Therefore, we will move to item 6, which is a statement by the Cabinet Secretary for Health, Well-being and Sport on improving care for major health conditions. I call on the Cabinet Secretary, Vaughan Gething, to move the statement—Vaughan.

Thank you, Deputy Presiding Officer. Last October, I shared with the previous Assembly my plans to extend the major health delivery plans until March 2020. The cancer, heart disease, diabetes, end-of-life care, critically ill and stroke delivery plans have been reviewed and are in the process of being refreshed. The respiratory and neurological conditions plans will be reviewed in 2017. The liver disease delivery plan is due to end in 2020. I am going to launch the second mental health delivery plan on 10 October on World Mental Health Day. This Government has invested £10 million annually—that’s £1 million for each of the delivery plans—and the impact of this investment is reported in annual reports for each major health condition.

There is a lot to be proud of. Since their introduction, each delivery plan has helped to improve the care and treatment of people with a major health condition. There have been significant improvements in patient outcomes including, for example, a steady decline in the rate of people in Wales dying from cardiovascular disease and diabetes-related diseases. Survival rates for many major health conditions such as stroke and heart disease are improving, as are survival rates for people being treated in critical care units in Wales.

Each delivery group has had a focus on prevention and support, with an emphasis on co-production with the third sector in particular. The diabetes implementation group has developed patient resources to educate and support people living with diabetes, covering subjects such as the importance of retinal screening, foot care and hypoglycaemia. The stroke implementation group is piloting an approach with primary and community care to identify those at risk of atrial fibrillation and ensure that the appropriate treatment is in place. This should reduce the number of people having strokes, as well as supporting people to understand and manage their own risk. The results from the pilot indicate that, if rolled out, this approach could result in a 10 per cent reduction in the number of strokes across Wales.

Ensuring services are working well and efficiently for the benefit of patients is a key aspect of each delivery plan. Working in partnership, the heart disease, stroke and diabetes implementation groups are introducing a national programme for cardiovascular risk assessment. This is focusing upon patients with the highest risk of cardiovascular disease in the most deprived areas in Wales, and aims to identify undiagnosed cardiovascular disease and to support people to reduce their own risk factors for developing the condition.

Developing effective rehabilitation services has been a national priority for both the neurological conditions and stroke implementation groups. As a result, both groups have jointly provided £1.2 million to support community neuro-rehabilitation services. In addition, staff at Cardiff and Vale University Local Health Board ran a pilot seven-day patient-centred, integrated rehabilitation service for stroke. The results have shown a reduction in the average length of stay for patients from 58 days down to 24 days. The new service has continued and has been expanded. The learning from this service will be shared with other health boards at a national stroke learning event.

Making sure patients receive fast diagnosis improves the support and treatment that services can provide, and there are many excellent examples of progress in this area, including the new community cardiology service funded by the heart disease implementation group, now in operation across all health boards. The service provides a direct access one-stop cardiology community clinic and has introduced community cardiology services to provide basic diagnostics and assessment closer to home in primary care or in a community hospital setting.

Supported by Macmillan Cancer Support and the cancer delivery plan, a programme of investment in primary care oncology has commenced. Lead GPs and nurses have been identified in each health board area to support primary care clusters to improve diagnosis, referral and post-treatment support.

In September last year, the end-of-life care implementation board introduced an advance care plan, which details a patient’s wishes and preferences for future care. To date, for example, more than 900 members of staff have received training on care decisions in Betsi Cadwaladr University Local Health Board alone.

In response to its local priorities required to deliver the critically ill delivery plan, Cardiff and Vale university health board opened a post-anaesthetic care unit in January last year, providing ring-fenced critical care capacity for high-risk, post-operative elective patients. The new unit has already delivered improved patient outcomes and revolutionised the delivery of critical care for elective surgery patients. For example, it’s reduced cancellations due to emergency pressures, it’s supported a further reduction in length of stay, and it’s reduced delayed transfers of care.

