Now, you may recall that 'A Healthier Wales', the Government's much vaunted vision and action plan, flowing from a parliamentary review, firmly puts social models of community-based health and care at the centre of health service delivery. The underpinning cornerstone of this direction of travel is to anticipate health needs and implement sustainable prevention and early intervention strategies in order to reduce the impact on poor health and the need for interventionist models of social care. The ambition is that people will only go to hospital when it is essential. Services will be designed to reduce the need to access hospital and to spend time there. 'A Healthier Wales' specifically states that there will be a 'shift in resources to the community', and this is good news if it enables pressures on the ambulance service and on out of-hours care and critical care to be reduced. So, the plan is to signpost people away from hospital and to community services. However, without the community services in place, people will still need their hospital, and, this year, some hospitals in Wales experienced their worst performances on record in the provision of emergency services.

Welsh Government is failing to strengthen the foundations of the NHS. We cannot build up a community-based model if we do not have 24-hour, 365-day responsive, preventative primary or social care provision. And how can that be built when spending on primary care by health boards decreased by 5 per cent in real terms from 2010-11 to 2017-18? This deterioration in services affects much of the patient experience and creates huge delays for people.

Cabinet Secretary, the most basic requirement for unplanned care is that it must be able to provide care quickly to people with urgent and emergency needs, and, as I've already said, the community will continue to rely on that. A 91-year-old constituent of mine fell and broke his hip in three places in a mental health unit located across the road from Withybush hospital in Haverfordwest. Staff at the unit were not allowed to get him up off the floor until medical professionals arrived. Cabinet Secretary, those professionals took five hours to arrive, and the poor chap was left lying on the floor for all of that time at 91 years of age. Fortunately, he eventually was collected by paramedics and was taken the staggering 380 yards across the road. It is only by chance that he lived through the experience given his age and the severity of the injuries. Now, we can and we must plan for our health services, but we must also have the flexibility to react to out-of-the-ordinary circumstances such as this, because I believe this story highlights that it's becoming increasingly challenging for Wales's emergency services to cope with winter pressures, summer pressures, and, indeed, all-year-round pressures.

Last year, the Welsh Government provided an additional £50 million to ease winter pressures and opened an additional 400 beds across Wales's NHS to ensure our services could cope with demand. Fellow Assembly Members, that is the equivalent of a general district hospital. However, there's been no indication that the Welsh Government will reallocate this funding this year despite demand for services growing throughout the year. Bed occupancy remains consistently above the recommended 85 per cent occupancy level, which means that patient safety standards are being compromised. In 2017-18, average daily occupancy was at 87 per cent within the Cardiff and Vale health board, reaching over 88 per cent at some times, and in Welsh Government-run Betsi Cadwaladr, it reached almost 88 per cent. That's a staggeringly high figure.

And the picture's even grimmer in the occupancy rates for acute medical beds. Within Abertawe Bro Morgannwg University Local Health Board, for example, it hit over 93 per cent. Already, we are rendered as some of the worst critical care services in Europe, and it's becoming increasingly the case that critical care beds are being used inappropriately and hospitals are having to cancel operations to ensure that these critical care beds can remain unused.

The Royal College of Emergency Medicine is calling for an additional 250 beds and funding that is specifically used to tackle delayed transfers of care. This would free up beds within hospitals and allow for a flow in the movement of people throughout the system. So, we're back to the crucial issue of funding. I'm not calling for more and more money, but for the money that is deployed into the NHS to be used more creatively. Every year, we get to a point where the Government says, 'No more money'; every year there's a volte-face as the pressure builds up. The problem is that this cycle is not sustainable, it doesn't allow for coherent planning and it means that funds inevitably get thrown at short-term problems, which makes for highly marginal short-term differences rather than a sustainable change. We need money, fundamental change, new outcomes, not pressure, money, pressure, money, pressure, money, or the picture will never change.

There's little transparency around the deployment of these funds. We cannot tell if the quick-fix delivers: were they value for money? Are we able to identify what they were used for? Whilst health boards may have been able to drive it through to the front line, the reality is it's probably just plugged financial holes, because to deploy effectively at the front line, you need human resource, and that cannot be switched on and off like a tap. And, ultimately, fixing the problem in the hospital is all about dealing with the rising demands in services, a lack of staff, the loss of too many beds, the lack of resources in the community and a diminishing level of proportionate funding for primary care. The very same GPs you asked to deliver an overstretched out-of-hours service, having allowed their funding to drop in real terms by 5 per cent, a service that should play an integral part in relieving pressures on emergency and unplanned services—it's not possible. There's no consistent access to out-of-hours services throughout Wales. 

In ABMU last year, 19 per cent of all out-of-hour shifts were unfilled. Hywel Dda cannot fill some 1,500 hours of GP-led out-of-hours. On 12 separate occasions, Cardiff and Vale had no GP cover across the whole health board for a period of time, and in Aneurin Bevan, that situation occurred on 27 different days. In January of this year, almost 14 per cent of shifts were unfilled in Betsi Cadwaladr. You can see it's across the whole of Wales, and I merely illustrate that this is the very tip of the iceberg. When we have the Royal College of General Practitioners saying, and I quote,

'weaknesses in the system across the country are compromising patient care and increasing pressure on emergency departments', then, surely, that is the time for the Welsh Government to realise that the situation in out-of-hours provision is critical.

Out-of-hours, ambulance services, critical care, unplanned pressures exacerbated by near collapse in social care. If you as a Government really want to cleave to the ambition set out in the parliamentary review, if you as a Government really want to transform services—as your fine words in the vision for health indicate—if you as a Government really want to deal with this never-ending pressure on our emergency services, on critical care, on out-of-hours or our ambulance services, then you need to look at the other end of the telescope, shift a measure of resources to primary and community care, fund and staff social care, and either support people appropriately in their homes or ensure that quality residential beds are available that match an individual's needs, invest in preventative care, respond to the dynamics of our population health trends, and focus on the integrated well-being of the people of Wales.

This is the hardest of choices for you, for the NHS and social care sector, and, truthfully, for us. You're obliged to meet the needs of today while planning, resourcing and funding the needs of tomorrow, but, at this rate, you'll spend the rest of your time as health Secretary firefighting, and you'll fall between two stools. You'll neither sustain our current systems adequately, nor will you affect the transformation that you seek and that we share with you. 

To quote the parliamentary review:

'Unless faster, more widespread progress can be unlocked, access to and the quality of services will decline in the face of predictable pressures.'

This is why the next five years will be a crucial test. It's about priorities, Cabinet Secretary, it was always going to be about priorities, and I commend this motion to the Chamber.