The next item, therefore, is the statement by the Cabinet Secretary for Health and Social Services on the long-term plan for health and social care in Wales. I call on the Cabinet Secretary to make his statement. Vaughan Gething.

Diolch, Llywydd. Next month marks the seventieth anniversary of the NHS. Nye Bevan’s radical vision, based on the model of the Tredegar Medical Aid Society, transformed health services for millions of people. Today, the NHS and the social care sector are critical to the well-being of our nation. Yet everyone in this Chamber knows that the context for these services has changed markedly. More people are living longer. This, of course, is one of society’s greatest achievements, and a cause for celebration, but it brings with it additional demand for public services at a time when more than eight years of austerity significantly restricts our capacity to respond. We also see the way that modern society puts pressures on families and, in particular, children. These are some of the important reasons why the boundaries between health and social care make less sense as time moves on.

The vision of a seamless, more accessible, and better quality health and social care service is one that is shared across the Senedd. It is the reason why all parties here agreed to the establishment of a parliamentary review of health and social care back in 2016. And the terms of reference for that review, and the membership of the panel, benefited from cross-party support. And that expert, independent panel, ably led by Dr Ruth Hussey, published its final report in January this year. We have discussed that report here, in some detail. The panel very clearly articulated the urgent need to bolster the response to the significant pressure on our services now, which is only set to grow over the coming years. The panel’s final report was well received by the many stakeholders in health and social care, including here in the Senedd and, indeed, in the Health, Well-being and Sport Committee.

Yesterday, I published 'A Healthier Wales: our Plan for Health and Social Care'. That plan responds to the final report of the parliamentary review, taking forward its key recommendations. The plan sets out a long-term future vision of a whole-system approach to health and social care, focused on health and well-being and on preventing illness. The plan is different, not just in its bold ambition to truly integrate health and social care, but because it has been designed in partnership with those who will be driving and delivering the change that it articulates. These stakeholders have shared our frustration with the pace of change thus far, despite a near-universal acknowledgment that urgent change is needed. An important theme running through the plan is stronger national leadership and direction to make the whole system align with our national priorities, with regular progress updates available to hold those responsible for delivery to account.

To achieve this future vision, we will develop new models of seamless local health and social care, which will scale from local to regional to national. A national transformation programme will help to deliver change at a greater pace. And there will be a transformation board to oversee and be accountable nationally for the commitments in the plan. It will advise on and commit targeted funding support to health and social care providers particularly focused on selected new models of seamless local health and social care. And the new models must be identified as delivering significant and enhanced value and be strongly aligned to national priorities.

We will strengthen national leadership and direction, including the development of a national executive for the NHS. The national executive will support and challenge health boards and NHS trusts and ensure the development of capacity and capability across our system. We will ensure that the whole system is fit for the future by focusing on quality and value and harnessing digital opportunities and supporting our workforce. All of this work, and our future system, will be underpinned by a strong shared philosophy and continuous engagement.

But we haven't just taken the panel’s recommendations at face value. I recognise that the key to any effective public policy is to understand the barriers that have frustrated change in the past and to put in place what needs to be done differently to overcome them. We have therefore taken great care in this plan to give strong national direction in realigning our policy levers so that they fully support the vision—in particular, financial strategy, planning, performance management, and inspection and regulation. These structures help to shape decision making on a day-to-day basis in our delivery organisations.

Finally, this plan has been developed through a major engagement exercise with our key strategic delivery partners. I have met with local government and health board leaders in each of the regional partnership board areas of Wales, together with the Minister for Children, Older People and Social Care. We've also discussed the plan with local government cabinet members for social care and the Welsh Local Government Association council. And we will maintain this engagement now that the plan is published, with a further round of regional footprint meetings planned for the weeks running up to our summer recess.

At executive level, the WLGA, the NHS Confederation, the Association of Directors of Social Services and the Wales Council for Voluntary Action have led or been involved in working groups that have helped to shape the plan. The most senior staff from these organisations were members of an external reference group that was chaired by the Welsh Government director general for health and social services. We've also received feedback from citizen panels during April, which has helped to shape the vision and the design principles in the plan. All of this builds on the high level of public and professional engagement already undertaken by the parliamentary review team.

