talking to Social Services

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and Public Health Minister Rebecca Evans.

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How do you see it? Are we facing a crisis in social care? The Welsh

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government is under no illusions that there are real pressures in the

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social care sector, which is why we have prioritised it as a sector of

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strategic importance, and whilst in England they are cutting the funding

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for social care, in Wales we are investing in it. An extra ?25

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million in the budget for social care this year and an extra ?10

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million to recognise the extra pressures the national living wage

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will put on the sector. We take these discussions having discussed

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them with care in Wales. But there is still a shortfall of 92 million.

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This year, that is despite you putting extra money in. You heard

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from Margaret Morgan, who is worried about the future. The demand is only

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going to increase. What is the long-term answer? The social

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services and well-being act, which came into force last April, was

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predicated on the understanding that demand for social care will grow and

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public finances will become tighter, so we are taking a preventative

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approach, seeking to support people more at home and in the community.

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Many people don't realise that the number of people having residential

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care at the moment is declining because of the success of being able

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to support people at home. But you heard there that we are 1 million

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miles away from where we should be when it comes to respite care,

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step-down beds and the sort of help for carers as well. Surely you must

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be concerned and you could do more. We are not where we want to be yet,

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but we are investing in integration of social care throughout our

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immediate care fund that fund is worth ?60 million this year and we

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pledge to keep that going throughout this Assembly, because we know how

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important a whole system approaches. Health and social care working

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together to meet the needs of people. So is the example to

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integrate it completely? There are two ministers in charge, one of the

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NHS and you for social care. Should it be fully integrated? The health

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minister and I work very closely on integration, which we are keen to

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drive forward. The intermediate care fund is already showing good results

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in terms of demonstrating numbers saved to the NHS, preventing

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unnecessary hospital admissions. What about the idea that is

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happening in England of raising council tax, giving councils the

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right to raise council tax? Is that a possibility long-term? We are not

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taking that approach in Wales because the Welsh government is

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directly investing in social care by providing extra money to local

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councils. Raising council tax isn't necessarily fair. Some parts of

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Wales have a much larger proportion of older people than others and

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obviously, if we were to put the burden on local authorities to raise

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council tax to pay for that, it would disproportionately affect some

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areas of Wales. No rise in council tax, you are putting the money in

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but there is already a shortfall. Are you just going to live year by

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year with a shortfall and just crisis management? We would like to

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take a longer, more sustainable look at social care but we need the UK

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Government to help us. They had an enquiry which produced a report and

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recommendations on the future of social care funding but

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unfortunately they have said there will be no change until at least

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2020 in response to that, so that means we can't plan on

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consequentials and we don't know what long-term funding will be.

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These are issues beyond our control but, within our control, we are

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doing everything can to make social care good quality and fair across

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Wales. Do you stay at wake -- do you stay awake at night worried about

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social care and the future and the growing challenge? I am under no

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illusion how fragile the sector is in Wales and the fact that the Welsh

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government needs to support it, but we are working hand in hand with the

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Welsh Local Government Association and the third sector to give us a

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sustainable approach for the future. Everything we can do in order to try

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and make the system sustainable and good quality, we are doing.

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Bethan Rhys Roberts talking to Social Services

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and Public Health Minister Rebecca Evans.

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Britain's journey towards Brexit has progressed a little further this

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week, with the Bill which triggers the Brexit process moving

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to the House of Lords from the House of Commons.

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Despite Jeremy Corbyn's instruction that Labour MPs should approve

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the Article 50 process, not all of his Labour

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47 Labour MPs rejected party orders last week,

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and they opposed the Government's Bill.

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One Labour MP who voted against the Bill, and who stood

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against Mr Corbyn for the party's leadership last year, is the Member

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I asked him if he was simply out of touch with public opinion. My view

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is that I was not elected to parliament for my hometown, my

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community in order to vote for things that will make my community

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poorer, and I am absolutely convinced that Brexit, if it goes

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ahead on the rock-hard terms the Tories are now proposing, for

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ideological reasons within their own party, in Pontypridd and working

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class communities like mine across Britain, we will get poorer. We said

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before the referendum that Brexit on these terms will make Britain... I

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didn't come into politics to do that to the people I grew up with and

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represent. Have you discussed your position with Jeremy Corbyn and that

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you are persisting with your line? I haven't spoken to Jeremy Corbyn

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since September 30 four. Do you feel a sense of obligation to the leader

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in the sense that he is trying to maintain a party line? Jeremy Corbyn

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was always a Eurosceptic and didn't fight for us to stay in the EU, and

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he is now in my view weaving through a Brexit on the worst possible terms

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for the people we in the Labour Party are meant to fight for and

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speak for. I am not prepared to do that, so I'm going to continue

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making my case and continue to speak up for what I believe to be the best

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interests of the constituents I represent and the country. The first

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duty of an MP is to speak without fear or favour in the national

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interest, and then in the interest of his or her constituents, and I

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feel absolutely confident and comfortable that I am doing that,

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and I am also confident that as a democrat those people I represent

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will have an opportunity at the next election to make their judgment as

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to whether that will be in their interests or not.

