The next item, therefore, is a statement by the Cabinet Secretary for Health and Social Services on 'A Healthier Wales': update on the transformation fund. I call on the Cabinet Secretary to make the statement—Vaughan Gething.

Diolch, Llywydd. Members will recall that in June of this year I published 'A Healthier Wales'. That responded to the recommendations of the independent expert-led parliamentary review of health and social care in Wales. And Members will, of course, recall that the terms, remit and membership of the parliamentary review panel enjoyed cross-party support from this place. 'A Healthier Wales' sets out our long-term future vision of a whole-system approach to health and social care. Our approach was formed in partnership with the NHS, local government, the third sector and colleagues from housing.

When our plan was published, I gave a commitment that work would begin immediately on implementation, and that I would bring back to the Assembly in the autumn a report on our initial progress. So, today, I can update you on the steps we have already taken as a Government, and the actions that our service delivery partners are taking with us, as we begin our journey of transformation.

As a first step, I established the health and social care transformation programme. This programme is led by Dr Andrew Goodall, the director general for health and social services and chief executive of the NHS. He is supported by a programme team made up of Welsh Government and senior health and social care professionals with experience of front-line service change. The programme will beresponsible for driving delivery at pace across the whole health and care system, and for ensuring that the 40 actions contained in 'A Healthier Wales' are discharged.

I have also constituted an advisory board, made up of senior health and social care leaders, together with key partners from across sectors and geographical regions of Wales, to provide strategic oversight, advice and challenge to the programme. This board has already met twice and is providing real additional value with the expertise and influence it is able to provide to our work.    

When the plan, 'A Healthier Wales' was published, I also announced that additional money was being made available to health and social care providers in Wales through our £100 million transformation fund over two years to support the testing of new service models on the ground. In July, we wrote to our health and social care partners inviting them to work together through their regional partnership boards to develop and submit proposals for potential support from the transformation fund. We asked partners to design proposals in line with our shared ambitions set out in 'A Healthier Wales', and in particular our vision and our design principles. This should guide thinking around new models of seamless care. We all recognise the need to bring services together, closer to home, and these new ways of working must have the potential to be scaled up across regions and, of course, at an all-Wales level.

I am pleased to report that we have already received eight proposals from regional partnership boards, with more in development. I have confirmed support for two of these proposals, including Western Bay’s Cwmtawe cluster integrated health and social care programme that I can announce today, following the Cardiff and Vale’s Me, My Home, My Community project that I announced and visited last week. These pilots will allow us to test and evaluate new approaches to care that support the principles set out in 'A Healthier Wales', including early identification and intervention to support at-risk individuals, innovative use of technology and information sharing to enable different services to work together, and multidisciplinary community-based approaches to care provision. All of these should reduce pressure on our GPs and hospitals and, of course, provide a better service for the public. 

The strength of the proposals that we have received so far, and the manner in which partners have generally worked together to develop these ideas in a short time, gives me great encouragement that our regional partnership boards will deliver on their role as the primary agents of change and transformation. However, I also recognise that if regional partnership boards are to play the leading role in transformation—and we know that they have the ambition to do so—they will need sufficient resource and expertise to do so. That is why I have confirmed in our 2019-20 budget proposals that regional partnership boards will receive an additional £30 million. This additional support will strengthen regional partnership boards and ensure that they are able to meet the challenges ahead. 

Whilst the transformation fund has, understandably, attracted much interest, I will say again now, as I have said many times since we published the plan, service transformation must be a core activity for all health and social care organisations. Strong system leadership will be required to drive the change needed across Wales. Ultimately, it will not be the £100 million transformation fund but the £9 billion of core funding that our health and social services receive each year that will deliver transformation. I have been at pains to point out that the transformation fund is itself only one small part of the much wider programme of change set out in 'A Healthier Wales' that we are now embarked upon and committed to delivering.

I would like to take a short amount of time to update you on some of the other work we have already begun in support of those wider actions. The plan promised stronger national leadership from the centre and a commitment to simplify, where possible, some of the planning and reporting arrangements that have grown around the health service in particular over time. In relation to the first of these, I can confirm that work is well under way in relation to our planned NHS executive. In relation to planning requirements, earlier this month I issued revised integrated medium-term plan guidance that sets out a more streamlined and joined-up process that we are supporting with an additional £60 million of new funding.