To actively self-manage, individuals need confidence and skills to manage their health on a daily basis and implementation groups have worked with health boards to improve services and patient experience. The diabetes implementation group has developed an all-Wales structured education programme for 11 to 16-year-olds with diabetes, called SEREN. For each of the delivery plans, the patient experience and their voice are represented by the appropriate support groups.

The neurological conditions and stroke implementation group are working together to develop a patient-reported experience measure and a patient-reported outcome measure for stroke and neurological conditions. This is a really significant piece of work that has not been attempted in other parts of the UK before. Both measures should be available for national roll-out by March 2018.

The cancer implementation group has established a three-year quality and governance cycle for peer review. All of the main cancer services have been reviewed and are now being re-reviewed, starting with lung cancer during 2016. Findings have already demonstrated measurable change, including the funding of clinical nurse specialists and other clinical staff, and the development of clinical policies and protocols to minimise unnecessary variation in standards of care across health boards. This model has been adapted by a number of implementation groups, such as those for the critically ill, heart disease and diabetes.

As I hope Members can see, from each delivery plan and implementation group, there has been a profound and positive impact. I expect the refreshed delivery plans to continue to do so, and I would like to thank the implementation groups for the progress that they have made against the current plans, and I look forward to further achievements over the coming years right across Wales.

Thank you very much. Rhun ap Iorwerth.

Thank you, Deputy Llywydd. I thank the Cabinet Secretary for his statement. I have two or three points and five questions, I believe. In terms of opening remarks, of course we welcome the improvements, the enhanced survival rates and better outcomes for patients for when that occurs. Of course, it’s happening across Europe and the globe because of improvement in treatments, technology and innovation, and in sharing best practice, and so on. The problem that we have in Wales is that these changes and the improvements aren’t happening as swiftly as we would like.

We, of course, shouldn’t take our eye off the ball on the fundamentally important issue of improving waiting times for treatments and tests, because, obviously, earlier treatment can reduce the likelihood that one will develop a chronic illness or make a chronic illness worse whilst they wait.

The third point—the context that needs to be mentioned here—is the failure to tackle obesity specifically, which means that there will be an increase in the need for services for people with chronic diseases. My first question relates to that. The Cabinet Secretary has mentioned structured education programmes for pupils between 11 and 16 who have diabetes, but, of course, children aren’t the only ones who need this education. Diabetes UK has highlighted the lack of attendance at such courses. Only 2 per cent of those with type 1 diabetes, and 6 per cent of those who’ve had a recent diagnosis of type 2 diabetes across England and Wales have actually attended a course. If we look at Welsh-specific figures, the situation is even worse: just 1 per cent of type 1 diabetes sufferers and 0.9 per cent of those with type 2 diabetes are supported or have actually attended a structured education course. And only 24 per cent of patients in Wales with type 1 diabetes have even been offered such a course, and that compares with a third of patients in England. So, would the Cabinet Secretary accept that we need to provide more courses, to advertise them better, to share information about these courses and ensure that they are held at convenient times?

I will turn to data, as I have done many times in the past. The poor quality of gathering data was highlighted in no fewer than 18 of the 22 inquiries by the Health and Social Care Committee in the fourth Assembly. It is shocking. The lack and poor quality of data actually hinders the planning of services, and it hinders the evaluation that we need of policies and specific initiatives. I will ask again: will you ensure that the situation is improved so that we can ensure that we don’t just take your word for things when you claim that improvements are made?

There is mention in today’s statement of investment in oncology and in primary care, and in developing more consistent services in cancer care, and that this will include the better collection and publication of data and more effective data. There was a recent report that suggested that only 32 per cent of patients actually access a key worker, and the Welsh Government response was that most patients did have a key worker in reality, but that recording this was the problem and the challenge. Would the Cabinet Secretary accept that when he does claim that the service is achieving something, he needs the data to back that up so that we can do our work in terms of scrutiny?

Regional divergence is the fourth question I have. Often, improvements occur and survival rates improve because some new technology or new method is introduced, and that happens, perhaps, more effectively in one area than in other areas. So, what plans does the Government have to ensure that these processes—delivering these improvements—happen more swiftly and more consistently across Wales?

