The next item on our agenda is a statement by the Cabinet Secretary for Health, Well-being and Sport on the ‘Heart Conditions Delivery Plan’, and I call on the Cabinet Secretary to make the statement—Vaughan Gething.

Thank you, Llywydd.

On 6 January this year, I published the refreshed ‘Heart Conditions Delivery Plan’. This plan reaffirms our commitment to reduce preventable heart disease and to ensure that people affected by any kind of heart condition have timely access to high-quality care. And that high-quality care should be delivered regardless of where people live. Increasingly, we expect to see that care delivered in the community as well as in a hospital setting, where appropriate. The delivery plan now includes a specific section on children and young people, and we’ve done this to take on board the findings from the independent review of children’s cardiac services in Bristol that was published last year. Children living with a heart condition should receive the best possible support and care in Wales.

There have been considerable developments in cardiac care across Wales since the original delivery plan in 2013. Fewer people now die from cardiovascular disease in Wales: rates fell by almost 1,000 people a year between 2010 and 2015. This is in part thanks to improvements in care, but we know more can be done. Hospital admissions for coronary disease fell by 21 per cent over the last five years, thanks to better management of the condition by both staff and patients. And we know that a range of innovative improvement projects are now in place, and these include: the development of the familial hypercholesterolemia programme; community cardiology; enhanced cardiovascular risk assessment; the adult congenital heart disease service in south Wales; direct access for primary care to diagnostics; nurse-led diagnostics; and e-referral and e-advice systems. All of these innovations have resulted in improved outcomes for patients, and I do want to pay tribute to all those involved in the planning and delivery of these services.

The British Heart Foundation, Members will be aware, recently described Wales as a world leader in cardiac rehabilitation, because of the significant increase in the number of patients receiving the service in Wales. We went from 42 per cent in 2014-15 to 59 per cent in 2015-16. However, we’re not complacent and will look for further improvement again in the future. The vision set out in our plan is for fully integrated primary, community, secondary and specialist pathways of care, and these are designed around the needs of the patient, providing the support they need to enable them to do what they can to manage their own condition. Cardiovascular disease remains a major cause of ill health and death in Wales, and the heart conditions implementation group has invested £1 million provided by the Welsh Government in the development of a cardiovascular risk assessment programme and community cardiology services.

Incidence of heart disease, we know, varies significantly and unacceptably between our most and least deprived communities here in Wales. The death rate for under-75s is 106 per 100,000 in Blaenau Gwent, which is nearly twice the rate in the Vale of Glamorgan, which is only 56 per 100,000. Recently, I was in Tynycoed Surgery in Sarn at the launch of the community cardiovascular risk assessment programme in the Abertawe Bro Morgannwg University Local Health Board area, and I was genuinely impressed by the enthusiasm of staff who are building on the success of those in the Cwm Taf health board area and the Aneurin Bevan health board area. They in fact spearheaded this project at the outset, and as well as having leadership from GPs at individual practice and cluster level, this programme relies on healthcare support workers for its success, because it’s their ability to engage reluctant but high-risk groups of people who do not make regular contact with GPs that’s essential to the success of the programme. That engagement deliberately takes place away from clinical or medicalised settings. So, equipping people with information to enable and empower them to change their current and future health has already made a real difference, and this programme should continue to make a real impact on health inequalities. The development of community cardiology services, whilst varying across health board areas, all support our priority to improve access to primary and community care, and we’re looking at different ways of treating people, where appropriate as locally as possible, to help reduce waiting lists and to avoid admission or re-admission into hospital. That’s particularly important for the frail, elderly and those with long-term conditions.

The heart conditions implementation group has identified their priorities for 2017-18, and these include developing treatment pathways for common cardiac conditions, piloting component and diagnostic waiting times, developing and implementing an out-of-hospital cardiac arrest plan, and further improving cardiac rehabilitation and physiology services, implementing the all-Wales accelerated cardiac informatics project, and developing cardiac peer review across Wales.

We’ve already seen improvements in cardiac waiting times through improvements in services such as the £6.6 million redevelopment in the Swansea cardiac centre, which has addressed increased demand for cardiac critical care beds after cardiac surgery. The draft clinical pathways for common cardiac conditions will be discussed at the Wales Cardiovascular Society spring meeting at the end of April to gain an all-Wales clinical consensus. Implementation of those pathways across Wales is key to delivering the aspirations in the plan.

