01/03/2017 The Wales Report


Bethan Rhys Roberts examines the challenges facing NHS funding in Wales. And on St David's Day, what does it mean to be Welsh in 2017? Radio 1 DJ Huw Stephens investigates.

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Tonight on The Wales Report: Endless demand and limited resources,


we discuss NHS funding with the person making


the big decisions, Health Secretary Vaughan Gething.


With Brexit on the horizon, how crucial is the role


of the Welsh Secretary in helping relations between Wales


And, on St David s Day, we ask what does it mean


Good evening and welcome to the Wales Report.


On tonight's programme, a subject which impacts on the lives


of all of us here in Wales, the National Health Service.


It's a topic that gets everyone talking, and don't forget


Now, the Welsh Government spends more on the NHS than anything else,


taking up nearly half of the budget for all public services in Wales.


Just how the service is funded with rising demand and finite


resources is one of the questions posed in BBC Wales's annual


Later I'll be putting the findings to Health Secretary Vaughan Gething.


So, what kind of changes to NHS funding are we talking about?


Just over four out of ten of those surveyed would pay more income tax.


48% were in favour of increasing national insurance.


And what about charges within the NHS?


Nearly half thought it was unacceptable to charge


for services that are currently free, such as prescriptions.


But, nearly three quarters thought patients should pay for missed


And even more, 79%, would increase charges for visitors from outside


And one final question that produced some interesting results.


We asked if patients who have diseases or illnesses caused


by their lifestyles should be charged for treatment.


The results were virtually split down the middle with 42%


And by the way, for this poll ICM interviewed 1,002 people in Wales


Before we examine those answers with the Health Secretary,


we went to a GP practice in Cardiff to get the views of patients there.


I've contributed a lot over the years and I think I have done my bit


so it depends a lot on how much more taxi would require in order to pay


for the increases in the NHS costs. Compared to places like America and


places like that this is luxury. We are well blessed and to be honest I


am still working and while I am working I don't mind paying a little


bit of extra tax. You have people struggling to work as well and if


they are paying taxes and it is hard for them and you take more money off


the land they are working, is there to push them for mental health and


you will need the NHS more because they are struggling with money


because everything is so expensive these days. How can you say that the


amount you are paying is going to the National health? Can we trust


the government? Game there was not going to be a little fun saying that


little pilots for the NHS. Sadly we live in a society where there is a


lot of rich people who pay no tax and it's not solely taxing the risk


but for the good of society they should be made to pay more. A more


level playing field in the tax system. All services in the national


Health Service should be free at point of delivery. Some people would


get ill and die because they could not get treatment. If you have a


life-threatening illness and unique treatment then it should be free and


everyone should have it but if it is things just for acute problems like


pain relief that I think people should buy them. I already do that.


That would save the NHS a lot. We have certain items like aspirin on


prescription and you can buy them for 90p for a bottle of aspirin and


I don't think that should be given on prescription. That is going to


the doctor. If I am coming here, don't give me paracetamol on


prescription if I don't need them. I have soluble aspirin on my


prescription every month! I should stop that but we don't think.


They should all have their own insurance. I'm pretty sure that most


of the stories are scare stories and there are some people but I think it


is a minority problem. There are half -- far bigger problem is not in


the National Health Service. There are a lot of people who would not


say no if a little girl came in cut a hand in hand stitches but it is


the ones who take the Mickey. I think if they had done it more than


once then maybe. If it is a historic sort of thing. With the hospital


there is such a long waiting list and so many letters we have through


it means that we have to chase it up and it is a knock-on effect and it


has to work for everybody and then the patient gets better and they


don't need it but they should have informed. If you start making people


pay for a service but it should be free for the NHS at the point of


delivery. If a person regularly books on appointment and doesn't


turn up then they should be sent a letter and said that if it happens


again you will have to seek services of another GP practice or whatever.


Earlier I spoke to Health Secretary, Vaughan Gething.