In keeping with our drive for greater emphasis on health promotion, I launched our healthy and active fund in the summer together with the Minister for Culture, Tourism and Sport within the Merthyr Tydfil and Rhymney constituency. This partnership is with Public Health Wales and Sport Wales. 

In support of our workforce objectives, we have announced new pay deals, extended our 'Train. Work. Live.' programme, commissioned Social Care Wales and Health Education and Improvement Wales to develop our new workforce strategy. We've refocused a new national leadership group that now includes representatives from the social care sector as well as the national health service. I will of course be happy to provide further updates to Members in the future to update you on progress.           

I'd like to thank the Cabinet Secretary for his statement on the transformation fund. It is very eagerly anticipated, because I have heard this transformation fund being claimed by so many people as a panacea for much within the NHS, so I'm very pleased, actually, to read about the general points that you make about the criteria. Perhaps you could actually just give us a little bit more expansion about the criteria for a project going ahead to the transformation fund. Who's going to be making the decision? Will it be just the regional boards putting forward the projects and then Andrew Goodall's team making the final decision, or will it be at a slightly lower level?

I'm a little bit concerned that only two projects so far have been agreed and we're coming towards the end of 2018. I appreciate it's a new fund—I'm not unrealistic—but given that the money is only available until 2020, are you confident that you'll be able to deploy that £100 million within the next, well, just over two years, and not only deploy it, but actually have it working and have the results of an evaluation so that we know whether or not those projects are then worth rolling out throughout the rest of the NHS?

Are you able to give us any indication of the projects that you have had in—the six where you have not yet said 'yes' or 'no', and whether that's actually because they're a 'no' or because you're still evaluating them—and can you confirm whether or not there is equity of application across Wales? The reason why I ask that is, of course, Betsi Cadwaladr is in special measures, Hywel Dda is undergoing a fairly rigorous transformation programme, and I am quite concerned that health boards—and there may be others, not just those two—don't miss out on this opportunity because they're so busy doing their day-to-day other jobs. So, can you assure us as to whether or not we are going to have that equity of application?

A couple of very quick questions, in particular: projects that you are looking at—will you be giving an extra weighting towards the primary and community sector? I ask that because, of course, the entire drive of the parliamentary review was talking about how we need to move away from the secondary sector. When I talk to health boards, I get the impression an awful lot of the application is going towards firefighting or trying to make things happen in the secondary sector. And so, this primary and community sector, which we're putting so much faith in to transform the way we deliver the NHS services over the next decade or two decades—we need to make sure that there are projects there that are going to be rolled out. Will you be able to assure us that there will be checks and balances across all of this spend and that it doesn't simply get sucked into either existing debt or fixed overheads or additional administrative personnel, so that it actually does hit the boots on the ground?

I would be interested to know if this is new money that you talk about in your statement. You talk about a very welcome, as ever, £30 million for the regional transformation boards, and an extra £60 million to support the IMTPs. Is this redeployed money or completely new money on top of the £100 million?

Finally, do you have a system of time framing your pilots to ensure that those pilots have a kill switch—they're either successful or unsuccessful? How long are you going to give them? Because, if they turn out to be unsuccessful—and I appreciate that we're not going to be able to be successful in every single one—then we need to be able to recognise that writing very, very quickly and move on to the next project so that we can maximise that amount of money as much as possible, to transform the NHS in the way we need to.

Thank you for the comments and questions. I'm going to start by recognising what you say about the fund, and, of course, some people have all been looking for an extra sum of money. Whenever you announce a certain sum of money, people always try to understand what their part of it is, what their chunk is and whether it will cure all ills. Well, I've been really clear from the outset, as indeed has my colleague Huw Irranca-Davies, that this fund is a specific fund to help deliver change and transformation. It is not a panacea. It really is about supporting and implementing new ways of working to transform our whole service. So, it's a way of leading change to then use the £9 billion to deliver that change on a system-wide level. That's what we're looking for. And, in that, the design principles that I've mentioned several times really matter. If they don't meet the design principles that we set out, they won't get supported. If they are not genuinely scalable, and they can't demonstrate how, if successful, these projects could scale, then again they won't be supported. I accept that not every project that gets supported, even on the best advice, the best design—not every project is likely to succeed. It's important that we accept that and say that again and again at the outset, because there'll still be learning from projects that don't succeed.

