The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
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Dechreuodd y cyfarfod am 09:30.
The meeting began at 09:30.
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Cyflwyniad,
Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
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[1]
Dai Lloyd: Croeso i bawb i gyfarfod diweddaraf y Pwyllgor
Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad
Cenedlaethol Cymru. O dan eitem 1—cyflwyniad, ymddiheuriadau,
dirprwyon a datgan buddiant—gallaf gyhoeddi nad yw Rhun ap
Iorwerth yn gallu bod efo ni heddiw, ond mae Bethan Jenkins yma fel
dirprwy. Felly, croeso, Bethan, am y tro cyntaf i’r Pwyllgor
Iechyd, Gofal Cymdeithasol a Chwaraeon—croeso i chi’n
wir. Gallaf i ymhellach egluro, er bod pawb, yn amlwg, yn ymwybodol
bod y cyfarfod yma’n ddwyieithog—gellir defnyddio
clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg
i’r Saesneg ar sianel 1, neu i glywed cyfraniadau yn yr iaith
wreiddiol yn well ar sianel 2. A allaf i hefyd atgoffa pobl i
ddiffodd eu ffonau symudol ac unrhyw offer electronig arall, neu eu
tawelu, o leiaf? Nid ydym yn disgwyl tân y bore yma, felly os
bydd larwm yn canu, dylem ni ddilyn cyfarwyddiadau’r
tywyswyr.
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Dai Lloyd: Welcome, everyone, to the
latest meeting of the Health, Social Care and Sport Committee here
at the National Assembly for Wales. Under item
1—introductions, apologies, substitutions and declarations of
interest—I’d like to announce that Rhun ap Iorwerth
cannot be with us today, but Bethan Jenkins is here in his stead.
So, Bethan, welcome, for the first time, to the Health, Social Care
and Sport Committee. Can I further explain, although everyone is
obviously aware that this is a bilingual meeting, you can use the
headphones to hear simultaneous translation from Welsh to English
on channel 1, or amplification on channel 2? Could I remind people
to switch off their mobile phones and any other electronic
equipment, or switch them to silent, at least? We don’t
expect a fire this morning, so if you hear the alarm, then please
follow the instructions of the ushers.
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09:31
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Ymchwiliad i Recriwtio
Meddygol: Sesiwn Dystiolaeth 11—Ysgrifennydd y Cabinet dros Iechyd, Llesiant a
Chwaraeon
Inquiry into Medical Recruitment: Evidence Session 11—
Cabinet Secretary for Health, Wellbeing and Sport
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[2]
Dai Lloyd: Felly, gyda chymaint â hynny o
ragymadrodd, awn ymlaen i eitem 2: ymchwiliad i recriwtio meddygol.
Hon ydy sesiwn dystiolaeth 11, a heddiw, y bore yma, rydym yn
croesawu Ysgrifennydd y Cabinet dros Iechyd, Llesiant a Chwaraeon.
Dyma’r sesiwn olaf, yn wir, yn yr ymchwiliad yma, ac felly, a
allaf groesawu Vaughan Gething, Ysgrifennydd y Cabinet dros Iechyd,
Llesiant a Chwaraeon, yn ogystal â Julie Rogers, cyfarwyddwr
y gweithlu a datblygu sefydliadol, a hefyd Dr Frank Atherton, y
prif swyddog meddygol? Diolch
yn fawr iawn i chi’ch tri am eich presenoldeb.
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Dai Lloyd: So, we now go on to item 2:
the inquiry into medical recruitment. This is evidence session 11,
and today, this morning, we welcome the Cabinet Secretary for
Health, Well-being and Sport. This is the last session in this
inquiry, indeed, so I would like to welcome Vaughan Gethin, the
Cabinet Secretary for Health, Well-being and Sport, as well as
Julie Rogers, director of workforce and organisation development,
and also Dr Frank Atherton, the Chief Medical Officer for Wales.
Thank you to all three of you for being here.
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[3]
Rydym wedi derbyn eich datganiad
ysgrifenedig, a gyda’ch caniatâd, awn yn syth i
mewn i’r cwestiynau. Mae gennym ni nifer helaeth o gwestiynau
a fydd yn cael eu gofyn mewn modd byr, bratiog, gan ddisgwyl
atebion yn yr un modd oherwydd pwysau amser. Lynne Neagle i
ddechrau.
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We have
received your written statement, and with your permission,
we’ll go straight into the questions. We have a number of
questions that will be asked in a succinct way, with the
expectation of succinct answers, because of the time available.
Lynne Neagle to start.
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[4]
Lynne Neagle:
Thank you, Chair. Good morning. Can
you tell us what the impact of the new single body, Health
Education Wales, is likely to be on the funding and structure of
medical education in Wales?
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[5]
The Cabinet
Secretary for Health, Wellbeing and Sport (Vaughan Gething): I
think it will actually allow us to use our ability to plan our
whole workforce in a different way, in a more joined-up way, rather
than having different streams looking at things separately, and
that’s been part of our challenge. Actually, what I’ve
been encouraged about is the buy-in that people have had. So, I
think, structurally, it will help us to have a more joined-up
structure that will make a lot more sense.
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[6]
On the funding question, though, I don’t think you could
honestly say that changing the structure will change some of the
challenges around funding. We still have difficult investment
decisions to make and everyone here is aware of the reality that we
have less money available to us in the Welsh Government. Even
though health has done well out of the last budget settlement
compared to every other area of Government, that doesn’t mean
that we’re awash with money. So, I wouldn’t want to try
and pretend to you that Health Education Wales means there will be
more money, but I think we’ll be able to make smarter and
better use of it in the way that we plan our whole workforce, not
just the medical part of it.
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[7]
Lynne Neagle: And where are we in terms of actually getting
it approved and established?
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[8]
Vaughan Gething: I’ve made a statement on this
already. I still expect it to be up and running by April 2018,
although we expect to have some form of shadow body in place before
then. So, it isn’t simply about asking them to start work
from day 1 on 1 April. So, yes, I think it’s all on track.
We’ll have options about how we establish it, and, obviously,
I expect to provide further statements to Members over the rest of
this year to confirm that we’re on track, and what the actual
structure of the organisation will be.
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[9]
Lynne Neagle: Thanks.
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[10]
Dai Lloyd: Diolch yn fawr. Caroline Jones sydd nesaf.
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Dai Lloyd: Thank you very much.
Caroline Jones is next.
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[11]
Caroline Jones: Diolch, Chair. Good morning. One of the main
purposes of medical schools is to provide the future NHS workforce
in Wales. Could you tell me if they’re delivering on this
responsibility? Also, given that medical schools are competing in
the higher education sector, with the emphasis on recruiting the
brightest and best from around the world, is this in conflict with
this responsibility to recruit those most likely to serve in the
Welsh NHS?
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[12]
Vaughan Gething: I think they’re two distinct
questions. I’d start off by saying that it hasn’t
always been the mission of the two medical schools that we have to
simply recruit the future NHS workforce for Wales. Swansea is
different to Cardiff, of course, because it was created after
devolution, but Cardiff’s history hasn’t always been
that they are there to provide doctors for a Welsh medical
workforce. There are challenges there about how medical schools see
themselves as well. They want the brightest and the best and we
should want very high-quality applicants, but there is a challenge,
I think, about ensuring that we do get more Welsh-domiciled
students to be offered places in our two medical schools, without
compromising on quality, because I don’t accept that you have
to compromise on quality to do that.
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[13]
I think it’s fair to say that, previously, we haven’t
had as much return as we would have wanted. I also think it’s
helpful to say that I think both medical schools recognise that. I
met them not long after I’d been appointed—I met both
deans together, and I think they’re very clear about the
message from Government and the expectation. That’s within
their current envelope—we expect them to do better. I know
Cardiff have recent figures showing they’ve done better this
year than last year, but I’m really clear that I think
there’s more they could and should do within their current
envelope, let alone any potential for expansion, because this
Government would expect that any further investment into those two
medical schools, to expand the numbers of training places, would
have to be on the basis that there would be more Welsh-domiciled
students taking up those places.
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[14]
Caroline Jones: So, are you content with the number of
Welsh-domiciled students applying to these schools? What are we
doing to offer encouragement?
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[15]
Vaughan Gething: I think it’d be wrong to say I'm
content with the current position, because I think it needs to
improve. We have numbers applying. There’s a challenge about
making sure people continue to apply—but, actually, we want
to see people offered places and we want to see those places taken
up. Equally, in terms of the point at which people make choices
about their careers, we need to be both better at retaining people,
wherever they come from, within the Welsh system, once
they’ve completed their graduate or postgraduate
training.
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[16]
Also, we need to be better at understanding where people from Wales
go if they don’t study in Cardiff or Swansea. We do need to
be much better at attracting back Welsh students who have
undertaken medical training in England or in Scotland—in
England in particular, because you’d understand why a lot of
people—say, if you live in north Wales, you might decide,
actually, Liverpool or Manchester sound like great places to be a
student, far enough away from home to not be at home and, equally,
not so great a difficulty to come back. We know lots of people go
to London, Birmingham and other places as well, but I don’t
think we really do well enough at attracting those people back.
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[17]
Caroline Jones: We have received evidence to suggest that,
perhaps, we should use positive discrimination to attract more
Welsh-domiciled students. Can I ask your opinion on this?
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[18]
Vaughan Gething: I used to be an employment lawyer, as
you’ll know, and positive discrimination itself is a loaded
phrase, and it’s a phrase that gets lawyers very excited. We
need to have a system where we can encourage Welsh students to
apply and be clear about our expectations for Welsh public funding
and what that will deliver for the Welsh NHS. I expect there to be
both more applicants and more students offered places without
compromising on quality, and I think the way that our current
medical schools look at their applications processes is important
within that. I wouldn’t use the phrase ‘positive
discrimination’, but I certainly expect there to be positive
forms of action, which is a more legally sound phrase to use, and
looking at the context in which admissions are undertaken.
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[19]
To be fair, I know that Cardiff and Swansea have already made some
changes. The challenge will be a proper review on what that’s
delivering. So, not just to say they’ve made changes, so
it’s all okay, but to look at whether they’re actually
making the sort of difference that they say they expect and that we
certainly expect in terms of the numbers of people who are offered
places, as I say, without compromising on quality. So, I think, in
the past, there’s been this idea that we’re asking them
to compromise on the quality of their applicants; that absolutely
isn’t what we want, and I don’t accept that
that’s the real reason why we haven’t done better at
recruiting Welsh-domiciled students into Welsh medical schools.
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[20]
Caroline Jones: Finally, studying medicine hasn’t
always attracted people from deprived backgrounds or
harder-to-reach communities, and I wonder if you could tell me: do
you have any plans to address this?
