Part of the debate – in the Senedd at 3:52 pm on 11 July 2017.
Thank you for the comments and questions. And I welcome your recognition at the start that the panel have been open and transparent, but also that this has, as I said in my opening statement, come from a genuine cross-party engagement. It started as being an agreement between Welsh Labour and Plaid Cymru, but there’s been, not just from those two parties but everyone in this Chamber, the willingness to sit down and agree on the terms of reference, and the panel to undertake this particular report. So, there was a challenge that each of us accepted in starting this process, and I hope that you found the way in which the Government has engaged with each of those parties to be genuinely open as well, because this is a concern for all of us and not just for one particular party to confront. I think it really has been useful to have a genuinely independent group of national and international experts to validate the concerns, the challenges and the imperative for change that we have often debated and discussed in previous Assembly terms, and I do wonder if the Chair of the committee may tell us about his previous incarnation as an Assembly Member where similar issues have been floated.
But the challenge we now have is that the challenge is more acute. We have even more demand coming into our system. We have even more demand based on the age of the population, public health challenges, demand that is driven by the behaviour of healthcare professionals and social care professionals, but also about the reality that the money is getting tighter and tighter and tighter. So, pretending we can run the same system now in five and 10 years’ time will see all of our constituents and their interests compromised. And I welcome the recognition about the change and innovation that is already in progress.
I think the point that you started to make about the balance between having local and regional leadership and innovation that comes bottom-up, and the responsibilities of local groups, whether they’re primary care clusters, whether they’re health boards or organisations in-between, but also the point about the central guiding hand that is made in the report, but also in the previous OECD report—. And Members of this Chamber regularly ask about wanting the Government to intervene and provide a central guiding hand and direction on a whole range of issues, from what happens in a particular ward, a particular GP surgery to health board-wide challenges. We need to find a balance on making sure that central direction is provided to help unblock some of the challenges that have prevented change from taking place previously, without simply then saying that, centrally, the Government will decide everything about health and social care. And that’s the challenge that we recognised before, and, equally, it’s set out for us very clearly in the interim report. I look forward to the next stage with the models of care that should provide more answers about how we do that. But whilst we wait another five to six months for that to happen, we’ve still got business to do now about trying to improve our system. What the interim report does do, as you recognise, is that it allows us to make some of that progress now to validate the direction of travel, and to think about how we provide the additional steps, the initial progress, that we want to make, and empowering people locally as well as nationally as well.
And I do take seriously your point about public engagement. When we talk about the interim report now being used now being used to talk to stakeholders. Well, the public are the biggest group of stakeholders, and I hope now having a report that sets out again the interim nature of this report to engage on and around, not just the big ‘What do you think about health and social care?’, but here’s a report that says, ‘Here are big challenges we face; here are the drivers for change; here’s the need and imperative for change; here’s what’s working already; here’s what we still need to improve on’, and that should lead to a more informed conversation, not just incidentally as our public events take place, but a deliberate and planned way to engage with citizens as well, and that’s important, as much as it is important to talk to staff groups and to the third sector directly as well. So, I’m very clear, and I think the panel are also clear that that’s part of their mission over the summer.
But what this also has, and I turn to your reference of prudent healthcare, well, we see that already in both the social service and well-being Act, the scheme in that, but also in prudent healthcare, involving and engaging the public as citizens who make their own choices, not having choices made for them. That’s very clear and is set out in the report, but also in the work that we’re trying to do to drive it across our whole system. That also goes into your point about the care sector, where Rebecca Evans is already leading on the work we’ve regularly said we want to see in the paid care sector—to have the status of the profession raised, and that includes the training and investment we make in the workplace. I recognise what you say about housing as a key determinant in health outcomes as well as places where health and social care is delivered.
I will finish on this point, Deputy Presiding Officer, but your point about the future direction of travel—. I’m happy to confirm that the mature conversation that led to this review being started in the first place is where I want to take on from today and when the report is provided to us. Because if we think the challenges are too important to ignore, there’s a challenge for everyone in this room and beyond about how we then talk about, discuss and agree on what we’ll do next. I expect this review and the Government’s response to it to form the direction of travel for another decade or so, and to do that we should absolutely engage across party about how we want to find the greatest areas for consensus and agreement on moving forward. What I can’t do, though, what no-one in this room can do, is to say that they will accept everything and anything the report says. We have to have a sense test on what comes back about that, and we have to respond openly about what we can do and how quickly we think we can do that together. But this absolutely will be a key part of setting the direction for the future, and how each of us respond in this Chamber, including, of course, the Government.