Item 3 on our agenda this afternoon is a statement by the Cabinet Secretary for Health, Well-being and Sport on the refreshed stroke delivery plan. I call on Vaughan Gething.

Thank you, Deputy Presiding Officer. On 13 February this year, I published the updated stroke delivery plan. This plan reaffirms our continued commitment for all people of all ages to have the lowest possible risk of having a stroke. When stroke does occur, we want people to have an excellent chance of surviving and returning to independence as quickly as possible. The delivery plan sets out the expectations of all stakeholders and provides a framework for action by health boards, NHS trusts and partnership organisations. Each year, around 7,000 people in Wales will have a stroke. This can have a very serious and lasting impact on the lives of individuals and their families. The Stroke Association estimates that there are currently in excess of 60,000 stroke survivors living in Wales.

But good progress has been made since the original stroke plan was published and, most significantly, the number of people dying from strokes is reducing. Deaths from strokes in Wales have fallen by 22 per cent from 2010 to 2015. The latest results published this March by the England, Wales and Northern Ireland Sentinel Stroke National Audit Programme—I’ll refer to it as SSNAP later on in the statement, If I may—that audit showed that stroke services across Wales continue to improve. The most improved site over the last two audit cycles is the University Hospital of Wales in Cardiff, with two other sites in Wales achieving a similar positive good overall rating. They are the Royal Gwent and Withybush hospitals.

We are now in a strong position to move ahead with even greater pace. The stroke implementation group provides our national leadership and support, together with a national clinical lead, based in Bronglais in Aberystwyth. They’re driving improvement and there is also a recently appointed national stroke co-ordinator. It is the co-ordinator’s primary role to support the implementation of the stroke delivery plan. The implementation group, in common with other groups, brings together health boards, the third sector and the Welsh Government to work collaboratively. The group has identified its priorities for 2017-18 and these include: identifying individuals with atrial fibrillation; the reconfiguration of stroke services in Wales, including the development of hyper-acute services; community rehabilitation; the development of a stroke research network and developing and responding to patient experience and outcome measures. These priorities will continue to be supported by £1 million from the Welsh Government for innovation and research to improve reducing the risk of a stroke and achieving better patient outcomes. We have that £1 million still being provided to each and every one of our major conditions implementation groups.

In this instance, that specific funding has helped to provide training at Prince Charles Hospital in Merthyr to enable nurse-led administration of thrombolytic medication for patients within the A&E department. In Cardiff and Vale, it has been used to support the pilot Stop the Stroke initiative, and that trains staff to identify patients with atrial fibrillation who may benefit from anticoagulation drugs. Preliminary results show that if the findings were replicated with similar success across other health boards, over a five-year period, more than 1,000 strokes could be prevented across Wales. The stroke implementation group is funding additional pilots in other health boards ahead of a possible national roll-out.

I also want to say something about the Welsh ambulance service, because they play a significant part in the success story of improving stroke outcomes here in Wales. It is so much more than a rapid delivery service. We now assess and publish the care that the ambulance service provides as part of the ambulance quality indicators. There is a very high level of compliance with the stroke care bundle that they deliver.

But we do, of course, continue to rely upon a strong team of health and care professionals to deliver improved outcomes for people who have strokes. So, nurses, physiotherapists, occupational therapists, speech and language therapists and many others, as well as doctors, are part of that healthcare team. Successful rehabilitation also relies upon having the right care support in place. Like many others in this room, I have seen that support from healthcare, local authorities and the third sector within my own family. We can, I believe, be confident that some further improvement is possible in stroke outcomes within our current services. However, our stroke services need to be planned in a way to make the very best use of finite resources to improve outcomes and to aid in the challenges of recruiting specialist staff.

Last year, the stroke implementation group commissioned the Royal College of Physicians to review the options for the reconfiguration of hyper-acute stroke services here in Wales. Stroke services were modelled to incorporate geography, travel times, boundary issues, current stroke services and co-dependencies. NHS Wales chief executives have asked the stroke implementation group and health boards to work together to consider the implications of that report and what actions need to be taken across Wales to reconfigure stroke services to ensure the maximum benefit possible for patients.

