The next item, therefore, is the statement by the Cabinet Secretary for Health and Social Services noting the seventieth anniversary of the establishment of the national health service. I call on the Secretary to make his statement—Vaughan Gething.

Diolch, Llywydd. As Members are already aware, this week marks the seventieth anniversary of our health service. This is a particularly proud landmark for us here in Wales, given that its founding father was of course our very own Aneurin Bevan. The son of a Tredegar miner who left school at the age of 13 and seemed to be set for a life working underground. Had it not been for a trade union movement committed to self-improvement and mutual support he would not have had the education and opportunities that ultimately set him on a career path into politics.

Of course, Bevan’s formative experiences indelibly shaped his political views: the absence of a universal healthcare service, a patchwork of local arrangements based largely on the Victorian Poor Law where those who could pay got care, and those who could not usually did not. The disparities and hardships that created and perpetuated are unimaginable to those of us brought up with the NHS. However, as we know, the local Tredegar Medical Aid Society offered Bevan a glimpse of what was possible when individuals took action collectively for the common good.

The battles that Bevan fought to establish the NHS are well documented, and his reputation as a firebrand was certainly one of the reasons why Attlee chose him for the task. In the face of ferocious and highly personal criticism, he succeeded in delivering a healthcare system with three fundamental principles that still hold true today in Wales: services are free at the point of use, they're financed from central taxation, and everyone is eligible.   

The achievements of the service that he delivered, and the positive impact this has had on our society, are too numerous to list. Yet it is far too easy to take for granted the extent to which we all rely on our health and care services from cradle to grave. Every single one of us has benefited from the eradication of diseases that in the past would have debilitated or taken the lives of people in their hundreds every year. We are now able to treat or cure illnesses and conditions that, even 20 years ago, would have seemed impossible. As a result, of course, more of us are living longer.

And these are incredible achievements to be celebrated. Yet we know that there's always more to do. A growing and ageing population places ever-greater demands on our services. The ever-faster rate of medical and technological advancement is creating opportunity and expectation, together with more funding dilemmas for services with finite budgets and a myriad of competing priorities. In many ways, none of this is new. Almost from day one, the NHS has been surrounded by arguments over funding, spiralling budgets, and arguments over structural and organisational arrangements, capacity and the rationing of services. 

What is different now though is the scale of the challenge, its urgency and the scale of the operation. Last year in Wales there were some 20 million patient contacts, more than 700,000 first out-patient appointments, more than 600,000 in-patient and day cases, more than 479,000 ambulance calls and more than 1 million people seen in our accident and emergency departments, whilst some 82,000 adults and around 16,000 children depended on support from our social care services. Between them, these services have a combined budget of over £9 billion and employ a workforce of over 170,000 staff. And all this for a population of just over 3 million.

And when we consider today, of course, we still face the challenges over a range of health inequalities. And I want to recognise now the pioneering work done on the inverse care law in Cwm Taf and Aneurin Bevan health board areas and the signs that they're actually closing a gap on health inequalities, which is a remarkable achievement. And it's worth reflecting, of course, on the passing away of the Welsh GP Julian Tudor Hart at the age of 91 on Sunday. As will others, I've met him and been impressed by him, but, more than that, the impact of his 1971 The Lancet paper on the inverse care law continues to prompt debate and recognition of how we still have a continuing responsibility to tackle health inequalities.

We know that meeting these challenges and coping with the different demands that the future will bring means that our services will have to change and adapt, as they have had to do in the past. That's why, with cross-party support, we commissioned the independent parliamentary review to examine our health and care system, and, having taken their advice on what needs to change, we've spent the early part of this year working with stakeholders across Wales to develop our long-term plan for health and social care. So, 'A Healthier Wales' is the first joint health and social care plan in the UK. It sets out actions that we will take as a Government to support our services so that they can deliver the transformation required and ensure that our services are fit for the future.    

As we reflect on and celebrate our past, we have choices to make for our future. More of the same cannot be the answer. We cannot allow our NHS to be changed by service failure. We have to empower and enable change to improve services and outcomes. And, crucially, we have to listen to our staff and provide them with a platform to lead a debate with the public about the future.

When I receive praise for the national health service, the letters and the conversations that I have themselves often refer to the amazing technical capability of the health service. However, they always talk about people. Because the service isn’t bricks and mortar—the health service, above all else, is our staff. Because the NHS would survive without me, but it won’t survive without our staff—the doctors, the nurses, the therapists, scientists, admin staff, the cooks, the cleaners, the paramedics, the porters and many more—all of the people who keep our service alive with their skill, their commitment and their compassion, and it's a tremendous honour to serve our staff. 

The other big 70 we celebrate this year is, of course, Windrush 70. Many of the Windrush generation played a pivotal role in shaping our national health service, the same incredible people who are being denied their place in the Britain that they helped to create. This country is their home, and our countries are better places for the Windrush generation, and they have been poorly repaid for their loyalty. We cannot and will not allow their fate to stain the hands of this generation.