Given the financial pressures on the NHS and the demands, the increasing


demands, do you acknowledge that you have to rethink the way it is


funded? The overall funding comes from our settlement has a government


and there are real challenges on every single part of public service


and public funding, we actually think the answer to funding the


health service and other public services is for the UK Government to


take a different approach on austerity but unless that happens we


will face incredibly different choices and you know we have had to


reports in the last few years talking about sustainable funding


for the health service and we have met the gap that they identified in


each of those reports. There is a real commitment here to fund the


National Health Service but every alternative model comes with very


real challenges and in the discussion for example about


charging then there is a lot of evidence that charging affects


people from less well off background Zummack gets to be really difficult.


You have clearly said to the Westminster government to give us


more but what can you do? You could raise income taxes and put 1p on


income tax and raise ?180 million a year for the National health


service, will you do that? We have already committed that we would not


use income tax powers to raise income tax in this assembly term. It


would be handy, though, would you like to do it? That is our


commitment to the people of Wales and that is something people voted


on and took account. The challenge is how to make sure the public


services across the UK, including Wales, are properly funded. The


Chancellor has an opportunity in the budget to do something serious about


it because it is not just the service in Wales that faces these


challenges. Let us focus on what you as a Welsh government can do, it is


tricky to raise taxes but you heard in the film that people do tend to


agree with the hypothesis of taxes specifically for the health service,


for example, and you could argue that the bus during Brexit saying


?350 million for the National Health Service, for many people that won


it. You might tell me it wasn't true or whatever but the idea of raising


taxes specifically for the NHS could don't down well in Wales. I don't


think responding to the big Brexit lights by trying to break a


manifesto pledges the right way at all. The challenge is how do we use


the resources we have got and how did they come in from the UK


Government at this point in time? We have used our own budget to make


significant additional commitments to the health service and we are


committed to meeting that gap in the future and that is why we have a


real shot of being financially stable now but we are not fully in


control of our own destiny and that is why we have to keep on top of


what the UK Government will do. Another tool in your box would be


charging people from outside the UK, what about that? I am already


reviewing charges for our visitors from the UK and we have reciprocal


arrangements with other European countries and as long as they work I


see no reason to intervene and change those but if people outside


the UK and Europe who do not have those, we are looking again at


charging arrangements. What kind of charging could there be. Under what


circumstances would you like to charge? It is about whether people


come here for treatment and whether it is routine or emergency or


otherwise. I'm looking at a range of different options and later in the


year I would get to make a decision about how charging may or may not


look. This is such a marginal area of activity, in terms of the overall


NHS budget this is less than 1%. In terms of the future of the health


service there is a great headline to be spun here but it doesn't really


get to the heart of financial sustainability and the big choice


and challenges that we have. It is a great distraction if you don't want


to talk about funding public services. In the polls 75% are in


favour of charging from beyond the UK, a big thumbs up, so they want to


know if you will already do it. We already make charges but it is about


the rate of charge would make an hour we recover it but when you talk


about the central funding of the health service with the big


challenges we face, the actual conversation about charging people


from abroad is an absolute distraction and it gets us away from


the responsibility of governments around the UK to make choices and


actually for a citizen as a user of the health service and the taxpayer


to decide what are they really prepared to pay to fund the future


of the health service. An opinion you could do is find people who miss


appointments. It is a huge problem with 1.2 million appointments missed


in hospitals in the past few years and 600,000 GP appointments missed


broadly on an annual basis, that is huge. What about fines? There is a


lot of inefficiency to work out some of this is about both GPs and


hospitals chasing people are more effectively and more efficiently.


There is at this point a question about how the citizen uses the


service and the number of missed appointments is not acceptable but


charging is not something I am persuaded by. Research suggests that


charging for appointments missed appointments puts people off


treatment, particularly low income groups, and you end up worsening


health outcomes and inequalities. Middle income groups don't see the


problem of paying for a fine. Surely repeat offender should be penalised


in somewhere because people suffer as a result. There is a different


conversation to be had there if people are repeat offenders.