But we have already seen the benefits of the reconfiguration of services and what they can bring in Wales. Over the last 12 months, the Aneurin Bevan university health board have seen considerable improvements in their stroke outcomes and performance levels, because their seven-day multidisciplinary stroke service is now provided for patients from across the health board area by a hyper-acute stroke unit at the Royal Gwent Hospital. I visited the unit last year, when I actually met the then nurse of the year; that’s the unit that she works on. And I heard first-hand from a variety of professional staff, including those who had been recruited into that unit and had specifically come to that unit in Wales on the basis of it becoming a hyper-acute stroke unit.

Patients spend an average of three days of care in the hyper-acute unit. By that time, if they’ve not already been discharged home under the care of the community neuro-rehabilitation service, patients will be transferred to a specialist stroke unit for acute step-down care closer to home for the next stage of their stroke rehabilitation. The time required for this varies, but it’s an average of six weeks. The Royal Gwent Hospital I think is a care model that is a flagship in Wales, and it’s leading the way for other stroke services in Wales. I look forward to hearing how other health boards will work with the implementation group, clinicians and patients to take similar action to improve outcomes for patients.

The citizen, of course, has a central role to play in avoiding strokes. As with so many major conditions that take lives or lead to disability, smoking, diet, exercise and alcohol are all major risk factors. Unhelpfully, some people try to describe this as blaming people for being ill. But we all recognise that the imperatives for significant and wide-scale change in the choices that we each make in living our lives could not be clearer. This does not just apply to stroke care. We as a country need to have a much more mature debate that is clear about our own individual responsibilities, the consequences of our choices and how we make healthier choices easier choices. I expect stroke care to be part of a drive across healthcare to deliver a more equal relationship between the citizen and the clinician. Health and care services need to listen to and understand what outcomes and experiences matter to the citizen.

In 2016, the stroke implementation group worked in partnership with the neurological conditions implementation group to develop patient-related experience measures, or PREMs, and patient-related outcome measures, or PROMs, for stroke and neurological conditions in Wales. The programme aims to gain a real insight into services from a patient perspective, and to use their real life experience to help improve services. By March 2018, my aim is for Wales to have PREMs and PROMs that can be administered, collected and collated on a national level. These should help to identify inequalities in health and care provision across Wales, support the evaluation of service development and demonstrate real and meaningful change over time.

This updated stroke delivery plan was developed through effective partnership working. That continued co-operation between the Welsh Government, the implementation group, the NHS, professional bodies and the third sector is key to delivering improved outcomes at greater pace and with greater impact, because we should all recognise that the challenges ahead are many and significant, but we can look to the future with a sense of shared direction and confidence. My unambiguous focus is on shaping a health and care system that delivers the very best possible outcomes for stroke patients throughout Wales.

Thank you for the statement. I think I have four questions that I’d be grateful if the Cabinet Secretary could respond to. Survival rates have risen in Wales, as elsewhere. New technology and better treatment have ensured that and, of course, we welcome that, and there has been a clear focus on rolling out these new treatments and on improving survival rates. But the services that are offered post stroke I think need improvement, and I think that point is conceded in the new delivery plan. What is needed is for all stroke survivors, not just some, to be receiving the six-month review, for example, and to receive the appropriate rehabilitation services. This means, inevitably, a need for physios, occupational therapists and ensuring that institutional barriers don’t prevent delays in these being provided. But there’s a lack of data on how many survivors are actually receiving the reviews. So, my usual data question: when will more data be made available on the six-month reviews? There are also other health problems that can be caused by stroke, and therefore patients would benefit from monitoring closer, post stoke, in case these problems develop. For example, stroke can trigger the onset of dementia. Also, around 20 per cent of stroke patients have depression following a stroke. So, the second question: has the Cabinet Secretary considered what ways can be developed to monitor this, in order to develop intervention?