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[21]
Vaughan Gething:
Yes, the previous health Minister, you
may remember him, started a programme on widening access, and,
again, working with medical schools to look at how you actually
provide an experience to people from non-traditional backgrounds
before they get to university. So, there’s been a pilot
programme and that one’s carrying on, and I’d like to
see how much scale we could add to that as well. So, we already
recognise that it’s a challenge about getting people into a
medical career from broadly poorer backgrounds. I’m not
saying there isn’t talent—there’s lots of talent
still available, and that’s part of the frustration. We know
it’s part of the mission, both of the Government, but also of
the whole service, and, indeed, the two medical schools need to
take on board their part of the responsibility, because if you
don’t think that a career in the health service is for you
and it’s never offered as an opportunity, we shouldn’t
be surprised if we essentially self-select the same sort of people coming through.
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[22]
Caroline Jones:
Thank you.
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[23]
Dai Lloyd: Bethan nesaf, wedyn
Julie.
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Dai
Lloyd: Bethan next, then
Julie.
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[24]
Bethan Jenkins: Rwyf jest eisiau gofyn
cwestiwn clou ynglŷn â sut rydych chi’n gweithredu
fel Llywodraeth ynglŷn â recriwtio myfyrwyr cyfrwng
Cymraeg. Rwy’n deall bod rhai staff yng Nghaerdydd yn meddwl
bod hynny yn rhywbeth positif, ond bod rhai eraill efallai yn
gwthio yn erbyn hynny. A allwch chi esbonio sut ydych chi’n
gweithio gyda’r Coleg Cymraeg Cenedlaethol i ennyn mwy o
fyfyrwyr cyfrwng Cymraeg i fynd i mewn i’r sector yma yn
benodol?
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Bethan
Jenkins: I just want to ask a
quick question on how you operate as a Government in terms of
recruiting students who are Welsh-speaking. I understand that some
members of staff in Cardiff think that this is something positive,
but others perhaps are pushing against that. Can you explain how
you work with the Coleg Cymraeg Cenedlaethol to attract more
Welsh-speaking students to enter this sector
specifically?
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[25]
Vaughan Gething:
We recognise that the ability to speak
Welsh is a real care need in both health and care, so we will need
more doctors who have the ability to speak Welsh. It’s also
partly why I said that we need to attract people back into Wales,
because a number of those will be Welsh speakers. They are specific
skills that we would obviously want to make use of here that
aren’t necessarily going to be utilised if you have a medical
career in Manchester or in Newcastle.
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[26]
Part of our challenge always is: how do
we ensure that the attitude that I think you put your finger on in
medical schools and in medical training recognises that skill, and
recognises that, actually, from a Welsh point of view, we need to
have Welsh speakers within our medical cohort? Again, it’s
part of the area where I think we need to recognise that we
haven’t done as well as we could have done. So, it
isn’t an area of complacency—for example, in Swansea,
they’ll guarantee you can have an interview through the
medium of Welsh if that’s what you want. But, actually, it
isn’t just about the interview process—it is about the
teaching and the learning. Going back to the point about access,
it’s about how we make sure that people see that there is a
career for them.
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[27]
I don’t think it’s just about
the Coleg Cymraeg—I think it’s through the whole
education system and what people expect for themselves as they go
through, and whether they feel that their ability to speak Welsh is
a positive advantage, which I think it should be seen as. Again,
being perfectly honest, we would have to say that we don’t
think that we’ve made as much of an advantage of that, so
that students themselves recognise that that is a positive
advantage for them as well as for the whole service to attract and
retain those people.
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[28]
Bethan
Jenkins: Felly, a oes yna weithredu positif yr ydych yn gallu ei wneud
yn yr adran yma? Beth ydych chi fel Llywodraeth yn gallu ei wneud i
newid hyn, os ydych chi’n cydnabod ei fod yn broblem nid yn
unig ar gyfer y Coleg Cymraeg ond ar gyfer y system ynddi ei
hun?
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Bethan
Jenkins: Therefore, is there
positive action that you can take in this area? What can you as a
Government do to change this, if you recognise that it is a problem
not just for the Coleg Cymraeg but for the system in
itself?
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[29]
Vaughan Gething:
That goes back to the point about our
recruitment process to undertake medical training and at what point
people make career choices, because everyone around this table
knows that you don’t just make a career choice when
you’re filling out your UCAS forms—in my day; I’m
not sure what they’re called now. When you’re making
your choices at the age of 17 or 18, lots of people have already
made choices, or the illusion of choice is no longer there, because
we know that, actually, lots of people’s aspirations change
before they leave primary school. So, the idea that we can resolve
all of this just by concentrating on one point in someone’s
life journey I don’t think is right.
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[30]
There’s still something about
making sure that people understand, despite some of the
publicity—. This is a concern that the BMA and royal colleges
have, that the way the NHS has been talked about, not just in Wales
but broadly, will put talented people off wanting a career in
medicine. So, actually, there’s something about the
conversation that a career in the health service will be demanding,
but also really rewarding—earning money and actually a much
greater reward—and how we make clear, actually, if you think
that this might be something for you at a young age, how you
maintain that level of aspiration.
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[31]
There’s something here about not
just about this part of Government as well. It is about, through
education, through the new curriculum, what we expect people to see
from themselves and how they place value on themselves as well. You
and I both know from our time in student politics that, when
we’re talking about access, we’re talking about that
the reality of access is that, if you don’t get it right up
to the age of 12, you’re unlikely to get those people
back—it’s possible, but it’s much more difficult.
So, what do we do through primary school and into high school, and
then, in terms of whether people are making choices and saying,
‘I want to study in Wales, or I want to come back to Wales
afterwards’, how easy do we make it for them? I anticipate
that we’re going to on to attracting people who are part-way
through their training or postgraduate training later on, but this
is all part of the same point. So, at each point, we have to
understand what we are doing, how effective it is and what we can
do better, and that obviously involves me, the Cabinet Secretary
for Education and our officials as well.
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[32]
Dai
Lloyd: Ocê. Diolch yn fawr. Julie.
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Dai
Lloyd: Okay. Thank you very
much. Julie.
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[33]
Julie Morgan: Thank you. We’ve had quite a bit of anecdotal
evidence saying that very talented Welsh students have been unable
to get into Cardiff, for example, and have got places at other,
prestigious English medical schools, although, in fact, when
Cardiff University came and gave evidence to us, the percentage of
Welsh students getting an offer was much higher than I
certainly knew, so that was slightly reassuring. But I just
wondered if you had any comments about that.
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09:45
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[34]
Vaughan Gething: I wouldn’t be surprised if lots of
Members have got those individual anecdotes within their
constituency of people who are clearly bright, talented young
people who don’t get an offer of a place in Cardiff but do
get an offer in a medical school in a different part of the
country. Part of the challenge for us to understand is that it
isn’t that we would say that every person who wants to study
medicine and gets over the bar to the entry criteria will get a
place in Cardiff and Swansea, but it is about saying that we should
not readily accept that everything is fine and we couldn’t do
any better, and that goes back to the initial question. So, I
recognise that, and I’ve had instances in my own
constituency, with people saying, ‘Why should it be that my
daughter, from a part of the city that isn’t a traditional
entrance for medicine, who is predicted to get straight As,
couldn’t even get an interview?’
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[35]
So, I recognise that that’s a real feature in the story, and
it’s really about ensuring that medical schools respond
properly to that, in looking at their own admissions procedures,
and understand that we expect them to do better. As I say, you
could not expect this Government to invest further public funds in
expanding medical places if we are not certain that we’re
going to see Welsh domiciled students have a much better prospect
of receiving an offer to study medicine in Cardiff or Swansea. When
I say ‘Cardiff or Swansea,’ I mean those medical
schools; of course, undertaking their studies will take them into
different parts of Wales as well. But I welcome the progress
they’ve made—to be fair, they have made some, but more
to come.
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[36]
Dai Lloyd: Symud ymlaen—Dawn Bowden.
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Dai Lloyd: Moving on—Dawn
Bowden.
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[37]
Dawn Bowden: Thank you, Chair. We heard quite a lot in
evidence about medical school places and the rise in the numbers of
places available in England, and whether we were going to do
something similar in Wales. I notice in the evidence that you
submitted—your written evidence—that you talk about
this is part of your 10-year strategy, really, around workforce
planning. But it was the particular concern about whether we would
lose more students to England, which has already declared that it
will have more medical places—have you got any views and
comments on that?
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[38]
Vaughan Gething: The English and the Scottish systems are
looking to expand their numbers of places. The challenge will be
whether they can actually fill those places in medical schools and
whether they can fill those places in training as well. So, it
isn’t just the point at which people make their choices to
study—it’s then where they’re carrying on their
postgraduate training as well. As I’ve said, on the medical
places for study, I think I’ve been clear that, if
we’re going to have any expansion, we’ve got to be
clear about what the return is, in terms of people who we can
expect to stay, or to be from Wales, ever taking those places.
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[39]
When it comes to doctors in training, and the number of training
places we have—for example, on general practitioner
training—we need to fill our places first. The English system
has a big, bold plan to have 5,000 extra GPs. Nobody believes
they’re going to do that unless they recruit them from
overseas, which, given the mood music, is unlikely. In Wales, we
know there’s been a consistent campaign, and you’d
expect it from both the Royal College of General Practitioners and
the BMA, to say, ‘We need more GP training places and we want
more GPs to be training within the system’. The honest
challenge I’ve always given back to them is: I won’t
say that we’re going to expand our number of GP training
places unless, and until, we fill our current places—we have
136 available this year. But if we get close to—once we do
fill those, we can have a different conversation in the future.
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[40]
Dawn Bowden: So, can I just be clear about that—the
current level of school places that we have, we’re not
filling at the moment?
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[41]
Vaughan Gething: No, in medical school, we fill medical
school places, but the training that takes place after that, we
don’t fill all of those. We had a fill rate of—was it
75 or 79 per cent last year?
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[42]
Ms Rogers: It was 75.
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[43]
Vaughan Gething: Seventy-five per cent last year; it
compares well with other UK nations. So, they’re not filling
all of their training places after they’ve undertaken medical
school. The challenge there, of course, is: well, if you
can’t fill all of those places, why would you then expand
that part of the numbers? There’s a different conversation to
be had about places at medical school, because I think, if you
expand medical school numbers, you almost certainly will get people
who want to go—. But, like I said, that has to be a
conversation. If we’re going to put that resource in, what
does that ultimately produce? Are we training doctors who we think
are going to stay in the Welsh system, or do we think we’re
potentially just training doctors for the rest of the UK system?
So, we have to think about the whole package of it—not just
the places at a medical school, but what happens in training after
medical school and where those doctors will ultimately end up.