Welsh Ambulance Services NHS Trust figures show that around 8,000 victims of out-of-hospital sudden cardiac arrests occur annually in Wales. Survival rates are low, but there is potential for many more lives to be saved if cardiopulmonary resuscitation and early defibrillation were undertaken more often. The availability of 24 hours a day over seven days a week primary percutaneous coronary intervention services in north Wales from 3 April is a significant development. We’ll now have all-Wales coverage.

Last December, I issued a written statement highlighting the progress we have already made in Wales in raising awareness, particularly in schools, of the importance of life-saving skills such as cardiopulmonary resuscitation and the use of automated external defibrillators. The out-of-hospital cardiac arrest plan that we will publish this spring will build on this success. It will cover early recognition of a cardiac arrest, immediate and high-quality CPR, and early defibrillation as well as effective post-resuscitation care.

We know that we must make the most of our resources here in Wales—not least the skill, dedication and hard work of our clinical staff, service managers, and third sector organisations. We want to create a more equal relationship between the patient and healthcare professionals, enabling people to co-produce their treatment based on their values, goals and circumstances. This refreshed plan was developed through effective partnership. That continued co-operation between the Welsh Government, the implementation group, the Wales Cardiac Network, professional bodies, and the third sector is key to delivering the next phase of working together, because our shared task is to deliver improved outcomes at greater pace and with greater impacts.

The Deputy Presiding Officer (Ann Jones) took the Chair.

I am proud to say that NHS Wales is making big strides forward. Cardiac care and survival rates continue to improve. I hope that Members across the Chamber will join me in acknowledging the hard work and dedication of NHS staff and other stakeholders, which have made these improvements possible and are essential to our continued success in improving more lives and saving more lives.

Thank you very much for your statement, Cabinet Secretary. Yes, I do join you in thanking our hard-working NHS staff. It is amazing and very satisfying to see the improvements in cardiac care, and I absolutely welcome these improvements and I thank the staff who’ve made all this possible by their very hard work.

I was delighted to read both the statement and the plan. You have laid out in your statement something we all know, which is that cardiovascular disease remains a major cause of ill health and death in Wales. Would you please expand a little bit more on any potential education programmes? The Royal College of Paediatrics and Child Health have suggested a ‘make every contact count’ approach when trying to address the issues of obesity and weight loss. What scope is there to encourage this sort of approach to help address the contributing factors to heart disease? I was very pleased to see that there’s a dedicated children and young people’s section now, but the key actions are about those who already have a chronic disease or condition rather than prevention to stop us from getting into this situation. So, a little bit more detail on that and how the implementation plan might be able to promote that would be more than helpful.

You very rightly point out that the incidence of heart disease, very significantly, is very high in our most deprived communities. When you talk about these huge inequalities, will you further outline what plans you have to educate people outside of these traditional healthcare settings so we can have a clear view of how we might be able to prevent these inequalities, or at least go some way to mitigate them?

The Welsh Ambulance Service NHS Trust figures and your paragraph, if you like, on defibrillation and cardiopulmonary resuscitation—I’m very glad to hear that there are plans to push life-saving skills, but will you also look at what other groups could be targeted to learn these skills, such as the Women’s Institute, scouts, guides, other community organisations? We’ve put a huge emphasis on donor schemes such as giving blood and donating organs. I wonder if similar resources should now be put into promoting life-saving techniques.

With reference to the heart conditions implementation group’s £1 million investment, could you please give us an indication of how this will be spread out or apportioned across the health boards? Finally, I wonder, Minister, how you are going to measure success. I see, in the heart conditions delivery plan, that you have a very small section on outcome indicators and assurance measures. In some ways, they don’t seem to be particularly tangible. Is there a view that you will be working to actually put some much harder KPIs in place so that we can see how well this is being delivered against the outcomes? Because, for example, just saying:

‘For outcomes relating to children, we will consider information available on smoking in pregnancy, perinatal death, low birth weight’, et cetera—‘consider’ isn’t actually a hard and fast outcome monitor. So, I’d be very interested to know how you intend to do that. Thank you.

