Renewal for the NHS in Wales : Does Plaid Cymru have the answer to the North Wales healthcare crisis? : An Interview with Siân Gwenllian, AM
A Gordian Knot is a complex problem that needs to be solved by lateral thinking. The term's origin is ancient - coming across an undoable knot that an oracle had predicted would only be loosened by a man who would then conquer Asia, Alexander the Great (although he hadn't earned the 'Great' bit at this point) pondered it, then sliced it open with his sword.
In North Wales healthcare is a Gordian Knot - Betsi Cadwaladr UHB is still in special measures, a whole string of GP surgeries across the region have been taken over, and more are under threat of collapse - in essence because no doctors want to replace those leaving. There is also a persistent and enormous spending deficit - itself in part due to the churn of medical staff, and the use of expensive locums where permanent staff should be.
If you are unsure if healthcare is already an unstable and stressed system in North Wales, find a frontline member of staff and ask them.
Primary care is an especially acute concern. A recent Royal College of General Practitioner survey suggested 40% of GPs across the UK plan to retire, or otherwise leave medicine, in the next five years; demographics may make this even more acute in North Wales. Even 20% of GP trainees do not expect to be working in their chosen profession in five years' time.
Holding a very sharp sword in front of a very knotty problem, new Plaid Cymru AM Siân Gwenllian has put a strong case for a North Wales Medical School as a key step to solving the regional health crisis - only to be rebuffed by WAG Health Minister, Vaughan Gething as the summer session of The Assembly drew to a close. She has also campaigned prominently for Welsh language access in primary care.
We spoke to Siân - to understand more clearly her position, and how she plans to proceed following this apparent setback. As it is an important issue, and her answers very clear, the interview is reported verbatim. We started discussing language access and services, but the conversation rapidly broadened:
FtM: "You have campaigned recently, and very visibly, for first language Welsh speakers to be able to access a Welsh speaking GP. The answer may be obvious - but why do you feel this is so important?"
SG: "You are referring to the situation in Penygroes. There are currently three GP practices in that village serving the whole of Dyffryn Nantlle - a large geographical area. One of those practices is closing as the GP is retiring and not being replaced. I have a general concern about the level of care that will be available once this happens; will the two remaining practices be able to cope with the extra workload?"
"Added to that the retiring GP is the only Welsh speaking doctor in the area, so there will be no Welsh speaking service. The reason that is important is because 70% of the people in that area are first language Welsh speakers - up to 90% in some of the communities."
"People find it easier to discuss medical problems through their mother tongue. This is especially important to the young and old; many of the youngsters in those communities won't be learning to speak English until they go to school, and maybe then won't be fluent and confident until they are 7 or 8. Older people, especially with memory loss or Alzheimer's - those people can lose their acquired second language, and just have their mother tongue as the only language that they speak and understand. That can present fundamental communication problems when accessing services - and therefore care might not be as good as it could be."
"To give you a concrete example, I do know of a difficult case in another area of Gwynedd where the language issue in an elderly gentleman's case meant he was not treated correctly; there was a wrong diagnosis. This is not just a theoretical issue but very real. There is also definite research to support the impact of language issues on care, especially around dementia."
"The principle is important too. There is a statutory right for people to be able to access medical services in the Welsh language when they need them."
FtM: "Does this Penygroes issue tie in with your medical school campaign?"
SG: "Yes, the Penygroes issue has shown that there is a general lack of GPs in the area. This is definitely not just about Welsh speakers. The Health Board is having immense difficulties in GP recruitment, including recent stories from Criccieth and Abersoch - it's across Wales, especially rural Wales. It is an acute problem. The Health Board is also finding it difficult to fill consultant posts - a lot of the posts in hospitals are filled by locums."
"Having a medical school based in the area where the need is most makes perfect sense - evidence has shown from other countries that where you base your medical school is where the doctors stay - they develop roots, build up networks, and naturally spend their career in the place. Until we get this in North Wales it is hard to know how the crisis will be addressed. If we don't train doctors in the area we won't fill the posts."
FtM: "You have had a lot of support for this idea - has that surprised you?"
SG: "No, not at all, because it's the logical answer to the crisis. When we are canvassing and talking to people in our surgeries problems with the health services are always at the forefront of people's minds and concerns. The lack of doctors and all the knock ons that come from that - when you offer a practical solution which makes sense on so many levels, it resonates with people, they understand the tangible effect of building a medical school."
FtM: "Why do you think the idea was rejected?"
SG: "That is a good question, and although I have sent Vaughan Gething a set of questions to try to find out, I haven't had the chance, with the announcement so close to the end of the Assembly session, to get any answers directly."
"All we have had is a very sparse statement - which says there is no need, and suggests the cost is too high, which I would dispute because of the current very high locum spend and the potential savings from that."
"The response was sparse and insulting in its lack of detail. We understood a business case was being worked on. The rejection statement doesn't even refer to this business case. I want answers - and I will pursue it until I get some; I want to know the cost analysis they are working with. Just a statement saying it isn't going to happen isn't good enough."
"We will be continuing with the campaign until we get the result we want, the one the region needs."
FtM: "If this isn't done, and what you are asking for isn't done with real financial and genuine political commitment, how do you see the future of the health service in North Wales?"
SG: "It is very worrying, very concerning. If there isn't some movement at least, a start made - the beginnings of a medical school - it is very worrying. I, and Plaid Cymru, will be campaigning and pushing for this to happen. It can't be left."
"It needs commitment and political will behind it, because that is not there at the moment.... to me it is symptomatic of the way Labour can take North Wales for granted."
FtM: "You feel there is an underlying sense of unreality around how the issues are looked at?"
SG: "Very much. It is at crisis point now. When we (Plaid) say this we are accused of being dramatic - but I think we have reached a real crisis point in the North Wales NHS. To see no immediate case for a medical school is nonsensical."
She finished by saying emphatically:
"(The current response to the problem) is not good enough, and that's why we won't stop pushing for the solution. I'm not one to give up easily!"
And I do not think she is.
It is evident talking to Siân Gwenllian that the language issue is vital to her and many of the communities she represents, but it is a specific aspect of a much wider problem; understanding it has led her to alarming conclusions and finally, a workable resolution - and she is not going to let go of that insight or its logical demand for action.
In conversation Siân Gwenllian is open and honest, with an intimate, deeply compassionate knowledge of the issues. She has the support of The Royal College of Physicians. As far as it is possible to deal in absolutes, it would appear she is right in her position. In this instance Gwenllian and Plaid Cymru, from working in communities, have understood fully a difficult question and have found the answer that cuts through all the complexity.
Practically and politically healthcare in North Wales is in an explosive situation - if not dealt with radically and decisively it will detonate in this Assembly term or, at the very latest, the next. It looks like a crisis that is real and that is going to get worse. It looks like half measures won't do.
Feasible, seemingly affordable and urgently required, a North Wales Medical School is essential. Maybe not sufficient on its own, but a major part of a creative solution to otherwise intractable problems. Yet it seems, in some quarters, that those very problems - and the sheer gravity of the situation - are not yet fully acknowledged.
At the very least, Siân Gwenllian knows a difficult, tangled knot when she sees one.