And finally, the statement today, like many statements made by the Cabinet Secretary, is supposed to show that the NHS in Wales can introduce improvements effectively and efficiently. But if we bear in mind that three out of of nine Welsh health boards are in targeted intervention, which is one step below special measures, and, of course, that there is one health board in special measures—. Whilst there is excellence in the NHS in Wales, is the Cabinet Secretary confident that the management skills and the right leadership are in place across the NHS in Wales in order that we can make the kind of changes that he wants to see?

Thank you for the series of points and questions. If I can go back to, I guess, some of the starting gambit—I think it’s rather unfortunate that, sometimes, the impression given, when you talk about broader improvements in healthcare, is that all of this is inevitable and that the role of the delivery plans and the implementation groups have had no impact at all. I don’t think that’s a fair or reasonable assessment. Certainly, if you don’t want to take my word for it, you could go and ask the clinicians involved in that work, each of the national clinical leads, and you could go and ask members of the third sector engaged on the implementation groups, for example, about the value of that work and impact they’ve had on actually setting priorities with the health service, so it’s genuine engagement and isn’t just about the service deciding for itself what it will do. You’ve got that direct representation from the third sector. It’s one of the strengths of the approach that we take, actually, that we’ve got the third sector there as critical friends, but who are still able to help set the agenda, and they recognise the impact that we’ve made. For example, at lunchtime, I wasn’t able to see Dr Lloyd there—sadly, he had to run away before I could see him—but at the British Lung Foundation event that you were at and other Members, too, there was a real recognition of the work that’s been done with them, for example, in the major health plans that they’re involved and engaged in. They recognise that that delivery plan and the implementation of it is an important part of service improvement. Indeed, the money they’ve had has been important too—not to, say, design a strategy, but for some of that money to then be used to deliver on recognised priorities. A good example is one that you’ve mentioned—the diabetes implementation group. They’ve actually had structured education and patient education as one of their five key priorities this year. As you’ve highlighted, we recognise that not enough people take up the opportunity for structured education, particularly at the point of diagnosis, when there’s a real window of opportunity to try and get someone to think about their condition and how they can manage it for themselves. So, there’s absolute recognition that structured education, not just on diabetes, provides an important part of service improvement and outcome improvement and patient experience improvement. There is something there again, and it’s a continuing theme that, in fact, you’ve raised yourself in discussions both within this Chamber and outside, about the role that the citizen can play and should play in helping to manage and improve their own health and how we help that person to make different healthcare choices. Whether it’s about avoiding diabetes, which, again, is another part of the five priorities that they’ve set this year, but also for type 1, where you can’t avoid having it—you either have it or you don’t—it’s about how you help that person to manage their condition as well. So, I recognise the point that’s made and Diabetes UK are indeed involved and engaged in the diabetes implementation group. They have a number of good and positive things to say, as well as honest and constructive criticism to make too. I welcome both approaches from the way the third sector engage with us.

I’ll deal with your point about the leadership for the seven health boards and the three trusts. I made the decision that we discussed in this Chamber before for targeted intervention to take place in three health boards. At the same time, of course, the Welsh ambulance service moved down in the intervention status because they’ve made real and significant improvements, which I hope that Members across the Chamber will recognise on perhaps a more consistent basis. I’m confident that we’ll be able to put in place a range of support and accountability to see real improvement made. The assurance the Member should take is that this is a real process—were it not, then we could have avoided trying to escalate three health boards for political purposes. That didn’t happen, and it didn’t happen because the process is real and it’s robust, and the role of the regulator is a real and important part of making that real too. So, if you see those organisations improving, it will be because real improvement has taken place. We’re always looking for improvements in leadership and management, and the delivery plans themselves have helped to deliver some of that clinical leadership within the service as well. I certainly think that each of the national clinical leads have had a real impact in improving parts of their service areas too. It works alongside, for example, the 1000 Lives improvement programme too.

