Thank you to the Minister. Now we move on to the next item on the agenda, the statement by the Cabinet Secretary for health on the parliamentary review into health and care services. I call on the Cabinet Secretary, Vaughan Gething.

Thank you, Presiding Officer. We believe, as other parties do, that the time is now right for a rounded and mature conversation about how we shape the future of health and social care services here in Wales.

The parliamentary review of health and social care in Wales was agreed as part of our compact, ‘Moving Wales Forward’, with Plaid Cymru. I’d like to take this opportunity to thank not just Plaid Cymru but all parties here for their contribution and co-operation in agreeing the terms of reference and the panel membership, enabling all of us to move this forward.

The panel will review the best available evidence to identify key issues facing our health and social care services and draw out the challenges that these will present over coming years. For example, there are challenges with NHS finances within a reducing Welsh Government budget, workforce planning, recruitment and retention, and meeting the rising demands of healthcare and rising public expectations. The review will examine options for the way forward and will then make recommendations about what the health and care service of the future could look like.

The review team will of course draw on the work that has already been done and carried out in Wales by the Health Foundation, the OECD, the Nuffield Trust, the Bevan Commission and, indeed, the King’s Fund. It will draw their findings together and identify gaps in the evidence and knowledge that the review will seek to fill. The terms of reference have been discussed and agreed with other parties and will be published later today. The panel will also meet to discuss them later this month.

We have all agreed that the review panel should be independent, comprising prominent leaders, stakeholders and academics with a wide range of backgrounds. So, today, I am pleased to announce that Dr Ruth Hussey has agreed to chair the review. Ruth was born in north Wales, is an ex-chief medical officer of Wales, has been regional director of public health at NHS North West and has worked with the Public Health England transition team at the Department of Health. She has also been the director of public health for Liverpool and senior lecturer in public health at Liverpool university.

Ruth brings with her a wealth of experience, a depth of knowledge of the system here in Wales, as well as beyond our border and within the wider view of health and social care. She will be joined on the review panel by: Professor Anne Marie Rafferty, who is the professor of nursing and dean of the Florence Nightingale school of nursing and midwifery at King's College London, and she is also a fellow of the Royal College of Nursing; Professor Keith Moultrie, who is the head of the Institute of Public Care at Oxford Brookes University, has worked directly with the Department of Health and the Department for Education, the Care Quality Commission and the Scottish Joint Improvement Team, and he also has experience of working within Wales; Professor Nigel Edwards, who is the chief executive of the Nuffield Trust, has been an expert adviser to KPMG’s global centre of excellence for health and life Sciences, a senior fellow at the King’s Fund, and has also been the policy director of the NHS Confederation for 11 years; and Dr Jennifer Dixon, the chief executive of the Health Foundation. She was previously the chief executive of the Nuffield Trust from 2008 to 2013 and she has previously been the policy adviser to the chief executive of the national health service.

In order to further widen the perspective, there will also be a business representative on the panel and I will, of course, discuss that position with spokespeople from other parties. There will be three further ex officio members of the panel: Professor Sir Mansel Aylward, chair of the Bevan Commission, professor of public health education at Cardiff University and former chief medical adviser at the Veterans Agency in the Ministry of Defence; Professor Don Berwick, who is a president emeritus and senior fellow at the Institute for Healthcare Improvement. He’s a former professor of paediatrics and healthcare policy and currently lecturer in the department of healthcare policy at Harvard Medical School, and a leading international authority on healthcare quality and improvement. The final ex officio member is Dame Carol Black, principal of Newnham College Cambridge, a former president of the Royal College of Physicians and of the Academy of Medical Royal Colleges. This will allow the panel to benefit from their extensive international expertise and experience.

Between them, this panel, therefore, should have the expertise and capability to deliver a comprehensive and independent assessment of how best to tackle the big issues facing us around health and social care. The review team will be supported by a wider stakeholder reference group made up of representatives of professional bodies and social service organisations. I expect the review to take around a year to prepare its report, but I also expect that interim findings could be available before then. This will allow time for recommendations to be discussed, debated and implemented within this Assembly term. And I will, of course, update the Assembly as the work progresses.