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[44]
Dawn Bowden: Okay. I guess that’ll come back to the
recruitment and retention questions that somebody else is going to
ask you later. Can I just ask you briefly, then, about the support
within Welsh Government for the development of a north Wales
medical school?
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[45]
Vaughan Gething:
Obviously, I’ve had several
questions on this in the Chamber and I remain
consistent—we’re looking at the evidence. There have
been a range of meetings that have already taken place with
stakeholders across north Wales—those who want to see a
medical school built as well as those who are already involved in
medical training. That does involve conversations with both Cardiff
and Swansea, because I’ve got an open mind about what we
should do. I’m interested in what we would do in terms of
having more medical school places available and what that would
look like. I’m interested in whether that is likely to result
in more people staying within the Welsh NHS and does that mean that
a new medical school is the answer, or does it mean that looking at
alternative arrangements is the answer. I’m certainly
interested in more people undertaking their training in north
Wales, or certainly a decent chunk of their training, because we
know that actually that is part of what has an impact on where
people then apply to undertake jobs afterwards.
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[46]
So, I’ve got an open mind, but
we’re still looking at the evidence and the views of
stakeholders. It’s taken a bit longer than I thought,
actually, so I’m not expecting to have a recommendation to me
until after the Easter recess, so we’ll be into summer. But,
certainly, when I get evidence and a recommendation, I expect that
this committee will be interested, as well as Members across north
Wales. So, it’s still on the agenda, but still the same
answer.
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[47]
Dawn Bowden: Thank you. Thank you, Chair.
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[48]
Dai Lloyd: Turning to trainee doctor places, Angela, you have
the floor.
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[49]
Angela Burns: Thank you very much indeed and thanks for your paper.
You referred, and, in fact, Dawn’s just referred, to the
10-year plan for the medical workforce. Can I just start off by
asking: what is the process for deciding how many trainee doctor
places there should be throughout the NHS in Wales?
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[50]
Vaughan Gething:
Do you want to take this? Do you want to
give the technical answer?
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[51]
Ms Rogers: Yes, certainly. So, we introduced a new process last
year, because what we’d uncovered was that traditionally what
the deanery had been doing on our behalf was rolling forward
similar numbers for speciality training in particular. So, what we
did was we brought together quite an inclusive group of key
interests to actually look at better matching the number of
speciality training places to the needs of the service and
particularly the shortage professions across Wales. We brought that
together last year—that produced a set of recommendations for
the Cabinet Secretary and then he took decisions around the
priority areas.
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[52]
So, building on that process for last
year, we’re into that process again this year and we should
get a set of recommendations before the summer. But it is trying
very much to target those areas where we know we’ve got
shortage specialties, and also looking at how we might actually get
a better match between training places and the needs of the service
in Wales.
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[53]
Angela Burns: So, just to make sure I’m completely clear, if
we were to take accident and emergency as a speciality subject,
what you’re talking about here is that you’re matching
the number of posts that you think will become vacant in the next
three, five, 10 years with the kind of training places that you
could put in there, because we’re basing this on the
assumption that where people might do their medical training and
their postgraduate training is where they will perhaps settle and
stay.
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[54]
Ms Rogers: Yes, absolutely.
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[55]
Angela Burns: That’s a decision of Welsh Government, or is
that a decision of the deanery?
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[56]
Ms Rogers: That’s the decision of Welsh Government.
It’s the Cabinet Secretary’s call, based on
recommendations from a group that includes the deanery, NHS
employers and Welsh Government.
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[57]
Angela Burns: Okay. I’ll tell you what I’m trying to be
really clear that I understand: the tensions between ensuring that
you have junior doctor training that is well-supported in a
hospital that does enough of whatever that person is training
in—psychiatry—for them to be able to get the training
that they need—the tension between that and filling gaps in
junior doctors in rural environments, and then also tying that in
with the fact that we’re trying to slightly—. I got the
impression from your paper that, in the long term, we’re
trying to just slightly pull away from just total specialisms all
the time and trying to build some more general practice back in,
and I don’t mean GPs, I’m talking about general
surgery, so that, when we get people going into hospitals,
there’s a slightly more holistic view of them and not simply
a specialist who looks at their small finger or something, because
that’s been the driver for the last x years, hasn’t it?
I wanted to understand how much influence you have, and how much
it’s about the deanery saying, ‘This is the way we need
to do it’ and how much it’s about the royal colleges
saying—the classic one is—‘If you’re going
to be a paediatrician, you must be in a place of 2,500
births.’ So, I’m just trying to kind of
understand that in order to understand how we get to where we need
our medical training places.
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[58]
Vaughan Gething: Yes, there are always tensions, and it
might be helpful to have Frank’s comments on a more
generalist approach to training, because a number of the royal
colleges have been very supportive of that approach. And
you’re right, there are always going to be tensions, and
that’s why, for example, we’ve developed a point about
having a proper education and training contract as part of our
offer to doctors in training, so there’s some certainty about
what is expected of them and what they can then expect in return in
terms of that protected time for learning, and that’s
actually been very popular. We’re the only part of the UK to
have something like that; we think that other parts of the UK are
looking at what we’re doing and actually recognising that
it’s positive. So there are a range of things where
we’re already taking steps forward where the rest of the UK
is looking to follow us. But there are always going to be tensions
about your training and your taking part in providing direct
patient care and what that looks like, and any decisions that the
deanery make at present on where training takes place and its
impact on service provision.
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[59]
It isn’t just the rural question; there are a range of
different questions in how we provide the right sort of doctors and
provide the right sort of service all across the country, whether
that’s in a specialist centre or whether it’s actually
a more generalist point as well. But, you know, the drive not to
have super-specialism as being the only game in town has been very
clear, and we’ve got a number of things we’re expecting
over the course of this year—you know, the Shape of Training
review and others as well. It might helpful if Frank tells you
where we are now and what we can expect over the summer.
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[60]
Angela Burns: But also, Cabinet Secretary, you haven’t
exactly answered my question, which is about who has that ultimate
decision making. That’s what I want to understand. Is this
driven by the Government’s desire to know where the gaps are
and fill them? Is it the royal colleges saying, ‘This is
clinical excellence; it overrides everything else’? Or is it
the deanery saying, ‘This is how we need to move the people
about the system’?
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[61]
Vaughan Gething: Well, we bring people together to make a
judgment call, because you have to try and balance those competing
demands and interests, because, sadly, Angela, we don’t get
unanimity on what the right thing to do is for the service.
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[62]
Angela Burns: No, but the buck stops somewhere, Cabinet
Secretary. Somebody has to make those final decisions, and I want
to drill down to who that is.
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[63]
Vaughan Gething: Well, ultimately, I made the choice.
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[64]
Angela Burns: So, it is a Government decision.
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[65]
Vaughan Gething: So, ultimately, the recommendations come
and then, ultimately, I have made a choice about what we’re
going to fund and where that’s going to be funded. But that
comes through the funnel of a process where you do have
stakeholders having proper engagement and involvement. But,
ultimately, you know, as in most things, it will end up on my desk
at some point.
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[66]
Angela Burns: So, how then would you cope the tension when a
royal college turns around to you and says, ‘Clinical
excellence dictates this’, but you don’t feel that that
actually serves the needs of the people? So, if I take for example
the Royal College of General Practitioners, if you press them a
little bit on the length of time that you might give to a patient
who wants to come and see you—it’s the 10-minute
window—you know, they’re quite soft on what that
clinical excellence should be, on what that standard should be. You
know, they’re prepared to accept that could move a bit,
whereas you get other colleges that are absolutely rigid and say,
‘Nope, if a junior doctor or trainee doctor does not go into
this kind of environment and do this type of thing, then they
won’t pass muster.’ So, I’m just trying to see if
there’s any way or what kind of negotiations are done with
the royal colleges to ensure that we have a correct balance between
clinical excellence and necessity of the population, or the needs
of the population.
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[67]
Vaughan Gething: Well, they’re part of the
conversation. So, it isn’t like they’re excluded; they
are part of that broad conversation that takes place.
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[68]
Dr Atherton: So, it’s a really important dynamic. You
know, as the Cabinet Secretary says, there is a training and a
service delivery aspect to doctors in training, and they have to
provide both of those, and the educational contract helps that.
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[69]
You’re absolutely right: the standards that are set by the
various colleges do impact on the training process, because the
deanery has a responsibility for making sure that training
placements are robust and meet criteria, and one of those criteria
is to take into account what the various colleges are saying. So,
that certainly has an impact, and we need to be mindful that,
really, the whole training programme has to be geared to the
population and the population needs of the future, really. So, you
know, we know that the population is ageing, that multimorbidity is
increasingly common, and so, that shift—to some of your
earliest points—from super-specialisation to more generalist
training is one that we recognise very clearly in Wales and we need
to move on, and we think that the ‘Shape of Training’
report is the right way to move.
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10:00
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[70]
So, we have to make sure that the doctors of the future are aligned
with what the population is going to need. But you’re right:
the various colleges do have an impact on the training programme
through the standards that they set. One of the discussions that we
have had with those colleges, and continue to have, is the extent
to which some of those quality standards apply in urban versus
rural areas, because that has a really big implication for us in
areas like mid Wales and north Wales of course.
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[71]
Angela Burns: My final question on junior doctor training
is: how well are we doing on that journey of trying to encourage
some more generalism within the specialties, if that makes sense?
Because, again, you were quite clear in your paper, and it was also
a point that was brought out by the previous committee’s
report into recruitment and training—it was one of the things
that were brought out—so I just wondered how well we are
doing with getting that, so that we get the orthopaedic surgeon who
has a good sense of the holistic needs of an individual. In fact,
the orthogeriatrician is perhaps an example of a specialism that
has that holistic bit added on, because their job is to send the
patient out completely well, not just with a fixed hip or whatever,
isn’t it?
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[72]
Vaughan Gething:
Again, to go back to the different parts
of doctors’ training, both their time at medical school and
what that looks like, what experience they get during that time, I
would expect that Cardiff and Swansea medical schools both talked
about changes that they have made to provide that sort of
experience. Also, when you think about the way that doctors are
trained, so that it will be consistent with what they can expect in
practice, so that you’re not training for a model that no
longer exists, so that you’re trained alongside other
healthcare professionals and that’s part of what you expect,
rather than, you get out, you finish your training, and you think,
‘Oh, I’ve got to work with these people that I’ve
never met before but I’ve only read about.’ So,
that’s part of the training.
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[73]
It is also then about understanding when
you actually go out and undertake that postgrad training where
people want to go, and about making sure that those opportunities
exist, because of course some people want to be generalists and
they recognise that that’s the move, and some people want to
work in rural healthcare. It’s about how we ensure that we
positively promote that. Again, you’ll see that some of the
successful recruitment activity is about positively promoting what
is different about that place to get people interested in working
there. So, that is part of our conversation with doctors in
training about what they think works and what they think we can do
better.
