The next item is a statement by the Minister of Health and Social Services: an update on the transformation fund. I call on the Minister, therefore—Vaughan Gething.

Diolch, Llywydd. In 2016, the four party groups in this Assembly agreed to establish a parliamentary review of health and social care in Wales. The report of the parliamentary review was published in January 2018. That report acknowledged our world-leading legislative framework, the organisational structures that underpin it, and the dedication of our health and care workforce. But it also contained some tough messages for us, setting for us the challenge to transform health and social care in Wales. The simple message at the heart of the parliamentary review was that our current system of health and social care is not fit for the future. Change is not simply desirable. Change is essential.

The Welsh Government has embraced the review recommendations. Throughout spring of last year, we worked with stakeholders and partners in health, local government, the voluntary sector and housing to develop our response. And I published 'A Healthier Wales', our first plan for health and social care, in June last year. Summarised in 40 actions, it sets out the steps that we will take as a Government and those that our partners need to take with us and, crucially, the steps that our partners agree need to be taken to deliver a whole-system approach to reform and transform health and social care in Wales.

Within weeks of publishing 'A Healthier Wales', I announced the establishment of a transformation programme—a key recommendation from the review. That programme is supported by the £100 million transformation fund, and the fund is intended to act as a catalyst to speed up the scaling up of new models of care that have the potential to fundamentally change how we deliver healthcare and social care in Wales. And that change is not simply a financial equation. We have to deliver greater value in how each partner uses their resources to improve the quality of care. Better outcomes and better experiences with and for our people are what drive this programme for change.

We know that the demand for health and social care will continue to increase. That is driven partly by changes in how we live our lives, in life expectancy, in technology, in the socioeconomic context and changing expectations of what modern health and care should be able to deliver. I am regularly reminded that, despite nearly a decade of austerity, the public and indeed politicians have not reduced their expectations of our national health service. New models must not only take into account new healthcare procedures, new medicines, new technology-enabled social care, but also what matters to people—the people who seek social care or healthcare and the people who deliver it. At some point in our lives, this is everyone. 

It is essential that new models for care are cohesive and affordable. We want to connect and streamline services at regional level, so regional partnership boards are essential in making this happen. I welcome the way that partners have worked together through regional partnership boards in developing proposals for the transformation fund at pace. The models supported through the fund are designed to shift the delivery of care closer to home, joining up health and social care services, with more emphasis on prevention. 

We all recognise that transforming an entire system is not a quick or easy task but that we are facing big challenges. The fund cannot resolve all of these concerns, but it can help to demonstrate how we can do things differently and how we can do things better. To date, I have approved seven proposals from regional partnership boards across Wales. These will be supported by up to £41.2 million over the next two years for those plans currently approved. I expect to receive further proposals for my consideration imminently. This is a significant investment. I expect to see real progress in how services work together to deliver more efficient and effective services that make it easier for people to access and, of course, to deliver better outcomes.

I am encouraged by the proposals that we have received so far. Every regional partnership has brought forward ideas and commitment to transformation. We have portfolio proposals from Cardiff and Vale, west Wales, and north Wales, spanning a range of services from preventative to non-scheduled, to post-hospital care. We have proposals from Gwent and Western Bay, north Wales and Cardiff and Vale, with a focus on moving care out of hospitals and closer to home, and from west Wales, looking to utilise assistive technology, community assets and intergenerational support across communities.

The first round of proposals shows a vigorous and confident response from our regional partnerships. They draw together partners from across health and social care and start to shape the transformation that 'A Healthier Wales' describes. We are seeing efforts to share good practice beyond regional boundaries and encouragingly, there are common themes in what change looks like. There is a strong emphasis on bridging gaps and reshaping how people access healthcare and social services. Workforce development is a strong theme in the proposals, reflecting the focus on people that runs through 'A Healthier Wales', including the quadruple aim. Without the dedication of people working in front-line health and social care services and in the third sector, we cannot achieve the essential transformation that is required.

To ensure that we stay on course, we are evaluating and challenging ourselves as the transformation programme develops. A recent rapid review that we commissioned into the scale and spread of the proposals that we have funded through the transformation fund has been encouraging. It is important that emerging new models are evaluated as they develop so that the most promising approaches can be scaled up for wider adoption across Wales. We are working with partners to develop a set of national indicators that will support this aim. I'm confident that with the continued support and goodwill of our partners, we can deliver the change that we all recognise is needed, and needed now. Our challenge is to ensure that there is real transformation and that we avoid the temptation to focus only on the most pressing needs. 

