Part of the debate – in the Senedd at 5:40 pm on 29 November 2016.
Thank you, Presiding Officer. I’m grateful to Members for taking part in today’s debate—a very consensual debate in many ways, with similar concerns and an expression of similar challenges that we know that we all face in different communities in pretty much every part of the country.
I want to start by dealing with issues raised in the amendment and in the contribution from Rhun ap Iorwerth, but every Member mentioned lifestyle challenges. I think there’s a challenge for us here in not confusing blame and responsibility. It’s right that we don’t blame people, but we do have to find a way to have a conversation about people taking more personal responsibility and how we get alongside them to help them to make different choices, and that’s got to be a conversation that we are prepared to have in our own roles, as well as expecting healthcare and other services to do so as well. Of all the different challenges that we recognise in public health—diet, exercise, alcohol and smoking being the big four—in each of those, people make choices. It’s how we equip people to make different choices and then how we equip people and empower them to make more healthy choices later down the line if we can’t prevent them from undertaking risky behaviours in the first place. In fact, alcohol, as Rhun mentioned, is the one example where you can demonstrate that, actually, it’s more middle-class people who have a problem with drinking—not so much binge drinking, but regular overuse of alcohol.
I recognise a number of the points that were made and I’ll try and deal with them before I conclude, Llywydd. A number of interesting questions and points were made by Angela Burns. I want to start by saying that I would be very happy to have a grown-up conversation about what we measure and why within our health service—the different measures that we have, the way that they’ve been generated and whether we can have something sensible, like is what we’re measuring sensible, is it helping to drive the right behaviour and whether it’s telling us something useful about the performance of our health service, but also about the way in which the public engage with the messages from that health service as well. We can look at things like the public health outcomes framework development, looking at outcomes and not just activity, and I do hope that, through the parliamentary review process at the end of that, we can continue to have that debate in the part of this term when, frankly, we can have it, because I don’t think we can have that same debate in the last 12 months of this term, if we’re being perfectly honest.
I’m pleased to hear you make mention of the dental process of contracts; I’m actively interested in them and I’m looking forward to the learning we get from those pilots and to look at what we could potentially adopt system-wide. Actually, oral health is an area in which we’ve had some success here in Wales. Designed to Smile has been successful. It isn’t the only thing to do and we do recognise that in general dental services there are still challenges for us to address and deal with. I think there’s a link here between dental services and pharmacy services, because there’s something not just about rewarding activity and volume, but a thing about how you reward quality. Because in pharmacy, which you mentioned, and I know other Members have mentioned in different debates here in the past—I think there’s a really exciting time in community pharmacy here in Wales, not just because we’re investing in an IT platform to enable pharmacy to do more, not just because our partners and colleagues in the British Medical Association are actually in a different place; it’s about recognising the value of pharmacy as part of that wider primary care team. The opportunity is there to try and understand what more pharmacy can do to take people away from general practice when they don’t need to be there, to be part of the team, but also to look at quality payments for the future, not just about volume and activity in dispensing, but, equally, I think there’s a really important piece of work already in place on the hospital discharge process. There’s much more we could do for community pharmacy, the individual and the hospital pharmacy service as well.