The next item is a statement by the Minister for Health and Social Services on the 'A Healthier Wales' transformation fund progress report. I call on the Minister to make the statement—Vaughan Gething.

Thank you, Presiding Officer. Last summer, I provided a written update on 'A Healthier Wales' and the transformation fund to Cabinet. I am pleased to provide a further update today to Members on the transformation fund.

I launched the £100 million fund in September 2018. The purpose of the fund is to support the scaling up of new models of seamless health and social care across Wales. New models of care were a prominent recommendation from the parliamentary review. This approach is reflected in the published guidance for the fund and in engagement with regional health and social care delivery partners. 

Every proposal has been considered against the 10 design principles set out in 'A Healthier Wales'. Those design principles bring together several key strategic considerations, including our commitment to prudent healthcare principles, the quadruple aim endorsed by the parliamentary review and the five ways of working incorporated into the well-being of future generations Act.

I have always been clear that regional partnership boards have a key role in driving transformation. That is why proposals needed to be supported by one or more RPBs. The Deputy Minister and I have met several times with key stakeholders and leaders in each region to understand the key pressures and to see developing new models. I'm encouraged that our regional partners have risen to the challenge. They have brought forward a range of proposals that show a desire to innovate and a genuine commitment to significant transformation. 

The Deputy Presiding Officer took the Chair.

To date, I've already awarded £89 million to support 14 proposals, with at least one in each region. Transformation projects are visible across Wales. For example, technology-enabled care in west Wales is bringing communities together and reducing social isolation. In Gwent, services are being reconfigured to provide specialist expertise to staff on the front line in order to support some of our most vulnerable children. Community Connectors in the most rural parts of Wales are helping people to access local well-being services. Over 1,000 expressions of interest have been received for the I CAN mental health support training that is now being rolled out across north Wales. I'm grateful to all of our regional partners for their enthusiasm and the tireless work of their regional teams in turning their ambitions into reality. 

As all of us know, health and social care is a complex system that is continually under pressure. Quickly translating policy into tangible change on the ground is a real challenge, and that is, after all, partly why four parties from this Assembly agreed to commission the parliamentary review in the first place, and we're now implementing the recommendations from the review. Of course, I set out the Government's approach and vision in 'A Healthier Wales', but we must continue to engage closely with our delivery partners and to evaluate the impact of what we do.

So, we have completed two rounds of quarterly reviews, with the third round imminent. Fourteen workplace engagement events highlighting local transformation projects have taken place across Wales, organised and run as a partnership by the Welsh Government and regional partnership boards.

I've listened to feedback from regional partners who told me that initial progress was slower than they had expected, largely due to recruitment and procurement issues. In response, I have extended the funding period in support of new models from December 2020 to March 2021. I've always been clear, though, that the transformation fund is intended as a catalyst and will be non-recurrent. Regional partners need to identify resources from their recurrent budgets to support the scaling up of transformation, including further transformative priorities. 

I also promised to look closely at options for the fund, including how to allocate the remaining £11 million. Given the delays in the budget process by the UK Government, we, of course, face a very challenging situation, and I also recognise the need and the reality that limited funding for the health and social care system has to support the whole system.

I'm grateful for the work and commitment of partners in developing their second-round proposals for the fund. In taking into account learning from the first round of proposals, I've made a decision, and I've written to regional partnership boards to set out the indicative allocation of the remaining transformation fund budget. This will be delivered on a regional basis in line with the NHS funding formula for health boards together with a call for new proposals that build on existing projects. That should enable regions to frame the scale and scope of their proposals in terms of an approximate funding envelope, to help focus time and regional effort. Confirmation of funding will be subject to regional partnership boards submitting viable proposals. I'll be looking for submissions that enhance and supplement approved proposals, with an emphasis on scaling out from single-region to multi-region working and to national scope.

A template and supplementary guidance will be provided and bids will be assessed by the appraisal panel within a set time frame. The core criteria for the fund will remain as in the published guidance, with that emphasis on multi-regional working and national scale. 

I expect regional partnership boards to provide proposals by the middle of March 2020, so within the next few months, and I will then promptly confirm decisions to regional partnership boards thereafter. The transformation fund team are available, of course, to support regions as they develop their bids. 

This, I believe, is a flexible and pragmatic approach that recognises the current position of our budgets, the urgent need to offer clarity to regional partners, the challenges in the delivery of approved proposals, and learning from the implementation to date, which has highlighted the need for further support to enhance the existing transformative progress. I look forward to answering questions from Members today.

Good afternoon, Minister. I do welcome the statement. It's good to see the 14 projects that have been funded, and I'll be very interested to see how the other £11 million is finally deployed.