I’ll turn to the third sector and draw attention to the tremendous work done by the Stroke Association. Funding cuts—in my constituency, certainly—mean that cuts in staff have become necessary. That means cuts and impacts on services, and in the ability of the Stroke Association to help patients through the recovery process. For example, 1,500 people in my constituency have survived a stroke—above the average. Nearly 1,500 have been diagnosed with atrial fibrillation—again, above the average. That’s now; that’s the challenge we’re facing. In future: over 11,000 have been diagnosed with high blood pressure, so we have many people in high-risk categories, when we have a Stroke Association who want to contribute with the provision of social contact and stimulation, the promotion of physical and mental health and well-being, the reduction in dependency on long-term social services provision and so on—it’s a long list. Can I ask, as my third question, what assurance the Cabinet Secretary can give that Government, working with health boards, will give leadership in ensuring that the third sector services can be maintained and enhanced in future, as an integral part of the care system?

And finally, survival rates across the UK are dependent upon income. They follow the usual pattern of health inequalities, with people in poorer areas, frankly, less likely to survive a stroke. And whilst, obviously, healthier lifestyles—we can all be agreed on that—would help to prevent some strokes, will the Cabinet Secretary look at whether the rehabilitation services available in poorer communities are as good as elsewhere, and make sure that service provision here doesn’t follow the inverse care law?

Thank you for that series of questions. I recognise what you had to say at the start about new technology, but I don’t think the better treatment that you refer to is a simple matter of accident, or that it’s inevitable. Those are deliberate choices that our clinicians are making. And actually, bringing together the stroke delivery plan and the implementation group has actually helped to advance those choices. There’s much greater conversation across Wales and helpful peer support and challenge about what are better models of care—both at the immediate point, but also in the sense of what rehabilitation could and should look like. That is also having to drive the conversation about reconfiguration of stroke services. I want to see more pace injected in that conversation and reaching a conclusion, because if we’re able to do that, then the points you make about better treatment at the outset—we’re more likely to deliver better treatment across the country if we do that, and if we have an agreed model for the future as well.

So, this really does matter, because if we do that, we’re more likely to save more lives and prevent avoidable long-term disability as well. So, there is a real price to pay in not doing this, as well as a real gain to be made if we can do it. In terms of your point—there were a number of points you made about rehabilitation and about, if you like, a person’s general well-being and not just their physical well-being as well. I recognise the points you’re making because, of course, that’s why I think the PROMs and PREMs measures matter. So, for that person, what matters to them in terms of, if you like, their clinical outcomes, but what matters for them in terms of their experience, and what, for them, matters and what is important. For some people, they may want to undertake rehabilitation so they can walk to the end of their street or walk to a local cafe or walk to a local social centre. And that isn’t just the physical part of actually recovering and being able to do that; it’s actually about being able to have that wider social interaction as well, and the points about their general well-being. In each of these, there is a danger that we only see the condition rather than seeing the whole person and what it is that makes them someone who actually has a life they enjoy leading and living. And on your broader point about the team who are supposed to provide this care, that’s one of the points I was trying to make. Having the right people available to deliver that improved rehab: that’s part of the reason why I announced that £95 million investment in the future of healthcare professionals in recent weeks, because we know we will need more healthcare professionals to deliver the quality of care that all of us would wish to see.

I was grateful to you for actually raising the issues in your own constituency—the numbers of people who have survived stroke, the numbers of people living with increased risk factors already, but also the particularly stark figures of people living with higher blood pressure and the significant additional risk they face from a number of conditions. That’s something that’s particularly personal for me given my own family history, because I understand what that really can mean and the range of risks that exist as well. That’s why I made the point, quite unashamedly, and why we will all need to return to this time and time again, as you did as well—. What it is—it’s to actually make healthier choices and the reduction in risk that that will deliver, and, actually, what that then means in terms of people having not just a longer life but a longer, healthier life. We haven’t been successful enough as a country in having that debate and in changing attitudes to the choices that each of us make and that we see made in each of our communities.

