Thank you for that series of questions, which I’ll be happy to respond to. On your first point about all the pilots and evaluation and whether all the evaluations are available: I couldn’t honestly tell you to hand, on each one of the list that you’ve set off, whether it is and isn’t available. What might be helpful, though, is if you write to me with the list of the particular areas that you’re interested in where you’re not sure if there’s been an evaluation of a pilot, I can then respond to you and then make sure that other Members are copied in as a result.

On best practice, it’s interesting; I’ve had a number of interesting meetings with Peter Lewis talking about work from the start of the programme to carrying through, and one of the phrases he uses—I think it’s very useful—is about adopting a ‘best-in-class standard’, so understanding what is the best in class, having evidence to get there and then saying, ‘This is what we now need to do’. And in doing that, there is evidence from within Wales, but across the UK system as well, of course. And what’s interesting, partly, is that actually our surgeons, for example, but also clinicians at every level, are interested in what happens internationally as well. So we have that evidence that is being brought to us and is available. What I don’t want to do is to get stuck in looking for evermore at this before we decide actually, ‘This is what we need to do in the here and now, and here’s how we need to plan our service.’ That’s understanding both the demand coming in and how that’s managed, as well as then deciding when we need different parts of our system to see them: how do we do that? Because otherwise, we’ll never plan for a service; we’ll always be thinking about the next step and the next change in demand and then how actually we have our activity to match it.

Some of that, then, coming back to your next route of questions about the ‘did not attend’ rate and reducing follow-up appointments—we’re exactly in the space of making sure that we (a) want people to attend appropriate appointments and that (b) they will continue to be offered an appointment that’s clinically appropriate. The first point is that we already recognise that we drive unacceptable waste and variation out of our system in some parts of it by offering standard follow-up appointments that are not clinically appropriate. And it is also then about understanding, if somebody needs seeing, who do they need to be seen by. That’s where, in the ophthalmology field, for example, we already now are moving to a system where we’re managing more and more of those follow-up appointments in the community. So, if you go into a range of high street optometrists, they will be able to tell you about a range of services they now provide. Actually, when I spoke to optometrists during eye health week, they were genuinely excited about what they were doing. In fact, one optometrist described it to me as, ‘This is great; it’s wonderful. We’re now having people referred to us on an emergency basis, in one instance, by GPs; that didn’t happen before. But also we’re doing more and more of what happens in the aftercare. So, before, we used to be a giant refraction machine, and now we’re using our clinical skills that we’ve actually got, and it makes the job more interesting.’

That’s the same in a range of other areas as well. Orthopaedics is another example of where we had a hugely inefficient system in some parts of our service, and there are real gains to be made in efficiency and value for the citizen, but also for the whole service as well. That does require changes in behaviour from a range of our clinicians who are deciding on whether to provide people with follow-up appointments.

On virtual clinics, it’s a really good example of how people can receive care from a clinician, or, where it’s appropriate, from a consultant, potentially, who is fixed in one point and where people travel to a different one. For example, I saw this directly in Betsi Cadwaladr: I was in Ysbyty Gwynedd, and the consultants there were able to provide a clinic with very high-quality images from people who were many miles away, but for them it was an easier place to go to. There’s something here about understanding the quality of our broadband network and the work that my colleague Julie James is leading on—understanding how and where we have high-quality broadband available. That may mean a short distance of travel for people, but it will be more local to them to receive their care, and that goes into us having more care delivered closer to home.

On co-design events, we have had two events within the last year as public large-scale events. But, it isn’t just the larger-scale events: the PREMs work—the patient-reported experience measures—and the PROMs work—the patient-reported outcome measures—really matter. They’re about us trying to understand on a regular basis what matters to patients in terms of experience and what matters to them in terms of outcomes, and how we then deliver against that. So, people are actively giving information that will be acted on in our system. We’re trying to do the right things. As I say, my frustration and my desire is that we do more of that more consistently and at greater pace.