May I welcome the statement by the Cabinet Secretary? I’m also grateful for the collaboration that has been going on since the agreement after the election, as we’ve put meat on the bones with regards to what Plaid Cymru had offered to have a parliamentary review as part of that agreement. May I note here that I wish this new team well under the leadership of Dr Ruth Hussey? I look forward to the completion of that team with the appointment of a business representative.

I have a number of questions—three questions. The first: will there be a short initial period of consultation on the remit before the team goes ahead with the full review, in case there is some work to tailor the remit as it is given to the team? Secondly, can I ask how the experience of the patient is going to be heard in this review, and that includes how we as Assembly Members can feed the experience of patients who come to us in our constituencies?

Thirdly, I see that the Cabinet Secretary says that the team will look at the findings of a series of reviews that have happened in recent years, including the OECD, the Nuffield Trust and the Bevan Foundation. Can I ask how confident the Cabinet Secretary is that we will have a really fresh look at how to answer the challenges of health services and social care in the future? We don’t want to just clarify the problems and look at recommendations that have been made in the past. Also, how confident is the Cabinet Secretary that we will see a real effort here to learn from innovation on an international level?

I thank the Member for the questions and comments. Again, this is an item that comes from agreement between the two parties—that another party in this Chamber has joined constructively with us to have what I hope is a unified position to start from. Then we’ll all have challenges to face when the review delivers its recommendations. There is no avoiding the fact there are very real challenges for politicians in every party about how we’re not just going to have a mature conversation now, but maturity in our conversations in the future, when we’ll all have difficult choices to make about what we wish to see and how we’ll actually make those choices a reality.

Now, turning to your, I think, three broad points, obviously, in terms of the terms that we’ve agreed between parties, we have an agreed starting point, but I agree it will be sensible to get a view from the panel themselves about the breadth of the terms that we’ve provided to them and to make sure that the terms are tight enough, because I’m really keen, as you’ll know from our previous discussions, to make sure we don’t have a long, freewheeling inquiry that takes years and years and years. I want something that is going to be useful and workable for us to give us some answers about the future within this term and the next one.

That’s also why we haven’t introduced a new NHS strategy. ‘Together for Health’ hasn’t been succeeded by a successor strategy now, because we’re going to have this review, and it would not make sense, as I said, I think, here in this Chamber and at our meetings, to simply say that I will introduce a new NHS strategy and then have the review as well. The review has to have meaning, and that does also mean that the remit has to be tight enough to be able to be delivered within that calendar year period. If there’s a small bit of slippage, that’s one thing, but I really, really don’t think it’s in anyone’s interests for this review to run over several years.

On the patient view and the patient perspective, again, these are things we’ve had some discussions about previously. So, just as with the IPFR review, we’ve managed to find a way to make sure that the patient perspective is real and directly taken account of in the review. I would expect that we would have to agree and find a similar mechanism as well. I would expect that not just for the call for evidence, because just in that broad call for evidence, we can expect people who are advantaged and part of organisations to take part, but to make sure that we have a facilitated patient perspective of people’s experience—not just a patient perspective, but a citizen perspective, across health and care. So, that is definitely something in our minds that we want to make sure that the review panel themselves can directly consider.

That then goes into your final point, both about innovation and also a fresh view of the future. We expect the panel to give us an idea of some of those challenges for the future. We have a number of well-rehearsed challenges that we face already. This is about looking at where we are now and where we could be in the future, and options to get there, about how we confront and deal with those challenges already. So, that is health and care together—the integration within healthcare between primary and secondary care, the integration between different groups of professionals, the integration between health and social care and other parts of public and private sectors, as well. So, this is about seeing the citizen within the service and what we need to do to have real choices to make about the future of our services. Because we can’t get away from the reality: there is a reducing financial sum available to us to run public services here in Wales. There are difficult choices available to us, but we still have choices to make, and this review should help us to make those choices and provide real challenge, I think, for politicians, whether in the governing party, or in opposition parties, about what those choices could be and what we’re then prepared to do.