The third sector are an important part of that as well. I’m happy to say that when you look at the deliberate choice we’ve made in how to construct our implementation groups, the third sector are important partners within that, because of the expertise they bring, either in being champions in the service or for patients, and many of them are service providers as well. So, they are part of the architecture that we have deliberately designed, and there’s certainly no intention and no desire from this Government to unpick their role in helping to deliver those health and care services. The challenge will always be how we use our limited resources, and, unfortunately, tomorrow I’m not expecting there to be good news in the way that funding is distributed around the United Kingdom. What I couldn’t tell you or anyone else in the statutory sector or the third sector is that there’ll be a sudden tidal wave of money coming in to these services—regardless of how important they are, we will all have incredibly difficult choices to make on where that money is distributed and prioritised and used for the best possible impact for each of our citizens.

And finally, dealing with your point about inequalities—we have taken this on board seriously about how we understand risk. That’s why the Living Well, Living Longer programme in Aneurin Bevan, and the similar programme in Cwm Taf are being rolled out, because we’re getting to people who are not interacting with the health service but are carrying significant increased risk. Because I recognise we do still see far too high a level of inequality within socioeconomic groups and that is not something that this Government finds acceptable.

Cabinet Secretary, thank you for your statement today. I welcome hugely the great strides made forward in the delivery of stroke services. There was much in this report that I found to be of really good news. I do have a couple of questions, though, that spin from it.

The first is that NICE guidelines suggest that patients suffering from stroke should, as you know, start thrombolysis within three hours of arriving at hospital. I’ve submitted an FOI on this to all the health boards, and from the responses I’ve received so far, which is just three of them, they’ve all had, consistently, patients waiting for between three and five hours. I wondered if you could tell me what plans are in place to ensure that these health boards are able to start this treatment within the three-hour window. And if I could just refer back to the debate last week on the Welsh Ambulance Services NHS Trust, this is entirely the point that I was trying to make about strokes not being in the red category, because my concern is that, if they’ve waited a while out in the field, and then they’re still waiting again whilst they’re in hospital, then by the time they actually have that treatment, they are many, many hours down the road and therefore are less likely to have success.

Just whilst we’re on the recommended guidelines, could you also please make a comment on the Royal College of Physicians’s recent guidelines that say that they believe that all stroke patients should receive a brain scan within one hour, and whether or not you think that we are able to drive towards that?

My second area of questioning concerns strokes in children and babies. Now, I admit they’re rare, but I wondered if there’s been anything specifically done to minimise such occurrences. The framework refers to the Royal College of Paediatrics and Child Health consulting on stroke-in-childhood clinical guidelines. Could you please provide an indication of when you expect this to be published and how long it might take to implement any recommendations? There obviously needs to be a clear pathway for the treatment of children and babies and, because it is rare, I do accept that it is unrealistic for every health board to have full provision, so I wondered what plans you might be putting in place so that children and babies who suffer strokes can access that very, very vital service.

Finally, the last area I’d like to concentrate on is the inequality agenda—or the equality agenda. According to the ‘State of the Nation’, and the stroke statistics published last year, people from a black or south-Asian background have strokes at a significantly younger age than Caucasian people. Is there anything being done to specifically target healthcare education and preventative measures to those communities? At present, they are being disadvantaged because of the sheer prevalence within their cultural community, or cultural heritage, and it would be really useful to know what Government plans there are to actually tackle that specific area.

Finally, Wales has the highest percentage of people with high blood pressure per population in the UK and, again, I wondered if, as part of the stroke delivery plan, you might be looking to see if there are any updates you can give us on what we might do to drive that down, if anything’s changed in the last 18 months. Thank you very much.

Thank you for the series of questions. I wouldn’t say that your questions spin from you; I’ve got to say they flow from you. I wouldn’t want to have any adverse—[Inaudible.]—about spin at this point in time. But I recognise the points that you make on a range of different improvement measures, and in particular the significant additional risk measures for some groups within our population and for people going across—[Inaudible.]

Actually, one of the priorities that the implementation group has had is a common approach to cardiovascular risk assessment with other implementation groups. They’ve actually jointly pooled some of their money to undertake a wider and more significant cardiovascular risk assessment. And that’s been helpful in the conversations that I had in my previous role as the then Deputy Minister in talking to leading third sector groups about how that could work. So, there’s been a—[Inaudible.]—that has been drawn together from that third sector group, and that’s been really helpful in getting their own implementation groups, which they then link into specifically, to undertake a joint piece of work. There is a recognition, as I said in my statement, across the health boards that the risk factors we’ve discussed and described here are risk factors in other major diseases and other major causes of death and disability.