Thank you for that series of questions. I know you like asking lots of questions, and I don’t have any issue with that; I just want to try and get through them in the time allotted.

I do welcome your recognition upfront about the role of staff in delivering very real improvements by NHS Wales. I know, every now and again, the tenor of the debate around health is about the challenges that we have, and I acknowledge we do have them, but this is an area of real and significant improvement, with more lives being saved as a direct result of what the NHS is doing.

I’ll deal first with the point about life-saving skills, because actually I’d indicated that, in the—. We’ll have a plan that’s going to be published in April. That plan is being developed with a range of different people about how we roll out further and build on the success, already, of life-saving skills, as well as understanding where those defibrillators are and people that are trained to use them. So, there is more work that’s ongoing and I’ll be launching that plan. I look forward to delivering it through the rest of this term with partners and to assess its impact again on delivering further improvement.

On your challenge about how the £1 million will be used, it’s not going to be allocated on a formula basis across health boards. The £1 million, as with every delivery plan, is actually allocated by the implementation group against their priorities. You should see those in the plan, but I’ve indicated some of them. So, that’s how the money will be used.

I think that part of what they’re going to do will answer some of your other questions about measures, because they’re looking at piloting component points to try and understand, at various different points, as you’re being treated, how long people are waiting along that whole pathway, to identify where there are potential blockages or inequality. I think that’s really useful. That should provide a very interesting overview for clinicians, as well as the public, and in the way in which we then engineer and deliver our services.

That may make some difficult reading at the outset about where we are waiting and things we aren’t happy with. But we have to be able to understand how we deliver that improvement, and that’s being driven by clinicians to understand where those component waits exist, and what they’re then able to do about them to reduce them, in the way that almost all of the elements we’re talking about have come from the conversation between clinicians, the third sector, and patients.

That’s the same in the community cardiology developments that are being rolled out. And, in particular, I think, your broad point about socio-economic inequalities, and the messages we have there about public health challenges, not just in heart disease, but a whole range of conditions that we’re all familiar with: the ability to do something about smoking rates, to continue to see that driven down, to do something about our alcohol use, but also diet and exercise as well, because we do know that obesity is a huge issue. So, if we can’t do something about diet and exercise then we’ll see a floor beneath which we won’t be able to make any further progress on reducing instances of heart disease within the population.

That’s also why the cardiovascular risk assessment programme started in Aneurin Bevan and Cwm Taf, in our most deprived communities—deliberately targeted in that way because we recognised the socio-economic inequalities that exist. That’s also why the rollout is now taking place in ABM and the more deprived areas first. It is because we’re getting to those people who don’t often attend, are in those high-risk groups, and if they’re not seen and treated and encouraged to actually undertake a different way of making choices about their own health then either their underlying medical conditions that already exist, or the additional risk they’re building up, we’re unlikely to see that challenged.

That’s why it’s deliberately being targeted in a way that tries to take away the medicalisation of that, to try and encourage people in their own communities to undertake different forms of activity, and it underscores the important things like social prescribing and the way we can make activity and healthier choices easier, without being judgmental. It’s about how you actually get into having a conversation within someone’s community that they’re comfortable with and they recognise the real benefit for them of making a change. So, there’s much to do, but lots to be optimistic about as well, I think.

I thank the Cabinet Secretary for this statement, which, of course, will be of interest to very many people in Wales because so many people do live with cardiac conditions or suffer from heart disease. Of course, we also welcome those areas where ground has been gained because of the hard work of our staff within the health service, and we must also bear in mind because of things that have emerged from this place, such as the ban on smoking in public places, which is having a very real impact on public health.

I have four questions to ask. The statement mentions cardiac rehabilitation services. The Government congratulates itself that almost 60 per cent of patients do now participate in rehabilitation programmes, but the delivery programme itself says that people in Wales wait too long before starting that treatment. We know of the waiting times for initial treatment, but we know very little about the waiting times for this recovery or rehabilitation treatment, which is so important. So, when will those data be made more public, and will the Government then establish how long patients should wait before they start that treatment, bearing in mind that the plan itself says that the waiting time is currently too long?

