Thank you for the question; it’s one that I’ve discussed previously with the Member for Llanelli, and not just, to be fair, in relation to his own constituency—not just with the Prince Philip Hospital where, as you recognised, there was a good example of what not to do, as well as then the way in which that was successfully achieved, and the same in Kidwelly as well, in some ways. There’s a really important message here, I think, for being able to talk to the public early enough, but in a way where they trust where the message comes from. I’ve got national responsibilities that I certainly don’t try to walk away from a contract out of. I’m quite happy to take on board those responsibilities; it’s the privilege of the job. But equally, if clinicians aren’t part of that, it makes it very difficult for people to trust the information and the imperatives for change, and we really do need a conversation that isn’t just between the health service in the shape of people who are chief executives and executive members of a board. They have a responsibility to do that, yes, but actually, local clinicians, people are used to seeing and trusting. Because otherwise I don’t think people trust the reason and the rationale.

It’s easy to understand why members of the public are instinctively suspicious and almost always think the first reason is, ‘This is about money, and you’re not prepared to spend money on the service,’ rather than it being about much, much more than money, and there are things even if we were in times of plenty in public service spending, there would be a need to change some of the ways in which we deliver care, and that’s part of the challenge that we will have. If we can’t engage our clinical communities and healthcare professionals and social care professionals in being part of that conversation, we’re unlikely to see the sort of pace and scale of the change that we are told, yet again, is absolutely critical to the future of our health and care system.

That’s why it is important, as I said in response to Angela Burns, that in the next stage, the biggest and most important group of stakeholders is the public—citizens themselves being engaged in the conversation as far as possible. I think the way this has been covered today has been helpful in that, but let’s not pretend that this will be the first item on the news agenda for the next six months. There will be a challenge about how we make sure that engagement is real and meaningful, even if we honestly accept that not every person in Wales who has an interest today will be engaged in the same way come, say, November, when the report is being written and prepared to come back to us, but that isn’t a debate that can stop then. It isn’t simply we get the report and say, ‘Right, that’s it. We’re not interested in anyone else.’ There’s got to be the constant process of engagement, and it goes back to your point about the way in which people engage in change at a local level, and often people are surprised to hear that change is required or necessary or proposed, and the first reaction is to fight against that change, and again, I understand that completely. It’s a reaction in every single community across the country.

If we don’t get clinicians engaging in a more open way to discuss and debate these issues with the public, we’re not going to see that change at all, and on your point about the primary care model, there is change already taking place. Some of you see this as a bit of a threat to the independent contractor model. Well, actually, the biggest change to that model comes from new entrants into the profession, many of whom don’t want to buy into that way of working, either because they don’t want to buy into a building and the potential liabilities of that for the future, or because they simply want to be more flexible about their career. Not every person who comes out of training to be a doctor, or any other form of healthcare profession, wants to say, ‘I’m committed to being in one community for pretty much the rest of my working life.’ We need to recognise that change and find a way to allow those different models of care to work. And to be fair, I actually think that both the Royal College of General Practitioners and the BMA are being very pragmatic about that discussion, in supporting their members who want to maintain the independent contractor model, and at the same time enabling those other members of their membership bodies to actually find different ways of working with health boards in that wider multidisciplinary team. So, I think there is genuine cause for some optimism, but that doesn’t mean to say that that makes it easy.