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.