Secondly, the statement also recognises that we need to tackle inequalities in terms of outcomes, and that we need to increase the level of engagement between people and primary care teams, something that people in high-risk groups very often don’t do. So, bearing in mind that the Government is going to put additional pressures on the primary care sector, what intention is there to provide additional resources to correspond to that, including additional doctors and so on, in order for the primary care sector to deliver the objectives that the Government is putting in place for them?

The next one is for the Cabinet Secretary to discuss with the education Secretary, perhaps. I welcome the section in the delivery plan on children with cardiac conditions. In that plan, it notes that the Cabinet Secretary—the Government—wants children who have heart conditions to enjoy full access to education, including school trips. Now, does the Cabinet Secretary believe, therefore, in terms of delivering those strategic objectives, that we need a review of the laws surrounding school trips in order to secure children’s safety? We are aware of a number of cases where children who do have chronic conditions have been at risk, and, at the very least, I think we need to enhance the first-aid provision so that that is a wider part of the curriculum.

And, finally, we also know that in previous years that long waiting times for treatment have been a problem, with patients waiting longer than is clinically acceptable. That’s why certain treatments have been put out to contract to the private sector and have been outsourced. Can the Cabinet Secretary, finally, therefore, give us an assurance that the capacity is now in place within the system to avoid turning to that kind of provision too often?

Thank you for those comments. I think, on your last point, we broadly have the right capacity within our system now. You’ll see that waiting times have improved significantly in our two centres in south Wales and that in itself was a challenge. Members here will be aware that at various points a significant number of people were sent into the English system because we didn’t have the capacity here. So, credit should be given to our centres in Swansea and Cardiff for the significant work that they’ve done, not just in making significant inroads into waiting times for surgery, but also in that their outcomes are very, very good and better than the UK average. So, again, we should not be shy about praising our NHS when it actually does deliver very good outcomes and really high quality care. That does not mean, of course, there is not more that we would wish to do, and there are some people who wait a bit longer than we’d like, but they’re much, much smaller numbers. So, I’m confident about our ability to deal with the capacity there. But it also underscores your points about the progress we will and won’t make on community cardiology, because what was really encouraging—I don’t know if the gentleman behind you has been part of this in his practice before returning to this place—was looking at the way in which in the Swansea area community cardiology has already got rolled out. And it was GPs with specialist interest, or specialist skills, depending on who you talk to as to how they like to be described, who actually took this on. And there was a challenge about the conversation between those primary care clinicians and their colleagues in secondary care about whether they could actually do some of this job. And not every secondary care clinician was enthusiastic about it, but they are now, because they recognise that there are skills in primary care that can be used, and not just people who are GPs, but actually around some of the more preventative work. It’s actually reduced waiting times in that area as well, so people are getting a better, more local service in primary care, and people who need to go into secondary or tertiary care are getting faster access as a result. And it’s actually helping with our rehab programmes too.

My understanding is that we have the capacity to be able to do that within primary care, but as I’ve said previously when people make different bids for additional resource in different parts of the system, overall our budget is finite, and so, if we ask for more money in one part of our healthcare system, we need to take it out of somewhere else, and that’s actually rather difficult to do. But, if we’re going to move services into primary care, then the resource has to be there and available in either financial terms, or in terms of people, to be able to deliver in the way in which we expect the service to be delivered differently.

So, some of this is about making better use of all our healthcare professionals, and it goes back to the conversations we regularly have about making the best use of a GP’s time, because some of what they currently do could be taken away and dealt with by other professionals. So things like this, where GPs with a special interest could do more, and deliver high-quality care more locally, is actually part of what we need to see driven more consistently. And I’m really pleased to see that every health board has taken on board the successful learning from the Swansea area of Abertawe Bro Morgannwg, which has made a really big, important and positive difference for patients.

I recognise the points that you make about how we appropriately manage children with chronic conditions—that aren’t about their ability to learn, necessarily—but the chronic health needs they may have and how they’re managed with an appropriate level of risk management in that. But, what I don’t want to see is that we take a risk-averse approach that means that children are denied opportunities because of their health condition. But it’s about how that level of risk is properly and appropriately managed, and there will need to be an ongoing conversation between local government, as well as Ministers and officials in the Government, about how that’s properly done. I recognise the recent tragic examples that are given about where things appear to go wrong, but I’m keen that we actually take a sensible view that doesn’t reduce the opportunities available to a range of children.