Looking beyond immediate and pressing needs requires extra effort, and it can only be achieved if we work in partnership. So, the role of regional partnerships will continue to be crucial, as they provide the vehicle for leaders in health and social care to work together with others to plan and deliver services that meet the needs of local populations.

Just over a year after the parliamentary review was published, our transformation fund is already making a difference. Each new model that is supported could help to shape and transform health and social care in Wales. What is even more important is that we have begun to see change and improved relationships across health and social care, with a greater sense of shared ambition. That goes well beyond the transformation fund and it will require both goodwill and leadership to maintain that approach and deliver the change that is needed. We still have much to do.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Can I thank you, Minister, for an advanced copy of your statement this afternoon? I'm very pleased to see that cash is being invested in transforming our health services here in Wales. We know that we are behind, in some respects, some other parts of the UK in terms of taking forward particularly closer working between health and social care. But it is encouraging that we're finally investing in these newer models of care in order to get improved outcomes for our patients. The cash, though, that's been spent so far is a bit of a drop in the ocean as far as the overall health budget is concerned, as we all know. So, I think the expectation that you have about this being a catalyst for significant change over the course of this Assembly perhaps is a little bit too ambitious.

Now, I note that you said that you have already approved seven proposals, and I think that that's good. I think in the last statement, only two had been actually confirmed at that time. Can you tell us: have all of these now commenced? You've referred to the fact that they are proposals that reflect all parts of Wales, that there's something operating in each individual regional partnership area, but you've given us precious little detail other than two or three sentences about what is particularly going on in different places. And nor have you given us a breakdown as to where the £41.2 million is actually being spent. So, can I ask you in which health board areas and which regional partnership board areas is that £41.2 million being spent? Is it being spent equally in all parts of Wales, or are some benefiting more than others? 

I also wonder, in particular, what is new about the cash that's being invested, because from what you describe—for example, the use of assistive technology, community assets, intergenerational activity, some of the preventative work that's going on, non-scheduled post-hospital care—a lot of that is going on anyway in our health board areas, and quite rightly. They ought to be investing in these sorts of things because there's a saving to be made further down the line. So, how can you be sure that these are projects that are adding value to the work that's already going on in our health board areas and not simply supporting those health boards, who perhaps may be a little bit lazy about transforming the services in their own areas?

You've mentioned workforce planning, or workforce development, being a strong theme. Pleased to hear that, because we know that we've been abysmal here in Wales when it comes to workforce planning, whether that's the nursing workforce, the midwifery workforce, the GP workforce. I mean, I raised earlier on the fact that you're turning people away who want to train as GPs and come to work in Wales. I mean, it's absolutely barmy, to be honest, that you're not simply just creating more training places to fulfil the need that we have in Wales in terms of the shortages that we've got in some of these disciplines. Can you tell us precisely how many additional staff you expect might be recruited and developed as a result of the proposals that are currently being implemented?

You haven't either given us any indication as to what the split of investment is between social care, community care, primary care, secondary care. I mean, we know that when you invest in primary care and community services, that tends to take the pressure off secondary care, which can often be more expensive. So, where is this cash aimed at? Is it in the hospital end of care, or is it in that primary and community care, which I think is where it may need to be focused?

You made reference to the rapid review, which you've undertaken, into the scale and spread of the proposals. You said that the outcome of that rapid review was encouraging. Can you publish the details of the review? Can you tell us a little bit about how you went about conducting the review, to test what was going on on the ground? I know it's early days for some of these projects, but some have been going for quite a while now, and I think we ought to be able to see pretty quickly whether they are going to be things that have legs or not, and which can be spread in terms of their practice across Wales.

You also made reference to the goodwill of partners in delivering the change that is needed. Now, I know that there's been some good and very positive engagement with partners like St John Ambulance and the British Red Cross of late, and that's work that I applaud, which has been going on in different parts of Wales. Can you tell us whether these partners, particularly third sector partners, are actually engaged in any of these projects, and if so, in what way? Because I think it would be good to know whether you're building on what clearly has been, certainly from my impression, a great deal of success with the British Red Cross up in north Wales.