That goes back to your final question about evaluation and time frame. With each bid that comes in, there will be something about evaluation within it so that we can understand what good it is or isn't doing, and also the time frame within which to do so. So, these are not never-ending projects. They can't be. They have got to lead to a point where we can understand: is this the right answer, and, if it is, how do we then scale it across our system? And, if it isn't the right answer, then we have to disinvest from it. I'm very, very clear about that and I have no difficulty in saying that, both in the initial launch that I attended in Cardiff and Vale, and the same goes for the Cwmtawe cluster, and whatever projects I decide to support in the coming weeks and months.

So, on the question that you asked about how the decisions are made, the advisory board is there to challenge the work that is being done by the programme board. That group, led by Andrew Goodall, will provide the advice to me, and I will then make decisions, based on that advice, about whether to support projects or not. So, I have decided on the first two projects. The eight areas that I mentioned—I'll get advice on those, and I will then look at them, and I will then make a decision about what to support. I'm happy to confirm that each part of Wales will provide a project to go into the transformation fund, of varying scales and sizes. I can absolutely guarantee that Hywel Dda and north Wales are not about to be screened out of this. So, you will see, in the choices that I make, that we will be making choices across the country. I expect every area, not just the two who have applied—. I expect, before the end of the calendar year, you will see a range of other choices. So, I can't give an exact timescale, because I need to consider the advice when it's given and make a choice when I'm content that it is the right thing to say 'yes' or 'no' to. But I expect to make further choices in the coming weeks, not necessarily waiting a matter of months.

I'm also happy to reprovide the commitments that I have given previously—that this transformation fund is not a way of using extra resources to primarily go into a hospital system. Now, that doesn't mean that projects can't have an impact on our hospital system, or can't use some of the money within the hospital system, but it is primarily about delivering a shift in how we deliver care. So, the primary focus is primary and community services. It really is about the partnership between health and social care and others, including housing and the third sector. That's why we have used regional partnership boards as the initial mechanism. Anything that wants to come to the transformation fund must first have the support of its regional partnership board. That's really important. So, health and local government are in the same place as co-decision makers, for the shared objectives that 'A Healthier Wales' sets out. It is not a question of all of them saying, 'This is my project. I will now decide.' They have to agree with their other partners around the regional partnership board table.

In terms of the £60 million to support the IMPTPs, that is new money. In terms of the £30 million I have announced for the regional partnership boards, that is new money too. Of course, with the transformation fund, if we don't spend all of it, I will then have to make a choice as to whether I can reprovide that money into the next year. I think we'll see an expansion in ambition and scale in the projects we are likely to see, and I want to encourage that, not level it downwards.

Thank you to the Cabinet Secretary for his statement. If I may just return to an issue that was raised by Angela Burns, as to whether this £30 million that has been announced today is new money, I think that's very important. If it isn't new money to the health budget as a whole, can you tell us from where in your budget you have taken the £30 million? I would associate myself with the welcome that Angela Burns has given to this if they are new resources, but if they are recycled resources, we need to know where they have come from. I would draw your attention—. As you said yourself in your statement, of course, this extra money is very welcome, but it is very small compared to the total £9 billion budget. In fairness to the services, it may be asking them to do quite a lot with comparatively little.    

Returning to this portfolio after many years, I suppose I was a bit concerned to see your statement that the 'A Healthier Wales' programme promises to provide strong national leadership from the centre. Obviously, part of me welcomes that, but you have to ask where that's been for the last 18 years. I'm trying hard, Llywydd, not to be sceptical here, but I've heard a lot of this before, about excellent pilot projects that can, in this case, deliver better co-ordination between health and social care, but what we haven't seen is those rolling out. I very much hope that this is not the case and that I will be proved wrong.

Of course, a candidate for the Welsh leadership position—and, you know, we all follow this very closely for very good reasons—recently said that change takes courage, and I'm sure that the Cabinet Secretary will agree with me that delivering change in the NHS is going to take considerable courage, and it will require him, I think, to face down some vested interests, possibly, and delivering that change may not be easy. Of course, his party has been in charge of the NHS and health and social care for 18 years.

