I'm pleased to contribute to today's important debate. I think an important point to be made at the start of this debate is that nobody—certainly nobody in this Chamber—denies that the NHS needs to change and to change in a transformative way that makes it fit for the twenty-first century, not just the twentieth-century, for which it was originally designed. It is, of course, the type of change that is in question. Is that change progressive? And, most importantly, does it carry the public with it? Too often, we see that it doesn't. 

Point 1 of our motion draws attention to the concerns of patients and clinicians regarding the performance and future of NHS emergency departments. The arguments against the downgrading of services in rural Wales are well-versed. Withybush hospital in Pembrokeshire is often discussed in this Chamber; today, we have the discussion surrounding the Royal Glamorgan. The loss of vital services, including paediatrics and accident and emergency, leaves patients having to travel much greater distances for their treatment.

Now, I know, from this debate and questions earlier, and indeed previous debates that the health Minister has taken part in, that he will argue that it is the quality of the healthcare on offer that matters, and its long-term sustainability, its safety, not the distance travelled for it. But the point is that the public are clearly not convinced about this and are not being carried along with the argument in the way that they should be. So, something is clearly going wrong with the proposals before us and the Government's way of consulting. 

Now, to be fair to the Welsh Government, it's not a universally gloomy picture across Wales. The reconfiguration of services in my area, in south-east Wales, as result, primarily, of the Gwent Clinical Futures programme, which I know Lynne Neagle, Member for Torfaen, has been involved in along with me over the years as well, has, by and large, met with support from local people. There have, however, been recent concerns about the extent of the loss of services, particularly A&E from Nevill Hall, to the new Grange university hospital in Cwmbran. There is a moral here—that people support change, but can only take so much in one go, and it has to be sold to them, they have to be part of that change, engaged in it, consulted on it and action it. 

A&E is a very sensitive issue, perhaps one of the most sensitive issues in the health service. Out-patients want to be reassured that those services are going to be available where and when they need them. The term 'minor injuries unit'— and I think it was Mick Antoniw in his excellent speech who mentioned minor injuries units—whilst it may work well on paper, when people are planning the layout and the division of new services, the sad thing is that, when you're out there, on the ground, talking to people, the term 'minor injuries unit' simply does not wash. It does not cut it with the patients and it does not cut it with the clinicians. It is no substitute for an accident and emergency unit, certainly not along the lines of what we've been used to previously. 

As I say, the reconfiguration in Gwent has largely been supported and accepted, but that is certainly not the case in other parts of Wales—certainly Hywel Dda. The proposals to end 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department have, of course, caused major concerns and those have been raised in this debate. There are choices here. Yes, the NHS requires massive resourcing. Modern treatments cost money. Money has been tight. Resources are tight. But, as previous Members have said, the Welsh Government can give a steer. It can intervene, if appropriate, and it can stand up for local people and local services if it wants to, if it believes that those priorities are the priorities of the Government and of the people, and, let's face it, this is what most people want. 

I think we need to recognise that there are no easy solutions here. There are structural problems that have built up over many, many years in the NHS—prior to devolution, in fact—and problems that are not easy to resolve. Simply saying 'We will downgrade services in one area and beef up services in another'—if you're lucky—just doesn't wash in the current climate. Transformative change needs to be accompanied by a vision, a vision that carries the public and clinicians with it, that truly does what the Welsh Government often in debates in this Chamber says that it wants to do: puts the patient at the centre of the process. How often do we talk about co-production, putting the patient at the centre, putting the recipient at the centre? Yes, a great idea on paper, but it hasn't happened hitherto in debates such as this, and that is what needs to happen.

In the absence of that vision, I believe, along with other Members, that downgrades of services should at least be put on hold, that they should at least be reconsidered, and that there should be a reassessment of restructuring across Wales where it is blatantly obvious that that restructuring is not supported. And the patient really should be put at the centre of the process.