On your point about the NICE guidance about the time for thrombolysis and in particular, your point about the RCP guidance on CT scans within an hour of admission, the points that I’d make in response go back to the improvement that we’ve already seen. That is that the snap audit looks at everywhere in the UK apart from Scotland and it’s been a really useful tool for driving improvement. Because when we first started looking at this about three years ago, actually, they had five categories: A, which is world class; B, which is very good; C, which is good; D, needs improvement; and E, which isn’t great. At that time, when we started, we had one site in Wales of the ones that regularly admit at level D, and all the others were at E level. So, we had significant improvement to make. We now have three or four sites at B, the majority at C or B, and, actually, we have no sites at E. So, overall in Wales, we’ve made significant improvement. However, the challenge is that we have more improvement to make again, and that’s why your point about the improvement that we expect to see will be greater adherence to NICE guidance, but also the measures and the fields that the snap audit measures—. And that will change in accordance with the RCP guidance on CT scans within an hour of admission.

Part of our challenge will be understanding, if we’re going to go about reconfiguring stroke care, how we can do that in a way that doesn’t compromise our ability to ensure that someone gets the right treatment at the right time, so that they quickly get taken to the right centre for their treatment, and then, once there, they receive the right treatment in that centre. I actually think it reinforces the case for reconfiguration to ensure that we have proper centres to deliver the right care within that time. That’s why I said earlier that I want to see the whole service—the clinicians working together, working with the third sector, and the public as well—to understand what that improvement could and should look like and having a conversation that sets out for the public the options for improvement and what it will mean if we reconfigure those services, not just in terms of where things are physically based, but, actually, what that means in terms of quality of care that you could expect if you had this medical emergency and you had to go there. I really do think the price to pay for not doing that is actually living with and tolerating unacceptable outcomes in terms of the level of disability we’re likely to see or the level of avoidable mortality that we could otherwise see. So, I recognise the points you make, and as we go through, having further snap audit outcomes, you’ll see what I expect to see is that further gradual improvement continuing.

Dealing with your point about strokes in children and babies, it’s an area of research activity and the research priority has been set. This is a particular area of concern about developing our research capacity in Wales and understand what we could and should do. I can’t give you a timescale for the Royal College of Paediatrics and Child Health work, but, obviously, once it’s provided, I’d expect that the Government will look at it, and I’d expect the NHS, and, indeed, the implementation group, to look at it to understand how that affects their priorities, what they think we should do to have the biggest impact on making the biggest improvement possible for people with stroke in Wales. So, they’re all valid questions, and I expect to see that work carrying on in the future.

Can I welcome this statement, but also the remarks that the Cabinet Secretary made about the role of the ambulance service here and the quality of care they provide? And also, he will have seen that at his visit last week to Bryncethin ambulance station, and he could see the dedication and the professionalism of all of the people involved there in responding to the needs of the communities across the Glamorgan area. But could I push just a little bit more on this issue that has been raised by the Stroke Association, which Angela has just raised as well, about the one-hour standard for access to brain scanning? They do recognise the significant progress that has been made. They also recognise the collaborative efforts that have led to that progress. But the one thing that they are calling for at this time is—and they say attaining the one-hour standard for access to brain scanning should be adopted as the overall aim of all acute stroke services across Wales. It should be factored into all existing service improvement programmes, and it should be incorporated into the forthcoming configuration of hyperacute stroke services. So, I do understand that there are different ways to push at to get the improvements that we seek, and, in fact, the way that we’ve done it, this collaborative approach working across all partners, is what has delivered the benefits. But they’re very fixed on this particular issue.

