Thank you, Presiding Officer. I’m happy to get a lectern and respond to the debate. Thank you to Dai Lloyd for bringing the debate today, but also to Mike Hedges for taking part as well. I recognise the very real concerns that local Members in and around south-west Wales have about the future direction of not just policy, but the practical reality of what that means in terms of where services are located.

I want to start on a more general point, though, about specialist services, because we already accept that people in any modern healthcare system will travel for specialist services. How specialist they are will affect how far they travel, whether that’s for a secondary care service or, in this instance, a tertiary service. There are some instances where, of course, we have people travelling outside of Wales to access highly specialist services, and with Morriston people travel into Wales from south-west England, in particular, to access the excellent services provided by the Welsh centre for burns and plastic surgery.

If I can just say at the outset, I recognise that the comments made by the person who led the independent review into major trauma services were particularly unhelpful, floating the suggestion that the burns and plastic unit might move or should move. He then qualified that, but there’s something about people getting involved in a highly charged political debate and not understanding the power of the words they use. So, I hope it’s helpful for me to clarify that this Government has no intention of moving the burns and plastic unit. Our challenge is how we sustain our services, and how we actually recognise and be proud of the excellence that the burns and plastic unit already provide. It’s my understanding that any choice about a major trauma network or centre does not require the burns and plastic unit to move.

On a more general point, we recognise that as we have new and more complex procedures and technology changes what we’re able to do, that means that, actually, some of our services are becoming new and groundbreaking. We’ve had a conversation about interventional neuroradiology, for example—a new service being developed in a small number of services. So, we recognise that some of our services will develop anew in a limited number of centres, and equally there will be times when we need to concentrate some of those centres to give them the robustness and stability that they will need, and make them attractive to staff. We know that in doing that, we are concentrating services so that people travel longer or a further distance to get to those services. Conversely, of course, technological advances will mean that we can deliver more care closer to home.

There’s a challenge here, though, about our general message about reform. I’ll talk later on about more care closer to home. As we have a conversation about reform in the health service, this isn’t new; we have always talked about the health service changing. As the reality of demand changes and the reality of what we can do changes, we need to then talk about how we keep changing our service to make sure it continues to provide the quality of care that people rightly expect. But in doing that, I think we have to have a conversation with the public based upon evidence. I recognise that in the past some of the current unhappiness is because people were simply told, ‘This is what will now happen’, as opposed to there being a conversation within the service so that staff feel part of the conversation, and also a conversation then with the public. In having that conversation, we need to have a real ambition for the quality of our services, rather than simply trying to explain to people that it would be acceptable for them to have a lesser service in different parts of Wales. That can be difficult, because that challenges local politicians in every party about the current location and organisation of services, and I know that just isn’t easy. But if we’re not prepared to have real ambition about what quality looks like and what better looks like, then we’re going to get stuck into a way of doing business where models of care that will be unsustainable will continue to the point of near collapse.

So, in terms of reform, we know there’s been a consensus for some time amongst a range of clinicians, the public and politicians that change is essential for NHS Wales. The challenge always comes when you get a local decision that really challenges how and where that is located. But for me, I think we have to be bold enough to change parts of our service, to reform them because we choose to do so, because there is a clear evidence base to do so as well as a consensus in clinical advice and opinion. And that’s why that’s still part of the conversation with the public. I actually think that, if we allow ourselves to be trapped in a position where we fight for the status quo then we’ll change our services but we’ll change them when they’re at the point of collapse or at the point where real clinical harm has been done as well, and that simply is not acceptable.

So, reforming our services is difficult, but it must be embraced with maturity and leadership to meet the challenges that we know that we face in Wales today and across every modern developed healthcare system. Those challenges include a rising number of our ageing population, enduring health inequalities, increasing numbers of patients with chronic conditions and, of course, austerity and the undeniable financial challenge that Dai Lloyd mentioned in introducing this debate. We can’t pretend those challenges aren’t with us and that we can simply carry on as we are and as we have done.

We also know—again, going back to comments that were made in a variety of debates and questions—that we have very real workforce challenges. Planning for a workforce when we know that there are challenges over money is difficult. Planning for workforce when the health service is changing and with the care system—that is difficult—and also, planning for workforce when we know we have speciality shortages, in particular, in Wales, in the UK and internationally as well.