And on your point about cardiac rehab progress, I’m really happy with the more successful engagement that we’ve had with patients. But some of this is still about how many people are prepared to engage in a rehabilitation programme. You may think it odd that after someone’s had surgery or intervention for heart care that they’re not willing at that point to go and engage in improving their care. But not everyone is, and so, some of the challenge is how we persuade those people of the value of it, as well as offering that opportunity earlier. I’m genuinely proud of the significant progress Wales made in the last year of recorded figures, because it shows that we’re ahead of every other nation in the UK in cardiac rehab. And, again, we should all be really proud. It’s not just about the Government congratulating itself; it’s about congratulating our whole service about what it’s doing—the fact that we re-engaging citizens in making different choices for their own care, because they have to engage in the programme for it to be successful.

But I want to be really clear: this doesn’t lessen our ambition for improvement. I think that’s really important as well. We’ll see a new set of figures that will come out and we’ll look again at what we’ve done in terms of the time that people wait to go and have the rehab programme started, as well as the number of people that take part in that rehab programme as well. I’m committed to being open about what we’re able to do and the improvements that we do make, and I’m confident that we’ll make further improvement again—but also the improvement that we still recognise we could and should make with our population as well.

We are what we eat and, sadly, far too many people are only eating food that’s absolutely drenched in fat, sugar and salt. And that, combined with poor exercise, is obviously a recipe for heart disease. You rightly point out in your statement that a lot of the target groups are those who are reluctant to go to the GP. I was pondering on that, and I want to applaud the work of people like Food Cardiff, who are reaching out to people to try and get them to change their diets, particularly through schools. But men, I think, are particularly at risk of heart disease and are less likely to be attending school and to hear what is on offer there. I was a little bit disappointed not to see this reaching out to those who don’t go to the GP very often, or not until it’s absolutely acute, and that that is not in the list of priorities that you outlined at the end of your statement. So, I wonder if you could say a little bit more about how we’re going to reach these people who are being killed early and are being sent to an early grave. They are being sent to an early grave by the food processors, which is, of course, why I want to see a tax on sugar, salt and fat, to enable us to care for these people when they inevitably end up in the acute sector.

Thank you for those comments. I recognise your consistent interest in the area of diet, health, and exercise. It’s not just around diabetes, as many of the risk factors we talk about in diabetes are risk factors in a range of other conditions, including heart disease and heart conditions as well.

We recognise the significant impact that diet and exercise have in a whole range of conditions, and I too recognise the work that Food Cardiff are doing on reaching a number of people. But when I describe the cardiovascular risk assessment programme, that is deliberately reaching into people who don’t engage in normal services. That’s the success that we’ve seen in Cwm Taf and in Aneurin Bevan, and I expect we’ll see more success in the Abertawe Bro Morgannwg area as well.

And so we expect the programme to be rolled out successfully, to reach out into those people who don’t engage in their own healthcare choices now, despite all of the evidence that exists. There is a whole range of things, but probably the Caerphilly study is still the thing that tells us about the long-term impact of making different health choices. And so that’s why the programme is being rolled out, because it goes to those people where we recognise there are socioeconomic inequalities and we recognise they are unlikely to engage in those wider public health messages, wherever they are. I think it’s really important we use school as a real lever—particularly primary school, where parents are more likely to be engaged. But I recognise that, even at primary school, it’s still more likely to be women who engage in and around the school.

And with the success that we’ve seen, we’re actually seeing varying rates, between 50 per cent and 70 per cent, of engagement with the cardiovascular risk programmes in Cwm Taf and Aneurin Bevan. That’s a significant improvement; a significant engagement of people who wouldn’t otherwise be there. That’s why—I’ve emphasised it in the statement—you’ll see more of that taking place right across the country.

And in all of these things, we need to understand why these have been successful. And it’s not just a model of healthcare support workers working in different settings—but it’s whether it’s still going to work as successfully as it’s rolled out. I’m confident it should work in almost all of our settings, actually, but, again, we always need to take a step back and learn: is it still the right approach, is there more that we can do, and how does it tie up with our other interventions, and other work right across the Government? So it’s not just health in all policies, but it’s all policies in health as well, and how we see that delivered right across the span of Government and our partners.

