Thank you, Deputy Presiding Officer. I’d like to begin by thanking Members for their contributions to this debate. As ever, these individual Member debates are a good opportunity for issues that would not otherwise receive a national profile to do so. We are talking today about a painful condition, as set out by David Melding—one that is not perhaps properly understood. That was referred to by many other Members. It’s often that human experience of meeting someone with a condition that triggers a particular interest, not just in one Member but in a range of us, to understand that, actually, we almost all probably have constituents who are affected.

The Government will abstain today and not support the specific wording of the motion. We do recognise that paediatric rheumatology services need to be reviewed, and I’ll outline in my contribution what is already taking place.

Yesterday, as has been referred to, in the statement regarding the parliamentary review, we rehearsed some of our challenges in providing a service fit to meet the challenges of the future, and this service is a good example of where we recognise and need to understand the level of need and then take a practical and evidence-based approach to improving services. It may also require the NHS family to work across health board boundaries and potentially national boundaries in providing the right configuration for all of the services.

Now, we don’t have, as the motion recognises, a formally designated paediatric rheumatology centre. In practice, a tertiary service is provided at the University Hospital of Wales, as has been referred to several times in the debate. Actually, a referral from the University Hospital of Wales to an alternative specialist service is sometimes necessary at present as well. As has been mentioned, all referrals of this nature are reviewed by a consultant rheumatologist who acts as a clinical gatekeeper, and he is authorised to refer and commit Welsh Health Specialised Services Committee—or WHSSC—funding for treatment at those specialist centres outside Wales. So, we do already have in place, for south and mid Wales, service level agreements in place with Birmingham, Bristol and Great Ormond Street. But I recognise that the current arrangements do not provide for the full multidisciplinary team that should be in place in a designated paediatric rheumatology centre. I also recognise the points that were made about travelling distances, which I will come back to later on.

The motion largely refers to the number of patients in Wales—in particular, the number of patients in south Wales. In north Wales, there are outreach clinics provided by the health board, and patients do attend Alder Hey for their paediatric services. Before today, significant concerns hadn’t been raised with us about the quality or the reach of those services for citizens in north Wales. In fact, the third sector hadn’t raised challenges about that, and there are a range of support groups that exist in north Wales as well, but I’ll reflect on comments made by Members in the Chamber and have that discussion with service users and the third sector too.

There are three streams of work that I want to refer to to inform the future approach. The first is the comprehensive review of specialist paediatric services by WHSSC, as referred to in the motion and in the debate today. I know that WHSSC have already been in touch with the third sector, in particular the National Rheumatoid Arthritis Society, as part of that review. It is important to me that the third sector and the voice of the service user is a real feature in that review that takes place. I do welcome the review and I look forward to the results that can inform NHS thinking on both the potential but also then the practical considerations to be addressed around specialist service provision in Wales.

The second area of work is the review of the snappily titled commissioning directive for arthritis and chronic musculoskeletal conditions. If you don’t mind, I’ll refer to it as the directive. Now, ultimately, of course, the direct responsibility for delivering improvements for musculoskeletal conditions, including paediatric rheumatology services, rests with health boards, but they do so in line with this commissioning directive. Now, we are currently in the process of updating the directive. It’s nearly 10 years old at present. The broad aim is to move towards a greater focus on helping people of all ages to develop skills to enable them to manage their conditions and, where appropriate, increase their ability to stay in work and live the lives they want to live. Obviously, for children and young people, living the lives they want to live, as has been said by a number of Members in this debate, includes normal social interactions, the ability to go to school, and a range of other things.

A project steering group has been convened to oversee that work, and it consists of both clinical experts from each health board in Wales and third sector representatives. Currently that’s the National Osteoporosis Society and Arthritis Care Wales, and individual service users. An initial meeting of that group has already taken place, and the next meeting is scheduled for the first week in August.

The third area of work has come from a specific area that I have already asked for, and as a result of my request the interim managing director and the acting medical director of WHSSC are due to meet with Arthritis Care Wales and the consultant who manages the tertiary rheumatology service at UHW to discuss a way forward. Representatives of the National Rheumatoid Arthritis Society and Arthritis Care Wales will be present at that meeting, which is due to take place within the next week.

I hope that provides some assurance to Members that the Welsh Government recognises the reality that our current provision and service model could be improved, and we’re committed to doing so, because I want to see all three strands of that work drawn together to provide us with practical steps forward. But if I may go back—