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What do you say to somebody who comes up to you on the streets of

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Pontypridd and say, we voted to leave, you are not represented as

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probably? I have had thousands and thousands of e-mails and letters,

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many from my constituency. They have been overwhelmingly in favour of the

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position I have taken. I went to the rugby on Saturday to watch

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Pontypridd versus Carmarthen, and not a single person came up to me to

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tell me they thought I was making the wrong decision, but a lot of

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people came to me saying that I proved what I was doing, the stand I

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was taking, and even if they didn't agree, they want a politician who

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has the courage of his convictions. When colleagues talk about party

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discipline and the fact that it appears disunited, what do you say

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to them? Do you say that has to take second-place? The party clearly is

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disunited. Some MPs from the whips' offers are doing the telling and

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voted against the bill just a few days ago, the party is completely

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divided on this issue. In that respect, it does reflect the

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country. The country remains divided. But I'm very clear that

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Brexit on these terms for sure is going to be bad for people in this

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country, bad for my constituents, and I'm going to keep saying that.

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Carwyn Jones was very clear, saying that freedom of movement is

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politically and issue that has to be dealt with, and that people do have

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legitimate concerns about levels of immigration. Is that a line that you

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feel comfortable with yourself? Well, I agree with Carwyn that

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freedom of movement is something that needs to be addressed across

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the whole of Europe. I said that during the summer, during the

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election campaign, and took some criticism for it. But I'm confident

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that other countries in Europe, France and Germany, also want to

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address it. It is a common problem across Europe. What I'm equally

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certain of is that if we were to simply pull up the drawbridge in

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respect of immigration in this country we would actually be doing

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ourselves damage in terms of our economic future. And crucially,

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immigration isn't going to stop once we exit Brexit, once we exit the EU,

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you know, the reality is that people who are discomfited by immigration,

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I think it is a mixture of immigration from within the EU and

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without, there will be no change to immigration from outside the EU. And

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in reality I suspect that people will be ultimately disappointed,

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disappointed that they were lied to about the extra money that was meant

:17:25.:17:29.

to come into the NHS, for example the famous ?350 million per week

:17:30.:17:36.

that we're never going to see. And disappointed too there will not be

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visible, substantive change in terms of immigration. When the First

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Minister and others within Welsh Labour talk about full and

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unfettered access to the Single Market, that has been described as

:17:45.:17:48.

completely unrealistic by others, do you think that is a prospect that

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they should be holding up? I wonder if you think that is deliverable in

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these circumstances? I absolutely think we should still be aiming to

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be a member of the Single Market. My view is that, my view is very clear

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that we will still be better off if we'll within the EU, and we need to

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hold open that possibility. In case the Government fail to get a thing

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like a good deal for us on Brexit, rather than falling out of the EU on

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to a terrible trade organisation terms, we need to retain the

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possibility of staying in, at least throughout the transitional period.

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But the crucial thing is of course we now know that the Government or

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intending to not enter into any further realistic, substantive

:18:33.:18:35.

engagement with the Single Market. Theresa May says we are leaving the

:18:36.:18:40.

Single Market, she says we are also probably leaving the customs union.

:18:41.:18:44.

That is a definition of a rock hard Brexit, the worst kind of Brexit but

:18:45.:18:47.

only the real Eurosceptic head-bangers on the Tory side of the

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aisle have ever wanted. That's why they are so happy. There is clearly

:18:53.:18:56.

a difference of emphasis between what you are saying and the tactics

:18:57.:18:59.

taken by your colleagues in Cardiff Bay. You asked all basically

:19:00.:19:04.

fighting the campaign to try to the, that is the opposition. Carwyn

:19:05.:19:08.

Jones's view is that there is no question of staying in, it is how we

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come out, it is not whether we come out, it is how we come up. That

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difference is therefore alter sees a POI suppose it is. The reality is

:19:17.:19:24.

that the decision will be taken in Westminster, Britain is a member of

:19:25.:19:26.

the EU, not Wales. Of course, colleagues in Cardiff Bay will

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rightly make their opinions known. I'm disappointed that the Supreme

:19:30.:19:33.