We've had programmes and legislation intending to deliver this outcome, and, as I've said, it hasn't happened. And I don't underestimate, in fairness, Cabinet Secretary, how difficult it is to make this happen, but I would like you to provide us with some reassurance that it is going to be different this time. And even if this is quite a long timescale, could you give us some indication this afternoon—and forgive me, new to my role as I am, if this is a matter that you've already dealt with in previous statements and previous debates—but what sort of timescale do you have in mind, not so much for the pilot projects, but for actually being in a position where you know which pilots have worked and you're ready to start rolling them out? Because, I think, historically in Wales, we really haven't been very good at that. We've been good at coming up with good ideas, but we haven't been very good at upscaling them.

And in order to provide this Assembly with some reassurance about the process, I wonder if you would consider publishing the meeting notes of the advisory board, so that we can see for ourselves what challenge is being provided to the transformation programme. I understand you may not feel that that's appropriate, because there is a question, potentially, of confidentiality, and one wouldn't wish to stifle robust debate. I suppose an alternative to that, Presiding Officer, might be further regular statements from the Cabinet Secretary.

Your statement also mentions simplifying planning and reporting for the NHS. Now, none of us would wish that to reduce accountability, but I think, neither would any of us wish people to be spending time on unnecessary paperwork. So, I welcome that commitment in the statement. But, I'm also interested to know what the time frame is for a new and simplified system.

Can you elaborate on what you've already said to Angela Burns about how the effectiveness of the pilots will be assessed? This will obviously be difficult to do, because they'll be addressing different issues, different problems, as you've already highlighted. And can you also tell us: what plans do you have to ensure that the successful pilots are rolled out and, perhaps more difficultly, that the unsuccessful ones are abandoned and that this is done in good time? I don't wish to be sceptical, Cabinet Secretary. I wonder if you would consider, for example, publishing the evaluations of—once you've made a decision, if you publish the evaluations, both of the projects you decide to support and those you don't, so that we can see more clearly the direction of travel.

I very much hope that this is a new dawn of leadership, and I remain to be convinced and look forward to pursuing this work over the next months and years.

Thank you for your comments and questions. Of course, I agree with you that change does take courage, but when we think about the questions that you've asked, I'm happy to reiterate the comments to Helen Mary Jones that I made to Angela Burns as well: I answered that the £30 million for regional partnership boards is indeed new money.

I should also welcome Helen Mary Jones to her new role in this Assembly term as spokesperson for Plaid Cymru. I'm sure we'll have lots of opportunities to talk at length in this Chamber and outside.

Just to deal with your point about the meeting notes, it's partly process, and I think it's also partly about wanting to have openness, but I would not want to stifle the robustness of challenge within that meeting. I'm more than happy to come to this place and answer questions, and I don't find that a troubling thing to do; I'm more than happy to do so. But, I want to think about a way in which we can not stifle debate and challenge within that meeting, but at the same time make sure that Members are aware that that is genuinely taking place.

On the broader point about time frame and evaluation that you asked about at several points, as I said to Angela Burns, there'll be a time frame and evaluation for each bid that goes into the fund. It's part of what'll be tested before any project for the transformation fund is approved, and I won't set an artificial time frame for that evaluation to take place. Not only will I expect there to be an evaluation framework within there, but of course that will inform any choice made about successful or unsuccessful. And I would expect to make that available, or information from that evaluation available, when choices are then made about whether to continue and to promote that as a project to be mainstreamed, or indeed if the choice is not to continue with that.

Because all of us in this room are aware, in our variety of roles, and will get lobbied constantly about different projects that are working where people are saying, 'This is a great project. You must support it.' There is often, even in an unsuccessful project, much that is of value and learning that people want to continue with, but we have to make a choice about what not to do that stops us from doing things that are potentially of greater value to the whole system. So, yes, I want to find a way to make sure that evaluation information is available to help support those decisions.

On your broader points about where we are, look: I recognise that change in the national health service is difficult, and, yes, there has been a Labour Minister in this position over the last 18 years, including of course during the One Wales Government, so we've all seen the challenges and difficulties over time of delivering health and care in Wales—in times in the first half of devolution when there was more money, and in the second half of devolution when coping with austerity. What is different now is we don't have money to avoid a process of change. We have rising demand that we could anticipate 20 years ago, but that demand is now at a point where it could overtop our system, so there is real responsibility on all of us in a leadership position to actually enable change to happen.