I’ll just deal, before I finish, with a point about data. We recognise that there are areas where data are messy and not as clean as we want them. There are challenges when coding, for example, a range of different issues, but the data really matter to us. The data and the process of clinical audit, too, have been a really important factor, for example, in the heart disease delivery plan and the cardiac area, and looking at what those audits tell us. It’s a really useful source, not just what they can tell us about accountability, but how they can drive service improvement, and not just by comparing ourselves on an audit basis within Wales, but actually these are significant surveys that take place across England and Wales, and certainly Northern Ireland and Scotland regularly take part in the same trials, also. We’re not just looking at ourselves within the seven health boards and three trusts in Wales; we’re looking at what data can tell us and what that improvement journey could look like.

So, there are real challenges to improve upon and that’s recognised. We’ve done a range of things to improve that too; for example, when you look at mortality reviews, that’s a definite improvement that we’ve made over the course of last term. But, there are also plenty of high-quality data, and one of the things we have seen from the delivery plans is that, where you can actually look at the high-quality data and look at research that’s going on in that area, it often helps to further improve clinical practice and that potential for innovation too. So, there are further questions to ask and points to be made about continuing to improve the quality of the data we have—not being complacent about it. We also have a good story to tell in a whole range of areas and I don’t want to lose sight of that in either this statement or in the work we’ll do in the years ahead.

Minister, thank you for your statement today. I’ve got four areas of questioning I’d like to raise with you. The first thing I’d like to talk about is co-production—this has become a watchword for many organisations, including the Welsh Government and the NHS. I would like to understand better what you’re going to be able to do with all these disparate plans to ensure that co-production and real integration happen, particularly in the areas that sit more comfortably side by side, for example, stroke services with neurological services.

You and I were both at an event only last week when the neurologists were talking about the fact that there’s still an awfully long way to go to ensure that they are able to be effective influencers in some of these implementation plans, and that they were calling for better integration of services. So, it’s not just there, it’s in other areas. What kind of read-across are you getting? How are you ensuring that the people who are carrying out these plans are doing a read-across of all the other plans in existence to ensure that we get the maximum integration and the maximum amount of co-production we possibly can?

My second area is on best practice. I was really pleased to read some of these examples of best practice that you cite here. You talk about Cardiff and Vale University Local Health Board with their pilot seven-day patient-centred integrated rehabilitation service for stroke, and I think you talk about—there’s another one somewhere—Cardiff University with their post-anaesthetic care unit. I’d be interested to know how long it is taking these areas of pilots (a) to be run, (b) to be evaluated, and (c) to then have that best practice shared across other health boards to ensure that we can make these gains throughout the entire NHS and not in just one or two areas.

My third area is about recruitment and I’d like to just say that, whilst I take on board the optimism with which you’ve delivered this statement, I have to say that we still have worse outcomes on some areas—stroke, cardiac care and cancer. We are moving in the right direction, but I would like to understand, in the ambition to reach the successful goals and to catch up with other countries, what part is played by the lack of specialist consultants, specialist nurses and other health professionals in those particular areas of these plans. What is that doing to impact upon the success? I spoke earlier—I think you were here—to the First Minister about the lack, for example, of epilepsy nurses. Because we don’t have epilepsy nurses, how about running epilepsy clinics? We don’t have either. Initiatives like that that would actually, in that case, promote better neurological service delivery for patients, and of course, ultimately, improve that patient’s life and save the NHS money. Because having 70 per cent of people able to control their seizures is much better than having only 50 per cent of people. For epilepsy, you can read across the piece. You and I both know that recruitment is a real issue. So, I’d like to understand what impact it is having on these plans.

My final area is just that I’d like to understand the monetary element of it. I believe that you said that it was £10 million per plan. [Interruption.] Ten million pounds over all of the plans? Yes, thank you, because I thought it was £10 million over all of the plans and I was thinking, ‘Good grief, I haven’t noticed you give out £100 million recently, very generous man that you are.’ So, can you actually tell me, that £10 million, how is it divided up across all of those different implementation plans? Who says who is going to get what money, how much money? And who is actually then following that money through the whole process to ensure that we have proper value for that money and that it is delivering an outcome that we deem to be satisfactory in connection with the value for that money?