Court didn't rule that there should be more formal consultation with the

:19:34.:19:36.

national assembly, because there ought to be. There will be changes

:19:37.:19:41.

that will have dramatic impacts for Wales. Carwyn Jones ought to have a

:19:42.:19:45.

seat at the table in shaping whatever the future of the country

:19:46.:19:49.

looks like. My contention is that we still don't know where this is going

:19:50.:19:53.

to end. There are many, many unknowns in this long process. This

:19:54.:19:57.

may take two years, like the Tories are telling us, but I suspect it

:19:58.:20:02.

will take a lot longer. During that period, our economy will change, the

:20:03.:20:06.

global security situation may change, the volatile world we live

:20:07.:20:10.

with, Putin at one end and Trump at the other, may change public

:20:11.:20:14.

opinion. It is perfectly conceivable that all of these things may flux

:20:15.:20:18.

and shift over the next few years, and we need to retain the

:20:19.:20:21.

possibility of having continued access to the Single Market, and

:20:22.:20:25.

having continued membership of the European Union. Mr Smith, good of

:20:26.:20:27.

you to come in, thank you very much. The latest facts on male suicide

:20:28.:20:29.

in Wales, according to experts, In Wales, men are nearly

:20:30.:20:32.

four times as likely Male suicide is a particular problem

:20:33.:20:35.

in rural communities, with the latest figures showing that

:20:36.:20:39.

six farmers took their Emma Picton-Jones runs a charity

:20:40.:20:42.

to raise awareness of mental health She set the charity up

:20:43.:20:45.

after her husband Daniel, a farm worker, took his own life

:20:46.:20:51.

in June last year. Daniel and I met just over five

:20:52.:21:13.

years ago. And, you know, we were kind of your average young couple in

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our 20s. I knew that Daniel had problems with mental health, that

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was quite apparent from the beginning. He wasn't ever hiding it

:21:21.:21:24.

from me. He was very good at hiding it from other people. Daniel worked

:21:25.:21:29.

on farms. And I think that specific kind of sector is quite an isolated

:21:30.:21:34.

sector. You can be doing 12, 13, 14 hour days on a tractor by yourself

:21:35.:21:40.

at times. I think he found that hard. You are around people who are

:21:41.:21:43.

very masculine. There is a real, like, sense of what you should

:21:44.:21:45.

behave like and how you should be. That night, he said, I think I'm

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going to go and talk to my Nan. That was really the last time that I saw

:21:59.:22:02.

him. He told us he loved us and gave us a kiss and he went. Looking back

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now, he was outside. To have ten or 15 minutes before he left. And in

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hindsight, I mean, I couldn't be too sure but I think he was probably

:22:16.:22:20.

putting things in the car. In order to... I think you probably knew what

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he was going to do. -- I think he probably knew. The thought never

:22:27.:22:31.

crossed my mind. I thought that the children and myself... I had a phone

:22:32.:22:36.

call at two o'clock. He rang and he said, you know, I love you, he said

:22:37.:22:40.

he was going to go and speak to his mum. I was half asleep and I

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remember thinking, gosh, it's 2am, why are you going to speak to your

:22:45.:22:48.

mum? Just come home, you know. He said, no, I'm going to go and speak

:22:49.:22:52.

to mum. I love you. That was it, kind of thing. Yeah, so that... He

:22:53.:22:57.

didn't go down to his mum's. Gijon himself. -- Gijon himself. He

:22:58.:23:11.

hung himself on the tree outside his family home. And we actually lived

:23:12.:23:18.

on a caravan there for two years. And the tree was right outside the

:23:19.:23:23.

caravan. I just remember falling to the floor and just screaming. My

:23:24.:23:27.

first thought was, the poor children, that was my first thought.

:23:28.:23:32.

Like, my children, they haven't got a dad any more. And I was just

:23:33.:23:39.

devastated for them. It's just pure devastation. Like nothing I've ever

:23:40.:23:40.

felt before. Sorry... Reading that letter, there was, sort

:23:41.:23:56.

of the part I suppose that resonated the most with me was the part that

:23:57.:23:59.

really drove me forward in supporting other people with mental

:24:00.:24:02.

health problems, where he said that we weren't able to help him, but we

:24:03.:24:06.

could support other people. I wouldn't want anyone to have to read

:24:07.:24:10.

that letter from the person that they love, or read that letter

:24:11.:24:14.

directed to their children. I'm dreading that day that my children

:24:15.:24:17.

are asked to read that letter. I really, you know, I feel like if I

:24:18.:24:22.

could stop somebody else from having to read that letter and having to

:24:23.:24:26.

get their children to read or have their children read that letter,

:24:27.:24:30.

then that would mean, you know, it would mean everything to me. Our

:24:31.:24:37.

thanks to Emma for sharing that very painful experience.

:24:38.:24:39.

I'm joined now by actor and writer Boyd Clack, who has spoken

:24:40.:24:41.

about his own personal experiences of mental health issues.

:24:42.:24:44.

And Richard Bundy, from Welsh mental health charity GOFAL.

:24:45.:24:47.