A significant and previously unseen level of engagement with people, professionals and indeed political parties has characterised the work of the parliamentary review right up to the publication now of 'A Healthier Wales'. I hope this is now a plan that the whole nation can get behind. It is a plan with a clear set of actions for the first three years. The work starts now and will move quickly to build momentum. The plan contains all the components needed to take health and social care forward, but it will count for nothing without effective execution. As I have said regularly to our external partners, the radical thing to do now is to implement this plan. 

Suzy Davies took the Chair.

Minister, I'd like to thank you very much for bringing forward this statement, and actually I want to pick up on one of the comments you made in here above all else probably:

'More people are living longer. This is one of our society’s greatest achievements, and a cause for celebration'.

I'm so glad to hear those words, because so very often we talk in a pejorative way about older people—they're talked about bedblocking and that the costs and the worries of the NHS are because of the longevity in our lives. And I for one celebrate the fact that we all might live longer—I most certainly hope that I do—and I'm very glad to see that you recognise that that is a cause for celebration. 

The vision you put before us tells us, to be frank, no new news, but then again neither did the parliamentary review. What it has done is—we all know a lot of this stuff, but it's structured it, made it in a way that we can digest it, and, hopefully, implement it. Now, I'm sure that you will agree with me that the biggest risk to delivering substantive change rests in leadership and behaviour. Do you believe that you have enough people of the right calibre and experience to lead a transformative process—and at pace, because this is vital? We know this, the Welsh Government know it, the NHS know it, and yet we've not been able to do it so far and we need to make these changes. 

A strong national board taking once-for-Wales decisions is very vital. However, which organisation do you see will become responsible for the external scrutiny of that board? I think this is vital, because it was raised with me and by me during the parliamentary review discussions. And, whilst I note that the director general led the scrutiny for the development of this plan, going forward, it is him and his national team who must be tasked with ensuring that it happens. I would like to know how you're going to ensure that you keep his feet to the fire to make sure that this happens at the pace that you describe that we need.

There have been many policy documents and attempted starts in the journey of both transformation and integration through health and social services. Again, the parliamentary review identified that Wales is heavy and good on a lot of policy, but light on delivery. I still don't see in this vision that it clearly identifies the how—how we are going to do it, how we're going to make this change. There are lots of boards, lots of local, regional and national, but, the front line change that we need, how will you ensure that there is no false start this time? If it's going to go wrong, it will go wrong at the beginning. So, you must lead well from the beginning and constantly assess the risks and the process. Can you perhaps tell us how you might do that across the three years before the formal review? 

The vision is quite light on workforce issues: how we develop our workforce from carer to consultant, how we value them, how we train them, and how we give them parity of esteem. The vision mentions in passing Health Education and Improvement Wales, but can you give us more detail, given that staff and the re-energising and the respect, evaluation and involvement of staff were such a key part of the parliamentary review? I don't think it comes across well in the vision at present and perhaps you can flesh that out a little bit more. 

There is so much to talk about, acting Deputy Presiding Officer, and I'm sure I'm running out of time, but given that so many GPs and community hubs have closed in the past, how do we start that up? There are no tangible targets or commitment.

I think I'd like to end on two points. One is that I'm sure we're going to discuss this more and I would ask if you would commit today to bringing forward a debate in Government time so that we might have the chance to flesh out this vision. And, secondly, could you just make a comment on the £100 million for the transformation fund? Extremely welcome, but it is described as time-limited funding, it is targeted towards rapid development and implementation—it does seem to mirror, to an extent, the aims of the integrated care fund. So, therefore, will health authorities or local authorities who are not leading on innovation in the end miss out and suffer further disadvantage, or will you be able to use that £100 million of transformation to bring a parity of delivery and service change across all the health boards, from the strong ones to the very weak ones? Thank you. 

Thank you for your comments and the questions. I want to start off by, again, recognising and welcoming the cross-party work that went into the parliamentary review, the membership and the terms, and where we are now. And I expect, of course, that there will be slightly a different character where we are as you quite rightly scrutinise me and the Government on taking this plan forward.

I understand your concern about some of the centralised functions that we've been advised and recommended to create, not just in the review, but also in the Organisation for Economic Co-operation and Development review as well. I think your question of are there enough people of the right calibre to deliver national transformation comes to that, together with your question about the scrutiny of the national executive. We may want to bring more people in. That's part of what we're looking to do to deliver a national executive. Some of that is about bringing together, in a more coherent way, different parts of our health and care system and to have those, I think it's likely, to be responsible to the director general and the chief executive of the NHS. That then means, of course, that that's going to be responsible to a member linked to the Government and, of course, I expect to be scrutinised on what happens both in committee and here in the Chamber as well.

