Ten per cent of all healthcare interventions are associated with harm; 20 per cent of all work carried by the health service has no effect on outcomes—this is a quote from the review, and, while that review might be ducking the rather difficult question of how we fund health and social care in the future, it is pretty straight up on showing that we, as a nation, are spending half our block grant on a system that produces these statistics. And I want to stress here that I do mean a system, not the individuals, because, like Dawn, I don’t want this to become a political football in the future; it is far too important. But I think Welsh Government needs to recognise now, actually, that principled and constructive scrutiny of what we’ll be talking about in these next few years can only be a help in this huge policy issue. Good faith is going to be essential in this debate, and I think the parliamentary review—I have to commend the Cabinet Secretary on this—has been really helpful in setting the scene for that, because, in my view, it’s not going to be Brexit, it’s going to be the speed and the bravery of our response to the demands of health and social care, that will define this fifth Assembly. And the fact that that response needs to be both speedy and brave will be a test of our maturity as an institution, certainly, as we consider ideas that may be difficult to discuss, but also as a nation, as we consider ideas that might be difficult to hear. So, I think we need to start preparing the people of Wales for radical change, in which they will be playing the leading role.

Calls for culture change are seeded throughout this report. There’s much in there about changing the balance of responsibilities, but the big one is the balance between the person and the state, as Jenny mentioned, and that is never a comfortable conversation in this place. This report majors on co-production. That’s what I’m talking about, and it is, as Jenny says, a partnership that, in itself, needs culture change within the population, a population that, by and large, is at the moment used to abdicating decisions for care about themselves to healthcare professionals. Now, the king of co-production is sitting behind me—Mark Isherwood—and I know that some of you who have been here for some years will be gracious enough to acknowledge his championing of this principle well in advance of it being captured in legislation. It is a real thing, and this report points us in the direction of models where the individual has more control over the type of intervention they get and responsibility for decisions affecting them.

Our population is getting older, and more of us will sadly reach a stage where we no longer have mental capacity, and then we will need care over which we personally exercise very little control. For the rest of us, citizen-directed services means getting used to making decisions and taking steps for ourselves and for our loved ones, without that being characterised as being refused help by the state. This report is clear: there was a desire to reach an explicit agreement with the public on the respective roles and responsibilities of services and individuals, but there is no point in 91 per cent of people believing that they have responsibility for their own health unless they are, in reality, confident and informed enough to exercise that responsibility without fear of being abandoned. And it certainly applies in terms of making healthy choices, I completely agree, but it also applies to the means by which individuals understand their needs and how they become confident to make decisions about their care, because there is no point recalibrating our system towards co-production if, as a population, we are still programmed to respond to any questions about our care with, ‘Whatever you think, Doctor’.

No national system can offer a personalised service, but we get much nearer to it in a system that facilitates, not blocks, a person who has the confidence to say, ‘I’m getting my check up from a high street ophthalmologist at my convenience, instead of waiting in a consultant’s outpatient clinic’, and, equally, which facilitates, not blocks, a GP who has the confidence to say to somebody, ‘Why are you here? Go to the pharmacist’. Citizen responsibility works both ways and Jenny is right there. We get much nearer to it, as well, I think, when we have an elderly person who has the confidence to say, ‘Do you know, I don’t want to pay a care worker to make me a cup of tea; I want to pay for community transport so that I can go somewhere and have company’.

This report says we don’t have time to go slow on co-pro. Now, brave and speedy culture change on Welsh Government trusting people, on silo mentality, on processes, on staff expectations and leadership is one thing, but I don’t think we can neglect either how we help our constituents to become confident decision makers, because without them the changes that this review is pointing towards will die at the interim stage. If we’re going to look at this as a serious way forward, we’ve got to help our citizens trust themselves. Thank you.