Thank you for the questions. I’ll start with: I openly want to challenge your assertion that there’s somehow an air of unreality in the statement that I’ve made. I think my job is to be balanced in what I say and do, and I make no apology for being both positive about what has happened, positive about the future, and at the same time frustrated that we haven’t done more. In my statement, I expressed very clearly that some people wait too long. That is why we have had a planned care programme and, several years after we introduced that, we still haven’t done enough, from my point of view. And part of the point of bringing a statement here is to be honest about the fact that the progress we have made doesn’t mean that the deal is done—far from it.

I also recognise—not just in this place, but on a regular basis—that there are variations within health boards and there are variations across health boards about activity, and orthopaedics is a good example. The progress that’s been made in some health boards is not being reflected in others. You’re seeing in north Wales a challenge that is seen more generally about rising demand and about how capacity and demand do end up aligned with each other, but actually there is a bigger problem in north Wales and in other parts of our system. There has been a bigger ballooning in the waiting lists there than everywhere else. And that’s not me telling tales out of school, because the figures are there to view.

And I don’t try to pretend that those figures don’t exist. For me, that is the increase in urgency that is required for lessons not to be learned and talked about, but to be delivered in practice. I do not want to keep on coming here and explaining why parts of our service are not making the progress that others are as well. There has to be proper demand, both from clinicians themselves—they should be frustrated about where they are and about the length of the list they have of the people that they see, and the leaders and managers in our services should be frustrated as well. And that’s why I was really clear, both in my statement, and you’ll see it again in the planning framework for the intermediate medium-term plans, that I expect to see the planned care programme delivered, and that isn’t going to be a negotiable part of what health boards want. If they want an approved plan, they have to plan to deliver it and then they have to be able to demonstrate that they are doing so as well.

In north Wales, you’ll know that I am expecting imminently to see the plan that the health board have for improving their orthopaedic function. I expect that plan to be robust and I expect it to work, and if not, there will be a rather more difficult conversation. Now, that’s not me threatening an organisation, it’s just being honest about where we are. And that’s a straightforward conversation that I have had and that system leaders had with each other as well. So this is not a game; this is genuine and it is serious, and I think it really does affect the ability and the willingness of staff to work in those services as well: to know that there is a real understanding that improvement is required.

In terms of how we manage our system to reflect what actually happens, that again is part of what we need to do better. So there’s something not just about the follow-up point, but how you actually make sure that consultants and people who are saying they will see people are available. It isn’t just an issue about consultants. That goes into one of your other points about how we actually deal with workforce issues and waiting times. We’ve spoken before about Health Education and Improvement Wales, which has finally come into being with the chair having started work, and I think that’s genuinely exciting. We have the shadow body starting, looking ahead to the formalisation and it coming into being on a statutory basis in April next year. That should help us improve our function in planning and understanding who we need, in what number, and across which particular areas of staff.

Again, I make no apologies for repeating the message, particularly because we’ve had more public conversations about austerity and the reality of it: if austerity continues, it will drive public service against public service, and we see that in some of the calls made by some actors in the field outside here. Actually, whilst austerity continues, we have awful choices to make where there can be no winners. It is simply about how we make difficult choices between different parts of the public sector. So my message to the health service, in public and in private, is: there’s a responsibility to use your additional resource to make a real difference in the here and now and moving forward. And that comes alongside not just a demand for having more staff than ever before in our service, the continuing demands for more staff—and in every specialty area and every lobbying group, they almost always call for more staff—actually, what we have to understand is how many more staff we think we need and how much smarter can we be with the staff we already have, because if we only think about expanding our services and numbers being the only answer, we will miss a proper trick in what we are able to do. That’s why the message of prudent healthcare about doing only what you can do really matters. That’s why people seeing the appropriate healthcare professional really matters, because we can create more capacity for consultants if different healthcare professionals have different parts of their job that they can do as well. It’s why the physiotherapy work and the clinical musculoskeletal assessment and treatment service really does matter. It will be a better service often for the individual citizen, they’ll get seen more quickly, and if they do need to then go and see a consultant, the quality of referral will be better and we won’t be unnecessarily putting people into queues for an operation that they may not need as well. That has to be an essential part of what we do.

Finally, I just want to deal with your point about follow up on RTT. I don’t want to avoid this, because I think it’s really important. I have acknowledged previously that there are some of our measures in RTT that don’t necessarily make sense, that don’t give us the assurance we’d want because they’re only measuring activity and time, and time at a certain point. And at that point, it may not be driving the right clinical behaviour. So, on eye care, for example, I accepted that our current measures probably don’t give us the fullest reflection and assurance. That’s why work is already ongoing with a pilot that is due to start this autumn in two health board areas—in ABM and in Betsi—looking at what we could do to have a new set of measures to drive more appropriate clinical behaviour. We’ll then have a better understanding of the risks we are carrying in our system, and a proper identification that does look at follow-ups where it’s clinically appropriate to do so. So, we’ll have a system that I think will make more sense, but it won’t be comparable with England. That isn’t about saying that I’m changing the goalposts to avoid a comparison with England—I’m doing it because I think and I’ve been persuaded by the clinical case that it’s the right thing to do for the staff and, much more importantly, it’s the right thing to do for our patients.