11/06/2014 Y Sgwrs

On Y Sgwrs tonight, do we need more GPs, nurses, dentists,

and opticians who speak Welsh?

And devolution - we'll be looking at its history

and its future with our guests.

Welcome.

Joining us tonight, AM Aled Roberts of the Lib Dems, GP

and lecturer with College Welsh National, Dr Zoe Morris-Williams,

and in our Wrexham studio, solicitor and former Labour MP Gareth Thomas.

First, frightening -

that's the word used by the Welsh Commissioner yesterday in announcing

a report on the experiences of Welsh speakers within the NHS.

According to the report,

only just over one in four Welsh speakers is able to

communicate with a GP, dentist , pharmacist or optician in Welsh.

But one GP from North Wales has told us

that placing too much emphasis on Welsh could lead to doctors

reconsidering before coming to work in Wales.

Janet Ebenezer has the details.

From week to week, the NHS is under scrutiny

and the headlines are often critical.

This week, it's the Welsh language.

The Welsh Commissioner has published a critical report,

mentioning her concerns over the shortage of employees who can

communicate with patients in Welsh.

In gathering evidence, the Commissioner heard the experiences

of over 1,000 Welsh speakers, as well as from the health sector.

Meri Huws said that she was shocked to hear

some of the experiences of Welsh speakers who had failed to

receive Welsh language services suitable for their needs.

The Commissioner wants to ensure that there are enough doctors,

nurses and dentists providing care through the medium of Welsh.

If we are to do this, the Government needs to start planning now to

ensure that there is a workforce for the future in Wales that can

provide a Welsh language service.

One with recent experience of the NHS is actor Lisa Jen,

who has a five-year-old daughter who suffers from epilepsy.

This is her story.

Back in March, Lucy was diagnosed with atypical absence epilepsy.

She has absences - for 30 seconds or so, she cannot hear, cannot see.

But sometimes it looks like she's just daydreaming,

but instead there is something happening to her brain

and everything freezes and that can happen 20 or 30 times a day.

And were you happy with the care provided for Lucy?

Very happy, on that point, with the care

and how quickly everything happened, but it was quite frustrating

because that's where we had this lovely paediatrician trying

to communicate with Lucy, who is five.

She is bilingual, but she's far more confident in Welsh.

That's her mother tongue.

Especially consultants and paediatricians from overseas who

maybe do not realise that children in Wales sometimes only speak Welsh.

But others are disappointed with the report and are concerned

that the language could stop doctors from coming to work in Wales.

We have got so many struggles in primary care,

trying to recruit doctors into North Wales, it's a

real desert here at the moment, particularly in those areas

where there's a strong Welsh speaking culture.

The Welsh language is a wonderful treasure in Wales, but for me,

the priority is getting doctors, whether they speak English or Welsh.

That's what I need here.

So, to be finding ourselves criticised for not having

enough Welsh speaking doctors is very disappointing.

Before coming here, I spoke to a doctor from Prestatyn to find

out his opinion on what you have announced today.

He said there is a recruitment problem

and that this would not help.

What is your response to that?

If you put the patient at the centre of health provision,

and that's what we should be doing,

you have to plan around that patient

and not around other elements.

So, if the patient wishes or needs to use Welsh in communicating

when they are in a such a situation, that should be central,

as providers and professionals in the field.

In a statement from the Health Minister's office,

they say they have a Welsh language strategy for health,

social services and social care, and that is reflected in this

document - More Than Words - published in 2012.

As far as this report, published by the Welsh Language Commissioner, the

Government says they will respond to the consultation within six months.

When you have a child who is sick, and who is suffering, I think

that is your priority.

You just want the proper care, in whatever language, in a way.

But, yes, it would be wonderful, especially for Lucy,

if she could communicate with nurses

and doctors through the medium of Welsh, but who knows?

That's the experience of Lisa Jen and her daughter.