I hope that helpfully deals with the points you made. We’ll carry on talking, of course, throughout the period of the review’s work and then final report and recommendations.

Minister, I’d like to welcome your statement today, and I do appreciate the consultation exercise that you have run with all the parties here. I do agree that it is time for a mature debate on the national health service and the social care model that we currently have in Wales. However, I think that, as a matter of record, I need to put on the record that I have expressed concerns about the size of the remit. I thought it was interesting that Rhun ap Iorwerth, who I know has constructed much of this with you, has brought that up as one of his concerns. I would have thought you’d have discussed that previously, but I would also like to see a very clear and tight set of remits going forward from the new chair of this panel, because it is such a big brief to look at the entire health and social care model that we have here in Wales. You’ve given this inquiry, you were talking in your statement, about a year. I’m concerned that if the remit is too large we will see too much drift. You said a little bit earlier, in response to Rhun ap Iorwerth, that you could see that it might drift a bit but you wouldn’t like to see it going on for several or more years. To be frank, I think that even two years might be too long. So, will you be able to give us an indication of how much time and effort the members of the panel are able to dedicate to this inquiry, and how much work you will expect to be undertaken in terms of investigative and analysis work by their respective support staff?

I would also like, Cabinet Secretary, if you could give us a clear and unequivocal direction, which can be listened to today by health boards, that this inquiry is not a stopping point to other tactical measures that we need to get on with, whether it is the workforce sustainability, whether it is winter pressures, new hospital builds, which I know you’re going to discuss later, because I know, from my experience in education, that when the Government announced various large scoping inquiries, it was used by some, in some quarters, to stop all other work and I would not like to see that happening in the NHS because we have tactical issues that we need to address on a constant basis.

You will know that I was very keen for the panel not to be the usual suspects, and I have discussed with you personally in great detail my view on those who are not on the panel. I don’t think it would be entirely appropriate to air those concerns and observations in public, but I do want to say that I’m extremely pleased to see the sector representatives from organisations such as the Nuffield Trust, the King’s Fund and the Health Foundation, who I believe will bring impartiality, hopefully best practice, and evidence of benchmarking experience to you. As you know, I’ve raised with you my concerns that the panel was being too health-focused and the whole review would become through the prism of the health service, so I was very, very keen to welcome Keith Moultrie—and I thank you for that appointment; I think that he will add to us—and to hear the voice of a practitioner such as Professor Rafferty. And, of course, you are very aware of my very strong desire to see somebody on that panel from a business experience who’s got large corporate understanding of enormous personnel challenges and issues and logistics and management of logistics. I, too, welcome Dr Ruth Hussey to the chair. And I would like to ask you, Cabinet Secretary, will the chair, Dr Hussey, be the person who will put into place the structure that will enable this panel to interface with Assembly Members, particularly members of the health and social care committee, or do you see yourself putting in place that kind of structure? Because I believe that when we’ve discussed this, we’ve talked about how we can get a measure of cross-party political engagement feeding into the panel on a day-to-day, or week-to-week or month-to-month basis as the panel develops its thoughts.

My final point: I would just want to raise again, and I know that Rhun ap Iorwerth has also raised this, was his comment that slid into the statement about the review team drawing on the work that’s already been carried out in Wales by various large research organisations. This is fresh thinking. One of the big guarantees was that the review panel would look from scratch, not to reinvent the wheel, but that they would reference—and I use that word very clearly—the work already done by organisations such as the Nuffield Trust, the King’s Fund, the Health Foundation et cetera. I would just like your absolute reassurance that they are going to look at this with clear sight, because, as you and I both know, there’s already much research in the public domain that one can argue has come from a particular point of view that might already predicate outcomes that none of us are wildly comfortable with. To just recycle those and put them forward as a set of recommendations would put this and me in a deeply uncomfortable position, because I would like to think that this august panel of highly intelligent individuals with a vast amount of experience will look with real clarity and focus to come up with a picture that would really suit a canvas that would really suit Wales going forward, so that we can put up on that canvas the structure for our health and our social care in the years to come.

