Thank you for the comments and questions. I too look forward to the models of care—the new models of integrated care—that the review team will bring forward to us with their final report, and I’m sure they’ll be challenging for us in a number of different ways. That’s part of the point of setting up the process. It is supposed to be challenging and difficult. It’s supposed to ask us awkward questions.

A number have come back to the points that both you and Andrew have made about delivering change and the difficulties in doing that, partly because it’s a big and complex system. Even in the private sector—I used to work in a firm that had 20-odd offices around the country—delivering change within a system where everyone was employed by the same organisation, you found that the culture was different in different offices. Delivering a single system, say for case management, was actually more difficult than you thought it would be. So, to deliver something across our health and social care sector—not just health, but health and social care—is going to be understandably difficult, but our challenge is to recognise, as I said earlier, that imperative for change and the fact that we haven’t done as much as we would have wanted to previously.

We should be honest about the fact that, even on a real evidence base, all of us are pulled in different directions by local pressures. Every time there is a significant service proposal for change, understandably, Members in every party will be put under pressure to fight local and to say that there is a different reason why change could not or should not happen. Now, we have to be prepared to recognise that, and when those new models of care are provided to us to consider, and with the suggestion and recommendation from the review panel that they are then trialled and then scaled up significantly and quickly across the country, that will be difficult for every party, not just for one in this Chamber, and for people locally in a range of different areas. But the challenge otherwise is that we go back to, ‘Well, actually, we slow the pace of change and we allow change to happen to us rather than making an informed choice about what we want to do differently’. That goes back to some of the points you then made.

I think it’s interesting your point about how we incentivise or require integration within the health system—actually, between different parts of secondary and other acute services, as well as primary care and secondary care, but also between health and social care and other partners too. Some of that is already happening. We’ve got pooled budgets coming in in the scheme in the Social Services and Well-being (Wales) Act 2014 from April next year in a number of services. We’ve got public services boards and regional boards already working together as partnerships and making decisions together. Some of that is about, if you like, the more genuine bottom-up approach where people are sitting together and realising that they could and should do more together, and that there’s more value to be gained by those different public sector budgets working together with decision making.

What the review also sets out for us is that, on its own, that is unlikely to be enough. So, the outcomes framework, the competencies and the key performance indicators we set for people have enough in common across different sectors to enable and require people to work together at the same time. We also have the challenge of working with the police—the most obvious non-devolved group that have a real interest in and an impact upon health and care outcomes. So, that also goes into some of the steps we’ve already taken in, for example, incentivising primary care to work differently together. We’ve required people to work together in clusters. We had points that were dependent on the quality and outcomes framework taking part, but also money that went with that. So, there was an incentive as well to say, ‘Here’s money. You get to choose how you spend it locally to meet the needs of your collective local population.’ So, some of that is already happening and the review team are positive about the work of clusters. The challenge again is: how do you then understand what local innovation looks like, and then how do you get to the point of evaluating that and deciding what to do, what to do more of, and then what to disinvest in, as well? That’s the more difficult choice that we often have to make.

Finally, just on this particular area, I’ve already required and am expecting some things to happen. We know we’ve had a challenge on working across health board boundaries. That’s why Hywel Dda and ABM are working together. They’ve had a joint planning meeting already and they’ve very sensibly and wisely agreed to my invitation to meet on a regular basis to plan services together—and the same in south-east Wales as well, with Cwm Taf, Aneurin Bevan and Cardiff and Vale. Because, actually, there are services, not just in specialist services, but in the way in which we deliver normal elective services as well, where there could and should be planning across those boundaries to make sure the services make sense. And if we can’t drive that sort of way of working into our service, then we’re unlikely to see the sort of significant change that we want to, and that you and I and everyone else in this room thinks is necessary for the future of the service.

That goes into how and why we invest in primary care, the choice that we’ve already made, but there needs to be more of that because the pressure is almost always to invest in staff and expensive services in a hospital-based setting. We need to do more to hold a line and to see that investment come into primary care and community care. I recognise the well-made points that you highlight on technology and the ability to have not just a ‘once for Wales’ approach in key systems, not just to have a system where you can transfer information between primary and secondary care and the social care sector, but also for the citizens themselves to have more control over their information and access to how to use the system. We can do that in so many different areas of our life already. You can bank online and have access to really sensitive information. Our challenge is: how do we enable a citizen to have access to their own healthcare information in a way that should help them to manage their own conditions and make more informed choices? There’s real potential there, but again, we need to be much better at meeting the expectations about how people already live their lives and I want to enable that to happen on a consistent basis across the country as well.