I'd just like to pick up on a couple of points. Regarding the final funding round, could you clarify whether you'll be targeting applications from any specific health board area, or will you be looking at a whole-Wales approach? And you say that proposals should be brought by mid March. Do you have a deadline for when you would be setting yourself a deadline for when these proposals might be signed off?

In the statement you gave on this fund last year, you said that workforce planning and workforce development would be a strong theme, and I wondered how this ambition is progressing and what evidence is there that the projects promoting better workforce planning are making that difference. Again, in last year's statement, my colleague Darren Millar stated that you hadn't given us any indication as to what the split of investment would be between social care, community care, primary care and secondary care. Are you looking at it in those terms or is it very much in the round? Because I have obviously had a look at the projects that have been agreed so far.

The statement draws reference to how the fund is intended as a catalyst and will be non-recurrent. What process exists if these schemes, once funded, ultimately fail? How are you able to ensure sustainability and ensure, if it's a good project, that it actually does get that buy-in from the people around it, the organisations around it, to be able to move forward? I just wondered what checks are in place to measure the success of a scheme.

Last year you highlighted that you were working with partners to develop a set of national indicators to evaluate new models as they develop so that more promising innovations can be scaled up, and I wondered if you can give us an update on what those might be. Following on from those aims, you expressed your desire to see these projects cross borders, and, again, it's all about what support will be there to fund schemes that are deemed a success in one part of Wales to ensure that they do make that transition across to other parts and pollinate through well.

And, finally, you put a lot of emphasis in your statement on the regional partnership boards and doing everything through them, and, of course, you'll be aware of the Wales Audit Office report on the regional partnership boards that showed somewhat patchy and inconsistent outcomes in some areas, and I wondered if you might be able to give us some reassurance that, whilst you're putting your trust, your effort, and you're asking them to come forward with those ideas, they will be able to take them forward and they will have that strength and support to make sure that this transformation money isn't wasted.

Thank you for the list of questions. In terms of the £11 million in the second stage, as I tried to indicate in my statement already, I will be targeting that in the sense that one regional partnership board area will have a larger sum than others, apart from the way that the funding formula works, which already takes in the variety of points about need and population. So, we will then publish the amount of money that each regional partnership board has potentially to bid against, but, of course, partners themselves will have budgets to add to or otherwise. And I think I want to link that to a couple of the other points you made, both about evidence of progress, the national indicators update, and the transition from one region to another and the scale of that. Because the point of the second stage is, if there are novel and new things boards want to do, about what those are, together with the design principles, with an emphasis on wanting to see people taking on board across more than one region what is working in another, and I want to see more scale as that develops. Because, when we get to the end of the transformation fund period, we'll still have choices to make, regardless of who is the Minister at that time or not, about how we take that forward.

And the point about regional partnership boards as a key building block to this is (a) they already exist. People are used to having to make more and more choices together to share information, share learning, and actually to resolve problems together as well, because none of us should pretend that, even within our own families, let alone groups and different public services, we all agree on everything all of the time. So, it's a way to resolve those differences but then to still have a plan that people sign up to for the future. And I do think, bearing in mind your reference to the confidence we can have in partnership boards, we can have real confidence, because you can see not just that they came together to agree bids, but, on a range of areas, they are starting to make more more of a difference. And, in winter, for example, the fact that every regional partnership board agreed how to use winter moneys, rather than having a big row about who had which share of it, and what the whole-system priorities were within that area. That does give us more confidence about practical choices being made. I'm hoping for more of that, and then there'll be an open question for me or a future Minister about what then happens if we end up driving that further.

So, after this next stage, the transformation fund is over. Is that about money? Is that about encouraging people? Is it about requiring people to do things? Or is it more than that? But that would be forecasting the future, ahead of the evaluations we've had on the success of the projects. And I think that does come back to your point about evidence on progress in stage one and your point about the questions that Darren Millar previously asked on whether there was going to be a split between primary care, secondary care and social care. I don't think that's helpful, so I do want to look at it more in the round about the impact across the system. That's also the point about having partners agreeing together what should make sense, because, otherwise, if it got to be what's a split between different parts of our system, you can easily see those people moving off into corners saying, 'This is my money to decide what to do with,' rather than, 'What should make a difference for the person who will need to flow through and around that whole system?'

I said in my statement that the third of the quarterly evaluations is due imminently. What I intend to do is to write to the Health, Social Care and Sport Committee after the fourth evaluation we've had, so a full year's evaluation of each of the areas, and to give an update at that point. I imagine the committee may or may not decide they want to look at it in more detail, but there'd then be a public and visible, 'Here's the progress at that point, and the progress across the system.' You could also check that off then against the national indicators. I think it'd be helpful to see that together with the context of the evaluation and progress.

We should also then have decisions made on each of the second-stage bids that I've announced. I can't give you a hard deadline as to when I'll respond to that, because, of course, I need to see what the bids are and whether there is a need to go back to people before making a decision. But I am keen to make choices sooner rather than later, so we can get on with delivering the future. 