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[74]
For example, we had recent awards for the
first time for doctors in training—a very inspiring and very
interesting evening. The deanery made it clear that they want to
talk to those people again about why they felt that they were doing
particularly well and what they felt worked, and equally what they
felt didn’t work so well. So, there’s still something
about understanding and listening to doctors in training as well as
us having a view. I think we’ve got a clear enough view. I
don’t think people would misunderstand where we want to go,
but we need to actually listen to the current and the future
workforce to say, ‘What does it look like to you and how can
we improve on it?’ That’s being properly
self-critical.
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[75]
Angela Burns: But you think that that journey’s quite
successfully started now, the journey to the—
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[76]
Vaughan Gething:
We’ve started, but we’re
certainly not complete.
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[77]
Dr Atherton: Just a couple of examples, I suppose. Foundation
years 1 and 2 training, when people come out of medical school, are
a really important time, because that’s when people are
starting to firm up on their career choices. So, building more
general practice into that has been a positive thing, I would say.
Core medical training, so that people develop general medical
skills as well as their specialty interest, is really important as
well. Again, you’re right to point out that it’s the
geriatricians and the GPs who have that broad range of skills and
they are a good model as to how we align the medical workforce with
the future needs of the population.
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[78]
Angela Burns: Thank you.
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[79]
Dai Lloyd: Ar gefn hynny, achos fe gawsom ni dystiolaeth yn
rhai o’n sesiynau tystiolaeth blaenorol. Er enghraifft, yn y
cynllun hyfforddiant meddygon teulu yn Wrecsam, mae mwy o feddygon
yn ceisio am lefydd nag sydd o lefydd ar gael. Nid oes llefydd gwag
ar gael ym mhob man, wrth gwrs; mae yna effeithiau lleol, yn amlwg.
Nid wyf yn gwybod pa rôl sydd gennych chi fel Llywodraeth i
nid jest cymryd y syniad bod wastad llefydd gwag mewn hyfforddiant
meddygaeth teuluol achos, yn amlwg, mewn o leiaf un cynllun, mae
yna ormod o feddygon yn ceisio am y llefydd. Ar ben hynny hefyd, pa
ddylanwad sydd gennych chi fel Llywodraeth, o gofio bod 40 y cant o swyddi arbenigwyr mewn ysbytai yn wag? Pa rôl
sydd gennych chi, felly, fel Ysgrifennydd y Cabinet, o ran hyrwyddo
bod y colegau proffesiynol yn gwneud rhywbeth ynglŷn â
hyn ar fyrder? Rydym wedi clywed tystiolaeth, er enghraifft, gan
Goleg Brenhinol y Radiolegwyr am eu dymuniad i ddatblygu imaging
academy, er enghraifft. Byddai hynny’n fodd i ddenu mwy o
feddygon ifanc i eisiau bod yn radiolegwyr, er enghraifft. Pa fath
o gyfarwyddyd a chefnogaeth y bydden nhw’n debygol o’u
cael, felly, gan y Llywodraeth yn hynny o beth?
|
Dai Lloyd: On the back of that, because
we had evidence in some of our previous evidence sessions. For
example, in the GP training scheme in Wrexham, there are more
people applying than there are places available. There aren’t
vacancies available everywhere, of course; there are local impacts,
of course. I don’t know what role you have as a Government to
not just take this idea that there are always vacancies in GP
training, because clearly, in at least one scheme, there are too
many applicants. Also, what influence do you have as a Government,
bearing in mind that 40 per cent of specialist posts in hospitals
are vacant? What role do you therefore have, as Cabinet Secretary,
to encourage the professional colleges to do something about that
urgently? We have heard evidence, for example, from the Royal
College of Radiologists about developing an imaging academy, for
example. That would be a way of attracting more young doctors to
want to be radiologists, for example. What kind of guidance and
support would they be likely to have from the Government in that
regard?
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[80]
Vaughan Gething:
I will deal with a couple of different
points in there, Chair. On the point about GP training places and
where, physically, people can be located, I would always want to
look at, if there is oversupply and if there are more people who
want to undertake training than is available in those training
practices, how we try and manage that. That’s actually got to
be a solution that GPs themselves are part of, of course. They will
often have ideas about how that could work, as opposed to simply
expanding those practices that are there. I actually think that the
clusters have been very helpful in getting GPs to work in a more
collegiate way—to recognise that it is in their own interests
for there to be that broader partnership.
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[81]
On the overall numbers of GP training
places, I said before—and it goes a bit back into the
comments I was having with Dawn—that if we get somewhere near
to expanding, we can look again at places, and if, this year, we
thought there was an oversupply, well, I would want to be as
flexible as possible in accommodating those people who we think are
over the line in terms of quality and to whom we would want to
offer a place, rather than saying to five people, for the sake of
argument, ‘We are full, so go somewhere else.’ There is
something about trying to be pragmatic within our overall resource
envelope.
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[82]
On the specific point you make about an
imaging academy, well, that’s part of what we want to do.
We’re awaiting a business case. We would like to see it
happen, and it would help us in a number of ways, both in terms of
our capacity, as well as in delivering the sort of workforce we
want—and, again, people undertaking that training within the
sort of environment in which we want them to work. So, we
don’t have any difficulty with the Royal College of
Radiologists pushing that as part of the answer. It’s part of
what I expect to see happening and coming through, because it is
part of what the agreement over the south Wales programme was
supposed to be. As ever, there’s a challenge about pace on
these matters. I imagine that Members around the table, as well as
myself, would be a touch frustrated that we haven’t been able
to do more at a faster pace than we have done. But, we are very
clear that that’s the direction we want to move
in.
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[83]
Dai
Lloyd: Diolch yn fawr. Jayne Bryant sydd â’r cwestiynau
nesaf.
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Dai
Lloyd: Thank you very much.
Jayne Bryant has the next set of questions.
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[84]
Jayne Bryant: Thank you, Chair, and good morning, Cabinet
Secretary. I would just like to focus on our recruitment and
retention, particularly of GPs. Employment preferences, as we know,
are changing, and there is more move to part-time working. We had
evidence that there was less desire to become a partner in a GP
practice, and the importance of work-life balance came across in
much of the evidence that we had. Do you think that NHS Wales is
responding well to these changes?
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[85]
Vaughan Gething:
Well, this goes back to NHS Wales and our
conversations with independent contractors. The BMA and the royal
college of GPs have been really clear that they want to see the
independent contractor model continue. I know that you will all
have been lobbied by those organisations about the value of the
independent contractor model. The honest challenge is that we all
recognise—and the BMA at the recent local medical committees
conference recognised—the point that you made, in fact: there
are new entrants who don’t want to work in exactly the same
way. What we can’t do is say that the independent contractor
model is the only valid model to provide medical services. But, it
is about how we make sure that we are flexible enough about the way
in which we organise and deliver general medical services with and
for the public.
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[86]
It will be the case that the independent contractor model, for the
foreseeable future, will deal with the overall majority of care.
But, for those who don’t want to fall exactly in that, how do
those independent contractors employ other doctors on different
terms and conditions? Some of the announcements that I made
recently at the local medical committees conference, I think, will
be helpful, about a range of terms and conditions around that. But
it is also about some of the newer models for organising general
medical services—so, the federation that is taking place in
Bridgend, and the moves in south Powys regarding a community
interest company. There is a range of GPs that are looking on with
real interest at what that looks like. Again, going back to
clusters, the way in which clusters are organised and how they
employ not just GPs, but other staff. So, are those going to be
people that are housed in the health board, effectively, as the
employer, or will there be an opportunity—? If the federation
appears to work in Bridgend, that could be a model that would allow
GPs to employ other members of staff, other healthcare
professionals, and what does that then mean for employing GPs on a
different basis as well? Because we’d want to be more
flexible about the GP workforce and how they can be employed,
because, otherwise, the challenge is that we’ll fill those
places and that need in agency and locum terms, which is expensive
and doesn’t then properly allow people that want to have a
career in medicine but on different terms to actually undertake
that career in a way that makes sense for them and their family,
often.
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[87]
Jayne Bryant: Thank you. With the backdrop of those
challenges that you mention, you mention the importance of being
flexible, but what more can we do to ensure that working as a GP,
working in general practice, is seen as an attractive option for
people, not just to recruit into that, but to retain? Because, some
of the evidence that we had, it was pretty startling to hear about
the retirement age, particularly for female GPs. So, how can we
ensure that it’s attractive for those going into it, but
still attractive for those people who should remain in it?
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[88]
Vaughan Gething: Well, there’s something there about
people’s expectations are different. If you’re a GP and
qualified some years ago, you might have had different expectations
at the start of your career about what you would expect to do, and
the commitment you would expect to give the job, and that was
normal. I think it’s quite healthy that people expect to have
a life outside work, and that goes for men and women in the
profession as well. And it is then about making sure that
employment models and practices reflect that. We’re talking
of people who aren’t always direct employees of the health
service here. In fact, in general practice, the great majority of
people—GPs at least—are not direct employees,
they’re contracting. So, it is a conversation with those
organisations that provide medical services about how we can help
them and how they can help themselves to make sure that, from an
employment point of view, it’s attractive. Equally,
there’s then that point about what does a career in medicine
look like and how is that attractive: that is the opportunity to
work with different professions, that is the way that people have
conversations with health boards and with Government, and
there’s all those different things around it to really
highlight that there’s actually still a really positive
career to have in medicine, there’s a really rewarding career
to have in medicine and in general practice, and there’s an
understanding of some of the very real workforce pressures.
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[89]
That difference that people might want to
undertake, whether it’s an academic career as well as being
in general practice, there’s more flexibility and opportunity
to do that. We need more GPs with special interests. That will help
us on a range of things, for example, when we talk about community
cardiology, part of the reason that’s been successful in
rolling out is there are a number of GPs with areas of special
interest. And, actually, that’s part of what should make
medical and general practice interesting for people—not just
seeing people on your list for 10-minute appointments, but actually
the opportunity to do something else as well—and I think it
will enhance our ability to reorganise and re-engineer the service.
Because, if we want to see services move from secondary to primary,
we’ll need GPs with that special interest and they’ll
need to be supported in a different way to undertake that part of
their career as well. So, it is very much seeing the whole picture
and not just one narrow part of it, because, of course, that gets
into other healthcare professionals and what they can do to take
part of that work away from GPs, to make sure they’re left
with something they will generally find more interesting and
rewarding. But the supportive environment question really does
matter, and it’s part of the reason we invest so much time
and effort and energy into our relationships with GP
stakeholders.