I think that they're all the questions that I have for the moment, Deputy Llywydd, but I do want to say that we welcome this investment. We do welcome the shift in the right direction. But I do think we have to make sure that this is investment that is being put in the right places and not simply replacing investment that should be in place already, and work that should be under way already in our health board areas.

Thank you for the largely constructive approach to the, I think, six or seven areas of questioning. On your first point, saying we are behind some UK areas in health and social care working together—we're actually ahead of others as well. It was a fact that was acknowledged by Stephen Dorrell—a former Conservative health Minister, now the chair of the NHS Confederation—when he came to the Welsh NHS Confederation dinner. He acknowledged that the NHS England plan talks about needing to have that much greater, more integrated relationship, but he acknowledged that we're further ahead in that journey here in Wales. We're not always very good at getting, if you like, network news acknowledgement of what we're actually up to here in Wales. 

Across health and social care within the UK, there is real interest in what we're doing, and I want there to be a genuinely open and two-way process, where we're interested in not just selling and telling the rest of the UK what we're doing, but actually looking at what the rest of the UK is doing as well. It has to be a genuinely rounded approach. That was actually at the centre of the speech that I gave to the NHS England confederation conference in Liverpool about 18 months ago.

In terms of where we are with the bids, well, we've confirmed each of those seven areas and it's now for partnership boards to deliver against the bids that they have submitted. In terms of where they are, Cardiff and Vale, Gwent regional partnership board—north Wales regional partnership board had two bids approved. Western Bay, which is soon to become Swansea bay university health board area, they've had two bids approved, and west Wales has had one. I'm expecting to have bids from other areas for me to consider—some this week and more in the pipeline. Now, overall, they make up £41.2 million. When we've made each announcement, we've highlighted what those sums of money are. For example, west Wales is over £11 million in the bid that I've recently approved; Gwent, the headline was £13 million—they're looking to reprofile that, but not to remove the scale or shape of the ambition—and others of varying amounts.

Now, the point is that I don't want people to get lost in money, as if this is only being allocated on a fair-share basis for each area, because the money for each of those bids is predicated on what they contain and what's required for each of them. So, your point about staff numbers—well, the bids are not predicated on staff numbers to be supported by the bids; it's how we transform the model of what we're delivering rather than talking about staff numbers. So, the spend depends on the agreed bids, and the staff numbers depend on agreed bids as well. But, crucially, this is about how you transform what comes. So, it's about what comes at the end of each bid, because this is a limited programme in the sense that there is a time frame to it, and what we're looking for is a clear strategy to understand, to evaluate, does it work, and then, if it does work, how is it scaled up and then how do actually those partners spend their core resource, rather than looking for additional money from the Welsh Government. So, that's important about how it adds value. 

The one part of your series of questions that made me wince a bit was when you talked about making sure this isn't supporting health boards that may be a bit lazy about transformation. I don't think that's a fair or a helpful description of any particular health board, or indeed the regional partners, and we've deliberately set this out as bids that have to be supported by the whole regional partnership board. So, it isn't just a health-led transformation programme, it is genuinely about health and social care together. So, health, local government and their partners in the third sector sit around those regional partnership board tables, and, within the period of a few weeks, housing will be there on a regular basis as well. And the point is that they have to follow the design principles that we have set out in guidance, and so that does look at how you add value. It must be about being genuinely transformative and having a real potential to be scaleable, rather than a micro project that everyone who lives around there will talk about but has no prospect of working across the whole system. I previously made it clear that the primary level and the partnership between health and social care is the area where I see this fund making the biggest difference. So, I'm not looking for projects to transform within hospital-based services. It doesn't rule out or say that no hospital-based service may apply, but the biggest aim and value and gain to be made is in that partnership with primary care and the partnership with social care. 

In terms of the review, it's an independently commissioned review. It's been shared with the transformation panel. It was a range of external actors outside Government as well. It's got points about what we can do to improve where we are, as well as the areas where we're working well. I'm happy to share key messages on that. It may be helpful if I write to Members, as we get through having made the next round of announcements, to give some of the headlines about that independent review—and I recognise that the Chair of the health committee and others are in the room—and to share those key messages with members of the committee and some of the points about where we are currently in the transformation fund and more broadly on delivering 'A Healthier Wales' as well. I'm fully expecting to be invited to the committee at some point to explain where we are and where we're not. 