Our NHS and social care sector is lucky to have such a skilled and diverse workforce. We have a rich history of welcoming people who were born or trained both in and outside Europe. We should not simply value them for their public service but for the contribution that they make as our friends and neighbours in each community that we live in and represent. Bevan was famously quoted as saying:

'no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.'

This Government still holds true to that principle today, as it was then. There will always be more for us to improve here in Wales, but I am proud that we have stayed true to Bevan’s ideals. We rejected the market in favour of a planned system, we have increased budgets faster than across our border over the last five years, we abolished prescription charges and capped the costs of social care.

But Bevan himself was not simply a man of fine words and principle. He compromised with reality to deliver an achievement of lasting value that touches and improves the lives of every one of us. If he were here today I think he would recognise the need to improve and not to get stuck with what we have instead of what we deserve. I think he would recognise the battle of ideas and the clash of values. I am certain that he would recognise our values, support them and fight for them.

I'd like to thank the Cabinet Secretary for health for bringing forward today's statement. It's 2018—70 years of our national health service and, wow, what a rollercoaster it has been. Like you, Cabinet Secretary, I absolutely recognise the determination and passion of Aneurin Bevan. He saw a need, he built on ideas put forward during the war years, and as part of Attlee's Government he was tasked with trying to bring our country back together again. He moved forward with the NHS, that amazing construct that we have today.

Just very briefly, Deputy Presiding Officer, some of the innovations and extraordinary celebrations we should have—1958: the introduction of polio and diptheria vaccinations. They used to kill people by the millions—gone. How wonderful is that? In 1968: the first-ever heart transplant in Britain was carried out in Marylebone by Donald Ross. In 1978: Louise Brown. In 1998: NHS Direct. In 2008: a debate we only had last week about extending this—the national programme to vaccinate girls against the human papilloma virus. What wonderful marvels that we have now done this. 

So, I say to you, Cabinet Secretary, Aneurin Bevan—he started something, but it's now become ours, and it's become ours and every political party's, every politician's, but above all, yours as Vaughan, mine as Angela, and that of others in this room. This is our NHS. It saved my life three years ago, it saves the lives of many people, it's always there when the chips are down, and we shouldn't forget that, and it is our job to move this NHS forward.

I would like to ask you, Cabinet Secretary, if we go back to Bevan's overriding principles—I just want to ask you three questions on three of them. A shared responsibility for health between the people of Wales and the NHS: how can we really get the people of Wales to buy into this, focusing on prevention not just cure, focusing on not just the obviously unwell, such as someone with cancer or a broken leg, but those who have illnesses buried deep within their souls that they cannot be seen so easily, people with mental health issues? How do we deal with those people who aren't sick in the conventional sense of the word, but are vulnerable, elderly, frail and need that help? How do we rewrite and strengthen that contract between the people of Wales and our NHS?

Another Bevan principle is a service that values people, and above all values, I think, the staff. There are some 80,000 staff who work in our NHS and this is why we've repeatedly called for a rapid access to treatment scheme for NHS staff. We lose over 900 years of staff hours every year because people are away, stressed and sick. You talked about the letters that you receive praising the NHS, and I get those letters. I get letters praising the staff and I get letters despairing of where the system has broken down, and where people have been let down because they can't get an appointment, they can't get a return call, they can't get the treatment they need. And those staff who deliver that NHS service of ours, day in, day out, Christmas Day, Easter Sunday, mother's day, father's day, whenever it is—they need our support, because they're working in a system that is flawed, that is creaking at the seams and that doesn't have enough resources to go around. So, what can you do, Cabinet Secretary, to really put those amazing 80,000-plus people at the heart of our NHS, because if we do not do that, then the 3 million people of Wales will be let down, and we want to keep that NHS going? 

Finally, how do we get that true patient and public accountability? I'd like to answer that partly, and challenge you to answer it partly—it's about the political football. Today, we had the Bevan Commission saying that too often the NHS is used as a political football. On Monday, Jeremy Hunt announced the most extraordinary app that can now be used by people to do all sorts of things, from making appointments to getting NHS 111 calls, to seeing what their prescription medicines are to reordering—a great idea. There's fantastic innovation going on in Scotland, particularly with the technology. Here in Wales, our own organ donation transplantation. All the home nations have great ideas. Cabinet Secretary, will you commit to really looking at how we can learn from best practice not just within our own country, but best practice in England, in Scotland, in Northern Ireland, so that the NHS that belongs to every single person in the United Kingdom is here in 70 years' time, not just for Aneurin Bevan, but for you and for me, and for everyone else in this room?   

Thank you, Angela. I do welcome what you say about the personal thanks to the NHS, not just the general improvement of public health. You mentioned polio, measles and a whole range of other things that killed lots of people in the 1930s, 1940s and 1950s that have been eradicated because we had a universal service that was able to deliver a comprehensive vaccination programme. So, it has been a tremendous achievement, and just as you have personal reasons to be grateful to the NHS, I too do, and I imagine other people in this room will have their own personal stories for themselves or their loved ones. 