Thank you for your statement, Cabinet Secretary. Despite recent advances in coronary care, heart disease remains one of the biggest killers in Wales. This month, around 750 people will lose their lives to cardiovascular disease; 720 will go to hospital with a heart attack; and, sadly, 340 of those will die. Also, this month, around 16 babies will be born with a heart defect. Therefore, Cabinet Secretary, the heart conditions delivery plan is most welcome.

As the plan highlights, we are at a point where we need to deliver not a gradual, sustainable improvement, but an immediate and fundamental change in pace. The delivery plan rightly places a lot of emphasis on prevention. To reduce the number of adults who smoke, the plan states we must ensure that every contact with health and care services is used to prevent smoking uptake and encourage cessation. Despite years of highlighting the dangers of smoking, the numbers of smokers remains stubbornly high. Cabinet Secretary, what consideration have you given to the utilisation of e-cigarettes as a way of reducing the harm of tobacco smoke amongst the 19 per cent of Welsh adults who continue to smoke?

With regard to the other main lifestyle factor in heart disease, the lack of physical activity, and poor diet, over half the adult population in Wales is either overweight or obese. Tackling this problem is much harder than reducing harm from smoking. So, what consideration has your Government given to ensuring that part of the new national curriculum focuses on teaching our young people how to eat healthily, and how to live healthily?

Of course, we will only prevent so much heart disease, and we therefore must ensure that we have timely and effective detection and treatment. The 95 per cent target to treat cardiac patients within 26 weeks of referral was last met in April 2012. We welcome the progress that has been made, and also the staff who work around the clock to ensure that we get the best service possible. Reducing the number of people waiting more than 26 weeks needs to be done and done urgently. Cabinet Secretary, what are the main factors in missing the referral-to-treatment target? Is it down to lack of manpower, or is it impacted by the reduction in the number of available beds?

Finally, Cabinet Secretary, the British Heart Foundation has highlighted that a large number of people in the UK are living with a faulty gene that puts them at risk of developing coronary heart disease, or even sudden death. Each week, around 12 apparently healthy people under the age of 35 die from sudden cardiac death. Cabinet Secretary, what is your Government doing to improve research into sudden cardiac death and are you looking to develop appropriate population-level screening for these heart conditions? I thank you, once again, for your statement and I look forward to working with you to improve cardiac care in Wales. Thank you.

Thank you for the comments and questions, and in particular for the welcome for the plan and again, the recognition of progress that we have made and intend to make here in Wales. I’ll deal with the last point first about research and screening. Of course, there’s a range of research that takes place across our university and health board sectors. Whenever people mention screening, I just—. We need to take a step back and actually understand what we mean by that and what the value of all of this is. The easiest thing is to call for a national screening programme to understand and to identify early a range of conditions, but actually, we need to have reliable tests that actually tell us something useful and not undertake harm to people. That is our challenge. Is there a reliable test that we can screen the population with? Do we really see health gain in trying to undertake a national screening programme in this area, or are we going to have a greater return in terms of the value for individuals, as well as the NHS, with other measures? At this point in time, I’m not aware that there is a sensible approach to population screening in this area. We need to undertake procedures where we understand there is risk and to understand the risk that people have in their own family histories.

On the point about waiting times, we’re seeing waiting times reducing. As you’ve seen, in my statement, I indicated that we’ve invested £6.6 million in the Swansea centre, as well, to give us more capacity to allow those waiting times to fall even further, as well as the work I’ve already described in answer to other questions about the work we’re doing in primary care to make sure that we have alternative services to make sure that the people who really do need to be referred to secondary or tertiary care have the opportunity to do so quickly.

On your point about smoking falling, again, it was remiss of me not to recognise what Rhun ap Iorwerth said. Measures taken by this place on avoiding smoking in certain parts of the public estate in particular have had a real impact on changing the nature of the conversation around smoking. It’s part of the armoury that we have in actually reducing rates of smoking. It was a difficult choice to make. People may think now that of course you shouldn’t be allowed to smoke in a variety of public places, but there was very real and significant opposition at the time that this place made a choice to prohibit that. We were the first part of the UK to do so. On your point about e-cigarettes, well, e-cigarettes are not unharmful; it’s not as if there’s no harm at all. The challenge is that we don’t understand the exact nature of the harm in these products. That’s why regulation is being taken forward on what could and should go into an e-cigarette. But I recognise that some people use them in trying to give up, but we’ve continued to say, as a Government, that we’ll be led by the evidence and what exists, both about the harm caused by e-cigarettes, and then as an alternative to tobacco. So, I’m not about to go off on a flyer today and announce an entirely different or new approach. We’ll continue to take a precautionary approach, but we’ll be led by the evidence on the right way forward.