Zoe, as a doctor, it's often not a pleasant experience visiting

the doctor, people are either in pain or are concerned.

To what extent is seeing a health professional

and communicating in Welsh important?

Does it make the patient more comfortable?

Does it may be benefit the patient in the long-term?

The first thing I'd like to say is that

I personally welcome this report and welcome the fact that we

are talking about the linguistic needs of patients within the NHS.

I think we have ignored such needs.

I think that communicating

and effective communication is vitally important in the way

we treat and discuss with patients

and create an atmosphere within the NHS where people can

trust in us to look after their children, give advice,

reassurance, and also they may want to tell us

something they have not told anyone else.

So, I do think if there is anything we can do to improve that

situation for patients, I think we must consider it.

As Meri Huws has said, I think, in looking at these reports,

if we are to talk about changes within the NHS,

the needs of the patient is the priority.

Aled Roberts, some within your party have said that the NHS

is on its knees as it is.

Shouldn't the Welsh language be a low priority for the NHS in Wales?

No, I don't think so because I'm sure that most of us

want a good doctor, first of all, whatever language,

but there are patients, be they young children or older people, who

maybe cannot communicate in English

and it is important that we consider the Welsh language as vital.

I think what is surprising is that the Government and NHS have

this strategy and clearly, at the moment, it is only words.

Gareth Thomas, there is a cost in providing the Welsh language.

We often hear councils complaining about that.

In this context, we are

talking about a health service under tremendous financial pressures.

Should this be an increased cost when money is short?

Well, there is a cost to the patient if we do not act in this field.

The ability and right to communicate in your first

language should be vital in the care of patients.

If you consider elderly people who maybe have

and a stroke or dementia, or young children, it is

vitally important that they can communicate in Welsh,

so the doctor understands what is wrong with them.

We heard in that piece by Janet about these concerns from one

doctor in North Wales that the emphasis on the Welsh language could

mean that people in the profession do not come to work in Wales.

-Do you share those concerns?

-I'm disappointed with that response.

Of course, we must act in a practical way

and this is a long-term thing,

but there must be an understanding of the fact that in some

parts of Wales we are operating within a different culture.

And I think that doctors

and those working in this field have a duty to learn Welsh,

or there should be other members of staff available who are fluent.

I think that is vitally important.

But there is a recruitment problem.

-The Welsh Government acknowledges that.

-This is a small matter.

Welsh speakers need fair play.

And this is a problem more in North Wales, but it is a lack of planning.

It's not going to happen overnight.

There are more and more young people in Wales

receiving their education through the medium of Welsh and yet,

for some reason, they reach 18 years old and the system fails them.

Some people would argue it is reasonable to expect to see

a Welsh speaking GP.

Is it reasonable, if you're going for complex surgery, that the

surgeon speaks Welsh?

Can I first respond to what Aled has said?

There are huge steps being taken within higher education to try and

ensure bilingual nurses, therapists and doctors are graduating in Wales.

There is work to be done to ensure that children from Welsh speaking

backgrounds and for those who have learned Welsh to get

the opportunity to study in Wales and follow bilingual courses.

But the matter is - what can someone reasonably expect?

I don't think that it is up to us as doctors to tell the patient

what they can reasonably expect.

I think we need to move away from this idea that

patients are unreasonable people. They are not.

I think what they want is for us to consider their linguistic needs

and even if the surgeon only said good morning in Welsh

and acknowledged the fact they could not communicate with them

in their first language, but show sensitivity,

that would be enough to ease many people's concerns.

A diplomatic answer to end that debate.

Next tonight, how much do you know about devolution and have some

areas in Wales benefitted more than others during the past 15 years?

A BBC Wales survey suggests that fewer than

half of people in Wales are aware that the

Government in Cardiff Bay is responsible for health.

31% believed the south east had benefitted most from devolution,

with 4% saying North Wales and just 1% suggesting Mid Wales.

