Now, we all know, of course, that areas like Blaenau Ffestiniog and its surrounding district pose problems. There's always going to be a tension with the provision of health services in sparsely populated rural areas, but the models that have been chosen are more related to what is appropriate for urban areas rather than rural areas. In urban settings, of course, the tendency is, for very obvious reasons, to pull services together into community healthcare hubs, but in rural north Wales it has been in the other direction. What we should be doing is pushing services into rural areas to gain the patient outcomes without too great a loss of financial efficiency. What we have seen is a very substantial expenditure of money in Blaenau recently—well over £1 million, I believe—but not a single bed is created; we've created dozens and dozens of desks for national health service pen-pushers instead. So, they closed the memorial hospital and replaced it with an office block. That is not what we expect from a health service, and the poor residents of Blaenau and district deserve a great deal better than that. 

Other countries seem to be able to manage to do this. Why can't we? In the United States, rural areas have long enjoyed support and protection from the Rural Health Clinic Services Act of 1977, and the Federal Office of Rural Health Policy and the National Rural Health Association provide a mechanism for rural health campaigners to receive significant support in their interface with Congress.  

We know that there is something called distance decay—that is, the further away you live from a hospital the worse the health outcomes tend to be, because people find it much more difficult to get to hospital so they don't go for treatment in time and regularly enough. There are problems with poverty in rural areas. People have to pay to travel to hospitals that are a distance from their homes, so they don't have a free health service because it actually costs them a great deal of money often in order to get the treatment that they deserve. 

In Scotland, there are some more imaginative models than we've got here in Wales. For example, in the Isle of Skye, they have a model of rural practitioners where the Broadford Hospital is staffed by GPs with additional skills and training in anaesthetics and trauma. The model was developed after a consultation with the local community, and the realisation that the size of their community, which was about 13,000, had a need for some emergency service but couldn't sustain a general hospital. Instead, the Broadford is now an enhanced community hospital. Why can't we do that in Blaenau? The previous health Secretary refused to intervene in the closure of the hospital services in Blaenau because it was supported by the local community health council, but, of course, the local community health council is not elected by anybody in the area that is covered by the hospital closures. That's why we need to introduce the kind of democracy to the health service that Michelle referred to.