01/03/2017 The Wales Report

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

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