Thank you for the series of questions. Perhaps I can start with the end, just to deal with that quickly. It is £1 million for each of the major condition plans, and how that money is used is decided by the implementation group. So, there’s a range of people from the health service who are involved. It’s often a medical director or chief executive of a local health board or trust who is involved in chairing those bodies, but they involve a range of different people from different parts of the health service and the third sector, which, as I said earlier, is an important strength. They will then decide on a set number of priorities and what to put into each area. So, the Government doesn’t tell them, ‘This is what you must now do with the money.’ It is for that group to decide, ‘What can we do with this sum of money to improve this service area, and what do we think are the real priorities within that?’ That’s actually been really welcomed by people from the service and outside—the lobby, the interest and the third sector groups: having a sum of money to make a real difference.

As I said earlier, in my statement, about those plans, this goes back to your point about how much is shared, because I’m actually really encouraged in the read-across about the amount of joint work that has taken place quite quickly since the money was there—so, the points that I made about the areas of joint work between neurological conditions and stroke, and the point about cardiovascular risk assessment on shared work there as well. So, we’ve actually seen people coming together to talk to each other about how to use their money in a joined-up manner, and that’s actually really encouraging. It’s also brought together a range of different people in the third sector in new alliances as well. For example, there is a new cardiovascular alliance between a range of different charities involved and engaged in the same sort of area of work, and that’s really encouraging for us. It probably means that they’ve got a bigger voice as a result, but it’s also more useful for the Government to engage them as a group, coming together with unified priorities. So, I think that’s been really encouraging too.

But the work is still relatively new, so the point about understanding what they want to do, how they inform themselves about priorities, getting on and doing, and being able to evaluate that, is actually still in train, so it will be somewhere into the next part of the year when we’ll be able to evaluate what impact that has had. But, in allocating that money, we have to accept that, in doing that, the money may not always produce the desired outcomes that we want it to. But, I think that in a range of those we’ll see real gains being made, and I think perhaps the best example of that is the community cardiology, rolled out initially in Abertawe Bro Morgannwg, in the Swansea area, and now being rolled out across the country. Because there’s real evidence that if you shift services into the community, it provides a real benefit to the patient, to the citizen as well, and it’s actually investing in primary care in that sense too. Secondary care for this has been very positive about it in the Swansea area, because they recognise that it really has shifted people in their area to where they could be seen, it’s released pressure on them, the waiting times are now reducing in secondary care as a result, and they’re seeing people as consultants that they recognise they really need to see. So, it’s a really good example of the progress we want to make.

And I guess I’ll try to deal with your points now about co-production and integration, because it isn’t just about the third sector, it is about the citizen, which is part of the ambition for the future of healthcare in Wales, not just in the delivery plans. It’s about making sure there’s a changed relationship between the citizen and the health professional, about making sure that that conversation is also matched up by a broader integration of services as well—so, the shift between primary and secondary care that we have talked about since the start of this place—and about making sure there’s more evidence that that happens, with community cardiology being one example where it has happened. But, equally, that integration with other areas of service as well, so not just primary and secondary care, not just social services, but with colleagues in education and housing too, and recognising the role this has to play in improving a range of different areas. And I think perhaps, on rehabilitation, there’s a really good example where the role of housing is really important too, about getting people into their own home more quickly, and what that means then for the joining up of different services, and actually the different professionals that need to be engaged with that. That’s really important, for example, with stroke care, moving forward, in the next iteration of the plan, and understanding the updated advice and guidance that the Royal College of Physicians has produced, with a heavy emphasis on getting people into their own home more quickly for the rehabilitation to commence. So, there are really important drivers that take place that each implementation group needs to take account of.