I'm going to start with your point about the shared responsibility of people and the health service. I remember one of the first things I voted on when becoming an Assembly Member in 2011 was a report from the Bevan Commission about key principles for the future of the service, and one of those was about the personal responsibility of individual citizens, and how we need to have something where we have a positive conversation and relationship between the citizen, the service and, of course, the rest of the state, because we do have a shared responsibility for the choices that we make. It's one of the things that we regularly talk about on almost every major cause of disease, illness and death—so smoking, how much we drink, how much we exercise and what we eat. In addition to that, we need to make some of those healthier choices—[Inaudible.] —easier. That's part of what we need to do, because if it's simply a finger-pointing or lecturing exercise, then we'll get what we have. So, there is a broad change from the Government, from public services but also from the business world as well, because work has a huge impact on people's health outcomes. Not just work, but good work makes a huge difference to the outcomes that people have. Of course, there is then how we persuade people to accept their own measure for their responsibility for the choices they make, and in particular the choices that we make for our children. 

I want to turn next to your point about the political football of the health service, and on the one hand this is, of course, inevitable. Labour Members will understand and I think will, rightly, complain about the way in which the national health service in Wales is regularly talked about in Prime Minister's questions. We heard previously the points about the 'line of life and death' being Offa's Dyke. Now, I think those things of course are bound to produce an inevitable and angry political response. But what we have to be able to do, though, is to recognise that there is innovation that does take place across the United Kingdom, and learning to be taken. There are points that, actually, it's in our interest to work together. The tier 2 visas, for example—I asked for that decision to be made, but I know that every organisation representing staff in the UK did, and I also know that the UK health department wanted the Home Office in the UK to change course rather sooner. So, it was in the interest of all four parts of the UK that that change was made. I welcome the fact that the change was made, even though we'll continue to have arguments about why the change wasn't made earlier, and yet we know that, in innovation, people do look to Wales. I'll give you an example there. On ambulance services, I know we still have scrutiny and disagreement about the changes that I chose to make for the ambulance service, and yet if you talk to people within the ambulance service around the UK, they are coming to Wales to look at what we have done, how and why, and we see pilots from Wales, where Scotland and England look remarkably similar to what we have done here. You won't hear an English Minister stand up and say that they're looking to learn from Wales, but that is practically what happens. So, in some way, the inevitable politics of it are actually about what we have to learn from other parts of the UK, including England, as well as what we have to give.

I just want to come back to your point about it being a service that values people and the huge numbers of employees that we have. We have over 91,000 people employed in the service and nearly 80,000 full-time equivalents, and yet key part of 'A Healthier Wales' is the quadruple aim and the need to value our staff. A good place to work with motivated staff will deliver a better service in every single part of activity, in public service and the private sector. I know you'll know that, having run your own business. I know it from my own time being a manager and an employer.

At the launch of the plan—this is the point I'll finish on, Deputy Presiding Officer—we spoke to staff within the service, and they recognise that changes that have been made to the way they deliver health and care already have not just delivered a better quality of care but a better place for them to work, and they're motivated by that change. I regularly hear on each of the visits that I undertake a sense of frustration about the way politicians behave and talk about the service and about wanting us to not just have the maturity to say, 'Here are the big challenges, let's create a parliamentary review', but it's about the way that each of us choose to behave in taking that plan forward, because most people who work in our national health service want to see a little more honesty about those challenges and some more licence and support for taking on the big challenges that we recognise exist and being brave enough to make choices about them in the future.

First of all, may I wish the NHS a very happy birthday, an institution that's so important to all of us?

A very happy birthday to the NHS. A birthday is a time for celebration and, more than anything, I think we celebrate all the NHS staff—hundreds of thousands of them over 70 years who have made the NHS what it is. They're our friends, they're our families, they're our loved ones. My grandmother—I was trying to work this out today—would have left the NHS in its very first few years. She was a nurse at the Royal Liverpool hospital and I know that she would be looking back with amazement at what the NHS has become. Any birthday is a time for reflection; the 70-year anniversary is a time to reflect on the feat in itself that we still have an NHS that has lasted this long. It's a fantastic achievement in itself. When it was created, there were great doubts about whether it would last, about whether it would be sustainable, and about whether the concept of providing care free at the point of delivery would lead to an onslaught of people seeking free treatment. At risk of playing political football, there are those on the right of politics who still question the sustainability of the NHS and think that privatisation is the way forward and raise fears of an onslaught of people seeking free prescriptions and so on. But I'm confident that we'll be looking back at 140 years, when 70 years has gone by again, and I'm sure the same questions about sustainability will be asked then. But the key thing is that all of us have to be clear that that sustainability is a priority, a priority for us in all that we do.

The point has been raised about the NHS being used as a political football, and I'll say at the outset here that I have no doubt that this Government and the Conservatives and everybody else represented want the NHS to perform as well as it possibly can. We have different approaches, of course, on how that could be achieved, and I think that, where we can work together, it is in the interests of everybody in Wales—the staff of the NHS and patients too—but it is important that we do hold Government to account. And I make no apologies—20 years after Labour took control of the NHS in Wales—about raising questions about why you've failed to get to grips with the workforce challenges in the way that I think could have been done; why there's still a lack of integration of social care; why there is still poor performance of waiting times compared with other nations in the UK. And the patients and staff of the NHS look to us to hold you in Government to account on those areas.