Now, I do actually think that, across Wales, our—. We could always look for would we want more people of greater calibre and quality, and we would always want to say, 'Well, you can never have too many good people'. I actually think our first challenge, though, is to get organisations pointing in the right direction at the same time and the leadership that already exists at not just the senior level, but at peer and delivery and front-line level, and we'll actually see real gain being made in doing so. And that's why the plan sets out that regional partnership boards—which already exist, so we're not going to create a whole new plethora of boards and organisations—they'll be empowered to take forward some of the transformation that we are discussing.

And, really, your point about the place of staff—I think it's pretty clear, in having a quadruple aim that we've validated and agreed to take forward in this plan, that the key additional in the quadruple aim is ensuring we have a motivated and sustainable health and care workforce. And that will be hugely important, not just as something to talk about but to deliver in practice. And the challenge in the detail of the delivery on this and on a number of other things is that I don't think you'd expect to see a high level of detail in this plan. I think you have to see the ambition and the clarity in the targets, the actions to be taken, in the timescale to deliver them, rather than a very detailed operational plan for the service. That would, very quickly, become out of date. But the challenge is how we achieve our targets and the actions that we have set out. It's also worth mentioning that the NHS staff survey has just recently opened, so, if any members of the NHS staff family are watching, then I'd encourage you to take part in the staff survey and tell it how it is about what's good, what's bad and what's indifferent within your organisation. We have a similar challenge about keeping on board the social care workforce, and I'm pleased to note that the British Association of Social Workers in Wales have welcomed the plan as well.

I just want to finish by dealing with your point about transformation. In the plan, you will have seen that we've asked each regional partnership board to develop two particular models to try and deliver some of that transformation. Now, there's a deliberate ask there to make sure that we're having something done on a large enough scale—so, not just a small area of transformation that is isolated to a single community, but a much larger level of transformation that all of those regional board partners can agree on and get behind. And that's really important, because that again reinforces our view that it must be the health service and local government and other partners who are agreeing on what our transformational areas of activity are for them all to engage in and support, to make the change that we've discussed many times in the past. And the transformation fund will help to promote that and to take it forward. But we also think that's likely to generate a number of areas where partners don't need the transformation fund to agree on doing something together. Because the real priority is not how we use £100 million of transformation funding, important as that is in advancing and kick-starting the pace of some of the change want to see, it's actually how we more progressively use the £9 billion of money on health and social care spend together and that's a challenge. How much more of it will they spend together on the same objective to the same high level plan and with the same workforce working closer and closer together and that is what we're looking to achieve.

Thank you, Cabinet Secretary, for that statement.

The Welsh public knows that Labour has lost its way with the running of the NHS in Wales and Plaid Cymru wants to get the NHS back on its feet. That is why we pushed for the parliamentary review of health and social care, which gave us a very useful, I think, set of guiding principles. The quick turnaround demanded by that review for the Government to come up with a plan of action was proof, I think, of what we already knew—that this Government has been lacking in strategy for the future of health and care. So, now we have a set of proposals, and there are positive elements, certainly. The £100 million fund, for example, is welcome. Of course it's welcome, but it's not enough, I fear. But, more importantly, it's not the evidence I think I and Welsh patients were looking for of a set of proposals that will lead to a new culture and actually provide the actual means of bringing about that change and setting us off on a new direction.

When the parliamentary review report was published, we came up with a set of asks of the Government, things that we expected of Government in light of what was proposed and set out as a set of principles in that review. So, I'll go through them. There are four that I'll mention here. We need detailed plans to recruit more staff, in particular in primary care. We're talking about putting more weight and more pressure on primary care. That means we have very acute staffing issues that we need addressed. Where is that plan for staffing? We need substantial proposals for policies to prevent ill health. I'm not seeing that. Where are those proposals? Thirdly, where are the plans that we expected, in light of the parliamentary review report, to provide better and comparable data on performance that will allow benchmarking with performance in the other nations, as recommended by the review? And finally, for the time being, this is something that has been partly addressed in the set of proposals that you have announced in the £100 million transformation fund to push forward the agenda of integration, and I think we all want to see integration happening, but we wanted proposals on how services provided by different public sector bodies with different budgets are going to integrate to provide the best possible health and social care. The parliamentary review could give us general principles. I believe actually that was the role of the parliamentary review, to spell out some guiding principles. The Government needed concrete and very, very comprehensive proposals, and I'm afraid that's not what we have here.