Sometimes they have different health care and sometimes people are not in


the system and in your clip there was the phrase taking the Mickey but


there was a challenge about what to do about those people. To deal with


those people do you say that everyone is subject to a fine or a


charge for an appointment? I don't think that is a large amount of


money. To add a system of fines you need to invest in that as well so


will you raise more money than you spend on administering the costs? We


both know there will be signs -- if I say there will be fines for missed


appointments you could then tell me that the system costs more than it


provides so there wasn't a simple answer and the big challenge is how


much public money goes into the service. These other things around


the sign do not get to the central question. These are the tools in


your box but I appreciate the big money comes from Westminster and we


are just looking at what you can do as Health Secretary here in Wales.


Another thing you could do is charge for some of the services that are


currently free. A lot of people in Wales say they don't need


paracetamol on prescription or aspirin, they are willing to pay 19p


or whatever. You could scrap that. If we are talking about scrapping


the fee, that is not a simple question. It is not a simple answer


to what seems like a simple question. It is about the GPs or any


clinician saying is this the right thing for this patient. It is their


responsibility to say yes it is or no it is not. That includes things


like parcel Mol and then -- paracetamol. What about charging


people who lifestyle induced problems like smoking, obesity, what


about that? There is some support for this and people say they should


pay their way. If you're saying someone with lung cancer who smoked


should be charged for their treatment, when we get into real


exam ples. But it isn't that simple at all. Part of challenge of


lifestyle choice is how we persuade people to make different choices.


There is a real health gain to be made here. Am I right in thinking it


is up to the Westminster government and there is nothing you can do


financially, you will keep going with the money you're given and


there is nothing the Welsh Government to get more money and you


have the tools in the box, but you have not going to use them. Is that


what you're saying? I've said we are looking at charging. The reality


with cost charging missed appointments is not simple. That is


honesty about what is possible and what will raise real sums for the


health service... In three years time that is it, you can do nothing.


We are meeting the gap and we are saying we are meeting the gap and we


have gone further than the gap they have identified for the next year


and there is a lot we can do to make the service for efficient, the


reform of out-patient should mean a more effective service so care can


be delivered in different way and it should save money to be reinvested.


There are things we can do that will deliver greater value. You will


balance the books and the NHS will keep on delivering and meet this


increasing demand? I expect us to meet the gaps identified by the


health foundation. There is a commitment from the Government to do


so. The challenge will be if we don't see the tide turned back on


austerity, every part of the the health service that face choices


that I don't think the public will tolerate. Thank you.


After nearly 20 years of devolved Government in Wales,


we've seen the relationship between the UK and Welsh


administrations range from indifference to verbal warfare


and everything in between, with arguments over funding,


the NHS and Education to name just a few.


The Secretary of State for Wales has played a key role in mediating


between the two Governments but, with Brexit approaching,


is that role becoming more important than ever before?


