In responding to the questions and the points made, I’ll start by repeating and then adding a little to some of the points that I made earlier about finances and the reality of services. You’re right: our current projections show that we’ll spend comfortably more than half of the Welsh Government budget on the health service in the medium-term future. That is because of the choice this Government is making on the one hand to prioritise the health service, to make sure that front-line services are funded and that we have a generally sustainable system. We’re not doing this simply on the basis of our long-standing political commitment to the service but because of the objective aims that we’ve taken both from Nuffield and then the Health Foundation about the gap that needs to be met to keep the service sustainable. That includes not just more money going in; it includes continuing efficiency gains being made year on year within our service. The risk in that also is staff. It requires a continuing element of wage restraint, otherwise the service is not affordable. And then we come back to both the pay cap and the UK Government decision and whether they are prepared to be serious about the pay cap. I notice they have recently confirmed they are going to put off putting evidence in for the pay review bodies. That means that our public service workers, who are expecting the review to take place, won’t know what the position is until much later in the year and any pay rise of any level is likely to be delayed as a result. That may produce a saving to the Treasury, but I think it puts more pressure on our hard-pressed staff. It goes back to the central choice about austerity. The financial lead for the Welsh Local Government Association, Anthony Hunt, this weekend made the point that Tory austerity pits public services against public services. If it doesn’t end, we’re going to have catastrophic results for communities up and down the country.

On our challenge here within the service to reduce waiting times and to make sure there’s no trade-off in quality, I recognise what you say about how we try and measure and get an understanding of what the patient experience is. It isn’t just PREMs and PROMs versus the community health council movement. It’s about understanding where there’s a differing role for different parts of our system. I think PREMs and PROMs could and should be really useful in understanding people’s experience and proactively asking people what matters to them and then designing services around what patients tell us, but equally it’s about understanding that there’s more than one place to go and get this. So, it’s in the numbers that we have, but it’s also in the clinical audit work that takes place as well. There are rich areas for improvement there as well, and that benchmarks us across other parts of the UK system. In each of the implementation groups we have for major conditions, the third sector are always involved within that so you have an area of challenge from those groups that are acting, if you like, as the voice of the patient within those services as well. A good example of where a third sector group helps us to understand the patient voice is in the Macmillan survey we’ve just had, telling us about cancer services and the direct patient input. So, we understand from a variety of sources what patients are trying to tell us about the services they value and how they want to see them improved. And in trying to make those more consistent or complementary, we should not choke off different areas to understand what people tell us.

Your points about follow-up I think I’ve broadly dealt with. I’m pleased you recognise that ENT appointments in Aneurin Bevan have reduced by 40 per cent. The challenge, as Angela Burns was asking, is how we make sure that follow-ups are clinically appropriate and we don’t drive unhelpful demand into our system that is of no value, either to the clinician or to the citizen. And I don’t think there’s a great level of reassurance to be asked to be told to come to a hospital site for a follow-up appointment with a consultant, if you’re then waiting for a period of time, you have to try and park somewhere, go along and take up a significant part of your day, and if you then have five minutes of time with a clinician who says, ‘Everything’s fine, thank you very much’, that isn’t a great use of that consultant’s time and it often isn’t a great use of the citizen’s time either. So, there’s much more efficiency that we could get by actually, in a clinically appropriate manner, changing the way that follow-ups happen and who people actually go to see.

On your other points about other areas of the planned care programme, well, that comes down to the advice we’ll get about the right number of areas, but also the capacity of our system to make a real difference in these high-volume areas of activity. On cancer, there’s more work that we’re doing on how we refine our cancer pathway to understand how we get the right system to deliver the right results for our patients.