Thank you, Deputy Presiding Officer. I want to start by saying that I do welcome the committee’s report and the range of comments that were made in today’s debate, even though I won’t agree with all of them. But I’m really pleased that the report acknowledges improvements that we have already made in planning for winter, and the continuing challenges that we still face.

The committee make, of course, a number of recommendations right across health and social care that reflect not only the importance of managing winter pressures, but also the year-round challenges that face our services. At the outset, I do want to acknowledge again that our health and care system is under very real and significant pressure. I said before Christmas, when I appeared before the committee, that we are better prepared than before for winter but that there will, of course, be difficult days, and there have been. Our hospitals and social services have seen surges in demand, especially from patients with increasingly complex needs. And I say again: there will be more difficult days to come before winter is over, and each of us should be very grateful that we’re here in this Chamber, not facing those pressures on the front line. Because it is a testament to the commitment and skill of our staff that despite the pressures they face, the vast majority of patients and citizens continue to receive high-quality care in a professional and timely manner.

That does not mean that, as a Government, we’re complacent or ignore the scale of the challenges that our whole system faces. We rely upon our staff, and we’re proud in this Government to see them as partners. That is why I have not and will not pick a fight with junior doctors. That is why I have not and will not blame GPs for winter pressures. And that is why I’m proud to be a member of a Government that is investing in our social care workforce.

We have deliberately taken a whole-system approach to planning, and I don’t accept the criticism of Rhun ap Iorwerth that the social care system is somehow being forgotten or overlooked. We continue to fund social care at a much better level than in England, but that does not mean that social care here in Wales is pressure free; it certainly is not. Social care is very much part of the planning and delivery in winter, and social care is also very much part of the market analysis work that is ongoing. We work, and we’ll continue to work, right across health, local government, in partnership with the third sector and our emergency services. Now, that doesn’t mean to say our system is currently perfect, but progress really is being made and will continue to be further strengthened in an integrated way, working between those services.

Now, I recognise, of course, that designing services that can anticipate and respond to the changing nature of demand can take time to get right. However, we’re determined to drive forward further improvements, and I was pleased to see the committee’s recommendations reflect much of this work. Organisations have been encouraged to build upon their plans and experience of previous years to prepare for this winter and beyond. I’m encouraged that delayed transfers fell again in December—that’s unusual; it’s not the case we see across our border—ambulance response times are better than last winter and holding up; and 111 has been a success to date in its pilot area of Abertawe Bro Morgannwg, and that was not the case when it was rolled out right across England. So, we are getting a range of things right, and we’re getting a range of things that are improving year on year. The challenge is: do they improve at a fast enough rate to keep up with the ever-changing and ever-increasing nature of demand? And actually, we are seeing more people at home this winter; that’s part of the reason we are continuing to cope. There’s lots of evidence about the approach that we are taking being in the right direction, but there’s always the question: is it enough and can we do more?

There has been a great deal of focus, of course, on hospitals, but I’m pleased that the committee recognises the critical role of GPs, social care, the intermediate care fund, out-of-hours and ambulance staff in treating and caring for people. Recommendations 1 to 5, 8 and 9 in particular focus on the planning, delivery and learning across our whole system, and I should say, as comment has been made on it, that recommendation 5 was rejected because we’re essentially doing what is being asked of us, and I’m keen not to duplicate our efforts or to restart. But I think there’s much learning to take place about how we design, deliver and co-locate our various services, and there will be those in favour of co-locating in an A&E and those who say, ‘Actually, you shouldn’t co-locate everything within a hospital setting.’ We’ve got to think about how we deliver that care in different settings around our whole community.

We recognise, of course, that the report makes mention of this as well: that health boards have to manage both scheduled and unscheduled care over the winter. This winter, health boards have changed their focus of their activity, with more out-patient and day-case activity, which is not reliant on in-patient beds. And we have provided that additional £50 million to the NHS this winter to help manage demand, and I expect that at the end of this year we’ll see further improvements made in both RTT and diagnostics, and we’ll see further increase in elective activity through winter. And I expect the end of March position for this year to improve again upon last year.

We will, of course, evaluate how our whole system has managed through winter. I’ve made it very clear that we can expect to have lessons to learn and to improve. That includes, though, the success, or otherwise, of Choose Well, and the impact of the public and their use of the whole system. We ought to educate and inform our public, not blame them. But, actually, the public are part of helping us to make the very best use of the whole system. I’m pleased to say that the views of both clinicians and the public will be sought as part of the evaluation of our response to and delivery within winter.

I recognise what Angela Burns has said because it’s a point that I’ve made on many occasions in the past. We regularly get told throughout the year in health that, actually, there’s no such thing as winter pressure because there’s pressure year-round across our system, and it’s true, there is pressure year-round across our system, in both elective care and in emergency care as well. But then every single winter, we talk about the particular and heightened challenges of winter, and it is because we have a different sort of patient and a different need coming through our doors in different numbers in winter. The overall numbers actually go down, but the nature of the demand changes significantly. That’s why we plan to deliver, and we are delivering, extra bed capacity in winter. That’s why I listen to GPs, as Dai Lloyd acknowledged, and I relax quality and outcomes frameworks through the rest of this winter to give more time for GPs to actually take care of their patients.

We should, though, acknowledge the year-round context of our health and care system, and the choice that we have to make—not just in the winter, but in planning and delivering our system throughout the year. We all know the well-rehearsed pressures of public expectation and ageing population, the impact of poverty, our long-standing public health challenges, and, of course, the unavoidable impact of UK Government austerity. It’s a regular and understandable feature of politics that people call for more money, and resources where there are challenges, and that is every bit as much the case in health and social care as in any other activity. But calling for increases in health, local government and third sector spending is a demand for the impossible, whilst we face the reality of austerity.