As austerity continues, the amount of money needed to run public services to the level the public want and need is not being provided. I'm sure the Minister will agree with me that austerity is not an economic policy but a political direction of travel. The Conservatives at Westminster want to reduce public expenditure and roll back the state provision of services.

As we pass the tenth year of at best sluggish economic growth, we need a change of direction and we need economic growth. The amount of money available to run the public services in Wales is inadequate. Unfortunately, we have to have a budget based upon what is available rather than what the people of Wales need.

I will be supporting the budget today but I would be failing in my duty to my constituents if I failed to raise the serious concerns I have. Firstly, I have seen no evidence that the budget has been driven by either the programme for government or by the future generations legislation. What this budget has done, in line with all recent ones, is increase the share of the Welsh Government budget spent on health and reduce the proportion spent on local government and other services, with some protection for the economy and transport. At a recent Finance Committee meeting, Michael Trickey identified when the percentage of the Welsh budget allocated to health would reach 60 per cent if the current policy continues.

Health is, in my opinion, a misnomer. The money is allocated to health, then it goes to the health boards, then it goes mainly to hospital services. The proportion of the health budget spent on primary care is decreasing. The Royal College of General Practitioners regularly identify the relative reduction in primary care expenditure. This is affecting primary care practices. Between October 2015 and October 2018, 21 GP practices closed, 37 submitted a sustainability application to the health board, and 45 practices were at risk. Too many people are now using accident and emergency as their primary care service, which is causing huge problems in A&E. There has been discussion on prudent health: diet, obesity, exercise, not smoking, limiting alcohol intake—all reduce ill health, and I think we need to talk far more about reducing ill health than we do about trying to treat people at the end of it. Let's have fewer ill people.

The auditor general, in about 2015, produced a report on medical interventions that do no good to the patient estimated at that time at several hundred million pounds. This did not include expenditure where the operation was successful but, following hospitalisation, the individual was no longer able to look after themselves and ended up in a nursing home. Elderly people who are just about able to cope at home with community care support, too often end up in a care home after a successful operation. And I had one of my constituents who didn't end up there, thankfully, because he was only in hospital for one week—he came back having lost 10 lbs, having lost a lot of mobility, but he recovered. If he'd been in hospital another seven days, he almost certainly would have ended up in a nursing home. I think this is where one of the problems is: we treat parts of a person, not the whole person. I'm sure that a lot of elderly people, if you told them that the choice was to continue having pain with their knee or end up in a nursing home, might well decide that they can continue to live with a little bit of pain in their knee. 

The late Dr Julian Tudor Hart, with others, identified expenditure on things such as reducing slightly raised blood pressure that do no identifiable good to the patient, yet we still pay substantial sums for the medication. The First Minister, whilst health Secretary, identified the different intervention rates for the removal of tonsils between two areas in the same health board—twice as likely to have tonsils removed in one than the other.

The Nuffield Foundation produced research showing that there has been a reduction of over 25 per cent in total in-patient admissions per hospital community health services doctor between 1999-2000 and 2011-12. Now, I'm not saying health is not important, but health boards do tend to act in a vacuum, and there is an awful lot of other things happening out there that need to be dealt with. I have not got time to expand on this statement, but I believe that the current structure of health boards and the ambulance trust is less than optimum.

On the rest of the budget, local government continues to be under pressure, despite providing services that can improve lifestyle and, hence, health. The importance of community care to allow people to leave hospital and also to keep them out of hospital—. I think that we underestimate the work done by a number of relatively low-paid, predominantly women in the social care service, which keeps people in their home and gives them a good lifestyle. I think we underestimate how much use they are, and I think it's unfortunate that, because of budget pressure, too many of those have been moved out of being directly employed by local authorities and have been moved into the private sector.

Also, local government provides the services we use continually: the roads, the pavements, the rubbish collection, street cleaning, parks, libraries, as well as education. That really is, for many people, the way of improving the lifestyles and life chances of them and their families. I think that we need to talk more about providing additional resources to education, so that every child gets the opportunity to do the best they can.