That doesn't mean we all need to agree. You can have unity of purpose without unanimity on every single question and choice to make. But I do think that each of us needs to recognise that there are voices in all parties against change. As I've said before in this place, I recognise there are people in my party who do not want to see change happen when it is difficult at a local level, and there's no point pretending otherwise. But it's my job in this position to try to make sure that our system has the leadership it requires, and has the opportunities to enable and support it to make choices to genuinely change the way in which we deliver health and social care. I am determined to do that and I look forward to a grown-up and mature response from every party in this Chamber to allow us to do that. That does not mean that there won't be challenge, but it took courage and change from people in all parties to create the Parliament here in the first place and we now need to demonstrate that same courage, leadership and maturity in delivering and driving genuine change throughout health and social care here in Wales.

I want to start by being perhaps uncharacteristically generous towards the Cabinet Secretary for health, because I recognise, having been in politics a very long time, that the health service is not always benefited by the party political dogfight, and the constant change and reversal of change that I've witnessed in the course of the last 30 or 40 years has often been an impediment to improvement rather than a spur to it. So, I welcome the approach that the Cabinet Secretary has brought to this, and I think it's an area where we're all aware of the potential problems that the health service has, in terms of funding, an ageing population, the diagnosis of new conditions that can be treated, et cetera, et cetera. And I believe there is a genuine opportunity here for us, without abandoning the combative democratic scrutiny that we're elected to carry out on the Government, to work together in the same direction, and, without abandoning challenge, to do it in a way that is constructive.

I do believe that the announcements that have been made so far—for example, the Cardiff and Vale partnership board proposal for Get Me Home Plus, which the Cabinet Secretary announced last week, is a genuine improvement in the way we do things, getting people discharged from hospital earlier and then for their needs to be assessed in their own homes, so that we can take advantage of the way their homes are adapted in order to improve their process of recovery, et cetera. That is going to be a very, very helpful thing and I do think that, in the statement, the Cabinet Secretary's to be applauded for the realistic tone that he has adopted, in particular saying that, whilst the transformation fund has attracted much interest, it must be a core activity for all health and social care organisations. I particularly approve of him saying that, ultimately, it would not be the £100 million transformation fund, but the £9 billion of core funding that our health and social services receive each year that will deliver that transformation. I think that sense of realism is vitally important because there are almost impossible challenges that lie ahead. Michael Trickey wrote, two years or so ago, in his document, 'Closing the health and social care funding gap in Wales', that 

'Improving productivity and efficiency will be an essential part of the mix....To make a real difference through improved efficiency and productivity, Wales has to outperform historic productivity improvement rates.'

That is going to be a significant challenge. Perhaps the Cabinet Secretary can devote a little time today to exploring the options in some of these areas. For example, we know that accident and emergency admissions in hospitals have gone up from 980,000 in 2010-11 to 1,030,000 in 2017-18. Part of that is because people can't get to see a doctor at times of their own choosing. That's an area where there needs to be improvement as well because, in 2012, 15 per cent of people said that they were unable to get a GP appointment at the time of their own choosing; that's gone up to 24 per cent in 2018. In fact, it's 27 per cent in urban areas. So, that's obviously a significant challenge.

Dementia is a growing problem. Again, there's a 48 per cent rise in the figure compared with eight years ago, and it's believed that as many people are undiagnosed again as those who have been diagnosed. Cancer diagnoses have doubled. Diabetes is up by a third. More prescriptions are written in Wales than any other UK nation at 28.3 per year. Is there scope there by tweaking the system to reduce the cost imposed upon the health service, which precludes us from spending the money in other, perhaps more productive, ways? NHS equipment has been in the news again recently as well. In Cardiff, for example, 10,000 walking aids are handed out every year, but 40 per cent of those are not returned to the health service when they're no longer needed. So, savings are going to be an important part of the mix.

Of course, the more collaborative working processes that we're talking about today are an essential element in achieving those productivity improvements and I appreciate that at the early stages of this programme it's very difficult to be specific. Reading the 'A Healthier Wales' document, the start, it's full of management speak, which I fully understand, and its aspiration, and we need to deliver and delivery will take time. So, perhaps the Cabinet Secretary can just add a little more to what he said in the statement already on that. 

