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.