Part of 1. Questions to the Cabinet Secretary for Finance – in the Senedd at 1:33 pm on 10 October 2018.
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.