I'll be chatting to a man whose done the job twice -


Lord Paul Murphy - in a moment, but first here s


another former Secretary of State, Stephen Crabb MP, with his personal


What is it that makes politics such a fascinating subject for


biographers and historians. Maybe because it is not just about ideas,


at the centre of it are personalities. All shape the course


of events. Nowhere is this more true than in the role of Secretary of


State for Wales. The days of Secretary of State for Wales


wielding serious Executive authority are long gone. The role has been


changing since the start of devolution. Which saw the wholesale


transfer of power from the Secretary of State and the Whitehall machine


to the new devolved Assembly. This left the job of Welsh Secretary with


a question mark - what would its useful purpose be? In 2014 David


Cameron decided to open the book and look again at the Welsh devolution


settlement, following the Scottish independence referendum. This


brought the role of Secretary of State back into the foreground to


balance how Welsh devolution should progress and forge a consensual


position as far as possible. More recently with the challenge of


Brexit I would say we are approaching a moment when the role


of Secretary of State has never been more important. Nobody should


underestimate the significance of change involved in exiting the EU


and the need for the Secretary of State to act as a go between for


Wales and Whitehall. It has been politically convenient for a measure


of competitiveness to be a feature of the relationship between devolved


Government and Westminster. Arguments about funding became


common, because each side could blame the other. Now we need the


leave some of the petty rows and develop a greater sense of shared


interest. We are at a moment when we need to go beyond just the rhetoric


of respect and actually develop new ways of working that give Wales its


best chance of maximising its opportunities and defending its


interests. When I was Secretary of State I met the First Minister once


a month, which we never cancelled, despite politically testing times. I


believe that this set a pat certain that subsequent occupiers of the


roles will take forward. If I had advice for them it would be this -


be ambitious, and ready to fight Wales' corner and be ready to say no


both to Welsh Government and to your own backbenchers to reach


compromise. In an age when politics seems more polarised than ever the


art of compromise is vital. I'm joined now from our Westminster


studio by former Secretary of State for Wales and for Northern Ireland,


the Labour peer Paul Murphy. Thank you for joining us. How do you


think the role has changed since devolution? I'm not sure it's


changed dramatically. Change I suppose because of the way in which


devolution itself has changed in Wales. But the role of the Secretary


of State was determined right at the beginning. The problem was that


other people, particularly here in London, in Whitehall, didn't quite


understand why it was that we should have a Secretary of State without


anything to run. Hasn't it become more after diplomatic role, the days


of wielding serious executive authority are gone when you compare


to the power pre-devolution. It was always a diplomatic role post


devolution. The Secretary of State for Wales had response for the Welsh


office, all that was devolved to the Welsh Assembly and the same applied


to Scotland. Not so in Northern Ireland. So the idea of running a


Government department and I was Secretary of State for Wales twice,


has long since gone. When you were in the job, it was Labour both ends


of the M4. Now of course there are different colours and it is a


different role, though dealing with Tony Blair one end and Rhodri Morgan


play have been tricky as well? I think it is obviously more testing


if you have got different political regimes at both ends of the M4, of


course it is. But the role is the same and I also think there is a


common interest within Wales among Welsh politicians, whatever your


politics. We are a small country, we know each other well and whether


you're a Conservative Secretary of State or Labour, at the end of the


day, you are arguing, debating the issues which you know are going to


affect the same people that both the MPs and the AMs represent. I wonder


if Stephen Crabb is right saying Brexit has given it a new importance


around the cabinet table? He couldn't be more right. I gave it


evidence a few weeks ago to the... The constitutional committee in the


Assembly. And I believe that as a consequence of the decision to leave


the European Union, and the enormous impact that will have upon Wales,


that the importance of that relationship between the two


governments, which is linked by the position on the role of the


Secretary of State, is now much, much more important than it was. It


was important before, but it is even more important now. Just finally, in


terms of pecking order around the cabinet, you have held several posts


there, where does the Welsh Secretary rank? Well it is not a


senior position. But it often depends on how long you hold the


position. Because what happens is you move around the cabinet table in


terms of your length of service. But if you start off as I did as Welsh


Secretary, I was low down the pecking order. But that doesn't


matter, you still have the same opportunities as the Chancellor or


the Home Secretary or whoever it might be in being able to raise


issues around that table. Thank you very much.


I've still got an hour or so to wish you Happy St


David's Day and time to ask what can be a complex


question - exactly how Welsh do you feel?


In a world that is more interconnected than ever


before, with globalisation impacting on all aspects


of our lives, what kind of effect is it having on our


To investigate, we sent Radio One DJ, Huw


Stephens, to speak to some up and coming


musicians in Cardiff to find out what Welshness


St David's Day, the date to celebrate the great things it means


to be Welsh. Some of you do that every day. But now what does it mean


to be young and Welsh? Has the Welsh identity changed and if so, how do


we make sense of it all. Music is one great way too look at identity,


it is a way of holding up a mirror to our society and reflecting our


identity back at us. Since I started on hospital radio in Cardiff, I have


been watching and listening and promoting the music scene in both


languages and what better way to keep your finger on the pulse than


by listening to the music made in Wales. I'm not joust u just talking


about the male voice choirs. There is synth pop, hard core metal and


everything in between. Something I have never predicted is a


successful,grime crew from Wales. Grime music is a London version of


hip-hop, but The Astroid Boys talk about identity and place and they


sound like they're from Cardiff. It is important to be proud of where


you're from. So we are happy to express that we are from Wales and


show that we are proud of it. But it is important to be proud of the


country you live in and very proud to be Welsh. When you go on holiday


and your Cardiff accent getting stronger. When we go around the


world it is nice to be, this is how we say it. This what is it is like


where we are from and when we are in London a lot, to show them the side


of Wales they might not know existed. People in London thought as


a group of rappers we lived on a farm, because we were Welsh. So it


is cool to be able to do what we do and make videos and show people and


give them the image of what Cardiff and Welsh life is about. So yes.