On third sector involvement, that is for regional partners to determine. I'm not going through each bid and saying that I expect a certain sum to be allocated to a third sector partner. I am well aware that, on a range of the bids delivered, it will involve the third sector not just in agreeing what happens, not just the third sector partner around a regional partnership board table, but more broadly than that, actually, the delivery of it will require the third sector and that will vary from each partnership board, depending on the bid that it is and the area of transformation they're looking to deliver. 

I'd like to welcome the Minister's statement and to reiterate my party's support for the transformation fund. It is a bit like taking one tugboat to try and turn around the Titanic, but the Minister has acknowledged that, and it is all about identifying good practice. I was also encouraged to hear the Minister say at the end of his statement that we still have much to do, because I think we all know that, but there is potential here in some of the projects that I'm personally aware of that have been put forward by some of the regional partnership boards in my own region—some of them quite simple ideas, but ideas that needed resource to put them into practice and that could make a tremendous difference. The Minister is right, of course, when he says that it is a challenge to service providers, especially in difficult times, to look beyond immediate and pressing need, and the transformation fund, I do accept, has given them an opportunity to do this and to look at working together in a new way.

I'd like to ask the Minister some specific questions. The first one is about how much of the £100 million has actually been committed up to now. The Minister mentions £41.2 million in his statement to us today. It's my understanding, in the papers that have gone to—very grateful to the Welsh Government for providing papers—the health committee, that a figure of £65 million has been mentioned. Now, it may be that those are projects that refer to—. That may refer to projects that the Minister is expecting to sign off—as he's already mentioned—later this week, but it would be useful to have some clarification there. I have to say that, if it is the £65 million, I'm very pleased to hear that, because I think the Minister would be right to believe that the faster we get the money out of the door, the faster we get the projects in action, the faster we can learn from them. But I would welcome that clarification.

Now, it's clear from the Minister's responses to Darren Millar that we haven't yet had bids from all the regional partnership boards. Again, the health committee papers refer specifically to nothing yet being agreed for Powys. Now, obviously, as one of Powys's representatives in the Assembly, this is something of a concern for me. So, I wonder if the Minister can tell us a little bit more this afternoon about what steps he and his officials are taking to make sure that there are bids in from boards all over Wales. I completely understand the points that he's made to Darren Millar that this is not some sort of tick-box exercise, that it doesn't mean to say, 'We spend this much money here and this much money there and this much money there.' That wasn't the intention of this fund, and we all supported that, but I would personally be very disappointed if we reached a point when there wasn't at least one potential project everywhere in Wales. And I would associate myself with what the Minister has said: I'm sure that those working hard to deliver our services and working in the regional partnership boards do want to really use this money to the best effect, but it would be a great pity if there was any community in Wales that didn't have some potential benefit.

If I can refer, then, to the regional partnership boards as, obviously, they're going to continue to be crucial in rolling this work out, can I ask the Minister to tell us a little bit more about how he and his officials monitor the performance of the regional partnership boards? I've had particular concerns raised with me about accountability because, obviously, you have people from all these different bodies coming together. How are they accountable back into the communities that they represent? So, I'd be interested to hear a little bit more from the Minister today about the guidance that's provided to boards in terms of how they relate to their local communities.

If I can refer, then, again, to the whole area of scaling up the projects, the Minister has referred in his statement and has said a little bit more in response to Darren Millar about the rapid review. I was pleased to hear that that was independent and I look forward to the Minister writing to us with some more details about what that found, but, at the same time, the Minister's statement talks about developing a set of national indicators. So, could the Minister tell us today a little bit about what were the criteria used by the rapid review? If we haven't yet got the national indicators—and I very much welcome the fact that partners are being involved in this process—on what basis was the rapid review making its judgments about what has been achieved so far?