Good of you both to come in. Richard, for you, what are the main

:24:48.:24:53.

issues that arise from Emma's storage? The huge issues that came

:24:54.:24:58.

up for me with the issue of isolation. I think the peer pressure

:24:59.:25:02.

that men face in the terms of the way they are perceived and expected

:25:03.:25:06.

to deal with problems. I think, inevitably, it draws thinking around

:25:07.:25:14.

stigma and the way people may feel judged, that may present a barrier

:25:15.:25:19.

for people seeking help. I think that talking about mental health

:25:20.:25:23.

problems has become much easier for people. Of course, it's still there.

:25:24.:25:27.

The problem is of course, the thing is, when you are suffering from

:25:28.:25:32.

mental health problems, you have a great feeling of isolation and fear.

:25:33.:25:39.

Isolation, fear, and profound unhappiness. Now, these things are

:25:40.:25:44.

the things that stop people communicating. What kind of

:25:45.:25:48.

framework of help is there at the moment in Welsh terms? And have you

:25:49.:25:51.

seen a noticeable increase in the kind of take-up of people asking for

:25:52.:25:57.

help? Yes, well certainly with the introduction of the Welsh mental

:25:58.:26:02.

health measure in 2010, our primary objective there was to improve

:26:03.:26:06.

people's access to mental health services. And certainly the

:26:07.:26:10.

introduction of primary mental health care teams, working alongside

:26:11.:26:14.

GPs, has opened up a huge level of demand that wasn't being satisfied

:26:15.:26:19.

before. In terms of policy and strategy, I suppose Wales has been

:26:20.:26:24.

ahead of the game in some respects. I gather from the mental health

:26:25.:26:28.

strategy, the measure introduced in 2010, and I think within the context

:26:29.:26:33.

of suicide, there is a suicide and self harm prevention strategy which

:26:34.:26:39.

was introduced in 2015. That is due to be reviewed by Public Health

:26:40.:26:43.

Wales at the midpoint. Are we in a better position, then, to be able to

:26:44.:26:48.

explain why the numbers are rising, and in Welsh terms, because the

:26:49.:26:52.

problem seems to be more acute, what are the factors in that rise which

:26:53.:26:55.

we can identify with some confidence? I think one of the

:26:56.:27:05.

factors with male suicide is that we have a deep-rooted tradition in

:27:06.:27:10.

Wales of masculinity. A sort of active masculinity. It comes from

:27:11.:27:13.

the mining days, where the miners were tough men who work together.

:27:14.:27:18.

They had friendships, they earned money, good money. It was a horrible

:27:19.:27:22.

job but they aren't good money. They could look after their families, go

:27:23.:27:27.

and have a point, go to church. They had an enormous sense of community

:27:28.:27:31.

and friendship. I think with the post-industrial times in Wales, this

:27:32.:27:36.

infrastructure has broken down. And now what we have is sort of a

:27:37.:27:43.

desolation. The churches, abandoned churches at the valleys, the pubs

:27:44.:27:47.

are boarded up. They had tombstones that had a very strong... Affect on

:27:48.:27:56.

the Welsh psyche. And that being taken away, a lot of people feel

:27:57.:28:02.

lost. And you combine that with the largest think contributing towards

:28:03.:28:09.

mental illness and suicide in the valleys, alcohol. We Welsh I think

:28:10.:28:12.

are part of our national characteristics as a people have a

:28:13.:28:18.

sort of morbid introspection. I think that has remained with us. As

:28:19.:28:22.

the landscape has changed, the landscape has come to reflect that

:28:23.:28:27.

mental state more. Alcohol has been mentioned. A morbid introspection

:28:28.:28:32.

has been mentioned, which is acutely may to some areas, those valid

:28:33.:28:37.

reasons -- which is peculiar may be to some Welsh areas. I think alcohol

:28:38.:28:43.

use is a significant factor in suicide. That is a well acknowledged

:28:44.:28:47.

point. Social cohesion is a real issue. And I think the statistics

:28:48.:28:54.

are borne out in terms of, you know, there are higher incidence of

:28:55.:28:57.

suicide and mental ill health in Wales's most deprived areas, in the

:28:58.:29:01.

same weight that there are higher incidences of suicide in their home

:29:02.:29:06.

was communities. There are real things. Thank you both for coming

:29:07.:29:07.

in. If you'd like to get in touch

:29:08.:29:09.

with us about what's been discussed tonight,

:29:10.:29:13.

or anything else, email us Or follow us on social media,

:29:14.:29:15.

where the discussion continues. All of them? All of them.

:29:16.:29:18.

Drafted by all of them. He went on to play for the

:29:19.:29:56.

Buffalo Bills in the Super Bowl and the Cleveland Indians in

:29:57.:29:59.

the World Series.

:30:00.:30:03.

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