Thank you, Deputy Presiding Officer. I’m grateful to Plaid Cymru for bringing forward this debate and for the generally constructive manner in which Members across parties have engaged. In Wales, we recognise that more than a quarter of our population are over 50, and this is due to rise by more than a third in the next 20 years. Inevitably, our ageing population will increase demand and put extra pressure on the health and social care system. In 2015-16, over half of all adult hospital admissions were for patients over 65. That accounted for over 70 per cent of the total bed days in our health service.

Hospital stays should, of course, be kept to a minimum, but here it’s appropriate to comment on some of the points made about delayed transfers. We have an improving picture here in Wales, in direct contrast to England, which has record highs—the highest figure since records began. What I’m pleased to see here in Wales is that health boards and local authorities recognise their shared challenge in this area, and it’s fair to say that hasn’t always been the case. There is room for optimism, as well as room for rigour and more challenge for improvement. We recognise that we need to ensure that older people are able to maintain their independence and focus efforts on returning people to their home with appropriate care and support.

So, the Welsh Government wants to make sure that health and social services work together to improve outcomes and the well-being of older people. In March 2014 we published our integrated framework for older people with complex needs. Now, that focused on ensuring the development and delivery of integrated care and support services for older people, particularly the frail elderly.

The intermediate care fund, mentioned several times in the Chamber today, has been a key driver for integration. The fund was established, as has been mentioned, in a previous budget agreement, to improve care and support services, in particular for older people, through partnership working with health, social services, housing and the third and independent sectors. This year, £60 million of funding has been provided, and we’ve continued with the fund and its existence, and this should continue to fund initiatives that will help older people to maintain their independence, avoid unnecessary hospital admission and prevent delayed discharges. There are successful examples up and down the country.

Members will be aware of the transformational Social Services and Well-being (Wales) Act 2014, which was commenced in April this year, and I was pleased to hear recognition of the legacy of the previous Member for Neath in delivering that piece of legislation. A key principle within this new legal framework is a requirement for integrated and sustainable care and support services. Now, though I’m sure everyone has read the regulations under Part 9 of the Act, they’ve established statutory regional partnership boards. These will drive the delivery of efficient and effective integrated services. They will not be bureaucratic talking shops. They will be a key part of making partnership real and delivering change on the ground.

Supporting statutory guidance sets out that these regional partnership boards must—not ‘will’ or ‘may’, but ‘must’—prioritise the integration of services in a number of areas. That includes a continued focus on older people with complex needs and long-term conditions, including dementia.

The second part of the motion deals with GP numbers and, as part of the compact to move Wales forward agreed with Plaid Cymru, this Government is focusing on increasing the numbers of GPs and primary health care workers across Wales. A key commitment includes delivering actions to help train, recruit and retain GPs, including in rural areas. We do now have more GPs than ever before, employed in different ways, but, in Wales, we are also filling more of our training places than England or Scotland. But we know that this is still a challenge, and they don’t fill all of our places. It’s a challenge to be taken on and dealt with, and not ignored. So, we will continue to listen to workforce representatives and other parties, as we do take this work forward.

I can also confirm, given the direct question, that I’ve already met with the Royal College of GPs and the BMA’s GP committee, and I look forward to a constructive working relationship with them. They, in fact, were very supportive of the measures the Government wants to take. Their key challenge for us is to deliver on the plan that they agree with.

So, we will continue to address workload concerns and support the development of new models of care. We also need to ensure that we recruit, train and retain other primary care professionals who can support GPs. Good examples are clinical pharmacists, nurses and therapists, for example physiotherapists, who are doing a great deal of work to make sure that people have their needs dealt with appropriately, within community settings and avoiding the need for people to go onto orthopaedic waiting lists. The challenge is how consistently we share that good practice, and I continue to want to drive that improvement throughout the whole system.

The role of the GP is, of course, critical, and the leadership role within those new clusters of arrangements, but there is broader recognition that their role has to evolve so that they can be used to the best effect to focus on patients with the most complex needs—as a number of people have said today and on other occasions, to do only what a GP can only do, to provide that leadership to the practice and also within cluster activity. I’m particularly pleased to see the broadly positive welcome that clusters have had, both from the BMA and from the Royal College of GPs, and we will take that learning forward over this next year and more.

I do expect services to shift into primary care and for resources to be shifted with them. We do recognise that the recruitment of GPs is a challenge, and it’s a challenge not limited to Wales. A plan to address this issue will be developed within the first 100 days of this Government to deliver on the commitment given by the First Minister. This work, of course, is complemented by a £40 million national primary care fund. In the last year this resulted in improvements in many parts of Wales, including an increase in the number of GP appointments later in the day.

I should now turn to the amendments. We won’t support the first amendment. The Social Services and Well-being (Wales) Act introduced a care and support assessment process for all people, including older people. That assessment is person-centred and focuses on the personal outcomes that they want to achieve. The core of this process is a conversation with the individual to agree solutions to help them retain or to regain their independence. Understanding what is important to the individual citizen and agreeing how to achieve that outcome in a much more consistent way is a real challenge for health and social care services, or, to put it another way, how to work with and not simply to deliver to an individual.

We also won’t support amendment 2. The Mid Wales Healthcare Collaborative is already taking action to improve access to primary care services, including the recruitment and retention of GPs. It’s already developed a range of innovative solutions, which will have a wider learning opportunity for other rural areas. The Welsh Government is supporting the move of care close to home, through initiatives such as a virtual ward scheme, and, indeed, work on the emergency medical retrieval and transfer service to make sure that people can be transferred to the most appropriate setting. I’d also mention here the scheme on Ynys Môn that I’ve mentioned previously in the past—the enhanced care scheme that is delivered between GPs, social services, advanced nurse practitioners and Ysbyty Gwynedd. The improvements that I’ve seen being directly delivered in that part of Wales—there’s learning there for the rest of the country.

We’ll also oppose amendment 3. We’re considering the review by Mike Shooter on the role of the children’s commissioner. That has lessons for us on the role of all commissioners, including the older persons’ commissioner.

And finally, we will also oppose amendment 4. Several outdated community hospitals have been replaced by modern primary care resource centres. We recognise the challenge that we face. We know that we cannot provide the same model of care and improve outcomes for our population for the changing demographics that we face. There will be, with this Government, a greater focus on integration, with care closer to home to both prevent and to treat. Our ambition is clear: to meet the changing needs of people across Wales, to deliver different services but better services with better care and better outcomes. I look forward to working with people in and outside the Chamber to do exactly that.