Could I just, in closing, say if he wanted to discuss these issues more with the Stroke Association, and also not only the survivors but family and friends, he’s more than welcome any time to come along to take part with us, I think it’s 21 May this year, on Newbridge fields, where we have the largest Step Out for Stroke event in Wales, down there in Bridgend. It’s a tremendous testament, I have to say, to the work of the Stroke Association, but also to the survivors and their families, and it shows, as we should be saying, that there is indeed life after stroke.

Thank you for the very particular comments and questions. I, too, enjoyed, and learnt a lot at the visit to Bryncethin. I learn an awful lot when going around meeting front-line staff, and I’m robustly confident that in the last two weeks I’ve now met more than 100 front-line staff within the ambulance service, and they’ve all been very honest with me on what they think has worked, and, indeed, on those areas where they think there’s further improvement to be made. It’s in everyone’s best interest that I’m not actually one of those paramedics now, because I certainly couldn’t do what they do. And seeing the new kit and equipment they’ve got for their learning as well was a fascinating exercise.

But I’m happy to deal with your main point, which is the point about this one-hour CT scan on admission, in the follow-up to what Angela Burns has already said as well. I hope I can provide some direct reassurance to you and other Members that this will be part of what I expect to see measured in the snap audit. So, stroke services across England, Wales and Northern Ireland will be measured on their ability, I expect, to deliver against that in an open and upfront auditable measure, to understand where we are now and where we’re going as well. So, I do expect that to be reported as part of the improvement of expectancy as well. But I go back to this point about the reconfiguration of hyperacute services, which again you mentioned, and I would expect to see that as part of that configuration drive. Because there’s no point in saying we want to reconfigure services if we don’t actually meet the service standards that we have now, although we expect to see it delivered in the future, because the sort of levels we’d all wish to see, we won’t see immediately. The challenge is: how do we make sure we have staff in the right place and services in the right place to deliver the right care? So, yes I do expect that to be part of what the service plans to deliver against in reforming the way in which we deliver stroke services. I hope that’s helpful, not just for yourself and Angela Burns, but for other Members in this Chamber listening, and gives that reassurance about the expectations for any reconfiguration.

On your final point, which was the invite—I haven’t checked my diary, but I’m sure a formal invite will come. Because I do recognise that there is life after stroke. And I recognise that some people pass away as well. I’ve seen recovery from stroke, and I’ve seen my own father pass away after his four strokes, so I recognise the very real issues that face families in this particular instance. So, I’ll be very happy to consider a formal invite, but I can’t give a definite commitment as, at this point, I couldn’t tell you exactly what I’m due to do on 21 May.

Thank you for your statement, Cabinet Secretary. Stroke, unfortunately, affects far too many people in Wales—the majority of which are preventable. Here in Wales, around 7,000 people have a stroke each year. One in eight strokes are fatal within the first 30 days, and one in four are fatal within the first year. Stroke kills twice as many women as breast cancer, and more men than prostrate and testicular cancer combined. I welcome the fact that there has been a reduction in the number of people dying from stroke in Wales. There have been vast improvements in the chain of survival, and the new improved stroke delivery plan will, I’m sure, continue this trend.

The majority of us now know how to recognise the signs of stroke, which has added to the improved stroke outcomes. This means more and more people surviving stroke, but that brings with it other challenges. We now have nearly 65,000 people living with the long-term effects of stroke here in Wales. We have to ensure that we have adequate rehabilitation and long-term care plans in place to support stroke survivors. Stroke is the largest single cause of complex disability, and over half of all stroke survivors have a disability. With these points in mind, Cabinet Secretary, I just have a couple of questions to ask you.

The new delivery plan prioritises the prevention of stroke. With nearly three-quarters of strokes being preventable, this is key to reducing the number of strokes in Wales. Cabinet Secretary, last year, the Stroke Association, in conjunction with community pharmacies, ran the Lower Your Risk of Stroke campaign, which encouraged people to get their blood pressure checked, to check their pulses for any irregularities, and to recognise the signs of a transient ischaemic attack. Does your Government have any plans to build upon this campaign and roll it out across all health settings in Wales?

The delivery plan rightly recognises the importance of stroke research. Despite being a bigger killer than cancer, when it comes to medical research for stroke, the UK spends just one fifth of the amount we spend on cancer research. What plans does the Welsh Government have to increase the amount of funding for stroke research in Wales?