Well, that's an interesting set of questions and comments from Rhun ap Iorwerth. I'll deal with your four points and then I'll deal with your more general observations, which you'll not be surprised I don't share.

On the proposals to deliver a new culture, I actually think there's a limited extent to which proposals in a plan can deliver a new culture. Actually, what has started to change the culture is the process that we've undertaken between partners in undertaking the review itself and in the broader work that the Government has undertaken over a period of time. A really good example of that is the integrated care fund, and that came from budget discussions between parties in this Chamber, and that has changed some of the culture and working relationships on the ground. It's given us good examples of what working together delivers: a better place for people to work across health, social care, housing and other areas of our workforce, and equally better outcomes for the citizen. That's crucially what this is about, and that's been reinforced by the way we've gone about developing the plan.

As I've said in my statement, we have done this by working with partners. The Government previously wrote a plan for the health service, gave it to the health service and told it to deliver it. They then told their partners in local government and elsewhere, 'This is what we're going to have to do.' We've done something different this time. It's been positively welcomed and recognised. We have brought together Government, the health service, local government and other partners that I've set out, and there's actually been a joint conversation between different people about their varied roles in delivering better services and better outcomes. So, we've made real progress in taking that forward and, interestingly, the Welsh Local Government Association recognised that themselves in the statements they've issued about how we've got to this point, and in the direct conversations that I've had, together with the Minister, with people of all parties and independents across the country. 

In terms of the challenges about workforce, not only do we have the quadruple aim, but we have a range of actions within the plan—actions 25 to 28 in particular—that talk about how we will take forward getting the right workforce to deliver a different way of providing health and social care services. Interestingly, yesterday when we launched the plan formally, we were very pleased to be in the Cynon valley visiting the Laurels care home in Aberdare, and also then visiting a person in a home in Ynysybwl. That was a really positive and real example of change that we're already delivering that we want to see more of: not just a virtual ward, but, actually, if you could have listened directly to those GPs that talked about how their jobs have changed and the way they believe their job has changed for the better. One said, 'I would not go back to the way we used to do things. We didn't really talk to each other before and we didn't think that we could do. Now we talk to each other, we have the space to do it, and we are delivering better care for the people we are responsible for as a result.' They also recognise that they have different staff doing different things with them. It wasn't just a validation of what I think; it's a validation of what they see in practice, and that's what we need to deliver more of. That's why we're bringing different partners together, and that's why regional partnership boards must be a key driver in delivering that change. 

On your point about performance benchmarking with other UK nations, that requires the other UK nations to want to do that, and thus far I've seen no desire whatsoever from our colleagues across the border to want to do so. The only time we've been able to benchmark quality data between the UK nations, actually, Wales did rather well. We were above the line in the majority of the 13 quality measures. We were below the line on two, but, actually, on five out of the 13 measures, we were above the UK average. That shows that on a quality basis, NHS Wales does quite well in comparison to the other nations across the UK, and every now and again it would be good if you could recognise that, as well as our challenges. 

We recognise the challenges about integration—that's what this plan sets out for us to do—but I just don't accept the starting point of saying that Labour has lost its way. If that were the case, we would not be here in our respective positions in this Chamber. Plaid Cymru pushed for this review, together with other parties, and we all recognised in a moment of maturity that this was the right thing to do. And we recognised that in doing so, it would mean that there wouldn't be a strategy while we had a review and we got to this point as well.

Now, I think that when you look at what other people are saying about where we are, far from saying that this is a disappointment—. If you look at the comments from the Wales Council for Voluntary Action, the range of royal colleges, including the royal colleges of nursing, podiatry, physiotherapy, occupational therapy, the Royal Pharmaceutical Society, the Royal College of General Practitioners, the British Medical Association, the Welsh NHS Confederation, the Health Foundation with a UK perspective, the Bevan Commission and the British Association of Social Workers Cymru—they all say this plan takes us in the right direction, the plan is a good thing, and, as I finished in my statement, the radical thing to do now is to deliver.       

