Part of the debate – in the Senedd at 4:06 pm on 12 June 2018.
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.