I'll ask you a few questions: one, I think the biggest threat, and I'm sure you'll agree with me, at the beginning of the second 70 years of the NHS, is the very real threat of a hard Brexit. I would appreciate your comments on some of the—. The concerning answer that I heard from the First Minister earlier today, when he suggested there are no preparations being made within the Welsh NHS for a hard Brexit. He suggested that there's no way the NHS could prepare for a hard Brexit. I don't believe that for a second, and now is the time to be making sure that all possible steps—however challenging they may be—are taken to prepare us for a hard Brexit.

Secondly, about valuing staff. I'd appreciate your thoughts on how we support staff who are overworked. We know we need more staff in the NHS, and, of course, we've put forward ideas such as the training of doctors, for example, in Bangor. We need to relieve that stress, but how will you deal with overworked staff and the help they need now?

And finally, in terms of the future, the third paragraph, I think it was, of your statement, refers to the fundamental principles underpinning the NHS. I don't think we've achieved the fundamental principles when it comes to care, and I would appreciate your comments on how we achieve the aim of providing care as well as healthcare for people in Wales, because those principles are as important in care as they are in the NHS.

Thank you for the comments and the questions. First I'll reflect on the progress made since pre the health service, as has been eluded to. Yesterday, I was at Llandough hospital looking at the mural where they'd actually developed some of the recognition and research into pneumoconiosis. After that, I saw a patchwork quilt with a number of different stories about the NHS. One of them was a grandmother who had done a patchwork quilt in memory of her 10-year-old sister who had died before the creation of the national health service because her dress caught fire, and the coroner's report said that the doctor refused to attend without payment of his fee. That shows the sort of progress that has been made. So, for all of our arguments, there is enormous progress—things that simply do not happen now, or if they do, they are a national scandal rather than a common part of life.

It's also worth reflecting that prescription growth in Wales—as you mentioned prescriptions—the growth has been lower in Wales than in England since the introduction of our free prescriptions policy, so it's not led to a ballooning amount of prescriptions being provided.

On your questions, I think the two biggest threats facing the national health service are the twin storm clouds of Brexit and austerity. If we continue to have not just the health service, but the wider range of public services that are key determinants of people's health, being underfunded, then we'll continue to pile on more demand into the health service, and we'll be blamed for that, whilst other services complain about more money going into the health service itself. We will have an unvirtuous circle.

You will recall from last week's statement the significant risks that a hard Brexit provides for the national health service. There's a level of a lack of awareness about the scale of those risks. I don't think it's a fair or accurate presentation to say that this Government is in any way complacent about those risks, or is somehow being blasé about not needing to plan for them. Of course preparations are being planned for a hard Brexit, but the point being made is, some of the consequences of a hard Brexit are impossible to resolve without consequence.

Last week, we had a really good example that you raised, and that I've mentioned at other times before. The radioisotopes used for treatment in the health service, almost all of them come from Amsterdam. If we have a hard Brexit, we will not be able to replicate production of those between now and March next year, or even the transition period that's likely, and so treatment will simply not exist in a range of areas. You have to be honest that that is one of the consequences of a hard Brexit, and you can't stockpile radioisotopes. So, there are challenges that we simply can't replicate if we leave on hard Brexit terms. And as I said last week, the biggest danger to the future of the health service, in the immediate future, is a hard Brexit. And, of course, Simon Stevens and NHS England recognise it too, which is why they've mentioned it in public.

On workforce planning, the creation of HIW will give us a new structure to plan for the whole workforce. And, again, we can't have competing demands from staff groups asking for more of them or for lobbying groups. So, whether it's more people in one part of medicine, more people in one part of nursing or therapy, we'll have to look at the whole service in the round and recognise that there is a team of professionals who work together to deliver healthcare. I expect to see a significant improvement in workforce planning and you'll see more of that once HIW is created from October this year. 

On your point about care, it's worth reflecting that, of course, social care has always been means-tested. Part of the difficulty in integrating health and social care is that the health service is free, paid for by taxation, and social care is means-tested. What we're looking to do is to try to eliminate some of the wrangles about funding, so that the citizen does not fall between the cracks, between the two services. That is why the parliamentary review recommendations and the plan we have for health and social care is so important. It's why I place such value on having regional partnership boards for health and social care to plan together, so that the citizen need not know and need not worry too much about whether they're in health or social care. It'll make it easier for the citizen to access those services, which is why the progress on pooled budgets is but a means to an end of making sure that we derive much greater value from the £9 billion of integrated funding that exists there, and much greater outcomes. I expect that integrated model will deliver exactly those outcomes that all of us in this room would wish to see.

Thank you for your statement, Cabinet Secretary. It is a huge privilege to be able to stand here today and celebrate 70 years of the NHS. 

Without the national health service, I wouldn't be here today. Eleven years ago, a hard-working NHS doctor discovered my breast cancer and an army of other hard-working doctors, nurses, radiographers and pharmacists saved my life. Without the NHS, many of my constituents, family and friends wouldn't be here. Seventy years ago, the average life expectancy was 65 and infant mortality was at around 52 deaths per 1,000 live births. Today, we can expect to live well into our 80s and it's believed that children born today could live well into their 100s. Infant mortality is down to well under three deaths per 1,000 and we have all but eradicated many of the biggest childhood diseases.