Thank you for your statement, Cabinet Secretary. I want to state at the outset that my party supports the direction you are taking with the long-term plan. I might not always agree with some of the decisions you may take or always support the way you've opted to implement those decisions, but I agree that things have to change, and they have to change if we are to see the NHS celebrate its hundredth anniversary. Health and social care in Wales have their problems, but we can all agree that the care provided is excellent. The problems are in getting the care in the first place. We have finite resources and because we're all living longer, our reliance on health and social care is increasing, putting those resources under greater strain. Sadly, in the past there has been a lack of forward planning in health and care, particularly in workforce planning and silo working, which meant a complete disconnect between services. I welcome the Welsh Government's recognition that all public services have a role to play in improving health and care. Ensuring an elderly person has a walk-in shower after a hip replacement will ensure that that person can stay in their own home and not be forced into a care home for two years while they wait for adaptations to their housing.

As I've said many times, and as the Welsh Government have indicated in their plan, the old models of care won't work in the future. We have to work smarter. There are many great examples of this happening within health and social care at a local level. For example, Aneurin Bevan local health board and the University Hospital of Wales worked with mathematicians from Cardiff University to improve appointments. The specialist in queue theory ascertained that, by rescheduling theatre slots, they could eliminate cancelled operations. This is the sort of thing that needs to be shared and rolled out across our NHS and social care sector. Best practice needs to be shared and scaled up. I am therefore pleased that the Welsh Government has chosen to implement a national transformation board. I hope the programme board will help identify and nurture innovation and roll it out quickly to the whole health and care sector.

Cabinet Secretary, while I welcome the role that digital technology will play in delivering future health and care, and there are clear advantages to increasing the use of telemedicine, what safeguards will be put in place to ensure that a move away from face-to-face consultations does not lead to increasing isolation for our elderly population? The move to a more digital health and care system will see greater investment in informatics and health-related software. Cabinet Secretary, have you or your Government given any thought to the role that open-source software will play in the future? And will you be taking steps to reduce the NHS's reliance on proprietary software? After all, if public money is being used to pay for software development, shouldn't the public own the licence?

Finally, Cabinet Secretary, in the spirit of a whole-system approach to health and care, what steps are the Welsh Government taking to ensure that Welsh patients are not prevented from playing a full part in participating in their own health and well-being as a result of poor broadband connectivity? As we move more and more services online, we have to ensure that the digitally excluded don't become excluded from health and care. Thank you once again for your statement, and I and my party stand ready to work with you to deliver health and social care services fit for the future.

Thank you for the comments and the questions. I certainly hope that I'm around to see the one hundredth birthday of the national health service—maybe not in this place but around nevertheless. [Interruption.] Well, easy now.

In terms of the three points that you mentioned about digital technology and whether the ability to consult people remotely leads to greater loneliness and isolation, there's a challenge here about understanding what's fit for purpose and how you still understand that human interaction matters for people with some of their health and care services in particular.

Part of our challenge, though, is that, actually, for some people, we recognise that it's difficult for them to move significantly out of their own home and, indeed, the move to have more treatment that is taken out of hospital settings and, indeed, if you do need to see someone based in a hospital, whether that person actually can do that from a remote setting in any event. We already see telemedicine doing this, and lots of members of the public are actually really pleased with what that means and does for them, but the challenge is a greater level of consistency because we've yet to take advantage of all of the efficiencies that could deliver. But also that can make a positive impact on how people don't feel lonely and isolated or the difficulties of getting to larger centres for different aspects of their treatment. That also matters in terms of our ability to use the technology available in terms of how we monitor people remotely and monitor their health and care conditions. So, there's more that we could and should do. Again, we are clear about the need to take advantage of those opportunities.

On your broader point about the intellectual property ownership for what we use, I'd say that there's a challenge about who owns the systems and the software that we would use and, at the same time, making sure that what we have is fit for purpose. Part of the challenge is that you end up developing systems with people who are specialists around the health and social care arena, and some of the challenge comes with the difficulty in procuring large-scale items and also, frankly, in making sure we're getting more and more choices that are 'once for Wales'. Because a large part of the opportunity to get greater gain in health and care outcomes actually comes from sharing that information and enabling that to happen, rather than having competing systems and information, which I'm sure is something that lots of Members will see from their own postbags at various points in time.