I'm grateful to the Minister for his statement and to see the progress that's been made in this important area. I welcome what the Minister has to say about the next stage, looking at more cross-regional working and looking at national scaling up. I won't, Dirprwy Lywydd, trouble the Assembly with some of the questions that have already been answered with regard to points that Angela Burns has made, but I would like to explore a little further with the Minister this whole scaling up and rolling out issue, because this has, I think, been one of our problems in Wales, not just in the health and social care system; that successive Welsh Governments have invested quite a lot of money in innovative programmes, where they've come up with some really good projects and really positive working, but we seem to fall down at that point when we need to translate that into a national programme and national transformation.

Now, the Minister quite rightly in his statement refers to initial progress being a bit slower than he'd expected, and that's understandable, I think, and he mentions that there were recruitment and procurement issues. I wonder if the Minister can tell us this afternoon a little bit more about what some of those were, or if it's more appropriate if he writes to us, because I think it's very important that we understand what those are in order to be able to scrutinise how the work moves forward. Because if there were recruitment and procurement issues in the early stages, one would expect that those will re-occur or may re-occur when upscaling and moving towards national programmes takes place. So, I'd be interested to hear a little bit more about what those actually were.

The Minister also refers to the clarity that he's always given, in fairness, that this is a one-off set of money, that it's to give people an opportunity to innovate, and that he will expect long-term delivery of the learning through core budgets. I think we would all expect that. But I wonder if the Minister can tell us a a little bit more about how he intends to work with the national health bodies and, indeed, of course, very importantly, the regional partnerships and social services to ensure that that actually does happen.

I fully appreciate that the Minister is not in a position yet to tell us what lessons have been learned from the programme, because the evaluations aren't finished, so it would be foolish of us to be asking for that. But I would imagine that there are some issues beginning to emerge, there are some patterns beginning to emerge. I very much welcome, by the way, the Minister's commitment, when you've got a whole year of evaluations, to share those with committee members, I'm sure we'll all be very grateful to see those, and it might be useful to have a statement to the Assembly at that time, in case there are Members who are not on the health committee who also want to contribute.

So, if we can hear a little bit more about what the barriers have been, a little bit more about the Minister's thinking in terms of, when the lessons are learned, how that's going to be driven through the system, because the Minister's statement itself says that that can be difficult. And the Minister refers to the transformation funding team being available to support regions as they develop the bids for the next round, which is obviously very helpful. Does the Minister intend that that support will then be in place, or some sort of similar support, when we come to the perhaps more difficult point where the transformation funding money is over, the lessons are learned, and that needs to be mainstreamed, if you like, needs to become part of core business. Because that is, as I've said, where we've tended to fall down in the past.

This is a really important innovation. The Minister knows he's had cross-party support for what he's trying to do with it. But we need to make sure that this is not going to be another one of those excellent innovative programmes that then hits the buffers when health bodies, and indeed social services and all those who sit around on the partnership boards, need to change the way they look at their core budgets when this very welcome pot of money has run its course.

I think there are some central challenges there. In terms of the progress, I was actually really impressed by how the first three or four regional partnership boards managed to agree their proposals in the time that it took to agree them. In particular, I can honestly say that I thought that north Wales, given the range of challenges that they're facing, agreed an approach very quickly. I expected them to be slower than they were, and I think that's a testament to the improved partnership relations that exist, from all partners in the room around the regional partnership board table.

It's then the challenge of getting it from having a plan, and then recruiting people, and more than that about backfilling some of those posts as well as people then move around. We've seen this, for example, in some of our other programmes where we've decided to move people around. To have a plan that everyone signs up to, but then to recruit those people there's a process to go through, all the people who are doing the recruiting, and then the recruitees are then moved, and then to make sure that we don't undermine the services that we currently have.

Because we've deliberately done this to double run services, because we haven't wanted to withdraw services and then say, 'We are creating something that will be great, so just cope without it for a while.' So, we've done this deliberately, and the practical reality of doing that has rubbed up against what should have happened or would have been possible in theory. So, it's simply a practical point, and I didn't want to shorten the time that each of those transformation projects had to demonstrate the value that they'd delivered in transforming the system. That's why I've extended the time frame for those transformation fund proposals to run, to be evaluated, and then for choices to be made.

Now, the transformation fund goes up to now the end of March 2021, and of course there are other events that many of us will be involved in at about that time, in terms of the future of the Assembly and looking at who the next Government is. There's a choice about what choices are being made at the very end of this Assembly term, although we'll be a Welsh Parliament/Senedd by then, with our name change. At that point, we need to make some choices about what the future looks like, and choices we can make within the budget. But then whoever the Government is will want to make choices about what to do to move things forward. That's the central point: not just, 'Do we have a list of things that appear to work?', but, 'How do we then make them work across the system?' That's one of the challenges I set about having projects that are potentially scalable, as well as the honesty about where things haven't worked and turning the tap off.

