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.