So, I want to finish by saying that, on the points you make about outcomes, recruitment and workforce issues, we certainly recognise that each of the delivery plans have been helpful in this way, in highlighting areas where we need to do better, where there’s a real deficit, where there’s evidence about what that means, but also what improvement can look like. So, this lunch time I was able to point out that having a multidisciplinary team approach for interstitial lung disease had been really positive in reducing waiting times for people, from something like 18 weeks down to two weeks. That’s been driven by the way that the implementation group has worked together, so there is a better experience, and there are now better outcomes for people as well. So, there are good reasons to be positive, as well as to say that we should not be complacent. Actually, this approach means that we should not be complacent because we have a range of different people who are involved and engaged in the work that we’re doing.

Thank you for your statement, Cabinet Secretary. I look forward to reviewing the refreshed delivery plans when they’re published. I note your comments that survival rates for many health conditions are improving and, whilst this is true, we still have much more work to do.

I welcome the work that the stroke implementation group will be undertaking with regard to atrial fibrillation, and hope that the projected reduction in the number of strokes can be achieved, with the emphasis on prevention and rehabilitation. Stroke kills twice as many women as breast cancer, and more men than prostate and testicular cancer combined. Thankfully, more and more people are now surviving stroke, but this brings its own challenges. We now have nearly 65,000 people living with the long-term effects of stroke here in Wales. Stroke is the largest single cause of complex disability, and over half of all stroke survivors are left with a disability. We welcome the priority being given by the implementation groups to the development of rehabilitation services and the funding for community neuro-rehabilitation services also. Cabinet Secretary, I note the successful trial of rehabilitation services in Cardiff and the Vale and the intention to share the learning with other health boards. But, surely, if the trial was successful, it should be rolled out across Wales, as opposed to just sharing the learning.

We welcome the improvements in cardiac care, and look forward to both the delivery plans and details of how the forthcoming public health Bill plans to tackle the biggest contributors to heart disease.

Finally, Cabinet Secretary, we welcome the reviewing of cancer services. On cancer care, we have a very long way to go. Wales has the poorest survival-of-cancer rates in Europe and, while we have made some progress, we haven’t made enough. In order to scrutinise effectively, the collation of data is of paramount importance. Therefore, we need data to produce an audit trail of both our successes and areas of failure. Only by capitalising on past experience can we truly improve the services we deliver. Traditional cancer care treatments are not always effective and, to improve survival rates, we must consider alternate treatment regimes. Will the cancer delivery plan include a commitment to improve access to stratified medicines in Wales? One of the biggest barriers to survival is the lack of early diagnosis. How will the Welsh Government speed up access to diagnostics, and will the Welsh Government be investing in improved IT infrastructure to speed up the sharing of test data in order to reduce, as far as is possible, the diagnosis pathway?

Once again, Cabinet Secretary, thank you for your statement, and we look forward to working with you to deliver healthcare improvement over the course of this Assembly. I would also like to thank the various implementation groups for the hard work they are doing to improve survival rates from major conditions in Wales. Thank you.

Thank you for the series of comments and questions. I certainly recognise that there’s more to do in the areas both of survivor rehabilitation and prevention—in each of these areas. That’s why we have this approach—bringing together people who have a direct interest in this from outside Government, within Government and the NHS too. The example you started with of stroke is a good example of where the implementation group had helped to be part of delivering improvement. There are also difficult questions for all of us as well about the change in the nature of delivery, because the improvement, for example, in Aneurin Bevan Local Health Board, came on the back of a difficult service redesign, and that’s not easy. But if you talk to the national clinical lead for stroke in Bronglais hospital, he will say that there needs to be a smaller number of hyper-acute units. Now, that means difficult choices for people around Wales. If we’re going to concentrate and specialise that form of service, then it’s got to be done on the basis that there is a real and clear evidence base that it will improve outcomes, as there will be difficult challenges if people are expected to travel further for that treatment. But, ultimately, if the evidence is that there is a better chance of them surviving, and a better chance of them having effective rehabilitation as a result, that’s something that the service will need to deliver.