Thank you for the uncharacteristic generosity that I recognise in your comments. I think the point that you're making about efficiency and about how we gain greater value and productivity, they matter. There's something about doing some things differently, doing them more efficiently, but there's also something in transformation about doing different things as well. And we need to be able to do both of those and judge when we need to do either one.

So, for example, you talked about prescriptions. Well, actually, prescription growth has been slower in Wales since the free prescription policy than it has been in England where people pay for prescriptions, which is an unusual fact—it's counterintuitive—but that's the reality of what has happened. So, people are already making choices about what to prescribe. And, actually, in Wales, we've had a national approach to prescribing on using biosimilars—so, not having branded products, but products where there is exactly the same efficacy and safety for the citizen. So, we've actually taken a national approach and made real financial savings.

But that isn't just the only part of what we have to do. There's a large part of this that is about how we just do different things. Your point about access to accident and emergency and the figures going up, well, of course, access to primary care is part of that story. I don't think it's the whole story, actually. It does, though, partly reinforce why we need to transform primary care to make sure we have GPs working in deliberate partnerships with other healthcare professionals, and not simply as a response to challenges in recruiting general practitioners in different parts of the country, but, actually, in every part of the country it's the right thing to do. It's a better job for the GP, a better job for the physio, for the nurse, and the pharmacist and the occupational therapist that will work with them and, ultimately, a better service for the member of the public, and people will get faster access to the right person. That is also the same reason why we want to have a genuinely more joined up partnership with social care as well. Most GPs will tell you that lots of the people who come through their doors to see them have social problems and not, really, health or medical problems for them to deal with. So, that partnership really does matter.

The point about demand coming into our system—we've rehearsed this many times about the age of our population, about the additional public health challenges we have, about dementia as a particular challenge that we face now and in the future as well. It reinforces why we need to do some things in a different way, but actually to do different things too. So, our 'hear and treat' services and our 'see and treat' services are not just about keeping people out of hospital, they're actually about that being a better way to deliver that care for the person. You'll deliver more local care that is more appropriate for that person and give them a better experience too, and there's actually less risk for that person in making sure they don't have an unnecessary trip to a hospital. That's why we have to have a different conversation about value. It's partly about prudent healthcare and about the value base of what we're doing, and what value are we gaining by spending money and using resources in a different way to provide better care and not just technically more efficient care.

Of course, I look forward to having this conversation in committee during the budget. I'm sure that we'll get asked plenty of questions about this by committee members, but, throughout the life of this plan, it actually underpins much of what we want to do and how we'll actually have a system that is in balance, that is financially sustainable, and is delivering high-quality healthcare to meet the challenges of today and the future.

Joyce Watson took the Chair.

I'm delighted by your statement, particularly by your recognition that this is not just about £100 million, it is about the £9 billion that we currently spend on the health service, because if we're going to deliver 'A Healthier Wales' we are going to need to transform the whole service. Cardiff and the Vale is an excellent example of how it would be possible to simply suck all the resources into hospital care as the hospital consultants are very powerful, so I'm delighted that Cardiff and the Vale have embraced the Canterbury experience, which indicates that it is possible to reverse trends in terms of more and more elderly people ending up in hospital, when, in fact, with better community support, they could be staying at home, which is obviously what people want. So, I'm very keen to hear more about Me, My Home, My Community and what outcomes we're going to be measuring to ensure that this is the right model that we could be rolling out to others.

We learnt from the Canterbury, New Zealand, model that it has slowed demand for acute care, but that it takes time—it doesn't happen overnight. One of the things that Canterbury has is the 'one system, one budget' mantra. So, how has that approach got on with being developed in regional partnership boards? I appreciate it's work in progress. And where does Buurtzorg sit in this, which is obviously neighbourhood care pioneered by the Dutch? So, in my mind, the spotlight can't just be on the transformation fund, it has to be on the whole-system approach to this, because simply throwing more money at pharmaceutical companies isn't going to actually transform the health of our nation.