Let's begin with the understanding of devolution.

Does it sadden you that

so few people know what the Welsh Government is responsible for?

I'm not surprised because a large number of our population

receives evidence and news from England.

But people like you are meant to be educating people.

It's easy to blame the London press.

Yes, but if they just watch BBC Wales or S4C for an hour a day

they receive so much information saying that London

policies are affecting our schools in Wales, it is no surprise.

Gareth Thomas, what is responsible for this?

Is it the fact that the devolution settlement in Wales is

different to that in Scotland and Northern Ireland?

To begin with, the assembly is relatively new.

You say that, but it is 15 years old. That is not relatively new.

Considering that the parliament in Westminster has been

there for centuries, yes, it is. We are only just beginning in Wales.

If you had asked the same question maybe ten years ago,

there would have been even less awareness. So we are developing.

The awareness is developing. The assembly's profile is growing.

So, I'm not too disappointed.

Zoe, on this question of who is to blame for the lack of awareness

and understanding, the Presiding Officer often says that most people

receive their news from London and so what happens here is not reflected.

Do you agree with that?

I think what worries people I see in surgery is what is

happening on a local level, so maybe we are not all aware who the

Health Minister is in Wales, or that health has been devolved.

What causes a problem is what is happening to local services

and I think the assembly deserves praise with some things,

especially regarding public health,

but maybe people are not aware that things like banning smoking

in public places happened sooner here because health is devolved.

I think we all have a responsibility to ensure that people

understand that and then when they vote,

they understand what they are voting for what they are voting

And who and what powers are affected,

especially regarding important fields, such as health.

If people do not know who is responsible for what,

does it really matter in the scheme of things?

As long as the services provide what is needed, does it matter

if they do not know who is responsible?

Yes, because if they are complaining about the standard of health

or education, it's important they know who is responsible.

-Who to knock in an election!

-Definitely, yes.

I think that the picture is changing.

Most of our children and young people do receive information

explaining who is responsible. I would agree with Gareth.

It will take time for this picture to change.

On that point, Gareth Thomas, do you think that if more people were aware

exactly what has been devolved that Labour would suffer bigger blows

when it comes to elections?

We hear about the NHS and the changes, many people are unhappy, we

hear about these PISA results, where the

education system is on its knees, according to some.

Do you think that would affect Labour,

if more people knew the Welsh Government was responsible?

Well, a lot of the criticism of the Labour Government is unfair,

in my opinion.

There has been an independent

report on health services in Britain

and the NHS in Wales, in many examples,

is better than it is in England,

but there is nothing to differentiate between the

standard, on the whole, of the NHS in Wales, Scotland, England.

And we need to put this into context.

People's experiences with the NHS in Wales are positive

and the figures are higher than they are in England.

Can I also ask you about the geographical context?

Who and where benefitted from devolution.

In North Wales, we often hear people saying they are losing out.

Is there a basis for that?

There is a lack of knowledge and awareness and with respect

to my fellow North Walians, it's the same old thing time and time again.

The awareness of the benefits of devolution is spreading.

And I hope this inevitable gap between north and south Wales,

considering the geography, is exaggerated.

I accept that Cardiff has done well, as far as buildings and culture

and so on, but on the whole, the assembly acts fairly, in my opinion.

Aled Roberts,

official figures confirm this as far as spending per head.

There is no difference in what goes to the north and the south.

I don't agree with you on that.

There was a report a year ago showing that...

I have the figures in front of me. £30 difference.

-Yes, so there is a difference.

-£30, from £3,147...

£30 does not make much difference.

But our responsibility as politicians in North Wales is

to ensure that our case is heard, rather than complaining.

But the Government needs to look at the A55

and railways in North Wales, as well as the M4.

We will now discuss the last 15 years -

how will Wales look in 15 years' time?

Daran Hill looks into his crystal ball.

Devolution, so far, has been a story of changes between Westminster

and the Assembly.