Your point about broadband and service provision: we recognise there's a need to invest in our broadband infrastructure to deliver greater public services. Sometimes, that will be into people's homes, sometimes it will be into hubs where people go for their treatment, and they can be local hubs rather than looking to travel a significantly greater distance. That will matter not just in more rural locations, but also in an urban location like the one that I represent, where, actually, being able to go to a more localised venue rather than travelling across the city for a different episode of care will be much more convenient for the individual person. So, there's the capacity to do that, but, crucially, the ability to make sure that our whole system is having a joined-up conversation and sharing information with the right number of health and social care professionals to make the right choices about health and care decisions.

You said at an earlier discussion in the Chamber that the health service either changes or it'll fall over, and that seems to me the challenge in front of us that we've all got to play our part in. And it's a really difficult job, because changing the way people do things is really complicated and many people find it difficult to adopt new ways of working.

So, I think one of the challenges facing us is how we get some of the excellent practice going on in different fields in different parts of Wales to be embraced by other people. For example, in Cardiff and the Vale, they've got this exercise and weight loss intervention that reduces people's need for surgery, and the evidence-based diet and exercise support—over three quarters of over 300 people lost weight, with an average weight loss over eight weeks of around 3 kg. I mean, that's a very substantial health gain and something that I'm sure could and should be adopted, as it's shown to work, across all the health boards. So, I was a bit bemused by Angela Burns's question, 'What will happen to local authorities or health boards who are not leading on innovation?' I think we should bypass them, because if they're not capable of leading on innovation in anything, then we have quite a struggle.

So, I suppose one of the things I'd like a bit more information on is how we're going to involve the citizen in transforming our health service, because Nick Ramsay earlier mentioned the excellent expert patients at the Breast Cancer Care launch of their report at lunch time—here are women who have had breast cancer and are now volunteering to support other women, and that makes them feel great, it makes the women who are most recently having to come to terms with this issue feel a lot more confident, having seen what can be done by others. This is exactly the sort of thing we should be replicating with expert patient programme across the piece. So, I think that's one of the challenges—I wonder how your new national executive is going to make it happen. How are they going to actually ensure that we are implementing good practice that's been properly evaluated across the piece, rather than waiting for it to somehow seam across?

I think the other thing that I really want to hear a bit more about is how we're going to empower grass-roots staff to be able to do the right thing because they understand the realm in which they're operating. It's disappointing that some district nurses have been reduced to a task and time measure, so I've been told by some of their managers, and they're simply unable to look at the whole patient, and that is the exciting thing about Buurtzorg—that we have client-centred thinking and ways of working, and the question mark, really, is whether front-line staff are going to be given that sort of opportunity to deliver person-centred care and be allowed to self-organise, and whether senior managers are going to allow them to get on with it.

Lastly, I just want to ask about something that's very important to ensuring that people aren't turning up inappropriately in hospitals. Last year, I attended a partnership meeting here in Cardiff that was identifying diversionary schemes for frequent attendance in the emergency department, the Welsh ambulance service and the police, and a key partner in that was Communities First. They provided the well-being courses, the confidence building, the Living Life to the Full courses, the people with pain workshops that the health professionals were referring these frequent attenders to. Now that Communities First has been abolished, who is going to be providing these sorts of grass-roots programmes, and how is that going to be picked up? Is it through the public services boards, or is it some other way? I'd be grateful if you can give us some indication.

Thank you for the questions. I accept your first point about the urgent need for change. We've talked about that on a number of occasions in the past, and, I think, when you raise the lifestyle management programme, looking at diet, exercise and smoking, that Cardiff and Vale run, a number of health boards have similar programmes. The challenge is not just how people get ready for surgery, but, actually, how we generate a different cultural change more generally within the population to avoid the need for medical treatment or social care.

In terms of your three specific questions, the final one—we are working, of course, with partners in the voluntary sector as well as in local government, and indeed with housing partners as well, in understanding how to link people into different services, because, often, people don't have healthcare needs where they engage with the healthcare system. They often have a social care need, or they're engaged in a part of the system that is open and available because they don't understand how to navigate through to get their healthcare need appropriately met. Interestingly, in a range of the pilots we've undertaken in Wales about people who are frequent callers to the ambulance service, they often have a mental health need that is unaddressed, and that's part of our challenge to try and find—. And, actually, that work will continue, because the Welsh Ambulance Services NHS Trust recognises it needs to happen, and, equally, health boards themselves recognise it needs to happen as well. They're now in the same space as their partners, and it should be a better fit to find the right answers.