I'm particularly interested in some of the social prescribing that is being pioneered in the south-west cluster of Cardiff, which I'd love to see being developed in my constituency, active ageing programmes, things to reduce loneliness and isolation through referring people to gardening projects, and something called the Grow Well project in south-west Cardiff. It would be fantastic if we could see that sort of thing going on in other parts of the city. 

The east Cardiff cluster was established as an informal system by the east Cardiff, Llanedeyrn and Pentwyn Communities First, but of course that has now ended. So, I wonder what intelligence you're able to share with us about how well that sort of social prescribing is moving forward in the absence of these Communities First programmes?

Thank you for the comments and questions. I'll deal with the specific points about Buurtzorg and social prescribing, and then I'll come back to the broader points about how we're moving forward, including your opening gambit.

On Buurtzorg, we have indeed invested additional money in training district nurses, looking at particular models of care, and that will, of course, feed into how we want to try and plan and deliver our services. It’s also worth mentioning that district and community nursing is an area that, of course, the chief nurse is looking at in working on whether we can extend the nurse staffing impact to understand that that's an innovation that’s already available and the principles that have already been delivered as well. District nurses are actually really important in keeping people in their own home and getting them back to their own home as well. So, we should never underestimate the importance of district nurses, and yet we rarely talk about them in this Chamber.

On your point about social prescribing, actually, when you look at a number of the projects that we have going on across the health service, social prescribing is a much more important feature of that. In some of the money that I announced on mental health and social prescribing, all of them have the direct link between social prescribing and mental health—every single one of those projects and partnerships that I've already given funding to over the last year. Not only that, though, but if you look at Me, My Home, My Community, the first project under the transformation fund, that has social prescribing as one of the seven elements to it. If you look at the Cwmtawe cluster approach that I've announced today, that too has social prescribing as part of it as well. So, we're looking to develop the evidence base for social prescribing, and in each one of the areas of Wales that you look at, you will see social prescribing as a deliberate attempt for the health service to work together with the care service and, of course, with the third sector and the citizen to understand how we help them.

Now, on your broader point about the Canterbury system, it's been interesting, of course, that Cardiff and Vale have taken inspiration from that. They have a settlement and an agreement over time on what to do to so they had consistency in approach. And the Me, My Home, My Community approach builds on Canterbury, but equally, when I was at the launch of this event, people from Canterbury were there and they were looking for things that they, too, could learn and take back to Canterbury. So, it is a genuine learning opportunity that goes in both directions. They're actually impressed by the unity of purpose and vision that are being delivered across health and social care. So, we should take some positives from what our staff are actually doing and delivering, now they have the opportunity to work deliberately together.

Much of the Get Me Home and Get Me Home Plus scheme that you see within the Cardiff and Vale Me, My Home, My Community, looks very similar to what’s happened in Cwm Taf with their partners in social care with the 'stay well at home' scheme, which, of course, was what I and the Minister visited on the day we launched 'A Healthier Wales', and they were the big winner in this year’s NHS Wales awards, too—a partnership between health and local government. That really is the future. That’s why we’ve placed so much emphasis on regional partnership boards. Where we’re getting the greatest gain and the greatest value is where people are deliberately working with each other, within the health system, the join-up between hospitals and community services and, even more importantly, the join-up between the health and the social care system and, indeed, the citizen. It’s a deliberate direction of travel, and we will only do it if our partners are able to sit in the same room and they want the same priorities for the same citizen.

Given that the Social Services and Well-being (Wales) Act 2014 code, too, requires the boards to work with people and communities to design and deliver services, what requirement will you, if any, be applying to your decisions regarding proposed spending to ensure that, for example, if this applies to the deaf community, the deaf community have been involved, or the autistic community, then for the autistic community to have been involved, or wheelchair users, and for wheelchair users to have been involved, or what have you, so that the real experts in the barriers that people encounter are addressed, rather than the well-meaning perceptions of people who are otherwise around the table but may not have personal experience?

