As a member of the committee, I largely welcome the response of the Welsh Government to the report as we continue to develop and strengthen the primary care clusters in the years ahead.

My overriding impression from the evidence we took in this inquiry is that, for many, it was too soon to take an informed decision or an informed view on the overall success of the clusters. So, I do think that the evaluation of activity in existing and developing clusters will be vitally important if we are to roll out good practice across Wales.

So, today, however, rather than focusing on any of the particular recommendations, there are just three points that I want to make. Firstly, investing our money to help deliver much-needed change and ensuring that we share good practice. Secondly, investing our money to help people make the right choice about their care, building on the work of the Choose Well campaign that Dai Lloyd's already referred to and delivering change in the primary care settings. And thirdly, how the work on primary care clusters is just one part of the huge responsibility to be placed on this whole Assembly in light of the parliamentary review of health and social care.

So, first, I'd like to link the growing role of primary care clusters to the vital task of spending the health budget wisely. I think the case for cluster working is well evidenced, although evaluation at present is not, and the task facing the Welsh NHS is to ensure the examples of best practice are rolled out quickly and effectively as the cluster models mature. The challenge we all face, irrespective of party-political colour, is to ensure that the moneys we invest in the Welsh NHS help to make the real changes in service delivery that we know are required. We now need to ensure that clusters are able to influence integrated medium-term plans and that those plans allow for the intended innovation the cluster funding was intended to deliver. I'm firmly of the view that we can't afford to continue investing in models of care that don't respond to the ever-changing needs. The evidence tells us that we need to shift services to the primary setting and if done properly, clusters can be an effective way of doing this, and there are some excellent examples of good practice already out there.

In my own health board area of Cwm Taf, for example, we've seen the success in Merthyr of the Baby Teeth Do Matter project, which is ensuring that under two and five-year-olds are receiving early access to dental care through healthcare support workers and dental therapists. GP support officers are supporting GPs to focus on what they can do, helping people with social care needs and care co-ordination, and the cluster is leading with ICT projects like the GP web, which provides online triage.

Cwm Taf have also piloted a virtual ward cluster project in Aberdare, which, I understand, they're soon to roll out in Merthyr as well, which saw a multidisciplinary primary care team target 150 frequent hospital attendees, mainly elderly frail, by proactively visiting them in their own homes, to offer support through physios, occupational therapists, paramedics and pharmacists. Over an eight-month period, this has seen GP appointments reduce by 60 per cent, hospital admissions reduce by 80 per cent, and calls to out-of-hours services reduce by 90 per cent. This has allowed GPs time to deal with more complex issues in their surgeries. 

So, to resist change in service delivery, like the examples I've just given, is to encourage stagnation, and stagnation does not reflect what the people of Wales need from their health and social care system. Therefore, I welcome the Welsh Government's response that firms up the commitment to provide a clearer vision on the work of primary care clusters. 

This leads me to my second point. As the current pressures on the system show, the next phase of the work on primary care clusters must help to strengthen the important work that underpins the Choose Well campaign. It's beyond doubt that, as users of the NHS, we must continually be reminded about the way in which our personal choices can impact on the integrity of the whole system. Strengthening services in primary care clusters, therefore ensuring that people do not need to routinely visit a hospital for their treatment, is part of the overall strategy. Perhaps we need to move back to using the full terminology of 'accident and emergency' to reinforce what the hospital-based service is truly about.

Finally, and my third point, this report on primary care clusters is just one part of what I believe is a significant year for the NHS in Wales, as we will also need to work extra hard as we receive and consider with great care the recommendations of the parliamentary review of health and social care that we debated yesterday. We have much important work ahead.