On your point about the citizen and their engagement, well, this plan validates and takes forward prudent healthcare once more, and there's a key role in prudent healthcare for the citizen being a more equal partner, not just in healthcare services, but, actually, the challenge for healthcare services is to catch up more with social care that already have been for some time—. It's about having a real citizen voice within the services that they require. And there's a point there about continuous engagement for the citizen to be involved in choices and a conversation about their own healthcare needs, and, crucially, as well, with our staff too, which goes into your final point, where we're talking about how we understand the greater value—have a greater value base—from health and social care. And you'll see that in the plan. You'll also see that in the way in which objectives are set for health board chairs as well this year, about the need to demonstrate a move towards value-based healthcare.

In terms of what that then means for front-line staff, again, on the visit yesterday, when we visited Mrs Benjamin in Ynysybwl, it was a really good example of how staff had taken ownership of the problem with the citizen. Because Mrs Benjamin didn't want to stay over in hospital. She'd broken her ankle and she needed to stay for a brief period of time, but, normally, her stay would've been about a week, but she was so clear she wanted to get home, for a range of reasons. She had a conversation with the Stay Well at Home team, so the occupational therapist had a conversation with medical staff about the need to get her home, they spoke to their partners in the Rhondda Cynon Taf council—the excellent care at home service they have—and they managed to make sure that within a very brief period of time, she was at home with the right package of care. And that ended, not because staff said, 'This needs to end now', but because she said, 'I don't need the support that I've got. I can manage now. I'm every so grateful.' And she talked about, 'The way my girls have looked after me has been amazing. I couldn't have done it on my own, and I was really worried.' That was a good example of staff taking ownership, changing front-line decisions, so not just being told by medical staff what they should, what they must do. They listened to the voice of the person, and that's changed the package of care she has now. And as a result, you have a much happier citizen who's regained her independence and is able to meet her other wider responsibilities. That is exactly what we need to see more of right across health and social care.

We have heard from one person from all parties by now, so may I ask for the next speakers to be concise, and also for the Cabinet Secretary to be concise in his responses? Thank you. John Griffiths.

Diolch yn fawr, Dirprwy Lywydd. Cabinet Secretary, I want to add my voice, really, to those calling for more preventative steps in the future, to make sure that the strain on the national health service is eased and we cope better with the challenges of an aging population. So, I just wonder whether you could tell me what, in future strategy and policy, will better support the sorts of steps that are taking place in my area at the moment, where Newport Live, for example, as the leisure provider, is working very closely with Newport City Council, local sports clubs, community grass-roots organisations, the voluntary sector, as well as the health board and a range of others, to try and get a more active population. We have been meeting and taking steps for some time. And there are also initiatives around the park run, which helped celebrate the seventieth anniversary of the NHS last Saturday morning, at the park run, and, indeed, with Newport county, with County in the Community, linking the local schools and working in the community generally. There's quite a lot going on, Cabinet Secretary, and I just wonder how, as part of these future initiatives, Welsh Government will provide more encouragement and support for that very necessary work.

Well, it's about not just empowering the people and providing the space, but how we judge new partnerships to be taken forward. If you look at the quadruple aim, the first leg of that is to improve population health and well-being. That will require people to be more active, as part of it. We've understood, for a very long time, that a more active population where we reduce smoking, where we deal with diet, and where we also deal with some of the challenges of alcohol as well—which we'll talk about later on today as well—will help to improve a range of those measures. We need different partners with different levers to help people make better choices. But also I think Members should take some comfort in the design principles for the new ways of working and the new models that we're going to test them against. The first of those is prevention and early intervention—that's a key design principle around how we will then judge the effectiveness of those measures we want to get behind in generally transforming health and social care, rather than just dealing with more of the same that hasn't been able to gain what we all want to see.

The competition is open for the quickest question here. Vikki Howells.

Diolch. Thank you, Cabinet Secretary, for your really important announcement today. I'm glad that you were able to see such good examples of best practice at two locations within the Cynon Valley, and hopefully they will enhance your ability to take that and roll it out elsewhere.