I recognise you mentioned particular points, yet I’m looking for the voice of the citizen, and the citizen isn’t one single person with one single characteristic, and I don’t want a narrow tick-box exercise so that people can tick off and say they’ve had a conversation with someone who has a particular characteristic. It is about how we serve the citizen and serve the community. So, in actually delivering a Get Me Home and Get Me Home Plus scheme and delivering the 'stay well at home' service, you have to look at that person in their context. So, if that person has sensory impairment, we have to understand how that impacts on their care choices, the information and communication that they will need, and that we actually understand what matters to them. If that person is a primary carer for another person—indeed, when we visited Doreen on the first day, her primary concern was not herself, actually; her primary concern when she broke her ankle was who was going to look after her husband, who was older than her and who she was the primary carer for. That was what she was most concerned about and why she didn't want to stay in hospital herself. So, it’s understanding her as a person, the context she was in, and not just seeing her as an old woman who needed to stay for a week in a hospital, to understand why it mattered to her to get her home quickly. And they built the support around her by understanding what mattered to her, and that's what we need to see. So, it isn't about saying, 'Have you spoken to this group, that group or another?', but to understand, if you're directing a service, for example learning disability services, whether you've directly engaged with people who take part in that service—not just the staff, but the citizen as well.

So, yes, that is what I would expect to see in each of the choices that I will make about the advice that I receive, to understand where the voice of the citizen is, how have their needs been taken account of, and, crucially, how we understand if we've made a difference. That comes back again through the evaluation points that have already been made by our colleague Angela Burns.

Thank you, Cabinet Secretary, for your statement. A lot of this has now been covered, so can I just bring you down to—it's a very simple point, actually, that I wanted to make? I've been doing a lot of work in my constituency around health and social care over the summer and into the autumn, and there is a clear suggestion that people don't always receive, certainly, the social care support that they think they should have. And although I'm treating that feedback with a little bit of caution at the moment, because I think that needs some further work, I do know that that is something that you're acutely aware of, and your £180 million announcement on the health and social care integration agenda is very much welcome in terms of moving us some way towards dealing with that whole-system approach to health and social care that clearly is the answer in the longer term.

In strengthening some of the new innovations that I've seen, and the people who I've been talking to, like the GP support officers and the community connectors, we've certainly got to continue improving the links between GPs, third sectors and local authority support. So, even at this early stage, could I ask that you give some consideration to whether greater consistency might help users to understand the innovation and change that's taking place at local level? I'll give you an example, and you and Jenny Rathbone have both alluded to this. I've been talking to GP support officers, I've been talking to social prescribers, I've been talking to community connectors, I've been talking to the virtual ward team, and by and large, they're mostly doing the same type of work. And while I accept that each of those innovations is slightly different, I do feel that some greater consistency in titles and terminology might help users to better understand what part of the service they're actually dealing with. Of course I appreciate that's probably very low down the order of your priorities in the wider scheme of things, but I do think it is important. Terminology is important and that people, when they're accessing the services, and when you're delivering the type of integrated care that we're looking at—that everybody understands that when they access that service, and when they are referred to a particular type of service, they are consistent in what they're getting and they know what they're getting in terms of the titles that people use.

I recognise the point that you make very well, and, to be fair, it was interesting for me to come to some of the events that you ran over the summer in Merthyr Tydfil and Rhymney, in trying to understand more of the detail of how health and social care are delivered—good things, bad things and different things, and areas of opportunity as well as areas to highlight.

I recognise the point you've made because, of course, when we visited one of the practices in your constituency, and the conversation about having early dentistry access, about having a social worker in that practice as well, and how that deliberate join-up had helped the GPs to do their job—it's not just about saying, 'This is a weight off my mind, I don't have to do it', but, actually, they knew that person was going to get a better service and they could then spend more of their time on people who they really needed to see and who needed to see them. And they didn't medicalise the social problems that existed. But I recognise your point that, at some point, after all the pilots are done, and we understand what we think will work, we'll make choices. If we're going to have a national roll-out, not to say things are different by accident, but actually while we've made a choice about why they seem different, and how to make it easy for the citizen to engage in the service. Because lots of this debate that we've had today will not mean much to people watching. When we talk about the integration agenda, if you then ask someone who was watching this programme, 'What does that mean?', well, actually, I think, for the citizen, we should make it easier for them to navigate their way through. So, it's a consistency in expectation, some consistency in the sort of titles people have—I can see that would be useful. And at some point, you're right, we'll need to get to a point where we make choices: what will be national and consistent and what will be down to national principles delivered locally. And that's what we set out in 'A Healthier Wales'. But all of us need to bear in mind that the conversation we have has to mean something to the people whom we're here to serve.