So, Ministers can do a number of things to try to encourage people to work together and to roll things out. You can encourage, and tell people you're very impressed with them, and that does work from time to time with different people. You can demand and bang the desk, if you like, and there are Ministers in different institutions who think that's the way to do things—that isn't the approach I take. You can have legal powers—you can either change the law or use the legal powers you have to force people or require people to do things. And we've taken some of that approach, for example, with the Social Services and Well-being (Wales) Act 2014 that Gwenda Thomas piloted through this place. That required people to have pooled budgets in place, but actually, despite the legal requirement, bringing it together has been very difficult, and there are real practical challenges. In this space, I think, they'll have reasonable relationships and they'll be in an even better place to have to make choices together, and they've made choices about how to spend not just money, but to deliver improvement.

Then the two things that I think will really help to drive where are is about how we tie money into it. So, even with the £100 million that we've announced now, and I've confirmed how it will be spent today, that has generated more than £100 million in the sense of the extra work that has been generated across regions, between partners, and I expect we'll see more of that. There are choices that Ministers will need to make in the future about whether we expect to see a roll-out and to tie it into money, and there are incentives for doing things, about choosing how to move on on some of this. And there's also just a necessity for change, because the parliamentary review talked about the necessity for change. And we have choices, and our central choice is to allow change to happen to us, because we wait for a point of crisis and our system breaks. We have to fix it in a rush. Or we'll make a choice, because a necessity drives us to it, because we can see that point coming closer and closer to us. Now, I think it would be a combination of each of those, but I'm most interested in the willingness and the necessity that partners have, the commitment to want to do things differently, to get over some of the organisational and cultural barriers to change. And I do think that the way that we use money will be a key part of that as well, to incentivise the future.

These fissures are rather starkly evident, so we better get on with this change, or we're going to bankrupt our health service. More and more research evidence underlines the importance of encouraging people to be and stay healthy through eating clean, fresh food and doing regular, vigorous exercise. And that's not just in our youth, but also throughout our lives. And we know that that is the best way and the cheapest way of keeping people out of hospital.

Camilla Cavendish, in her book Extra Time, talks about 10 lessons for an ageing world. We're talking about the importance of growing old disgracefully. However, given the obesity epidemic across all ages, that is easier said than done, and we already have huge differentials in life expectancy from one ward to another in my constituency alone. So, I'd be very interested to explore further how you plan to do this scaling up.

I see that the Cardiff and the Vale regional partnership board's project on Me, My Home, My Community does talk about community gardening projects, walking groups, Men's Sheds, and talking cafes, all of which we know work well for people, but could you tell us about the size of that project and how you're going to be measuring its effectiveness?

That will be measured against the evaluation process we have, and it goes back to the questions that I've answered from Angela Burns and Helen Mary Jones, and it's then about, well, is it then at a point where it can be scaled? Because part of our challenge is that each of us within our own constituencies or regions could point to things that we think work really well in a local areas, but we know that they aren't necessarily going to work somewhere else. And sometimes we meet people in our communities who we think are really inspiring, and they bring people together in a way that doesn't work just a few miles down the road. Well, that's not a systemic way to improve our health and social care system. So, it is about the scale of those projects; whether they can be scaled up to a much larger scale or whether, actually, that represents a system approach or a local approach.

There's nothing wrong with people having a local approach to work within that community. From a whole-system point of view, the new models of care we need to impalement have to be bigger and more scalable. That's why I set those parameters for the second stage, and it's also why, in response to Helen Mary Jones's questions, I've pointed out there are a range of areas where Ministers can make choices to help, encourage or require people to change. This is also about the drivers from regional partners themselves, who recognise that the system can't carry on as it is and deliver on the level and the quality and the dignity of care that all of us would expect for our own families, let alone our constituents.

So, I do think when you see the sharing of the evaluation after a whole year, I hope it'll give you some of the more detail around that. But of course, Members in their own local areas are perfectly entitled to approach their local partnership board for an update on practical progress already. I know, in some of the Cardiff areas, they're ahead in some of the seven portfolio areas that they've got than in others.

The other point that I'd just make is it's helpful to remind ourselves about the point about preventable ill health as well. It's not just about demand on the health service, but social care too. So, diet, exercise, smoking and alcohol are four big areas that we all know we can make a difference in ourselves, but it's about how we help and encourage people to do that, and actually the transformation fund itself has deliberately taken an approach that is about prevention and earlier intervention to help keep people well rather than the acute intervention when people are already acutely unwell.

Thank you very much, Minister. Thank you.