So, we do know that, in a range of our services, in amongst all of that challenge, to maintain the right level of skill and quality, doctors and the wider team will need to see a minimum number of patients to maintain their skills and expertise. There is a wealth of evidence that, in some cases, that is best done by concentrating those specialist services into fewer centres. In fact, the interim report for the parliamentary review of health and social care reconfirmed the compelling case for change, highlighting the need for further integration of services that are more readily available within the community. Again, it makes clear that doing nothing is not an option going forward. And that brings us back to local care. We spoke yesterday, actually, about the fact that telehealth and the new technologies are big enablers to delivering more care closer to home. They give clinical staff anywhere in Wales potential to have the information they need to provide better, safer, more integrated care, and we see that in a range of services, whether it’s eye care or whether it’s dermatology—a range of things that are already happening now as a matter of course, and the potential is there to do more. It isn’t just the potential; I think there’s a real demand and a real expectation that we need to do more, because otherwise our system is unlikely to last. We’ll miss out on the opportunity to give people a better experience of working with the health service if that is not our absolute ambition, and I do look forward to receiving the final report from the parliamentary review, and there will be undeniable challenges that each of us will face in trying to do so.

I said earlier that, when a service change is proposed, it has to be clinically led—proper engagement with our staff so they understand and agree whether there is or isn’t a proposal for change that should be supported, and accepting from the outset that people won’t always agree within the health service as well. Clinicians in specialities do not always agree on the physical relocation or indeed the service model for how services should be run and managed. But we have to be able to have that debate within the health service and then to engage wider stakeholders, including, of course, the most obvious and important stakeholders, the public, and focus on how we improve both experience and outcomes. So, staff, the public, carers must be more involved in the design, implementation and evaluation and subsequent development of new models of care to show that they are clear on their shared roles and that responsibilities are better understood.

Turning to the comments made more directly about the major trauma network and centre, it is the case, of course—and people in this room will know this—that, ultimately, it’s possible that I will have to decide on this if, following the current and ongoing consultation and engagement process, it’s referred in to me. So, I won’t make any comments about the proposed location between the two tertiary centres. But what I will say is that, when we look at our major trauma network in itself, we already know that north Wales participates in a major trauma network. It’s not seen services pulled out of the three major accident and emergency units across north Wales, despite the fact that the centre is based in Stoke. We also know that there is clear evidence that outcomes for people in north Wales, from north Wales, have improved, as a result of being part of that network. For me, the overriding objective here is how we get to a point where we understand that having a major trauma network with the centre will improve outcomes for people—there’s a good evidence base for that—and then to make sure that, actually, we say, ‘Well, that must be delivered.’ We have to make sure that we don’t continue to have a conversation in south Wales where we argue over a choice rather than ultimately making a choice, because we’re then denying people in Wales, I think, an improved quality of care and outcome.

I recognise that our NHS needs to make that choice for people in south and mid Wales in creating a network, and for me, there’s something about understanding how people, whatever the choice that is made about a centre, can get to that centre properly, because if the centre was in Swansea or Cardiff, there would be people who would live, physically, at a decent distance from that.

It’s why, regardless, when you think about our transport options, the choices that are made, even now, when there are significant accidents, people are taken by helicopter. They don’t get asked what will happen. These normally are people who are unconscious—they’re taken by helicopter to the most appropriate place for them if they need to be there rapidly. So, the development of the emergency medical retrieval and transfer service—the flying doctor service—in all the different things that it does, is a real bonus in the treatment of trauma—so, the treatment at the scene, the treatment in transit and the rapid transit to the right place for those people to receive their care. Whether that would be a major trauma unit within a new network, or the centre—that’s a choice for clinicians to make about what is appropriate.

For me, it’s that focus on outcomes for the public. That’s my overriding priority. In every choice that I make and that I try to make in this job, that will be where I start with my focus. I will continue to be guided by the best available evidence on what we should do to configure our service, the outcomes we can expect and the experience that people expect to get from that care. I look forward to the more difficult conversations that are to be had, but, ultimately, to getting to a point where we make choices because we understand the evidence, and we’re making a choice based on that about what to do with this most precious and most trusted public service.

So, I appreciate I can’t give, perhaps, the direct guarantees that some south-west Members may want me to give, but I think people understand in this Chamber why I do that. But I hope the comments I’ve made about the burns and plastics unit have been helpful, and, ultimately, the basis on which I will make any choices I have to in the future is helpful too, about the direction of travel. And I really do look forward, again—I’ve said this before—. The maturity and the leadership that went into creating the parliamentary review—I hope that each of us who took part in that can continue to behave in that way as we face many more difficult challenges in the months ahead.