And, finally, Cabinet Secretary, life after stroke can be challenging for many, and I welcome the recognition that we need greater collaboration between health, social care and the third sector to deliver rehabilitation and support. With around half of stroke survivors left with a disability, what additional funding will be available to provide for the ongoing support needed for stroke survivors?

Once again, Cabinet Secretary, allow me to welcome the new stroke delivery plan, and I look forward to working with you to ensure we can deliver a reduction in the number of strokes, and improve outcomes for those blighted by this illness. Thank you.

I thank you for the broad welcome for the work that is being undertaken, and, in particular, for the recognition of the significant number of strokes that are preventable. Depending on which particular piece of research you look at, 70 to 75 per cent of strokes are preventable because they are down to lifestyle choices and behaviours. I don’t think we’re ever going to get to a point where we’ll completely eradicate strokes, but we could still make a significant additional reduction in the number of strokes, building on the significant reduction we’ve already seen over a five-year period, with a reduction of between a fifth and a quarter in the number of people having a stroke here in Wales. But we still reckon that we have much more to do.

On your point about research, I said earlier that there is a clear research priority going forward for the stroke implementation group. Not only is that a clear priority, but you will hear more from the Government in the coming weeks and months on how we’ll allocate specific research funds within Wales through Health and Care Research Wales. But there is a challenge here about the fact that some conditions have a higher profile and a higher ability to attract research funding in, and the priorities that are set outside, and we’re trying to make sure that a high-quality level of stroke research takes place here in Wales.

On your point about rehab, again, there have been a number of questions, from Rhun ap Iorwerth and others, about how we make better use of the rehabilitation resources that we have, those staff that are already here, how we organise our services to deliver that, and ensuring that partnership goes across health, social care and the third sector, and the citizen as well. But, also, I’ve made clear that we’re investing in the future of those services, via the professional groups that we’re investing in, in the here and now. And the £95 million investment I announced in recent weeks really will be a part of delivering the workforce for the future, to deliver the health and care that we want to have for the future as well. So, this isn’t a Government that is saying we should simply stand still in this area. And, actually, at a time of austerity, when all of us confidently expect that we will have a real-terms cut in our budget in the years to come, that is a significant choice that we are making, to invest in the future of health and care professionals.

And finally, on your point about the continual need to reinforce risk reduction, so that people can get help at an earlier stage and actually have an opportunity to take proactive action, that’s very clear, both in the statement and in the priorities of the group. It may be helpful, in terms of the commitment and the recognition of this Government, just to remind people that the Lower Your Risk of Stroke campaign was launched at the time indicated, between the Stroke Association and Community Pharmacy Wales, and it was launched in the Well Pharmacy, a stone’s-throw away from this National Assembly building, and it was launched by the then Deputy Minister for Health, at the time.

Can I also welcome the new plan, and wish you the very best of luck with that? I’ve got a few questions, beginning, actually, with where Huw Irranca-Davies left off, and the question of the use of scanners. I appreciate you wouldn’t be able to answer this question in the Chamber today, but I wonder if you’d consider making a statement at some point regarding the availability of scanners that don’t have enough people to operate them around the clock. We’re still getting occasional pieces of casework on this—about people turning up at various departments with suspected strokes, and other conditions, where scanners are available, but there’s no-one available to run the scanners. So, I wonder if you can perhaps give us a statement on that, in the future.

But, relating specifically to this now, could I ask you about the stroke survivor six-month review, and the relationship between the NHS and third sector and care workers on this? Now, I’m presuming that, if somebody’s primarily cared for by a member of the family, like so many people are, those family members will be included in any discussions. But, when someone doesn’t have that advantage, and is primarily looked after by care workers, can you give us some indication about who you’d expect to be involved in those discussions? It may well be an individual social worker, if they’re disabled enough as a result of their stroke. But I’m just looking for ways to make sure that nobody is sort of accidentally left out of this useful procedure.