When people think of Welsh music, they think of male voice choirs and


rock bands b s but not necessarily grime. Do you think you're


abolishing a stereotype? Yes having urban music in the public eye shows


there is people from all walks of life here and it is good to show


people that what is is going on here. One thing became clear talking


to them that having that Welsh identity is important to them, even


in the globalized world of 2017. It gives them a unique outlook that


informs their creative process. I'm joined now by


journalist and commentator And the poet Claire Putter. That is


so different that grime to the Welsh cakes, the daffs that are every


where today. It is complex, Welshness? Yes favourite statement


on this, Wales singular noun, plural experience. We reflect on ourselves


with certain imagery and it is more complicated. Where you grew up


shapes your idea of identity and we are a multicultural nation. That


could be said about anywhere or there is any something flex about


the Welsh identity? Yes it is grounded in language and views


whether the Welsh language should be supported and it has been under


pressure and it is important that we preserve that. That speaks a lot to


our national identity. But when you think about people who don't speak


Welsh, how do they express their identity? Is it a unifying force? It


be divisive. I went to pant pat Goan ya and was amazed to see that. I'm


learning Welsh and there are south Americans and English who are


embracing the culture. You embrace the stereotypes sometimes in your


writing and you like the daffodils and the rugby, sport, get it right,


don't they in making the Welsh identity travel. We saw last year


with Welsh success what a great calling card sporting success can


be. Particularly football, because it is the global game and you have


got multinational companies tweeting in Welsh and the New York Times


talking about Wales and I feel if we apply the same passion and obsession


and scrutiny to other areas of Welsh like, like how we are governed as we


do to sport we would be all right. How do we do that? And export our


culture, or are we doing a good job. I think we are doing a good job and


that is a strength supporting the arts and if schools you have


children who have experienced that and you look at Cardiff Bay, you


have the politics, the millennium centre, the film industry and we are


doing a good job of supporting arts and showing its diversity and the


culture within Wales. If we look at the political picture and the


anti-globalisation feeling, a lot of talk of identity politics, is now a


good time to promote a national identity. The debate has been thrown


open by Brexit. I was shocked by the Wales Brexit revealed, some


uncomfortable truths. I thought we were an inclusive, keep a welcome in


the hillside nation, but a lot of it was about immigration. Maybe we are


not that different, maybe for Wales, see England. Yes we took our cues


from the English media and didn't ally yourselves with Scotland or


Northern Ireland. I think the political landscape is changing so


rapidly and we have to keep up and think, what is our part in this? How


do we see ourselves in relation to Europe and Britain and within our


own boundaries? Does identity always have to be political? If you look at


Scotland and the nationalism force. They don't have the language. It


depends what you mean by political. If you talk about changing our


curriculum and so we have more of a Welsh focus, we need that. I grew up


in the Welsh valleys. We didn't have much input, because of English


curriculum of Welsh writers and politicians and history. There will


be people who have listened to speeches tonight and Welsh cakes,


daffs, is that the future? There is tartan presents and there are pipers


and look how Ireland have stuck an Irish pub in every city. We can have


fun with how people see us. There is nothing wrong with having a heritage


we can be proud of and we are a musical nation. We should enjoy them


them. And happy St David's Day. If you'd like to get in touch


with us about what s been discussed tonight or anything


else, e-mail us at [email protected],


or follow us on social media where the discussion


continues - hashtag


Bethan Rhys Roberts presents a current affairs series taking a look at issues that matter in Wales. There's a report on the challenges facing NHS funding in Wales. And on St David's Day, what does it mean to be Welsh in 2017? Radio 1 DJ Huw Stephens investigates.

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