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[90]
Jayne Bryant: Thank you, Cabinet Secretary. I think Frank mentioned
about post-foundation year doctors experiencing GP work. Do you
have anything you’d like to add on that or are there any
other ideas to get doctors to experience this before perhaps taking
up a career as a GP?
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[91]
Dr Atherton: Well, you know, it starts at school, doesn’t
it? And I think, again, the experience here of the universities
reaching out to schools and getting pupils who have a potential
interest in medicine as a career into general practices so they
actually see what’s happening, I think that’s a really
good thing. In FY1 and FY2, making sure that people have
opportunities to look at general practice as an attractive career
is really important. I think part of challenge going forwards is to
break down the old silos in working in the medical profession, both
between specialties—we talked about the move towards
generalism—but also between hospital doctors and primary
care. I think that’s a very unhelpful divide, and it still
exists to some degree, and I think we need to narrow that. So,
giving people more exposure to general practice generally, and
making sure that clinicians work across that divide, will be very
important going forwards, as a way of working and a better way of
meeting the needs of our population.
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[92]
Dai Lloyd: Just on the back of that, would you agree that for
hospital speciality training—in other words, going to
be a consultant—that it would actually be advisable to
actually undergo a period of training in general practice,
regardless of whether you end up in general practice or not?
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10:15
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[93]
Dr Atherton: I’m not sure that putting a requirement
would be the right way to do it. I think there are other ways of
making sure that clinicians, through their training process, are
working with GPs, and really understand and respect how GPs work.
In my career, what I’ve seen is that the isolation of
consultants within a hospital sometimes leads to that division,
which can be problematic and which doesn’t help to
co-ordinate patient care. There are great models, I think, in
Wales, of where, for example, paediatricians work out in the
community in some of the areas around Cardiff, and that has helped
to build alliances and to streamline patient flow, and the patients
get a better experience. So, I think more work on that kind of
model would be helpful, Chair.
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[94]
Dai Lloyd: Good. Angela, on this point.
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[95]
Angela Burns: Yes, just to follow up on the Chair’s
point, slightly. We’ve had quite a bit of anecdotal evidence
that GP training can sometimes be really fraught, and, because
there’s so much pressure out there, that the trainees are
very much in the firing line, and it tends to be a bit of a baptism
of fire from time to time. I just wondered who monitors the
training of a junior doctor in a community post of any sort.
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[96]
Dr Atherton: Well, the deanery is responsible for training
overall, and they do monitor, and they have annual surveys, and of
course we get headline figures on that, and Wales tends to do
fairly well on trainee surveys, overall. But, where there are
concerns, trainees are able to raise those with the deanery, and
the deanery does consolidate those and feed them back so that
Government can then have a conversation with the local health
board. So, there are escalation processes that support that.
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[97]
Angela Burns: Thank you.
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[98]
Vaughan Gething:
I’m sure you’ll be aware of
the survey evidence on the quality of training and feedback
directly from doctors in training. I think, the last two occasions
when the four nation surveys have been undertaken, Wales has
finished top in terms of people’s satisfaction with their
training. It doesn’t mean to say there’s no room for
improvement, but I wouldn’t want to give the impression that,
actually, training is an awful experience for doctors. There are
real challenges in the profession, but we’re doing well when
it comes to people’s experience of training in general
terms.
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[99]
Dai Lloyd: Yes, and that’s reflected in the evidence
we’ve had from the junior doctors here. They’ve all
been very impressed with the quality of training in
Wales—very positive vis-à-vis training in other parts
of these islands. So, that is part of our evidence base. Moving on,
Julie, you’ve got the next fleet of questions.
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[100]
Julie Morgan: Yes, I think I’ll go on to the junior doctors
contract, and I wondered what you felt the effect had been in Wales
in the fact that we haven’t imposed a contract here.
We’ve had mixed messages, actually, but I’d be
interested to know what you felt.
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[101]
Vaughan Gething:
We took a deliberate decision, which I
absolutely believe is the right one, not to impose a junior doctors
contract. I think it was deeply unhelpful to go down the imposition
route, and every time I meet a group of junior doctors, the anger
is palpable towards the UK Government. I think it is incredibly
short-sighted, not just for now, but in the longer-term damage in
relations between the UK Government and doctors, and you see that
seeping into the conversation with consultants as well. It would be
desirable, though, to have a contract that was broadly similar
between the four nations, because, actually, mobility between the
four nations, broadly, is a good thing for us. Because, actually,
we recruit and encourage doctors from England and other parts of
the UK to come here as well, so having contracts that are not
massively different is something of an advantage for us, but that
doesn’t mean that we’ll simply do whatever England
do.
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[102]
And in some areas of speciality there are
particular challenges, because the contract that is being rolled
out now in England, some speciality areas have significant
financial incentives, and so we need to think about what we do in
response to that, because otherwise there is a real risk that we
potentially get outmuscled in recruitment, just on the financial
terms. We’re still not really clear about the cost for the
contract and that’s part of the challenge. I’m not
clear that, if you asked the Department of Health, they would be
able to tell you exactly what the total cost of the contract will
be and how that’s going to be worked out and paid for, and I
certainly don’t see that flowing over our border in massive
consequentials for the Welsh NHS. But, as I say, I think we did the
right thing in not imposing. We’re trying to learn
from what is already happening in England because they’ve
imposed a contract in a number of areas. We’ll know more
through the rest of the spring and the summer as to what that looks
like and the real impact, but we’re determined to ensure that
the future for junior doctors in Wales and any contract is done via
a process of negotiation, and that’s been very well received
by junior doctors here, and it’s certainly been recognised by
junior doctors on the other side of Offa’s Dyke.
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[103] Julie
Morgan: So, you don’t actually have any plan at the
moment. You’re waiting to see how things go.
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[104] Vaughan
Gething: No, we are. We offer regular meetings with the British
Medical Association, and it shouldn’t be a surprise that
their junior doctors representative has been part of those meetings
that we’ve had. Again, we’re expecting there to be more
from the BMA—feedback from their own membership base about
what the junior doctors contract looks like, in practice, in
England. So, yes, we’re expecting to continue those
conversations with the BMA to understand what that really looks
like, and what we should then do here in Wales. Because there
isn’t a view that we should just do nothing forever and a
day, but it is about understanding what the real impact is and,
actually, when the contract rolls out into larger areas of the
junior doctors workforce. What’s been interesting is, for
example, that one of the areas where they’ve already got
financial incentives, histopathology, which has been a problem for
us, we think that we’ll get very near, if not completely,
filling our own training places here. So, we need to understand why
we think that is. Is it that because people value the different
approach that we’re taking here and that, actually, the
short-term gain for some of the financial rewards on offer for that
particular area of challenge and speciality isn’t enough to
persuade people that that’s where they want to work?
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[105] Julie
Morgan: Certainly, the Welsh Government’s approach was
generally welcomed, but there were some concerns about the
specialties where there were bigger payments in England.
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[106] Vaughan
Gething: Yes, and to be fair, the BMA are interested in talking
to us about those areas because they don’t want to get into a
position where they’re saying to the Welsh Government,
‘We don’t want you to do anything’, and not
recognising the fact that, for some speciality areas, you may need
to do something as an interim point, if nothing else. But,
certainly, I think there’s an understanding that, at some
point, we will need to get into much more material conversations
about the junior doctors contract here. But they will be
conversations and negotiations, and we won’t have an air war
conducted through the pages of the press where we’re
effectively denigrating doctors and the job that they do.
That’s part of the reason why they’re so angry, because
junior doctors are angry. In fact, they think that the UK
Government misused statistical evidence. It’s generally upset
an awful lot of people. I don’t think you could overstate how
angry and upset people are, still.
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[107] Julie
Morgan: Thank you. To move on, we have heard evidence about the
possible need for some trainees to move to England to have some
specialty training. The deanery’s evidence expressed concern
about the risks to joint training programmes with England. So, have
you got a view on this and any plans about how you’re going
to develop the links with England?
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[108] Vaughan
Gething: Yes, but we have some reciprocal arrangements in
training. I guess that north Wales is probably the most helpful
area to put that across—you know, going east and west and
into north-west England for some of the speciality training.
That’s been much more helpful for doctors in training
themselves. There is a challenge, though, about the English system
wanting to have a properly co-operative relationship with us.
We’d want to see further progress made. I don’t want to
use today as an opportunity to try and make things difficult,
because I think there is real benefit for the Welsh system in
having some of those where it seems to work, but it is about making
sure that the landscape of the contract, that that doesn’t
get in the way of what should be a sensible training relationship
that works for both Wales and for England. It’s in our
interests for doctors in England to be well-trained and content as
well. We think there should be advantages to coming into Wales that
don’t simply rely on saying that you’re being
mistreated in England. That isn’t a long-term strategy for
persuading doctors to come to Wales and stay here and be generally
happy with their career in medicine. So, yes, there are sensible
and practical relationships that exist already, and, yes, we expect
those to continue.
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[109] Julie
Morgan: Thank you.
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[110]
Dai Lloyd: Reit. Diolch, Julie. Symud ymlaen. Bethan,
mae’r cwestiwn nesaf gyda ti.
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Dai Lloyd: Thank you, Julie. Moving on
to Bethan with the next question.
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[111]
Bethan Jenkins:
Ie, jest cwestiwn ynglŷn â
hyfforddiant ar gyfer modelau gofal newydd. Mae yna dystiolaeth gan
goleg y seiciatryddion—gan Broffessor Keith Lloyd—yn
dweud nad yw modelau ar hyn o bryd yn gynaliadwy, a bod angen newid
hyfforddiant i gyd-fynd â’r cyd-destun newydd o
ddelifro ar gyfer gwasanaethau newydd. Rydw i jest eisiau deall os
ydych chi yn cytuno â’r farn honno, a sut mae
hyfforddiant yn newid er mwyn hybu pobl i allu gweithio o fewn
ysbytai, ond hefyd o fewn cymunedau. Oherwydd rydw i’n credu
beth roedd e’n trio dweud oedd nad oedd digon o staff
arbenigol ar lawr gwlad, efallai, i wneud y gwaith hynny yng
nghyd-destun y modelau newydd.
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Bethan Jenkins: I have questions on
training for new models of care. There is evidence from the college
of psychiatrists—by Professor Keith Lloyd—that says
that models at the moment aren’t sustainable, and that there
is a need to change training to correspond with the new context of
delivering new services. I just want to understand if you agree
with that view, and how the training is changing in order to
encourage people to work in hospitals and also in communities.
Because I think what he was trying to say was that there
weren’t enough specialist staff at grass-roots level,
perhaps, to undertake that work in the context of the new
models.
