THE HERALD FRIDAY FEBRUARY 3 2017


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fundamental level of care based on unpaid family carers, informal community networks, befriending and other support provided largely though the third sector and non-statutory provision such as leisure and libraries (Tier 1). For those who have needs which


cannot be met purely by community, universal and prevention support early intervention and reablement services will be designed to avoid the necessity for specialist intervention, encouraging people to recover their independence within the community. All of this sounds uncontroversial


Neil Hamilton: 56% of GPs plan to leave or reduce their hours in the next five years


“In dementia, people tend to


lose last thing they’ve learned. That includes language. People can speak Welsh as a first language and lose the ability to speak English as the illness progresses. “This is why there is a need


for medical services in the Welsh language in health and social care.” Alun Lenny related the how a


counsellor went to see a home in England, where someone whose first language was Welsh lived. Their family were not able to speak Welsh, and thought he had lost the ability to speak. When the counsellor spoke Welsh, they were able to respond immediately in Welsh.


DIGITAL EXCLUSION Despite the roll out – still


continuing – of ‘superfast’ broadband across Wales, there remain pockets of rural Wales where broadband of any description, let alone ‘superfast’, remains something hoped for rather than expected. Not spots for mobile phone


coverage still exist, and the costs of rolling out broadband to Wales’ more isolated and sparsely populated areas remain a burden upon those who need it the most. An ‘internet coast’ is a fine ideal, the existing project to avail all of Wales’ residents of superfast broadband ahead of the much-vaunted City Region deal and the dubious benefits of Growing Mid Wales are, however, hopelessly adrift. 60% of Ceredigion homes eligible


for superfast broadband had received it by the time of the original project deadline last summer. Currently, 13% of farmers still don’t have reliable access to the internet and 60% of those with a connection only have speeds of 2mbps. With support services, information


Table B


Te savings could be significant as the data below show: BUDGET 2013-14


Carmarthenshire £


Tier 1 Tier 2 Tier 3 Total


2,478,078 4,803,373 29,786,957 37,068,408


% 7


13 80


Ceredigion £


1,213,338 892,962


9,629,600 11,735,900


% 10 8


82


Pembrokeshire £


2,278,561 2,183,095 16,556,858 21,027,514


% 11 10 79


Health Board £


613,214 869,000


20,734,242 22,216,456


% 3 6


93


‘Improvements in social care are needed throughout Wales’: Simon Thomas AM


and resources being increasingly available ‘digital-only‘ by default, it is increasingly important to support people in rural areas where broadband access is often patchy, but conversely where digital services (if accessible) could be transformational in reaching communities and individuals who might otherwise be left totally isolated. The Carmarthen East and Dinefwr


constituency ranked 649 out of 650 for broadband speed. Jonathan Edwards MP said: “Rural


Carmarthenshire has seen little to no improvement from the tens of millions of pounds invested on broadband. “As parts of Wales move ahead


to ultrafast broadband speeds, it is imperative that rural communities are not left behind.” Simon Hart MP told us: “Part of my


constituency in South Pembrokeshire was lagging significantly behind in superfast broadband provision. At the end of 2016, we are the seventh slowest area in the UK for average download speeds. “It is shocking that three quarters


of people are not getting the speeds that they are paying for,” he added. “I was one of them so I checked my contract and I was allowed to cancel it because the speed I was getting was significantly less than advertised. Broadband providers should be made to be clearer about what speeds will be in reality.”


HEALTH RESOURCES There has been a problem with


GP recruitment in west Wales for even longer than there has been a Hywel Dda University Health Board, although that is partly attributable to fewer and fewer doctors entering general practice across the UK. An examination of the Health


‘Rural Carmarthenshire has seen little to no improvement’: Jonathan Edwards MP


Board’s website going back several years reveals a number of initiatives seeking to recruit GPs to work in west Wales, while study of the Welsh Government website reveals any number of plans and policy announcements intended to encourage GPs to work in rural Wales. Speaking in the Senedd last


month, Neil Hamilton observed: “GP numbers are broadly static yet there’s a rising demand for their services. 56% plan to leave general practice or reduce hours in the next five years.” The First Minister said there were


more GPs in Wales than ever before and a recruitment drive had been launched last year. That response rather begs the question as to why there have been so many recruitment schemes and so many surgery closures, mergers, and an increase in GP practices being taken under direct control of the Health Board. One step the Welsh Government


has taken is the continuation of bursaries for student nurses. People who start training in September 2017, and are studying an eligible health- related course, will be able to get the help they need. The bursary will require them to commit in advance to taking up the opportunity to work for two years in Wales after they qualify.


HOW MUCH? A taste of how the Health Board


and local authorities aim to address the problems of paying for the care of an ageing population can be found in a report prepared by the Mid and west Wales Health and Social Care Collaborative, a body to which west Wales’ three councils contribute with the Health Board. That body suggests adopting


a new model of integrated health and social care services with the


and is no more than an extension of current arrangements; however, the conclusions indicate an increased reliance on third sector organisations (charities); development of a more diverse day opportunities market, including the stimulation of social enterprise to enable people to have greater choice and control in how they wish to be supported and pay for it. (Tier 2). The new model of service


requires a much stronger emphasis on the first level of care, comprising a combination of family carers and informal community networks. That decision will switch the


emphasis of service delivery away from traditional long terms services (Tier 3) towards services that ‘promote well-being and independence’ and are also cheaper (See Table B). Telehealth, remote clinics held


locally across the internet from a distant location, is held out as one solution for the problem of delivering rural healthcare. That rather depends on the resilience and speed of the rural broadband network and does


13 News


not tackle the problem of how people will either get to centres where Telehealth will be delivered or how they will access services if Telehealth is impractical.


TRANSPORT It’s about 55 miles from


Aberystwyth to Fishguard. The national speed limit of 60mph applies along almost the entire length of the A487. It will take a careful driver a lot longer than an hour to make the journey; a careless one will end up in a hedge or worse. Try to make that journey in much under an hour and three quarters in the rain and you will fail more often than succeed. A respondent to a 2010 survey


of rural areas reported: “The bus services are inadequate to allow for access to common services even if they existed. It is appreciated that this is a difficult problem to solve without substantial subsidies. It is virtually a necessity for the inhabitants of the community council area to possess their own means of transport, with a substantial number having two cars.” In the seven years since that


response, rural bus services have not increased, but markedly decreased. At the same time, rural communities have suffered a loss of local infrastructure, leading to isolation and difficulty in accessing services which have been centralised and moved farther away from smaller communities. With road project budgets in


rural Wales squeezed as billions are devoted to a metro structure and M4 relief road around Cardiff, it is difficult to perceive when and whether that situation will change.


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