On your broader points—the points that you made around cancer—actually, it’s a remarkable success story for the national health service to sustain the increase in demand on the cancer services, and to still see as many people as they do. We are seeing record numbers of people within time, as more people have a diagnosis of cancer, and more people are treated more successfully than ever before. I don’t think it hurts to remind ourselves that survival rates are now over 70 per cent at one year, and over 50 per cent after five years. The challenge for us is how we make further progress. The next stage of the delivery plan, I think, will help to set that out for us: in particular, some of the areas we’ve highlighted, for example, diagnosis and earlier access. But, you know, that’s—. We’re not just learning from within the UK. So, part of the work that’s been done has been to go out to Denmark and look at what they’ve done successfully over a period of time to improve their own survival rates too. This does come back to how we share learning, but not just talk about the shared learning, but how we get on and implement it. That’s been a very consistent message from myself and leadership here at Government level—that we expect to see greater consistency in delivering upon improvements and greater pace in delivering them across the country too.

Finally, Darren Millar.

Thank you, Deputy Presiding Officer. Cabinet Secretary, there are just two areas I want to ask you about, if that’s okay. I’m surprised that you haven’t mentioned dementia at all in your statement this afternoon. Dementia’s one of the four biggest killers, an extremely prevalent disease, and it’s growing in prevalence as well in Wales and other parts of the UK, and yet there is not one single reference to dementia in the whole of your statement, which is supposed to be on major health conditions. I’m very disappointed by that, and perhaps you could give us an update on what the Welsh Government is doing to tackle dementia, and indeed to encourage health professionals to actually diagnose dementia.

Secondly, there’s only one reference to children in the whole of your statement, and that’s in relation to the work that is being undertaken in terms of the structured education programme, SEREN, which, of course, is something that I welcome very much indeed. But there’s no other mention of children throughout the document, and, as you will know, children and young people very often face life-limiting chronic conditions, and very often require a great deal of support as a result of that. I wonder whether you could tell us what specific work is being done in relation to the health conditions that you’ve referred to in your statement to support children and young people with those conditions, and, indeed, what action you are taking as a Welsh Government specifically to expand the role of school nurses in supporting the young people and children in our schools who are living with these sorts of conditions, and indeed others that might affect children and young people. Thank you.

Perhaps if I start with the first point, I think perhaps there may have been some confusion about the content of the statement. This is about the action plans that we have—the delivery plans covering major health conditions, of which there are 10. And, in particular, I’ve been referring to the six that are being refreshed and are due to be re-launched within this year. That’s why dementia hasn’t been mentioned, because there will be reference to it in the mental health delivery plan, and—. [Interruption.] You can either listen to the answer, or we can have a to-and-fro, if you like. I’m trying to be helpful, because I don’t think you were listening earlier on, Darren.

[Inaudible.]—the answer, and then—

The dementia action plan is going to be written this year. So, it will be available this year, and work is actually being undertaken now to do so. I attended an event two weeks ago at the University of South Wales, bringing together a range of different people, both carers and individuals who have dementia, and third sector organisations, as part of how we’re actually trying to drive improvement in this area to deliver on the ambitions—not just of Government; I think there’s a broader ambition here that goes across party about how we have a more open conversation about dementia itself and how we then improve services and work alongside people as well.

So, the chief medical officer, for example, is on the group trying to take that forward. We expect to publish that action plan within this calendar year. And, whilst we haven’t specifically mentioned children within each of the delivery plans that have consequently been given, of course the range of these services will affect the quality of services that children and young people receive as well. And, on a range of the priorities that the implementation group set, they’re looking in particular, for example, at the paediatric diabetic service, as well—a range of different areas and different conditions. They do specifically consider services for children and young people. So, just because I haven’t specifically said that this is something that affects children and is only prioritised at children, that does not mean that children and young people are being forgotten—far from it.

I’m really proud of what the national health service has done with its partners and with the third sector in making major gains for people in Wales in both the patient experience and patient outcomes. We have a good approach to take. I’m proud that we directly engage people outside Government and outside the health service, and I look forward to more success being reported on the back of the next stage of these plans of implementation groups moving forward.

Thank you very much, Cabinet Secretary.