Thank you, Deputy Presiding Officer. I’d like to update Members on the national planned care programme. This was established in 2014, with the aim to reform and improve NHS planned care specialities. The programme uses the expertise of clinicians in Wales to identify and promote best practice. Unless we are able to achieve reform and improvement in practice then we will not continue to deliver high-quality and sustainable healthcare services. Our vision is of a modern healthcare service ensuring patients’ needs are addressed at the right time, in the right place, by the right clinician. The planned care programme is helping to take that forward with a small number of speciality implementation and transformational plans.

Over the last two years, the programme has focused upon ophthalmology, orthopaedics, ear, nose and throat, and urology. These are specialities where there are either unacceptably long waits for treatment or elements of clinical risk to long waits, and a speciality plan for dermatology was introduced within the last few weeks. The national planned care programme is empowering healthcare professionals with opportunities to review their practice, replicate them and implement the very best possible standard. An early focus of the programme has involved working with clinical specialties to help them understand the demand for their services, their capacity, and to support them to develop plans to bring their services into balance. That means reform if we are to see progress. It’s meant acknowledging limitations on the current ways of working and committing to addressing variations in practice within and between organisations, and those variations in practice also lead to some variations in outcome.

When we launched the programme, we wanted to build on good practice that is already taking place within our system. We have a range of positive examples to highlight. In Wales, for example, we now have orthoptists giving injections directly into the eye to treat conditions such as wet age-related macular degeneration and diabetic macular oedema, using a device that has been developed here in Wales by a consultant in Wales. In a number of health boards, people with hearing problems can now be examined by an audiologist without having to travel further than their own GP surgery, and that will now be extended to other health boards following a successful pilot. The redesigned prostate cancer pathway, which is now in place across Wales, involves a multi-parametric MRI scan before a transrectal ultrasound biopsy and that’s significantly reduced the number of biopsies carried out, which we know are painful and potentially dangerous to the patient.

The planned care programme has published a small number of key impact changes and these direct health boards to actively manage follow-ups, which is the next area of priority over the rest of this year. Follow-up out-patient appointments account for a considerable amount of activity undertaken by the NHS. Traditionally, patients have routinely been given appointments rather than the appointment being based on their clinical need and with the most appropriate healthcare worker. Evidence has shown us that around 9 per cent of patients already do not attend their follow-up appointments and that, in itself, is an unacceptable waste of resources. So, we will focus upon reducing the number of follow-up appointments offered as is clinically appropriate and for the right healthcare professional.

Some of the changes that I expect to see rolled out across Wales include the roll-out of more virtual clinics. The introduction of virtual reviews and patient reported outcome measures in Cardiff and Vale reduced the number of hip and knee appointments needed to be seen by a consultant by 70 per cent—that’s 70 per cent. Health boards need to redesign appointments so patients can receive all necessary treatment in one visit, also known as more ‘one-stop clinics’, and these are already being used extensively in urology and are receiving a positive response from patients. And the training of healthcare specialists to undertake appointments releasing consultant capacity—. In Wales, we are rationalising, for example, our ophthalmology services by increasing the number of appointments done in the community using optometrists and nurses, and that’s released capacity in busy consultant clinics—more capacity for people who really do need to be seen by a consultant.

We are already receiving, from these changes, positive feedback from clinicians, operational staff, and patient representatives, who have been involved since the programme was established. So, the planned care programme is starting to deliver changes. So, some of the outcomes already achieved include the introduction of national follow-up guidelines for ENT services. That’s been endorsed by health boards. Evidence from Aneurin Bevan health board shows the potential to reduce unnecessary follow-ups by approximately 40 per cent across Wales, and other health boards are now implementing and following those guidelines. They are already having an impact as patients waiting for their first appointment across Wales have reduced from over 3,000 in March 2016 to 1,949 in March 2017. There have been 863 fewer referrals this year compared to the same period last year.

More patients are now being seen by an audiologist rather than an ENT consultant. That means around 72 patients per month are now being seen on a revised pathway direct to an audiology service. That means, across Wales, patients will be seen quicker as they are not waiting to see a consultant in a clinic but will be seen and assessed in appropriate community settings.

Our national clinical musculoskeletal assessment treatment—that’s CMAT for short—principles document has been agreed, based upon best-practice models currently in place in well-established services. Starting last month, that’s now being rolled out across Wales. That should ensure that patients with musculoskeletal problems have access to a wide range of community-based treatment opportunities in addition to secondary care services. That should ensure that patients are seen by the right healthcare professional as appropriate. It should also reduce demand on our orthopaedic services.

Health boards in Wales have seen a reduction in the number of urgent suspected cancer patients being referred into secondary care since the asymptomatic non-visible haematuria guidelines were adopted.

In ophthalmology, the number of GPs referring patients to secondary care since the programme started has reduced from 17,775 in September 2015 down to 14,268 in March this year. So, as a result, more patients are being seen in the community by optometrists.

It is still the case that some people still wait too long for treatment. Health boards have action plans in place to reduce long waits and, last month, the Welsh Government invested an additional £50 million to help the NHS further improve waiting times. We are seeing improvements in planned care services. However, these are not happening quickly enough. There needs to be a greater pace and consistency amongst all health boards in delivering improvement. It’s why I really do expect good practice to become standard, consistent practice across Wales. I expect health boards to adopt or justify. The planned care programme will therefore become an integral part of the integrated medium term plan process. Health boards that do not plan to deliver the planned care action plans will not have approved plans.

I’ve said this is a clinician-led programme, so I want to finish by thanking Peter Lewis, the consultant vascular surgeon who is leading the planned care programme. This is not a straightforward process. It involves people in different specialities coming together to agree, and that isn’t always an easy process, and it involves service planners and leaders, so every chief operating officer takes part within the conversation. But the straightforward challenge now is how our national health service delivers against this clinically led improvement programme that Peter Lewis has helped us to create.

There is a really significant prize for staff and the wider public in reducing waiting times, reducing variation, whilst improving efficiency and outcomes for patients. So, I look forward to seeing action this year and the next in every health board across Wales.