I thank the Member for her comments and questions. Perhaps I can try and deal with the size and the membership of the panel first. I think we're fortunate to have already secured a panel of genuinely independent-minded expertise and experience that covers a range of fields across social care, across the health service, people who have direct experience within Wales and outside Wales, too—that’s important, to see different perspectives—people who have international learning and international experience, too. So, I hope that gives that reassurance that we’ve discussed previously about this being a genuinely wide range of expertise that we've managed to secure, which I think we should all be very pleased with, actually, and to give people that assurance that this group of people will do that job with an independent mind, and that means that they'll have information drawn to their attention on work that's already been done, but that won’t determine what they then conclude. Because if they disagree with anything, if they want more evidence to be found, as I said in my statement, it’s for them to do it, because, ultimately, whilst I take on board your point, and I agree with you, that this is not about reinventing the wheel on work that's already been done, but this review has to be independent, it has to be challenging and has to be evidence-based, and it's a review that, ultimately, the panel will have to put their names and their reputations to—and these are significant figures within the field of health and social care.

And that's why, going back to the point about the terms of the review and timescale, it's sensible to make sure that the terms and the timescale make sense with each other, and to have a discussion between spokespeople if there’s a need to consider whether we've got those two things aligned. I think we have, but let's take a review of it when the panel are in place; after all, we're looking for them and their expertise. But I certainly don't want something that goes on for two years. When I talk about the possibility of extending time a small bit, I do mean a small bit. I'm talking about period of weeks or months; I'm not talking about it going on to two years. I think two years is too long. If the review takes two years, then I don't think there's going to be a real opportunity to allow that review to then be considered and to have a real impact in this term and the next one. Now, we all know the political cycle, and in two years’ time, people will be gearing up and looking for other things, and it will stop us having the sort of maturity and objectivity that I think we need in this debate. So, I hope that's helpful about the review and the timescale being real and honest.

Again, I take on board your points that were made in our previous discussions as well about the balance between those issues that the Government shouldn't make decisions on, because they’re part of the review’s consideration, but, equally, not avoiding our responsibility to deal with challenges now, whether that's in the Government or within the service as well. I don't want to see things somehow stop and be put on pause, because that is not the right thing to do. We're talking about the future. We're not talking about issues that we need to decide upon now, and I don't seek to avoid my responsibility or the health service's responsibility or social care's responsibility to continue making movements forward. That means there will be difficult choices that have to be made in advance of the panel's reporting, but that's what we have to do. That goes with the responsibility of being in Government, and I certainly won't be looking to avoid that.

Thank you for your statement, Cabinet Secretary, and for the honest, open and transparent way you have approached this review with the opposition Members. The health and social care sectors will face immense challenges in future as our population grows and ages, and it is right that we review how we can best deliver those services in the coming decades. I welcome the opportunity you gave to us to help influence the terms of reference and the make-up of the panel, and I look forward to reviewing the panel’s terms when they are published later. One of our biggest concerns for this review was ensuring that the panel was truly independent and expert-led. I’m pleased to see the panel will include individuals from the Nuffield Trust and the Health Foundation and a Fellow of the Royal College of Nursing.

I am also grateful that the panel will include a business representative. It is important that we get input from the private sector, and I look forward to learning who will fill this position. I’m also pleased that we are to receive the benefit of having an international perspective from Professor Don Berwick. I would also like to welcome the appointment of Dr Hussey as chair of the review. Dr Hussey has experience of the NHS in both Wales and England, and her insight on this panel will be invaluable.