Maybe one thing that will change during the next 15 years

is the relationship with local government.

The people providing services.

Maybe that is where the focus will be.

The story of devolution may be one of devolving

out of the assembly, or from local government back into the assembly.

As far as the themes of next 15 years, I think

health will remain vitally important.

But I think one thing that will arise will be social services,

with the ageing population.

I think that will become a crisis in Wales.

I don't see Labour being out of government in the next 15 years.

They are too strong, too constant,

and also for us to have a government that is not a Labour government,

the other parties need to form a coalition.

At the moment, especially when there is not a Labour

government on a British level, that is not going to happen.

I think that politics is always exciting.

One of the best things about it is you can look ahead,

but what arises from nothing is always the most surprising.

As Harold Macmillan said, "Events, dear boy, events." I think

we will have plenty of events over the next 15 years.

Daran Hill. Wales, Aled Roberts,

has led the way in a number of fields during the past 15 years.

The tax on plastic bags, organ donation, the smoking ban.

How can they set the agenda over the next 15 years?

We need to be clear on the relationship between Wales

and Westminster. I think that is developing.

But I think what we also need to do is find a Welsh way to move forward.

I don't think that some of the changes within health and

education in England are things we would like to follow here in Wales.

We have our own way of doing things. We should try

and ensure that standards are the best that they can be.

There is an Assembly election in two years' time.

Gareth Thomas, many people would say that we will have

more of the same if Labour remain in power.

Well, the people decide at the end of the day.

The voting system we have for the assembly is far fairer than

the Westminster system. But you asked the question -

what will happen during the next 15 years?

I do see devolution developing.

Whatever happens in Scotland, I see more powers coming to Cardiff.

Maybe the body itself will grow, as far as the number of members.

And I think that would be a good thing.

Fewer local councils in Wales.

I agree there is one big challenge facing the health service, but

England also faces that challenge, as regards the ageing population.

The health service In England is also under strain,

but in England, they are going down the privatisation route.

Thank goodness we are not going down that route in Wales

because devolution has given us the ability to make our own way and

that is vitally important and I'm so pleased that we have the assembly.

Zoe, regarding the health service, over the years

more of the budget has gone to health and less to other fields.

Over the next 15 years, are we likely to see a Welsh Government

becoming a huge health authority?

Well, I'm not sure.

One thing I can say is I think that the Government has

concentrated on public health and I hope that campaign will

continue, looking at alcohol and obesity and diabetes.

I think that the Government needs to work more effectively to

make decisions regarding the NHS and then stick to those decisions

and let things settle,

rather than changing direction every time we have a new Health Minister.

Also, we're always comparing England and Wales.

We need to stop looking over our shoulders

and talk about what we are doing in Wales.

Our population is different, we face different problems,

and we need to look forward and have a Welsh way of doing things.

Gareth has referred to the Scottish referendum.

Will that define what happens in the assembly during the next 15 years?

It will definitely affect the finance.

Maybe this devo max will be more of a problem,

as far as what we can do over the next 15 years.

What about the institution and the kind of people within it?

In the news today, Nick Ramsay, the Conservative AM,

denying being drunk in the Senedd. Any comments to make on that?

I have no comment to make on that individual case.

But everyone in public life has a duty to behave appropriately.

We unfortunately live in an era where there is

a lot of cynicism, as regards politicians.

And we must take care and behave ourselves.

-Aled Roberts?

-There are strict rules.

A complaint has been made.

I think we must wait for the inquiry to be carried out,

so we can see exactly what has happened.

Rosemary Butler has said there is no drinking culture in the assembly.

-Is there?

-No.

-Right.

-I think there is a drinking culture in Wales, generally.

And that is a problem.

Instead of an inquiry into one person,

we should be looking at society.

Our time is up. That is it for tonight. Thank you to my guests.

We will return in a fortnight. Good night.