We have Wales to thank for this. If it wasn't for the Tredegar Workmen's Medical Aid Society and the vision of Tredegar-born MP Aneurin Bevan, we wouldn't have an NHS, and without the NHS, we wouldn't have kidney transplants, hip replacements, CT scans, bone marrow transplants or a whole raft of medical science improvements.

What makes the NHS such a success is the staff. Their commitment and dedication must be celebrated and we all owe them a debt of gratitude. From porter to paediatrician, admin assistant to anaesthetist, the NHS would be nothing without its hard-working staff.

The NHS is a fantastic achievement and one that we should rightly be proud of. But while we celebrate the achievements of the last 70 years, we have to look to the future. As our population grows and many of us develop long-term life-limiting conditions, and as medicines become more bespoke and therefore expensive we have to adapt. The NHS today is very different from the NHS in 1948 and will be very different in years to come.

Cabinet Secretary, I believe that your long-term plan is in the right direction, but we have to ensure that the policies are delivered on the ground. The Organisation for Economic Co-operation and Development described the NHS as fairly mediocre with great policies not being translated into great practices. What can we do to ensure that policies can make it to the front line, and how can we improve buy-in from staff? The NHS is the world's fifth biggest employer, so any changes will require buy-in from a lot of personnel.

Cabinet Secretary, the Association of Anaesthetists of Great Britain and Ireland, the Royal College of Anaesthetists and the Faculty of Intensive Care Medicine have raised concerns about the impact of fatigue and shift patterns on the NHS workforce and have launched the Fight Fatigue campaign. Our NHS is reliant upon the staff, and we have to put the well-being of staff first. Cabinet Secretary, will you support the Fight Fatigue campaign and ensure the roll-out in all health boards across Wales?

Finally, Cabinet Secretary, I would like to take this opportunity to thank the staff, once again, and hope that I can play a very small part in ensuring that the NHS is around to celebrate its one hundred and fortieth anniversary, still providing world-class care free at the point of delivery. Thank you.

Thank you, Caroline. Again, I recognise your personal story and recognition of the fact that the NHS has helped to protect and maintain your own life, and also the huge progress made in improving health and in removing significant causes of disability, illness and death. Again, we've all mentioned staff within the service, and it's absolutely right that we do.

The challenge then is about whether we're prepared to take forward our headline commitment to a conversation about the future of health and social care into delivery. That doesn't take away from people asking awkward questions of the Government—it never will do, and it should not do—but there are still challenges about how we make choices when change is proposed in different parts of the country and what we're actually prepared to do. That isn't simply a challenge for one party, it's a challenge for all of us, because all of us will be challenged by changes within our local areas, which we represent, and the concern that people have where something they value and understand is proposed for change. That's why it's so important to have staff leading the conversation, staff talking to other staff, staff talking and listening to the public, because I guarantee that 10 politicians talking to the public about the NHS will never be believed compared to a handful of members of staff talking about the challenges they face. It's understandable why people trust staff in that way. So, we do need to listen to staff, but the key stakeholder in improving public health is the individual citizen themselves, in their context. The choices we make have a much greater impact on health outcomes for the nation than the technical service that is provided by the NHS.

On your point about Fighting Fatigue, last week, I agreed a fatigue charter with the British Medical Association, so I'm looking to see how the Fight Fatigue campaign links to the charter that we've agreed, because I do recognise that our staff need to be able to go into work and not just be content and motivated, but to have time to have rest and to perform their duties without coping with fatigue itself. So, I'm interested in the area, I'll have a look at the campaign that is being launched and how it actually is consistent with the charter that I've agreed with doctors' representatives within the last week or so.

It's great to use this opportunity to recognise all the achievements of the NHS over the last 70 years, particularly recognising the longer lives and the drop in the infant mortality rate, the huge drop in unplanned pregnancies, and I'm particularly pleased to welcome the initiatives we've been able to take here specifically in Wales, such as the free prescriptions, because I think that is absolutely right in delivering healthcare free at the point of demand. I think it is a great credit to the Welsh Labour Government that we have brought in free prescriptions, and, of course, the free parking as well. I think the free parking in hospitals is vitally important, because the last thing you want to do is worry about finding money to park when you're either going to an out-patient appointment or, in fact, visiting your loved ones. So, I think there is so much to celebrate, and it goes without saying, my total commitment and support for what the Welsh Government is doing for the NHS.

But I did want to use this opportunity to bring up the contaminated blood scandal, because, obviously, this is one of the big issues that the NHS has had to cope with. I wanted to bring it up today, because the terms of reference were agreed yesterday in Parliament, so that means we can now move on with the inquiry. As the Cabinet Secretary will know, we have all been very involved with this inquiry here, including the Cabinet Secretary himself, with the families and the people who have suffered. Of course, in Wales, 70 people did die as a result of this scandal. So, what we really need to do now is to do all we possibly can to see that we do get answers, because there have been two previous inquiries, but those haven't really found out why this contaminated blood continued to be given to people who were suffering from haemophilia, many of whom went on to contract AIDS/HIV through the contaminated blood.