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[112]
Vaughan Gething:
Yes, we recognise there is a need to
change the way that doctors’ training works. As I said
earlier, you can’t expect someone to be trained for one model
of patient care and delivering that, and then going out and finding
out that, actually, there’s a very different expectation. It
is the same Professor Keith Lloyd who’s also the dean at
Swansea, and I was in Swansea recently opening part of the new
college of human and health sciences, and, again, they’re
deliberately looking at training people in a multi-professional
environment, and that’s really important. It’s
important for those other healthcare professionals, the other
therapists and nurse practitioners, and it’s important for
doctors in training as well. So, I wouldn’t disagree with his
assessment. It’s part of the challenge for us as elected
representatives, actually. If we accept that models of care are
changing and need to change, then that means the way that
healthcare is delivered will change as well. All of us will
know that we’ll get asked from time to time to stand up for
and defend what currently happens, and to say that, actually, we
don’t need to change we’re currently doing. I actually
think that in lots of healthcare we really do, because it’s
in the interest of the staff and ultimately the patients who rely
on the services. So, when you go into, say, GP training practices,
I think that you would expect now, compared to, say, 10 years ago,
more therapists working in and around that service. There’s
been a proper turnaround—turnaround is the wrong phrase, but
I think there was a concern from the BMA and the royal college of
GPs that the drive to have more therapists and nurse practitioners,
advanced nurse practitioners and advanced paramedics in and around
primary care was a desire to simply exchange people where there
should be doctors. I think there’s now a greater recognition
that, actually, it’s a good thing to have a multidisciplinary
team, and they need to work in different models. That means that
the numbers of GPs—. You need to look at how many you
need—and you do need to have GPs leading those teams and
working alongside people—but also that you can safely and
properly have other healthcare professionals undertaking large
parts of that patient care. So, if that’s what you’re
going to experience in reality, then the way that you train as a
GP, for example, should reflect that too. So, I have no difficulty
at all in agreeing with what Keith was saying.
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[113]
Bethan Jenkins:
But do you think it’s changing fast
enough? I can only use my personal experience, because I
haven’t heard the evidence here, I’m afraid, but for
example, in Port Talbot, GPs are now having to—and I think in
other parts of Wales—take on phone triage because of not
having enough GPs. If a nurse or another practitioner could be put
into that practice in a timely fashion, then that would then
potentially alleviate the GPs from having to do this. Because,
quite often it’s not out of choice, it’s because
they’ve been forced into doing this. Is the system changing
fast enough, knowing that GPs are retiring now, and that we are
facing a potential crisis in this particular area—that we can
then filter new and different types of staff into GP practices that
can aid them in their work? Because, at the moment, we see pockets
of that happening very well where the health centres have changed
in what they do and what they provide, but in other areas of Wales
the progress is very slow on that.
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[114] Vaughan Gething: That’s part of the challenge of working with
GPs and other primary healthcare professionals. You mentioned the
telephone triage in Port Talbot; I went to the Neath pacesetter,
and it was really interesting talking to the GP who’s running
the service there and her view on what it means in terms of a
better use of GP resources. She thinks a telephone triage is a good
thing, and she would prefer to have a GP doing telephone triage.
You have GPs who then see people and GPs who do the telephone
triage and see people as well. Those resources are used and,
actually, they’ve then got a hub where they’ve got
other healthcare professionals—physiotherapy being an obvious
example, but also mental health provision, as
well—where they can refer people to as well. And her
very clear view is that that’s the future. She was upfront
about the fact that she thinks the challenge in GP numbers is part
of the driver for doing that, but in any event, even if it wasn't,
this is a better way to make use of GP resources, and ultimately
it’s a better service for the public.
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10:30
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[115] She was
completely honest about the fact that not every healthcare
professional was an enthusiastic champion for changing the way that
they have always worked, and that not every member of the public
was initially delighted about it. But, you know, that’s part
of the challenge of change: not everyone enjoys it and will sign up
to it. But then in a different part of Wales, in Brecon, for
example, they have nurse triage and they think that works for them.
So, there's something about understanding what we need to do
consistently, what could that and should that look like, and then
how do we persuade people to come with us, bearing in mind that
lots of people we’re talking about in primary care, GPs in
the great majority, are independent contractors, and we can't
simply say, ‘You will’. So, it isn't quite so simple in
terms of command and control. We don't have that direct
relationship with lots of these people, but I think the best
champions for change are GP leaders themselves who can talk about
their experience in general practice and why changing the way that
they work has made a real difference and how and why it’s
positive and the downsides that do and don’t come with
it.
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[116] Because
I’ve got responsibility, of course, and there are occasions
when I think I might even be persuasive, but it's much more
persuasive to hear a fellow GP talk about their job and how it's
changed, and why they think it would be a better reason and a
better path for other GPs to take on the same sort of working
practice. That's why we deliberately draw people together in
clusters, it’s why we have opportunities for clusters
themselves to talk to each other, it's why we held a national
primary care event last autumn and it's why I want to repeat that
this autumn to make sure that momentum happens, because I don't
think you can just rely on the incidental sharing of good, better
or best practice. I think we need to give it a real push, because
otherwise, my concern about pace comes in. You may have great
models of care that aren't being taken on in other parts of the
country, and you potentially have something falling over before you
do something different, and I don’t think we should do that.
We should choose to do things, not allow change to happen to us
because it comes at a time of crisis.
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[117] Bethan
Jenkins: But that's what I'm trying to say, really. I'm not
saying that phone triage is necessarily a bad thing, but they feel
forced into it. So, you’re having these discussions, but how
are you doing it in a strategic way, so that you can
identify—whether it’s a rural area, whether they have,
say, more cases of an eating disorder in one area so that they
would be able to have more specialisms in that area? How are you
forming an opinion nationally on that, but talking to them,
obviously, not forcing them to change? How is that working so that
we don't get to a position where surgeries are just having to close
because the GPs are retiring and there's nobody else there to take
up the job?
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[118] Vaughan
Gething: Well, some of this is about people's appetite for
change. You know, let's remember that we’re dealing with
human beings here; not every one of them will want to carry on and
work differently. We would rather that they did, and that's why I
say the most persuasive people to have that conversation are the
GPs who have changed the way that they work. I wouldn’t say
that people are being forced in to working differently, but the
health service always has to work differently, because what comes
through the door changes and because our ability to do things
changes sometimes positively and sometimes less so.
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[119] But, you know,
if we’re going to have that—. We do have that
conversation nationally. The team here, they talk to stakeholders
in the royal college as well as the BMA. And, to be fair, there's a
proper constructive relationship with those partners as well. It
certainly isn’t the case that Charlotte Jones comes and
agrees with every single thing that we say. But there’s a
proper conversation that takes place. There's a conversation with
primary care leaders in different health boards, there's a
conversation that goes into the ambulance trust as well. So, that
conversation does take place, but the reason why I asked for a
national event last autumn and why I want to have another focus
again is that there's got to be a clear focus about the importance
of primary care and the importance of primary care change, because
if we don't choose to change primary care then change will happen
to us and we'll be left firefighting, which is the wrong thing to
do. And, again, it's about bringing forward and making sure there
are deliberate opportunities, not just for the government to say,
‘This is our view on what should work.’ But, actually,
so that people running and leading those services—GPs and
their healthcare colleagues—actually have a deliberate
opportunity to talk to each other about what is working.
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[120] So, you know,
the different drivers exist and are there. There’s the stuff
that we can put into the contract where we require people to work
differently. You know, the new and enhanced services that were
announced recently—that's a change. There's also the drivers
about people recognising that, when there’s a different way
for you to use the money you've got within your clusters, you then
make a choice about whether to change and re-engineer your service,
and actually understanding what someone a few miles away is doing
with a broadly similar population. Because if you work in rural
healthcare in mid Wales, there'll be other practices in mid Wales
doing different things, and in north Wales, and actually at the top
of the Valleys—there’s huge rurality there as well. So,
this isn’t just a geographic challenge in one part of the
country. The proof will, of course, be in how quickly we see change
and whether we see improvements in GP feedback and healthcare
professional feedback on what they’re doing, as well as some
of the more objective measures we have about the number of patients
that get seen, how quickly, and then what their outcomes ultimately
are as well. I think that's much more difficult territory to
measure outcomes in primary care in many instances. I'm convinced
that were moving in the right direction, but I wouldn't tell you or
anyone else that we can be completely satisfied that everything is
working as it should do. There's certainly no time and no
opportunity to put your feet up and relax.
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[121] Dai
Lloyd: Symud ymlaen tuag at y
diwedd nawr. Dawn.
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Dai Lloyd: Moving on to the end now.
Dawn.
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[122] Dawn
Bowden: Thank you, Chair. You spoke very positively in your
evidence, and we've also had some positive evidence presented to
us, about the Train, Work, Live campaign. So, I just wanted to
explore a little bit more with you about how that’s
developing and what you've seen as being the key successes of that.
Have there been any failures, really, or do you feel that it's so
far produced the results and you're carrying on the same vein?
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[123] Vaughan
Gething: I'm really positive about Train, Work, Live, because
that's the direct feedback we've had from the people we’re
targeting. The additional interest we've had in Wales—. We
can probably give you some of the facts and figures on the social
media profile in particular areas that we’ve targeted as
well. The challenge will come in converting that interest into
people who want to undertake places, either to train or to work
permanently in Wales. We had a focus on all three aspects: train,
work and live—so, what it is to train in Wales, what it is to
work and the opportunities of working in a different system and to
be positive about our differences, say, to England, for example,
but also to live in Wales. Because, in the past, I don't think
we've properly sold what it is to live in Wales and actually the
life you can have outside work as well as your life in work.
There's got to be a balance in all of those aspects, but we'll
review again through the rest of this summer how successful
it’s been, because the next stage of Train, Work, Live is
going to be a launch immediately ahead of the Royal College of
Nursing congress, and then we'll have an event there in terms of
looking at nurse recruitment—Train, Work, Live for them. And
then we'll have other healthcare therapists and another focus on
them in the third stage of the campaign later in the year. We'll
also be looking to gear up to go back to the British Medical
Journal's careers fair this autumn as well. So, it isn't a
single-shot campaign. It is about learning what's worked and been
successful.
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[124] Dawn
Bowden: And presumably you'd be quite happy to look at other
campaigns that have worked well. We did hear evidence from north
Wales about some particularly unorthodox kind of campaigns that
they were running, with some success. Now, whether that would work
everywhere—but you'd be happy to look at—
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[125] Vaughan
Gething: Oh, definitely. I suspect you may be talking about
Linda Dykes, who is a proper force of nature. She worked at looking
at what it is to live in north Wales and the opportunities to do
that and to work in a different way—so, a proper focus on
mountain medicine: ‘You can do all these different things by
living here as well as an opportunity to work in this
environment.’ So, it is about looking at the job as well as
looking at the opportunities to live somewhere as well. Even if you
don't have the specifics of that particular offer—it may be
different in Pembrokeshire, for example, and would be different,
say, for someone who wants to live or work in a city. Because some
doctors don't want to work in a rural environment; others
positively do. So, it is about understanding the different parts of
the message, how that’s focused, and what learning
we’re taking on board.