I have one question, Cabinet Secretary, and that is: when will you be in a position to share with us the make-up of the wider stakeholder reference group?

Thank you once again for your statement. I look forward to working with you and the review panel so that we can deliver a health and social care system that is responsive to the needs of Wales’s population and resilient to future health challenges. Diolch yn fawr.

Thank you for those comments and questions, and, again, I should have noted both from Rhun and Angela, and now Caroline, the recognition about the role of a businessperson to add an additional perspective and international experience. And, of course, I’m very pleased to hear the welcome that Members have given to Dr Hussey agreeing to chair this review panel.

On the stakeholder reference group, that’s something I would wish to discuss again with party spokespeople to make sure that it is something that makes sense, and making sure that we have enough views to come in, about how we take advantage of that expertise within Wales’s experience, and how different people see different demands being made upon the service. The Welsh NHS Confederation will have a particular view on a range of these challenges, and we’ll find lots of people in the third sector having a range of views as well. We’ve also heard already from Rhun the importance of having a patient perspective, too. So, those are things that I think are eminently manageable and achievable, and I hope that we can come, as we have done previously, to a sensible agreement on how to make sure that they are a real part of the review and its work. We’ll then see that influence in the recommendations that are provided at the end of the review panel’s work.

And finally, Suzy Davies.

Diolch, Lywydd. Thank you, too, Cabinet Secretary, for your statement. I, too, am pleased to see the reference to existing research, although obviously work needs to be done on the back of that rather than just accepting it as it is.

I was at a recent King’s Fund conference in London and I had the opportunity to engage with local authorities from different parts of England—there was nobody from Wales there apart from one person from north Wales—and they’re developing very different models, depending on which part of England they represent. One of them had actually gone so far as to transfer its entire cohort of social workers across to the NHS so that they became NHS employees. Now, it may well be that the demands of social care are going to prove too much for local authorities on their own, but I think there is a real risk, isn’t there, that we’re going to end up with an enormous, centralised service if we’re not too careful?

So, can you just advise me whether the panel will have enough time to consider a range of models for providing integrated services, especially those that are perhaps from different parts of the world, which help face the inevitable problem–both a practical one and a cultural one—that the NHS could end up swallowing responsibility for social care? I only raise this because the NHS, of course, already has some difficultly meeting its needs from the existing resources, and I wouldn’t like to think that social care just becomes one of those areas competing for attention from within a larger NHS. Thank you.

Thank you for the point—I note the picture you paint about English local authorities having widely varying responses, given the population they have, the financial resources they have. And, actually, I think that’s part of the challenge that we want to try and avoid: having a multifaceted system where, actually, you can’t understand the logic of that, and how that meets the needs of the citizen. That’s part of the reason to have this review, of course—to try and understand how health and social care in Wales can work in a more integrated way together, and understand that we should see them as a whole system. That’s part of the approach we are trying to take in Wales, not just in policy terms and leadership, but then in delivery as well. That’s why we place such store on integration between health and social care in the delivery of those services.

That will definitely be part of the review. It’s within the terms. I think your fear about the NHS centralising and taking over and swallowing up social care and then forgetting about it—I appreciate that the concern is being expressed in a certain way to make the point, but we’re looking to see how we can actually have a genuinely integrated system in the future to recognise the importance of that social care.

In fact, much of what we’re already doing with the legislative architecture, with the Social Services and Well-being (Wales) Act 2014, is about promoting and, at times, enforcing collaboration. So, the joint commissioning that will be taking place between health and social care on a range of areas of residential care, the joint understanding of needs within a particular population, the regional footprint boards—there’s something about how we take that forward and make that work. This review will bring with it experience on a national and international level about what has already taken place, it will look at where we are now, and will give us recommendations about the future. As I said earlier, I expect those recommendations to be realistic, implementable and, at the same time, really challenging. That, after all, is the point and purpose of having what I hope will be a genuine, independent and mature conversation about the future.

I thank the Cabinet Secretary.