So, I wondered what the Cabinet Secretary could tell us about what involvement he sees from the Welsh Government now that this inquiry has started, and whether there is any support that the Government can offer to the group who, under the leadership of Haemophilia Wales, are putting the case for the Welsh patients to the national inquiry. I'm hoping that the cross-party group on haemophilia and contaminated blood will possibly be involved as a core participant, as we've been campaigning for this judge-led inquiry, but we do want everybody in Wales to make their voices heard. So, I just think it's appropriate to raise this on the day that we are marking the seventieth anniversary, because it's an issue to do with the health service that is so vitally important and so current for many of our constituents in Wales. 

Yes, and I want to recognise in particular the point about the contaminated blood inquiry, because the impact of the health service is so great because we recognise the challenges we would have without it. That also means that there are times when healthcare goes wrong and has a huge impact on people's lives too. And there is always learning to be taken from complaints and from when we get things wrong. And, actually, the contaminated blood scandal has led to a significant improvement in the safety and the traceability of the use of blood and blood products within our health service. We can be really proud of the work that is being undertaken by the Welsh Blood Service in pioneering a different range of ways to deliver medical benefit. The challenge then, looking back, is not just how we learn lessons but this challenge of understanding what really happened, because that's the biggest grievance that I think people have, that they don't ever think they've been told the truth and they never got to the truth. So, I welcome not just the inquiry, but the way that Sir Brian Langstaff has gone about the inquiry as the appointed Chair—a recently retired judge and a man of significant integrity. I think he's developed trust from a community who weren't really sure they could trust the inquiry itself. And I also think it was helpful to move the sponsor department from the UK Department of health to the UK Cabinet Office as well, and I welcome the move that was taken to do so. 

So, we do want to encourage people to give evidence. My officials continue to have regular conversations with Haemophilia Wales and other stakeholders here in Wales about their expectations for the inquiry and the practical business of how we support them to give evidence to the inquiry, including here in Wales, which we have asked for and I think will happen. And our challenge is how we have a conversation with not just the Cabinet Office, but the inquiry itself about how it goes about its business to make sure people really can tell their story and ask questions where they think they've not been answered before. And, in that regard, I'm very pleased that Sir Brian has indicated that he expects to have additional experts for particular parts of the inquiry. So, they haven't ruled out having an additional wing members to sit with him when it comes to deliberations, but, in the evidence-gathering part of it, he is looking to make use of additional expertise for different parts of what went wrong at the time, and I think that is a real advantage. So, I approach this with some cautious optimism at the outset, but we will, of course, continue to listen to and work with stakeholders here in Wales. 

I welcome the opportunity to welcome this statement and also to wish a happy birthday to our national health service at 70 years of age. May I start by paying tribute to Aneurin Bevan and Dr Julian Tudor Hart, who passed away in the past few days, and whom I met on a number of occasions as a fellow GP in the South Wales Valleys? But, essentially, we are celebrating the survival of a vision of free treatment based on need alone and a health service funded from general taxation—everyone, therefore, sharing and paying for the risk. It is something quite unique across most of the world, namely that all of these people share the risk as well as contributing towards payment. And the health service, therefore, is dealing with real health inequalities, because having to pay for treatment is always going to make things worse in terms of health inequalities, because some people won’t be able to afford treatment.

Now, I’ve been a doctor for 38 years. Now, that’s over half the existence of the NHS, and I’m still very proud to still be a practising doctor working for the NHS. That is a source of great pride to me, I have to admit, because some people who come to see me as patients were children when I started working as a GP, and now they are grandmothers and grandfathers themselves, and it is an honour to be an unbroken line within the lives of very many people in Wales.

We can’t overemphasise the relief of taking money out of the equation—taking money out of the consultation, if you like. Of course, prescription charges were introduced in 1951, and Aneurin Bevan left the Cabinet as a result of that. And, of course, the Government here scrapped prescription charges some 11 years ago. With the abolition of prescription charges, we truly can focus on the best treatments, because having to pay for prescriptions in England means that you pay over £8 for every item on your prescription. Therefore, we don’t have to under-treat our patients here in Wales because we as doctors may be concerned about the cost to the patient. We don’t have to change treatments and we don’t have to fail to prescribe something because of the cost here in Wales, and that is very much in contrast to the situation over the border in England.

We would be staggered, therefore, if we were to have to save money, or sell our home, or pay a huge price for health services—can you imagine such a situation? In many nations today, you have to save money for an operation, for example; well, that isn’t the case with the NHS. But, surprisingly, today in Wales, and in the UK, that is the situation with social care. People are expected to save up. They are expected, on occasion, to sell their homes. They are expected to pay a huge amount for support and social care today. I would say, as we celebrate a free NHS, based entirely on patient need, funded from general taxation, that we need the same solution for social care, and that that should be provided free of charge, on the basis of a national social care service. Would you agree?