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[126] Dawn
Bowden: You’re tailoring it where need be.
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[127]
Vaughan Gething: Absolutely, yes. And that's definitely
what's been done in north-west Wales. You can't replicate Linda,
but what you can do is understand the quality of leadership and
what that does for a whole workplace environment, having a team
where people do generally feel supported and that radiates out.
People are happy to confirm that’s the environment in which
they work, and that point about positive thinking: ‘How we
can make sure to job matches up with what people will expect, and
to make it the best possible fit for the job, and then how do we
say you've got all these other opportunities too. So, you can learn
a lot from what she's done successfully, and you can take lots of
that out and say, ‘How do we then make sure we have the best possible prospect to replicate
that in different parts of Wales?’
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[128] Dawn
Bowden: Yes, okay. Thank you, Chair.
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[129] Dai
Lloyd: Okay. Julie.
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[130] Julie
Morgan: Thank you very much, Chair. What assessment has the
Welsh government made of the effect of leaving the EU on the
workforce?
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[131] Vaughan
Gething: I think this is a really big risk for the whole
national health service, not just in Wales. In our White Paper,
we've been really clear about the impact on a whole range of
workforce challenges. I'm sure you'll be aware of the evidence from
both the BMA and the survey that they undertook, and also the GMC
undertook their own survey on doctors and EU nationals working in
the UK. They don’t feel as valued, they’re more
uncertain about their futures and significant numbers of them are
thinking about leaving. That’s a really big problem for
us.
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[132] We’ve been
talking about the challenges in medical recruitment and what that
looks like now, with those doctors currently working, providing
direct high-quality care with and for our communities. If numbers
of them leave, well, there’s no guarantee we’ll replace
them readily and easily because the impact of leaving the European
Union isn’t just on recruiting European Union nationals; it
is something also about how other doctors from outside Europe see
this country as well, and whether they feel welcome. Because part
of the evidence also is that other doctors who are not originally
from Britain don’t feel welcome and valued either. I think
we’ve been really clear as a Government that we value those
people not just because they provide high-quality healthcare
services, but actually they’re a part of the communities that
we live in, and they’re a part of this country.
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[133] I think the
challenge is, if the message is, ‘You’re welcome here
for a period of time, but we want to train lots of our own people,
then you can go home’, I think that message came out in the
autumn from the UK Government and I think that was deeply
unhelpful. That resonates and that is felt in other parts of the
world. If you look at some of the press in India, for example,
that’s been really, really unhelpful. And there’s a
real tension here between what health departments want and some of
the different policy drivers, for example, in the Home Office,
where there is an honest challenge about what the Home Office want
to do. And you’ve seen the recent issue about having charges
made for healthcare professionals coming in from outside Europe as
well; well, that’s deeply unhelpful, deeply unhelpful. It
sends out the wrong message about whether people are welcome and
whether we want them to be here or not. We know we have recruitment
challenges that we need to address and part of addressing that is
about recruiting doctors from outside Europe and within it, so
it’s a really poor message on that front, but also at a time
when everybody knows there are challenges about NHS finance, to
then say, ‘The NHS will have to pay an additional sum to
recruit people who want to come here to provide patient services
that we all recognise that we need’, I think it’s
incredibly unhelpful and short-sighted.
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[134] So, I generally
do worry about the reality of Brexit as the national debate
continues. Because the national debate is not a kind one; it is not
a generous one. The fact that European Union nationals do not have
their rights as citizens guaranteed still, I think is, again,
deeply unhelpful. And, again, this Government has been really clear
that we think that European Union nationals should have their
positions confirmed. It should not be used as a bargaining
chip.
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[135] As I said,
there’s real anger—very real anger—and very real
upset on this. So, this is not a synthetic point that is used for
the purpose of bashing the UK Government or that is a
party-political point of view, it’s real and it’s
obvious. I know that if you talk to politicians in other parties
they’ll say, ‘Well, those people have said that to me
as well.’ Simple anecdote: I went to north Wales on Monday,
early journey on the train, and I met someone that I know who,
again, told me very directly that as a Dutch citizen he
didn’t feel welcomed in this country in the way that he had
felt completely accepted in previous years. It’s a real
problem. We can’t properly assess the impact though, because
we don’t know what’s going to happen.
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[136] Julie
Morgan: Do you feel that this delay in knowing what’s
going to happen is making things more difficult?
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[137] Vaughan
Gething: Well, we want certainty. I think certainty for the
position of EU nationals would be really helpful and would go some
way towards undoing some of the unnecessary damage that I think has
been done. But the challenge with certainty is that some people
ask, ‘What is a good and a bad deal?’ But, actually,
because none of us know what the UK Government really wants to
achieve, we can’t know. And that uncertainty is not going to
be helpful in terms of people who are currently here and will make
choices about whether they stay or whether they go and try to
practice medicine somewhere else, as well as our ability to recruit
and retain people who are not here already. So, I’m due to
meet the BMA to talk specifically about this issue in the coming
months, but I think it’s incredibly difficult and it’s
done real damage to healthcare right across the UK, not just in
Wales. We’re going to live with this challenge for a period
of time because, unfortunately, I don’t think there are
grounds to be wildly optimistic that we’re suddenly going to
see helpful certainty created by the UK Government, despite the
very clear view, not just of this Government, but others, and of
politicians in all parties, that this is something that the
Government could and should act on now.
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10:45
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[138] Julie
Morgan: And then just to end on a positive note on ways of
welcoming people from overseas, I know you’re aware of the
British Association of Physicians of Indian Origin, and we had
evidence to the committee by the health boards saying how positive
their initiative was. Do you think there’s space for a lot
more of that sort of work to be done, and also to be done to
recruit possible GPs?
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[139] Vaughan
Gething: Yes, the relationship with BAPIO is incredibly
positive. They’re genuine partners who want to do the very
best for Wales and at the same time, they’re proud of the
fact that they’re doctors of Indian origin, so they want to
talk about their links into India, as well. They’ve been
really helpful on the medical training initiative, which is about
bringing more high-quality doctors from India to undertake
training, and it brought us some service provision at the same
time. So, I would like to see a relationship that looks and feels
like BAPIO with all of our doctors, including the doctors from the
European Union, because they recognise that they’re valued
and they value the access that they have both to Frank and to
officials in Julie’s department, to discuss what they’d
like to do, because they want to make the very best possible case
for people to come and train and work within Wales and to train and
work within our national health service. So, yes, a really good
example of what the future could look like and what I would
definitely want the future to look like with doctors from within
the European Union, as well as outside.
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[140] Julie
Morgan: Thank you.
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[141]
Dai Lloyd: Bethan, a oedd gennyt ti gwestiwn?
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Dai Lloyd: Bethan, did you have a
question?
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[142] Bethan
Jenkins: [Inaudible.] to expand on this a bit, just in
relation to finding out, not just about taking people in, but in
relation to how our medical professionals have a chance,
potentially, to work internationally so that they can go and
practice a specialism and then bring that back. How are you mapping
potential areas of development in Wales in certain areas, so that
you can have a two-way process as opposed to us talking negatively
about losing people? How are we sending people away and then
bringing them back with more skills, so that they can develop the
Welsh health diaspora in that regard?
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[143] Vaughan
Gething: Well, given that we’ve had someone return from
an international career to return to the UK system with the CMO,
and not just your own experience, but actually what we’re
already doing, so, I think Frank will be a helpful person to answer
that.
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[144] Dr
Atherton: There are a number of dimensions there. I mean, one
of the things I’ve been very impressed with in coming here is
the Wales for Africa links and the fact that the various health
boards do have ongoing quite deep links with various programmes and
projects in parts of Africa, and that’s a really positive
thing. I was very pleased to see that local health boards have
generally taken the guidance from Welsh Government to make those
opportunities available to staff, to give staff leave of absence
and to make sure that their indemnity arrangements are covered when
they do that. So, that’s one kind of dimension to it.
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[145] There’s
also a need to look at academic links and opportunities for doctors
here to look to other parts of the world—to the US and to
other developed countries—to go and gain experience there,
and there is a study—
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[146] Bethan
Jenkins: And, you’re using that as part of the
recruitment process, is what I’m trying to say, so that
people, when they try for a job here, can see that they’ve
got that potential to go and work abroad for x amount of time, and
it’s a sweetener, potentially, to come in and work in the
NHS.
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[147] Dr
Atherton: It’s a good idea. I’m not aware of any
specific initiatives around that, but it’s certainly
something that can be built in, because the more
‘sweeteners’ as you put it, the more opportunities that
you build into the programme, the more attractive it becomes.
We’ve talked a little bit about leadership. Doctors often
want to step into the leadership space, but they find it difficult
to do that, and so, we have a culture again, in Wales, of building
leadership training into postgraduate training. For some doctors,
that’s very attractive. There are international fellowships
that physicians from Wales can opt into—the Harkness
fellowship in the US is a good example. So, I think it is an area
that we need to probably explore more in terms of giving people
rounded opportunities and again making Wales a very attractive
place.
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[148] Vaughan
Gething: Do you want to talk about the global health posts, as
well?
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[149] Ms
Rogers: Yes, okay. Just to add on to that, really, and to
reassure you that when we were compiling the evidence and the
business case for the Train, Work, Live campaign last year, what we
did discover was that, actually, we’d not been terribly good,
I suppose, in promoting the things that are on offer in Wales.
Traditionally, we just relied on people finding out about it
through the deanery. So, one of the aspects of the campaign was
actually unearthing lots of these things that we do have on offer.
But, there’s more to do on that, I suppose, and with the
second phase of the campaign, it’s something that we’ll
be emphasising more strongly, because, certainly, a lot of the
feedback from junior doctors is that, actually, they want that
experience more broadly. They want to be able to go away, they want
to be able to travel, and if we can incorporate training with
travelling, that would be fabulous. So, that is an aspect of it.
But we do have posts available, and there are global health posts
that we do advertise and provide those opportunities to people to
apply for those, and those are proving very successful and
attractive.