The £100 million is very welcome, as I've said, but it's a very small sum compared with the £7.5 billion total health and care budget. I hope the Minister would acknowledge that we have historically in Wales suffered a little bit from 'projectitis'—that we have good ideas that are tested, that they prove to work, and then get lost when the grant funding ends. Now, I know it's not the Minister's intention that this should happen with regard to projects funded by the transformation fund, but can the Minister tell us a bit more about how he intends to ensure that this 'projectitis'—the good project that disappears when the money is gone—is not going to be the fate of some of the very positive work that can be funded by the transformation fund? And can he outline for us today the process he will use to ensure that the successful projects this time are actually scaled up and that we don't find ourselves again in five years' time saying, 'We know that worked very well, but, for whatever reason, we didn't make that work across Wales'? We are, of course, a country of very varied communities. Things won't always work from one place to another, but the whole purpose, as I understand it, of the transformation fund is to provide good practice that can be scaled up, and I think it's crucial that this Chamber understands how the Minister is going to make that happen.

Thank you for the questions across a range of areas. The £41.2 million is the figure for the seven bids that I have referred to. The larger amount that you refer to is the potential in the bids that have already been received that I am looking forward to reviewing—over this week is my ambition; I would like to make choices on those to allow people to get on with delivery. There are other bids in the pipeline, and I'm happy to reassure the Member and the Chamber, and anyone watching, that I confidently expect every single regional partnership board within the country to have a bid within it. Absolutely. That includes Powys, it also includes Cwm Taf—their bids are in discussion with officials. So, they are at an advanced stage, as opposed to a thinking, pondering and considering stage. And, actually, being in a position to start making announcements, as I was in the autumn, was helpful about generating pace in other parts of the country—nobody wants to be seen to be left behind—but also about the sharing of the information in the areas that are being covered as well at the outset. And, more than that, our plan is to share evaluation and learning through this process as well. So, as we go through, the learning will be iterative as well, and I want to make sure that is deliberately plugged in. So, part of the point about having the rapid review is to make sure that we can understand both against, obviously, the evaluation priorities within each bid, but also the policy priorities within 'A Healthier Wales' and the design principles that we set out, to make sure that we're actually—in having an external review, whether they're actually approving bids that actually are true to the policy priorities and the other design principles that we've set out.

On partnership boards and their links to local communities, I think we're straying slightly from the transformation fund, but, of course, local government members have their own mandate and their own democratic mandates to undertake their functions. We agreed in the Social Services and Well-being (Wales) Act 2014 to create regional partnership boards to try to draw people together. So, we decided, as a national institution, to create that structure, and some of our challenge now is about how we recognise the different partnerships that we have and making proper use of them. So, they're a forum for people to make sure they agree on what they should do and then to go ahead and deliver it. And we have varying local, regional and national accountability mechanisms for that, including, of course, the conversation we are having in this Chamber today.

The transformation fund, as I set out on a regular basis, is not so much about the use of the £100 million. I really do try to avoid getting drawn into the shares for different parts of the country. The £100 million is a catalyst; it is a way to design and deliver the future—to draw together the best ideas to have the most transformative impact. And it's at least as much about having our health and social care system see together a level of ambition and to recognise what they can do. So, if there is not a transformation fund, then we've created the sort of culture and environment where, actually, those partners can, together, continue to transform health and social care. Because we won't do everything that we need to do in the next two years and the lifetime of the fund. So, it is about the impact that transforms the use of the current approximate £9 billion of shared resource that health and social care have that is the objective of the transformation fund, not about how we can spend the £100 million itself.

And in terms of how we're going to be able to do that and how we're going to be able to demonstrate and evaluate the impact of the fund, well, there'll be an evaluation at the end of each project. But, more than that, it's about what we then see being delivered in the joint plans of partners, about having joint health and social care plans that people buy into, and that, if there is a successful project, that then that partnership will be able to take that up, and, actually, how successful we are in scaling that up on a national level. So, there's a role for individual partners within that. There's a role for regional partnerships, and, of course, there's a role for the Government as well. For example, when we approve the integrated medium-term plans of health boards will we see, and will there be an expectation—if I am in post, you can expect there would be—that successful ideas are scaled up and you see a progressive way that they're going to be implemented within health board areas that start them, but also those health board areas that are not growing those particular bids? So, I expect to see real national input. And a good example would be, for example, the transformation in Gwent on children's services and a more preventative approach to mental health. Well, actually, that's part of what they're looking at. Now, if that works in Gwent, I would need to be persuaded that you could not and should not want to see that scaled up in other parts of the country, and we have different mechanisms as to how we could look to do that.

Thank you very much, Minister.