Two quick questions, then. Firstly, can I welcome the recognition in the plan of the work carried out by carers and volunteers? As you will know, this week marks Carers Week, so could you say a little bit more about how the Welsh Government can support, in particular, those unpaid carers supporting their family and who, of course, make such a big contribution to our health service? I also welcome the focus on equity of outcome in the plan's vision for the future. Part of this involves making sure our future generations are healthy and active. How do you see cross-Government work like active transport, education and access to the outdoors fitting in to achieving the plan's goals?

Thank you for those two questions. It was a very good time we spent in Cynon Valley and, in fact, one of the people we saw was herself an unpaid carer, effectively. So, we recognise that's a huge value to what we can do and, actually, our health and care system and the way it operates is really important in allowing those unpaid carers to do what they want to, and what they need, but at the same time the challenge is around respite. We need to make some financial choices that we've made in the past about supporting them with respite, but also about recognising that those people have their own care needs as well. And that's about taking forward the consistent implementation of not just the Social Services and Well-being (Wales) Act 2014, but making sure that that is embedded within the strategy, and I think you can take comfort that it really is. I also am very pleased to have an opportunity to welcome Carers Week and the contribution that they make today.

On cross-Government work, there is a range of work that we're already doing on a range of the areas in 'Prosperity for All'—the four big themes that require work across the Government to improve health and care outcomes. In the economic field, for example, we know that, actually, people who are not in work or in poorly paid work—their health outcomes are poorer. We recognise that within the significant amount of money that we spend within the health and care system, there is real economic opportunity as well. So, it isn't just simply about saying, obviously, 'health in all policies'; it's still about all policies in health as well. And a good example of your point about the outdoors is the work that I'm doing already with our ministerial colleague, Dafydd Elis-Thomas, to look at the work that Public Health Wales and Sport Wales do, and, indeed, in Lesley Griffiths's portfolio, with Natural Resources Wales. So, there's lots more for us to do, and I look forward to coming back to this place in the future to talk about what we have done.

Thank you. Finally, and quickly—Julie Morgan.

Thank you very much. Just a few quick questions. I'm also very keen that we should concentrate on the preventative agenda, and I wondered what role you saw for organisations like the Forget-me-not Chorus. I attended an event last week, so I wanted to mention it in the Chamber, where people with dementia and their carers are able to join every week in singing together and enjoying themselves. That seems, to me, the sort of key activity that brings together health and social care in a way that is pleasurable and enjoyable. So, could you say how you think that would be involved in the future?

The other question I wanted to ask about was international comparisons. I know that, in the parliamentary review, there's mention about Canterbury in New Zealand and the huge change that's happened in that city, in comparison to the rest of New Zealand, because of their clear vision of one system and one budget. I wondered whether international comparisons were going to be something that did influence as we go along this journey.

I'll just take your final point first. Of course we'll continue to look at international evidence. We'll continue to be challenged by it, inspired by it, and there will be times when we'll have to discount it because it doesn't apply to the context we have here. The Canterbury example is a good one to look at, actually. There are enough similarities for us to focus on, to learn and be interested in. Cardiff and Vale are taking a real interest in it, but interestingly, that took them time to get there. It took them a period of years to be pointing in the same direction and for partners to agree on what they were doing, and they will have a better system as a result. Indeed, at the start of that journey, there were plenty of sceptics who didn't believe that it would really work, and there's a lesson for us there as well, about having enough consistency of approach from a range of different partners to achieve real gain. But, of course, we'll continue to be led and challenged by evidence of what works.

Your final point about the Forget-me-not Chorus is a really important point—the enjoyment you get from taking part in things, not necessarily understanding they're taking part in treatment, and what takes place around that and the social networks matter as well. I recognised that on my first visit to such a choir—actually, in the Gower with Rebecca Evans over election time. It was a really interesting day where there were lots of people who positively wanted to be there; they didn't need to be dragged out. There's something about recognising it's not just about having health and care professionals there to do something to you, or with you; it's also what we do with each other and our social links and networks.

Thank you very much, Cabinet Secretary.

Before we move on to the Stage 3 debate on the Public Health (Minimum Price for Alcohol) (Wales) Bill, I will suspend proceedings for 10 minutes. The bell will be rung five minutes before we reconvene, and I would encourage Members to return to the Chamber in a timely fashion. Thank you.

Plenary was suspended at 16:17.

The Assembly reconvened at 16:31, with the Llywydd in the Chair.