Thank you, Deputy Presiding Officer. I’m happy to formally move the motion before us today. To go back to where we were in June, I’m still pleased to have received the interim report of the parliamentary review of health and social care in Wales that we shared with Members, sorry, in July, not June, this year, but I tabled this debate today to allow more discussion now that Members have had further time to consider the interim report.

There is, of course, a political reference group that is regularly briefed on progress with the review, and will meet again this month, but this is an opportunity for all Members to comment directly. The independent panel we’ve put together has looked at data, taken evidence and drawn on extensive international experience to develop its own view on health and social care here in Wales. The interim report defines key issues facing health and social care. It sets out the case for change, and identifies areas where improvements are needed. The report signals areas the panel wants to explore further over the next few months before concluding the review and delivering a final report with recommendations to me by the end of the calendar year.

I ought to say that the interim report sets out that there is a compelling case for change, with a general consensus among stakeholders and the people who have given evidence to date on the need for further integration and services that are more available within the community. The report is also clear that inaction is not an option going forward, and the report challenges all of us: are we prepared to support change and to meet those difficult challenges? That requires us to make choices for health and care services in Wales or we will simply allow choices to be made for us. So, the future is a collective effort across political parties and it will require a continuing level of maturity and leadership across parties that led to this review being established in the first place.

Wales, of course, is not alone in facing the challenges set out in the interim report. We need to look at how we can design a way of working in the future that is both sustainable and continues to deliver good outcomes. The report provides us with a renewed urgency for discussion and decision, a need to engage citizens and the workforce in deciding the type of services that will be available in communities in the future. The national strategy launched by the First Minister today, ‘Prosperity for All’, aligned with the direction for travel set out in the parliamentary review and its interim report. It commits us as a Government to respond to the review and publish a long-term plan for health and social care next year.

The panel, though, in their report, have recognised the important legislation that Wales has already developed—the Well-being of Future Generations (Wales) Act 2015 and the Social Services and Well-being (Wales) Act 2014 being two particular Acts that, taken together with prudent healthcare, offer us a powerful set of principles that can apply equally to NHS Wales and social care, and they do enjoy a high level of support. Widespread and comprehensive use of these principles should help us to transform health and social care in Wales, however the scale of the challenge means concerted action is required and at some pace. The messages in the interim report are frequently repeated back to me as I move around the country listening to both staff and patients, and especially the point about the voice of the patient and the service user, because the report recognises the need to involve staff, service users and carers more in the design, implementation, evaluation and subsequent development of new models of care, and to ensure that there are clearer, shared roles and responsibilities.

I recognise that the best results frequently come through active co-production and it’s something that I want to see more of. One of the key interim review proposals focuses on developing new models of care to be trialled, evaluated and then scaled up rapidly. The references to local citizens’ needs are of course important in this, and I know from speaking to the chair of the review that the stakeholder forum that has been established to help progress this work aims to frame the principles and standards that characterise successful models that can then be used to develop and test newer models of working. That should give us some assurance about our consistency at a national level with the freedom and space to adapt to local needs, especially in rural and/or urban contexts.

I note that the review has now been working over the summer recess to gather examples of successful models of integrated care, and I understand there has been a good response to continuing engagement from stakeholders across the country, but they are also looking at examples from outside Wales too. The models, of course, are just one element to this. I do look forward to recommendations that will be framed around the triple aim of improving population health, improving the quality of care and, of course, improving the value and productivity.

The workforce will of course be key to making the changes needed, so it’s good to see a reference to large-scale planning for the skills and career paths required for the health and social care workforce to deliver these new models—these new ways of working. The report states that the current workforce shortages inhibit change and need to be addressed, and that’s something that I recognise. In particular, there are some medical specialities and some geographical areas of Wales where there are particular struggles and, again, we can recognise a similar pattern in other parts of the United Kingdom. That’s why we remain committed to continuing to take action to attract and to train and to keep more GPs, nurses and other healthcare professionals here in Wales.

We launched a campaign to encourage doctors, including GPs, to come to Wales to train, work and live and, as I’ve said previously, that’s had a significant and positive early impact, with a 91 per cent GP trainee fill rate compared to 68 per cent last year, and that includes a 100 per cent fill rate in some of our hardest-to-recruit areas, in particular more rural parts of Wales on GP training. It’s also important that we’re running the Train, Work, Live campaign not just for doctors, but for nurses, and later on this year there will be further campaigns for therapists and pharmacists as well.

The report signals for us the need for the streamlining and alignment of governance, finance and accountability arrangements across health and social care. Closely linked to that is the drive for a more systematic and effective approach to continuous quality improvement and how we encourage and develop a culture that creates a supporting and engaging environment for our staff and, of course, the Government shares that ambition; you would expect us to. That helps to underpin our approach to our White Paper ‘Services Fit for the Future’. It’s framed around how we unlock the potential for local health boards to demonstrate that they govern and behave strategically with quality at the heart of all that they do.

The interim report also highlights for us the need to spread innovation and to make better use of data and information to design and monitor the progress of change. This is a crucial area for us, and I look forward to seeing how this can be supported further. There is, of course, a balance to be struck between national direction and local autonomy in generating change, and that is part of our challenge of continuous improvement, based on outcomes for citizens across the whole health and care system, and within that the pace of change that is needed, with clear and accountable decision making.

The report again rehearses for us the drivers for change: advances in healthcare, rising public expectation despite the reality that there is reducing public expenditure as austerity continues—that is an unavoidable challenge regardless of our party political positions. In addition to that, though, we know that demand continues to rise. Part of that is because, unfortunately, we have a less healthy population than in decades past, and that is not a cause for celebration. What is, though, a cause for celebration is the fact that we can all expect to live longer, but that provides us with different challenges and different additional demands coming into our system. That does, though, mean that we can’t pretend to ourselves or the wider public that simply carrying on with the health and care system that we have today will do for the future. If we allow that to happen, our system will become overtopped and we will allow real harm to be done to our citizens before then having to change our system at a time of crisis, rather than trying to plan a way forward to develop and deliberately deliver a changed, reformed and improved system that is genuinely sustainable.

But we should take comfort from the fact that there are genuinely talented people in Wales already delivering change to improve services and offer better care, because I regularly see local innovation that makes a real difference for patients. I’m sure Members do in their constituencies and regions as well. For us, it’s imperative that we understand what could and should be scaled up quickly so that benefits are delivered system wide, and we need leaders with local health and care to be champions for improvement—not just with the public, but with their peers as well.

So, the message of the interim report, I believe, is clear: we cannot make the improvement in quality and experience that we all want to without seeing change in the way our service works. The interim report, I believe, is balanced, and it’s an independent assessment of where we are now. I recognise the progress that we have made, but a faster change is needed so our health and care system is sustainable in the future. I look forward to receiving the final report before the end of this calendar year, and to continue to work constructively with all parties to help implement as many of its recommendations as possible, and I look forward to hearing the views of Members in today’s debate.