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[150]
Dai Lloyd: Grêt. Jest dau bwynt bach i orffen sydd yn
deillio o dystiolaeth rydym ni wedi ei chael yn flaenorol—
eto, rwy’n mynd yn ôl at feddygaeth deuluol. Wrth gwrs,
mae yna ddigon o dystiolaeth ei bod hi’n anodd iawn cael
locums fel meddygon teulu, ac un o’r cwestiynau a
godwyd gan rai o’r meddygon iau yn gynharach oedd beth
ŷch chi’n ei feddwl am alluogi meddygon iau sydd yn F2s
i weithredu fel locum GPs. Nid ydyn nhw’n gallu gwneud
hynny ar hyn o bryd. Roeddwn i jest yn meddwl a fuasech chi’n
credu bod hynny yn fodd i helpu’r sefyllfa. Ar ben hynny, pan
fydd gennych chi feddygon teulu sydd yn aeddfed ac yn gyfiawn yn
feddygon teulu, ond wedi bod yn gweithio yn Lloegr neu bellach i
ffwrdd a ddim yn gallu dod nôl ar y rhestr perfformwyr
meddygon teulu yma yng Nghymru, pa waith sydd yn mynd ymlaen i
wneud yn siŵr—? Mae rhai ohonom ni ar y rhestr
perfformwyr yma yng Nghymru sydd ddim yn annhebyg, y buaswn
i’n disgwyl, i’r rhestr perfformwyr meddygon teulu yn
Lloegr, ond, ar hyn o bryd, os ydych chi ar y rhestr honno, nid
ydych chi’n gallu bod yn gweithio yn fan hyn a’r ffordd
arall draw. Pa waith sydd yn mynd ymlaen yn y cefndir jest i
helpu’r sawl sydd eisiau dod nôl i Gymru fel meddygon
aeddfed i allu gwneud hynny?
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Dai Lloyd: Great. Just two points to
finish, deriving from the previous evidence that we’ve
received—again, going back to general practice. There’s
enough evidence showing that it’s difficult to get locums as
GPs, and one of the questions that came up from some of the junior
doctors was what do you think about allowing F2 junior doctors to
be locum GPs. They can’t do that currently. I was just
wondering whether you thought that that would be a way of helping
the situation. In addition, when you have GPs who are mature and
are full GPs, but have been working in England or further afield
and can’t come back to be on the performers list for GPs here
in Wales, what work is ongoing to make sure that—? There are
some of us on the performers list in Wales that is not dissimilar,
I would presume, to the performers list for GPs in England, but, at
the moment, if you’re on that list, then you can’t be
working here and vice versa. So, what work is ongoing in the
background just to help those who want to return to Wales as mature
GPs to be able to do so?
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[151]
Vaughan Gething:
On the point about GPs returning,
we’ve done all that we can to make it easier for people to be
based on both performers lists in England and in Wales. It’s
not as easy as we’d like it to be, and it does require some
co-operation from colleagues across the border. But in terms of
people returning, not just from England but from other parts of the
world, that was something that, to be fair, GP representatives
themselves brought up, and it’s something that Richard Lewis,
our head of primary care, has taken on board as well, in terms of
trying to make that process easier, so we have a single point of
contact so you don’t need to go and run around the houses to
find out what’s going on. The initial view, I think, is that
that’s been helpful, and we’ve got specific examples of
doctors who are returning from working internationally, who are
coming back, and that process appears to be smoothing the process
for that to happen. So, rather than anecdotes, we should have some
more evidence about that developing through the rest of this
year.
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[152] I guess, just
while we’re on the GP training posts, I should say we expect
to have numbers at the end of March from the first round. So, I
don’t know when you’re planning to do your report, but
I did want to just indicate that. When you’re planning on the
drafting of it, I’m happy to share those numbers with you so
they can be taken account of in your report, as opposed to us
providing the numbers the week after you’ve published your
report, which you might be frustrated about.
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[153] Dai
Lloyd: We look forward to receiving that evidence. About the
point about F2 locums.
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[154]
Vaughan Gething:
I’m happy to consider it.
There’ll be a lot of things about, ‘Well, what would
make sense?’ and, actually, because these are people who are
already providing some direct patient care—so it’s
about making sure that we can do something that would help from a
service point of view, without compromising their ability to
undertake training and all the points about making sure that we can
reassure ourselves and them about the quality of care that is being
provided. But I’m certainly open-minded.
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[155]
Dai Lloyd: Angela had one final question.
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[156]
Angela Burns: Just one clarification, because I’ve had
representations that the issue isn’t just a performers list
between Wales and the rest of the UK, but between health boards, as
well, and that you have to be logged with—if you are, for
example, a GP or whatever in, say, ABMU and you’ve been asked
to go over and do some hours with Cardiff and Vale, then
you’ve got to have made sure that you’ve registered
with them and that whole process. If that’s correct, would we
not be better off to have a national register that would just work
across all health boards, without having this duplication of effort
and time?
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[157] Ms Rogers: I’m happy to take that. We have made some
changes in the last year, and I think we need, really, to promote
those, so, hopefully, speaking about it today will help with that.
We have streamlined the processes. The Cabinet Secretary referred
to the single point of contact, which makes it much easier for
people. What we are doing now is, actually, once we know somebody
who needs to come back, we’re putting them on the list
straight away and that list is being managed on an all-Wales basis
by the NHS shared services partnership, so there is a list for
Wales. But what there are, though, is individual employment checks
for individual health boards at the moment, so we’re looking
at how we could streamline that and make that simpler.
We’ve cracked it for junior doctor trainees in the GP land,
but we haven’t yet done it for those people who are already
qualified. So, it’s a work in progress, but we have made
efforts to streamline it already, and to hold that as a single
point of contact for the whole of Wales.
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[158] Angela
Burns: Have you got any idea of when that might occur? Because
one of the points that has been made to me is that GPs are not fond
of all the extra paperwork, and therefore there’s a
reluctance, if you’re already a GP, established somewhere, to
fill in another health board’s endless paperwork and another
health board’s endless paperwork. That would surely free up
hours very, very quickly.
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[159] Ms
Rogers: Absolutely. So, portability of those applications is
really important and that’s something that we have. We have a
consistent standard and a consistent set of forms. What we’ve
done is we’ve cut those back considerably. So, in terms of
getting back onto the performance list, that’s being
streamlined and we’re looking now at the things like the
disclosure and barring service checks and the health and safety,
and those sorts of things that need to be done where people are
being directly employed. As much as we can streamline, it’s
really important to do that.
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[160]
Dai Lloyd: Diolch yn fawr. Dyna ddiwedd y sesiwn
gwestiynau. A gaf i ddiolch yn fawr iawn i Ysgrifennydd y Cabinet,
Vaughan Gething, a hefyd ei swyddogion,
Julie Rogers a Frank Atherton, am eich presenoldeb, am y papur
gerbron a hefyd am ateb i’r cwestiynau mor raenus y bore yma?
Diolch yn fawr iawn i chi.
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Dai Lloyd: Thank you very much.
That’s the end of this session. Could I thank the Cabinet
Secretary, Vaughan Gething, and also his officials, Julie Rogers
and Frank Atherton, for being here, for the paper you submitted and
also for answering the questions? Thank you very much.
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[161]
A gaf i jest cadarnhau y byddwch
chi’n derbyn trawsgrifiad o’r trafodaethau jest
i’w wirio a gwneud yn siŵr ei fod yn ffeithiol gywir.
Nid ydych yn gallu newid yr agwedd ynglŷn â dim byd, ond
o leiaf fe fedrwch chi wirio’r ffeithiau. Diolch yn fawr iawn
i chi.
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I would just like to confirm that you will
receive a transcript of this meeting, just to check for factual
accuracy. You can’t change the view on anything, but you can
check the facts. Thank you very much.
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10:56
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Papurau i’w Nodi
Papers to Note
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[162]
Dai Lloyd: Rydym ni’n symud ymlaen at eitem 3,
a’r papurau i’w nodi. Bydd Aelodau wedi darllen y
llythyr oddi wrth Rebecca Evans, y Gweinidog Gwasanaethau
Cymdeithasol ac Iechyd y Cyhoedd, sy’n hysbysu’r
pwyllgor ei bod yn bwriadu cyflwyno gwelliannau’r Llywodraeth
yn ystod Cyfnod 2 i wneud y newid y gwnaethom ni ei argymell fel
pwyllgor, sef y dylid diwygio adran 92 o Fil Iechyd y Cyhoedd
(Cymru) i godi’r cyfyngiad oedran arfaethedig ar gyfer
triniaethau tyllau mewn rhannau personol o’r corff o 16 oed i
18 oed. Mae hynny’n ganlyniad cadarnhaol i ni fel pwyllgor,
ac yn deillio yn union o’r dystiolaeth a wnaethom ni ei
derbyn gerbron.
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Dai Lloyd: We’ll move on to item
3, papers to note. You will have read the letter from Rebecca Evans, the Minister for Public Health and
Social Services, notifying the committee of her intention to bring
forward Stage 2 amendments to make the change that we recommended
as a committee, namely that section 92 of the Public Health (Wales)
Bill be amended to raise the proposed age restriction for intimate
piercing from 16 to 18. That’s a positive outcome for us,
directly arising from the evidence that we received.
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[163]
Mae yna ail bapur i’w nodi
hefyd gan y Gweinidog, a byddwch chi wedi gweld ei bod hi wedi
derbyn rhan fwyaf o’r argymhellion hynny hefyd.
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There’s a second paper to note from the
Minister, and you will see that she has accepted most of those
recommendations as well.
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10:57
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Cynnig
o dan Reol Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd
Motion under Standing Order 17.42 to Resolve to Exclude the
Public
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Cynnig:
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Motion:
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bod y pwyllgor yn penderfynu gwahardd y cyhoedd o
weddill y cyfarfod ac o eitem 1 o’r cyfarfod ar 23 Mawrth yn
unol â Rheol Sefydlog 17.42(vi).
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that the committee
resolves to exclude the public from the remainder of the meeting
and for item 1 of the meeting on 23 March in accordance with
Standing Order 17.42(vi).
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Cynigiwyd y cynnig.
Motion
moved.
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[164]
Dai Lloyd: Felly, gyda hynny o drafodaethau, a gaf i,
gyda’ch caniatâd chi, gynnig, o dan Reol Sefydlog
17.42, ein bod ni’n penderfynu gwahardd y cyhoedd o weddill y
cyfarfod yma, ac y bydd y trafodaethau ynglŷn â’r
dystiolaeth heddiw yn cario ymlaen ar ffurf sesiwn breifat? Diolch
yn fawr iawn i chi.
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Dai Lloyd: So, with that, could I then,
with your permission, move on to item 4, a motion under Standing
Order 17.42 to resolve to exclude the public for the remainder of
the meeting and for the discussions on the evidence to carry on in
private form? Thank you very much.
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Derbyniwyd y cynnig.
Motion
agreed.
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Daeth rhan gyhoeddus y cyfarfod i ben am
10:57.
The public part of the meeting ended at 10:57.
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