Thank you for your comments. Funnily enough, you mentioned Julian Tudor Hart—I know a man whom you have met several times yourself—I last met him at the south west Wales faculty of the Royal College of General Practitioners, and he still had plenty to say at that point in time, as he always did. I recognise what you say about sharing risk and sharing benefit, and we see developed countries—not just developing world countries, developed countries—where they don't have the same privileged access that we enjoy as a right in this country, the United States being the most obvious example, where people still cannot afford what we would think of as basic healthcare.

On your challenge about social care funding, of course, in 'A Healthier Wales', we committed to reviewing the future needs on a social care basis and to do that in partnership with local government and, in particular, the Association of Directors for Social Services, but also to review the funding to go with that as well. In that regard, in the last week we had the report from Gerry Holtham, looking at the future and potential options for how we might choose to use our powers in this place to fill the gap in social care funding. I would be delighted if we did not need to do so, if there was a different settlement at a UK level for public services, but we should not wait for that to be the case. His proposal of creating a fund that is ring-fenced for social care purposes is particularly interesting, and Ministers across the Government are looking at those proposals to try and understand what that would mean for us. I look forward to a range of cross-sector engagement and involvement in what those proposals mean, because this is a challenge for the country and not just for one political party.

I have two more speakers, and I will call both of them even though we're running out of time, but that's no indication that you can go on for five minutes, and I'm sure you won't, either of you. David Rees.

Thank you, Deputy Presiding Officer, and I won't. Can I, first of all, thank the Cabinet Secretary for his statement this afternoon? It gives me an opportunity to put on record my thanks and appreciation to all the NHS staff who have worked over those 70 years and who are still working and will be working in the years ahead of us. Again I put on record, Deputy Presiding Officer, that my wife is one of those members of staff at this point in time. Can I also pay tribute to Dr Julian Hart, who passed away on Sunday? Of course, he was a GP in Glyncorrwg in my Afan Valley. He actually worked alongside Dr Brian Gibbons, my predecessor, and also former health Minister. So, he is well-known to many of us, and his loss is a sad loss to society because of the work he did for deprived communities, particularly in the Valleys.

Cabinet Secretary, you've highlighted many issues, and I think one of the biggest things you've highlighted is perhaps the understanding that there is a need for change and we have to empower that change, both within the service and also within the public. Part of our role as politicians is to take that challenge on board and to lead that change—[Inaudible.]—anywhere else and to recognise that we can't always keep on saying, 'Well, it worked better 10 years ago, so that's the way it has to stay', but in doing so we need also therefore to look at strategies for that change. Clearly, recently, in my own area, we've seen a change in the strategy of bed closures as an example, but we don't have a clinical strategy. The Welsh Government has put together fantastic programmes and plans—the cancer care delivery plan, the respiratory care plan, and many others—but the question I want ask is: where's the joined-up thinking to ensure that all these plans can work together to deliver a clinical strategy for the whole of the service, and how do the health boards also ensure they have a clinical strategy? So, when we come across a service that is working better, that is improving because of efficiency measures, instead of closing beds we look at how we can best use those beds to improve the strategies in other areas to deliver the service for our patients. I think that is an important way forward because I—like Angela Burns—want to see it, not for 30 years or 70 years—and I won't be around in 70 years—but for years ahead, so our children, their grandchildren and their children beyond that will have a service that they can rely upon as free at the point of need. I have a sister in America, who doesn't have that service, and, believe you me, we don't want to see anything like that. We need to ensure that the health service continues, but we do have to embrace change, but also change that carries us with it, and carries the patients with it. So, therefore, that's important.

Can I also ask the question: the South Wales Programme was clearly one of these mechanisms by which we would see this change, but I'm seeing very little as a consequence of the South Wales Programme, so when will we see more on that to ensure that the service change, which was led by clinicians, will actually deliver those changes we so desperately want? Because we know that there is a difficult challenge ahead of us. We know the resources are difficult.

Finally, on the workforce, I think Rhun ap Iorwerth highlighted a very important point about how we develop it, and you answered quite well. It's not just about nurses and not just about doctors; it's a wide range of staff. Can you assure that Health Education and Improvement Wales covers that wide range of staff, and, if we are talking about new equipment, we also have the additional staff to resource that new equipment? Because a positron emission tomography scanner in a new hospital is fantastic, but it needs staff to work that PET scanner, and those staff are important to delivery.

Good to hear mention of one of my predecessors, Dr Gibbons, who I saw recently, in reference to Julian Tudor Hart as well—and Dr Gibbons is still full of ideas and views about the future of the service.

On your point about clinical strategy, there is a challenge about what should be national and what should be regional, and how that clinical strategy needs to rub up against and be designed in concert with the wider care strategy within regions. That's why we're looking at how social care and health have high-level plans that are designed together, as well, indeed, as health boards themselves working alongside each other. So, the work that Abertawe Bro Morgannwg University Local Health Board, for example, are progressively doing more of with Hywel Dda Local Health Board is really important. They have a more joined-up view of what services should be provided where, and what that means in terms of both access and excellence for those services as well, and never forgetting, of course, that we still want to maintain local services. Because when we talk about joining services up, it's often a focus again on hospital-based services rather than where over 90 per cent of ill-health interactions take place. That again comes back to the point about our staff, and the crucial importance of staff leading a conversation about what change looks like and why it is or isn't a good thing. As I was saying, me turning up in a suit doesn't persuade a whole bunch of people about what the future of the service should be—having six different health and care professionals is much, much more persuasive, particularly if they recognise them as people who live in that community and serve that particular community, wherever it is.