Finally, your point about diet and exercise. Again, it’s come up in other questions, but there is a consistent healthy schools message, and any Member who visits one of their local primary schools in particular will be hard pressed not to see a healthy living and healthy eating messages within their schools. So, actually, I think our schools are delivering their part of the bargain in delivering that healthy eating, healthy living message. The work that we’re doing, for example, in rolling out the daily mile in schools is part of that message. The challenge always is how we engage with the parent and the carer group around that school, because they are bigger influences than our schools are themselves on the health behaviours that people acquire and then take with them into adulthood. So, it’s about the whole picture; not just saying it’s the responsibility of schools, because actually, each of us in our roles—as individuals, parents and carers and in our roles in communities—we have some responsibility too, but the challenge always is how we help people to make choices, rather than be seen to be lecturing people or telling them that they’re doing the wrong thing. Actually, that hasn’t proven to be a very effective way to deliver change. Most people understand healthy living and healthy eating messages; our challenge is how we help them to do that more successfully and more effectively.

And finally, Suzy Davies.

Diolch, Lywydd. Thank you very much for your statement today, and for the information that you’ve given us. I certainly appreciate that. One of the things I wanted to ask you about was one of the key actions in the heart conditions delivery plan, namely the plan to have an out-of-hospital cardiac arrest plan for Wales—something I’d certainly welcome. Now, that plan would ensure that there are clear pathways for patient management following the return of spontaneous circulation, and I believe you can plan for that. What’s more difficult to plan for is the losing of spontaneous circulation in the first place.

Without pre-empting tomorrow’s debate, I think you could consider more defibrillators, and a whole-population-level training to give the confidence on how to use the equipment, how to practice and update it, because it does need to be updated—wider cardiopulmonary resuscitation techniques. All these things could actually be step 1 of your out-of-hospital cardiac action plan. If you agree with that, I’m just wondering whether you think the way of creating that first step would be by adopting a rights and responsibilities approach, rather than relying on the kind of activity that you mentioned in the statement that you put out in December—showing a huge and very, very welcome rise in interest and activity on the issue of emergency lifesaving skills, but which actually seems to bring no certainty of longevity or, indeed, reaching the entire population, which is what would have been needed in order to manage the unmanageable, which is the sporadic and random nature of people having heart attacks outside of the hospital setting. Thank you.

I indicated that it was April, but actually it’s May when I expect to be able to publish the new plan. I don’t want to completely pre-empt tomorrow’s debate either, which you’re going to be leading on a new legislative proposal, but some of this is about how we deliver more lifesaving skills and where and how we’re going to be able to do that. And there is a balance between what we make mandatory, and what we don’t. You’ll see the approach—I’m not going to pre-empt tomorrow’s statement and debate—. But part of this has definitely been about understanding where all the defibrillators are.

So, actually, a couple of years ago we launched what we called an amnesty—which is probably the wrong term, actually—on where defibrillators are and about making them available to the public. A number of businesses had them, but they were available just within that workplace rather than for members of the public. I visited, in fact, a pub in Barry high street, with the Member for the Vale of Glamorgan, to look at their defibrillator, which was on the register so the Welsh Ambulance Services Trust knew where it was, community first responders knew where it is and then are able to use it if there is a sudden arrest on the high street in Barry. So, that’s part of what we need to do more of more effectively. We’ve already got 2,000 defibrillators registered across the country, and it’s about understanding more of what we can do more of in that area, as well as equipping people with those lifesaving skills.

I won’t say more at this point, Deputy Presiding Officer, because we do have a debate on this tomorrow, and I don’t want to pre-empt anything you might say there, or anything I might say in response to the debate. But we do take this issue seriously, and we of course want to make further progress.

Thank you very much, Cabinet Secretary.