1. What consideration did the Cabinet Secretary give to preventative services when deciding on the draft budget? OAQ52717

Well, Dirprwy Lywydd, amongst the decisions taken when considering preventative services, I was especially pleased to be able to restore in full the early prevention, intervention and support programme of the Welsh Government in the draft budget.

Notwithstanding that, you have repeatedly and, I believe, sincerely committed yourself to driving forward preventative approaches to health and care in Wales. Yesterday's local government provisional settlement figures show an overall 1 per cent reduction for local government, with every local authority in north Wales seeing a reduction, although seven in south Wales saw a standstill or increase, and with NHS funding, however, going up 7 per cent, rather than seeing how we could budget smarter in order to deliver more through early intervention and prevention. How, therefore, do you respond to the statements in the letter from the Welsh Local Government Association, issued to us all yesterday, signed by the WLGA leaders from all parties, in which the WLGA Conservative group leader, Peter Fox, said,

'With £370 million new monies arriving from Westminster, an imaginative approach to funding preventative services to keep people out of hospitals was needed. Instead, the Welsh Government has given the NHS a seven per cent increase and cut council budgets for the eighth year in succession.'

We're not advocating a cut in NHS funding; what we're advocating is imaginative, smart, preventative budgets that keep the pressure off health services by the two working better together.

Well, I'm sure, Dirprwy Lywydd, that Peter Fox, for whom I have great respect as a leader, is very grateful that he is a council leader in Wales and not in England. By working hard all over the summer, we managed to reduce the gap in revenue support grant to 0.3 per cent—less than £15 million. Cuts that are facing English local authorities next year, were they to be translated into Welsh terms, would be £65 million-worth of cuts in RSG budgets for Welsh local authorities. So, I'm quite certain that the Conservative leader of Monmouth is very grateful he is living in Labour Wales rather than under the regime of his own party.

The general point that the Member makes, however, I think is a sensible one of course. When money is as short as it is, and when it reduces every year, everybody has to focus on trying to make that money go further, to use innovation, to have new ideas. My colleague Vaughan Gething has used £30 million of the health consequential to put that on the table of the regional partnership boards in Wales, where decisions have to be signed off jointly between the health board and the constituent local authorities. And I think increasing that budget in that way puts a new premium on the ability of those authorities to act in the imaginative way that Mark Isherwood mentioned.

Does the Cabinet Secretary accept that it is difficult to define preventative spend? For example, spending on home social care is preventative of needing residential care and hospital care. Expenditure on GPs is also preventative of hospital care. Would it not be better to define the expenditure as that which provides long-term good?

I thank Mike Hedges for that supplementary question. He will know that, when I was in front of the Finance Committee last week, I set out the new agreed definition that we have used in this budget of what we mean by 'preventative spend', a definition developed by the third sector and Public Health Wales in consultation with the commissioner for the well-being of future generations Act. And it's not perfect, I'm sure, and we'll develop it further, but it is a genuine step forward in having a common language. That divides what we mean by 'preventative spend' into a number of categories, from primary to acute. Any definition only helps us so far in the decisions we have to make, and Mike Hedges's idea of defining expenditure against long-term good, I can well see the sense that that would bring. By itself, it would not avoid decision making.

Dirprwy Lywydd, I was reminded, listening to that supplementary question, of a day that I spent when I was health Minister. I had two pieces of advice on the table. One was to use a sum of money that would have made a profound difference in the lives of very few people in Wales—fewer than 20 people, each one of them at a very high cost per person. On the same day, I had advice that told me how I could spend the same amount of money on a new cadre of, as I remember, epilepsy nurses around Wales—people who would have been able to do good things in the lives of a far larger number of people but where that difference would have been incremental to services that they provided rather than transformative. Both of those were possibilities that would have promoted long-term good. So, whatever definitions we have, and helpful as they can be, in the end they can't make decisions for us, and decisions are always difficult when you are faced with a finite sum of money and many different ways in which that money could be usefully spent.