Then I wanted to ask you about the specialist supported discharge service, to enable people with a stroke to receive their rehabilitation at home, or in a care home. I guess that I’m asking, ‘Why isn’t this happening now?’ Delayed transfers of care is a real issue, for a number of reasons, but one of them is that it can be very difficult to get an appropriate package of care together for the individual who’s trying to leave the acute setting. So, can you give us some indication of what’s missing from these delayed transfers of care packages for stroke victims, and perhaps give an indication about whether the ongoing monitoring of the rehabilitation activity that’s enjoyed by that individual will be the responsibility of the acute placement or the primary care team? Because it’s likely to have been designed by the rehabilitation professionals in the hospital setting, rather than in the primary care setting. So, it’s a question just to make sure that, again, somebody takes overall responsibility for that individual, rather than two people either agreeing they’re both responsible or neither taking responsibility.

And then, finally—

Well, yes.

It is a final one. I’m really, really pleased that you picked up on the mental health vulnerabilities of stroke victims. And, to keep it short, I’m just curious to know how this plan fits in to ‘Together for Mental Health’, and, in particular, the additional funding that was introduced last year, and whether any of that is being earmarked for stroke victims, bearing in mind they’re very complex comorbidities. Thank you.

I’ll deal with the last point first. We haven’t taken an approach of saying there are specific conditions where we’ll think, in particular in ‘Together for Mental Health’, about the mental health needs of that individual, because I think the challenge will be, we could easily parcel up money and activities in a way that would actually dissipate our resource, rather than add to it. The challenge, I think, is for a whole-service approach to seeing the whole person, and understanding—as I said in response to Rhun ap Iorwerth—not just seeing that person with a physical condition, but seeing them as a whole person, and what matters to them.

And that’s why the work on patient reported experience measures really does matter, because that is asking that person about what matters to them, and how we then make sure that we can understand that and measure that in a way that is meaningful for them. So, even if their clinical outcomes are good, actually that may not mean that they are leaving, if you like, the part of the physical care service until they’re actually happy and contented, and that makes a really big difference in terms of their general well-being. So, it is something that we are giving real time and attention to, and that’s why I think, when we come back to 2018 and understanding what those measures are going to look like, we’ll have a lot more information on what could and should make a difference and think about the voice of the citizen in directing some of the care and what outcomes for them are important. So, there is a real and meaningful attempt to have that conversation in all parts of the service, and not just trying to parcel it up. I appreciate that that’s one approach, but I don’t think it would actually deliver the best value for us.

On your first point about whether there are staff unavailable to undertake any scans, I would be really interested in specific examples of what that looks like and how that matches up against our ability to plan the workforce, the investments that we have made in who and where people are, and, indeed, the reconfiguration of the service. I would be very happy if you want to send me correspondence on the examples that you have.

On primary and secondary, there is a constant struggle in understanding who actually has responsibility, but that’s not been brought to me by anyone in the Stroke Association saying that they’re concerned, for example, that there isn’t an understanding of responsibility, either who has the responsibility for rehab or for understanding who will actually undertake the reviews of patients. Their concern has more broadly been about whether we’ve got the right numbers of people working in the right teams as opposed to whether it’s primary or secondary care-led at that point.

On some of your points about advocacy, where people don’t have family members to accompany them when some reviews take place, again, I’m interested if you have specific examples of gaps that you identify rather than the more generalised. There could be. I’d be interested in what does that mean and look like now, and I’d be very happy to deal properly with that. I know that the cross-party group is due to meet in a few weeks’ time. I don’t think I can attend the first meeting, but I expect that there will be a number of points from that group that it might be helpful to collate and send to me, and I can hopefully respond in a helpful and constructive way to the comments that are made. But, broadly, on delayed transfers of care, we have a good record. We have a reducing number of delayed transfers of care, and there is continuing ministerial oversight and expectation for further improvement. In any areas where we see further gaps that still exist, I want to understand why those are there and what we can expect our whole health and care system to do about them. So, I would be very happy to receive that correspondence and then to look at some of the details of what we can do to see further improvement in stroke services across Wales.

Thank you very much, Cabinet Secretary.