Your point about the South Wales Programme is well-made. It was clinician-led. There was agreement on what to do, and we have achieved a number of those things but, again, it usefully highlights the point about the pace and the scale of change. We have taken a long time not to deliver all of the programme, and that's one of the things we need to be able to get over and get around for the future, because the pace at which we're able to move frustrates everyone, it makes people anxious about whether change will really happen and it means that we don't deliver the improvements we recognise are necessary as quickly as possible. So, yes, the south Wales work is still being delivered, and key building blocks have happened, but I want to see much greater pace in the future for the change that we are talking about. Otherwise, whoever is a successor in this role at some point in the future will still be talking about the same things, the same challenges and the same problems, and not being able to make change happen. I can assure you, I hope, that Health Education and Improvement Wales will take an all-staff approach to all grades and types of staff. It is about a holistic and genuinely integrated approach to the future of the staff that we need today and, of course, for tomorrow. 

Finally, Jane Hutt.

Thank you, Deputy Presiding Officer. Can I welcome your statement, Cabinet Secretary, on the seventieth anniversary of the NHS? It was born in Wales as a result of one man, Aneurin Bevan, who had the political will and strength of conviction and vision to take this forward, building on the local Tredegar Medical Aid Society, as you said, which so inspired him.

Cabinet Secretary, you may not have had the opportunity in your busy schedule to see the ode to the NHS created by Welsh poet Owen Sheers with his film To Provide All People. It was broadcast last week and last weekend. He chose to honour his local district general hospital, Nevill Hall, and in a preview in the Radio Times—it was filmed at Nevill Hall—he spoke in tribute to Nevill Hall, where his mother received her knee replacement, his premature daughter received life-saving care, and his eldest daughter attends ophthalmology clinics. Will you join Owen Sheers and myself in thanking the staff of Nevill Hall Hospital for their devotion to care and clinical excellence, which we know is replicated in our hospitals across Wales? Would you also agree with Owen Sheers when he describes what Nye Bevan achieved—creating the NHS as a monument to the communal, and yet providing care for the individual, meeting the health needs of the population? Do you agree that this is how we must sustain and safeguard our Welsh NHS?

I would also like to pay tribute to Dr Julian Tudor Hart, who sadly passed away at the weekend following a very active retirement, leading the Socialist Health Association, following 30 years as a 'new kind of doctor'. He wrote a book about that, obviously, from his Glyncorrwg health centre experience, where he inspired Dr Brian Gibbons to come from Ireland to work there and then become health Minister here. Julian was a huge influence on me before I became an Assembly Member and the first Minister for Health and Social Services. During my time in that post, he was an inspiring and supportive influence in those early days. I would like you to express again your recognition of his contribution with the inverse care law. I looked at the paper in The Lancet that he wrote—it was back in 1971—and in the summary he says:

'The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.'

Do you agree that is still pertinent today as evidence, and that we have a duty here in Wales to ensure that it is our policy and our commitment to provide free healthcare for all, without the negative impact of market forces?

Julian Tudor Hart's work will continue to challenge not just this part of the national health service system, but actually every part of the developed world. The challenge is that those who most need medical care are the least likely to receive it and utilise it, whereas those with the least need of healthcare tend to use health services more, and more effectively. That's a challenge for a range of our public services, actually, not just the health service. That's why it's particularly interesting—and I mentioned it in my opening—that you can see both Cwm Taf and Aneurin Bevan university health boards making real progress on their inverse care law programme work. That's a real cause for celebration for us, that they are turning the corner on health inequality. The challenge now, as with so many others, is to be able to roll it out more consistently across the country. 

I recognise again the points made about the communal and the individual contribution and benefit with and from the health service. I have found time to watch To Provide All People. I particularly enjoyed it: a range of stories, and the actors were reading words provided by people describing their real experience of the health service in a range of different areas. It wasn't a work of fiction. It was telling the stories of people in and around the service. It was particularly poignant for me because that's where my father passed away—Nevill Hall. I remember getting a tearful call from my mother and going to the house that they had retired to in Llangynidr and finding the remnants of where my father had fallen over, visiting him in hospital, talking to him. I was the last one in my family to talk to him in Nevill Hall. I don't just remember the fact that they cared for my father, but I particularly remember the kindness and the compassion they showed to my mother. Because she could not accept that he wasn't coming back. When he was on a ventilator she didn't believe that he wasn't going to come back, and the fact that they did that gently, but they did it as they should have done, not to provide false hope, I thought was a great kindness. It's that kindness and compassion that I think people remember when they think of the best part of our health service—not just the machines, but the people who provide and deliver the care.

Thank you very much, Cabinet Secretary.