Front-line capacity in the NHS is on the verge of turning from a weakness into being a threat to the sustainability of the service as it’s modelled today. While that threat might be manifesting itself across the UK to varying degrees, it’s mattering most here in Wales now. This debate is not tabled just to have go at Welsh Government, although we do invite you to be frank here. This Assembly’s concerns about workforce planning, the deanery and the slothful approach to horizon scanning for gaps in clinical provision aren’t new. So, we do hold you to account for your unwillingness to change tack when previous forays into this haven’t worked and we do hold you to account that unprecedented cuts to the health budget in the last Assembly made the Welsh NHS a less attractive place to work.

While I’m sure you’ll want to divert attention in your response, Cabinet Secretary, we don’t really care that much about your views on the NHS in England; we care an awful lot about your plans for the NHS in Wales. So, this debate is primarily tabled with a benign purpose and that is to help you flush out the challenges, some new ideas from all parties—you’ve heard from us and from Plaid—and the priority actions on which we might be glad to support you. Let this Assembly help you. Just be aware that, as representatives of the people of Wales, we cannot accept a same-old, same-old strategy presented by you in the hope that this problem will go away.

The Welsh Conservatives are asking you for a comprehensive strategy. That means it must include, or at least be drawn up in parallel with, a strategy to reduce demand on the NHS in the first place. That means enabling, encouraging and maybe even insisting in some cases that we take more responsibility for our own health. So you shouldn’t dismiss ideas such as charging for missed appointments or informing patients of the cost of their prescribed drugs just because the Welsh Conservatives came up with those ideas. Please consider variations on those that are more palatable to you. Don’t dismiss the voluntary at-home assessments and the at-home wardens just because they’re Welsh Conservatives commitments. At heart, these are sound proposals for helping prevent those with degenerative conditions, age-related or otherwise, manage and control their own lives without early resort to the medical profession.

And don’t be afraid to take the Welsh Government badge off the public health messages. I’m not going to stop buying doughnuts because the Cabinet Secretary tells me—in sporadic advertising campaigns—that they’re bad for me, but I might if they weren’t used as loss-leaders in supermarkets or if I were repeatedly exposed to sugar and fat warnings on them or pictures of clogged-up hearts on the box. Stick a sign to the lift saying you could have used 20 calories using the stairs, but don’t stick a Welsh Government logo on it. With public health, legislate or get others to fire your strategic bullets for you.

Your key assets in reducing demand on the NHS are the value and power of other services. Angela mentioned a few, but I’m including here social services, bodies like housing associations, the third sector, of course, or society itself. Our young people should be growing up seeing responsibility for others as a natural part of life, even if it’s just that understanding that you get social and emotional support by being a member of some sort of community. So much of our good health could be supported from outside the NHS by nudging our culture away from ‘a pill for every ill’, just as Angela said. Good continuity of social care, for example, where the individual’s views are completely material to what that care looks like, can help older people maintain confidence at home if every point of contact, in or outside the NHS, has reinforced the information about, say, preventing falls, what help you might get at a pharmacy, and how technology helps you stay in touch with the people who matter to you.