Can I ask the health Minister to make her statement on item 5? 

That statement is the statement on the health and social care outcomes framework. Eluned Morgan. 

Thank you very much, Llywydd, and thank you for speaking so slowly there.

Llywydd, can I thank you for the opportunity to outline the plans of our health and social care outcome framework? Now, in my statement today, I will outline the role and function of the outcome framework, how it's being developed and discuss the proposed next steps.

The Deputy Ministers and I are committed to improving the health and well-being of the people of Wales. We're clear that plans and service delivery across health and social care are focused on doing the right things well and the need to deliver our national sustainability goals.

The development of the outcome framework fulfills our commitment in 'A Healthier Wales' to develop a shared outcome framework based on the quadruple aim, which is improved population health and well-being; better quality and more accessible health and social care services; higher value health and social care; and a motivated and sustainable health and social care workforce. The framework complements the outcomes framework for people who need care and support and for carers who need support, which is part of the Social Services and Well-being (Wales) Act 2014. This framework, together with the public health outcomes framework, will remain and will continue to provide a valuable focus for delivering improved outcomes. The main aim of the new health and social care outcome framework is to measure the impact of health and social care, working together through the lens of our citizens. It prioritises a small number of critical areas that, combined, will improve the outcomes for the whole population of Wales.  

By measuring integrated outcomes, we will shift our emphasis from measuring what the system does to what it achieves for people. It will enable us to demonstrate the effectiveness of our collective actions and help us to answer if we're doing enough of the right things well. It's an opportunity to develop joint plans and accountability, particularly in the context of regional and integrated working. Our current ways of working can lead to fragmented working, which make sense in the context of individual organisations but which are in conflict with each other when looked at from a whole-system perspective.

If we look at our current unscheduled care system, the solutions are wider than ambulance and emergency departments' performance. As demonstrated by the six goals of urgent and emergency care, we need to look across the whole system, including social care, and come up with shared goals and integrated actions. Prevention at all stages needs to be embedded in our actions, supporting individuals to stay healthy, moving from an illness system to a wellness system.

The outcome framework provides the strategic context for the planning and delivery of health and social care services for the future. Its suite of indicators focuses on delivering integrated health and social care services that will make a positive difference to individuals in Wales. The framework has been developed based on three core values: prevention, to support the anticipated health needs to prevent illness and reduce the impact of poor health; equality, improving the lives of all—there is an equitable system that achieves equal health outcomes for all by closing the equality gaps in Wales; individual responsibility, supporting people to manage their own health and well-being, enabling people to be resilient and independent for longer in their own homes and localities—this includes speeding up recovery after treatment and care, and supporting self-management of long-term conditions.

Through a series of workshops and group sessions, we've developed the population-level aspect of the outcomes framework. It sets out the desired outcome for the population, supported by a small set of indicators to measure achievement.

The Deputy Presiding Officer (David Rees) took the Chair.

The overarching outcome chosen for the framework is based upon the 'A Healthier Wales' vision, namely all people in Wales enjoying good health and well-being. This is supported by 13 proposed population indicators that, when combined, will help to demonstrate the achievement of the outcome. Five of the 13 outcome indicators are national well-being indicators that are used to monitor progress against the well-being goals. And a further two outcome indicators are closely linked to the national well-being indicators.

While each proposed indicator has been chosen for its relevance to health and social care and the ability to influence, it is important to recognise that other partners are critical to turning the curve or improving the trajectory of the chosen indicator. Examples include helping people who are lonely and keeping families together.

The next stage of development will be to establish integrated actions for each of the indicators. This will enable us to identify what we need to do to achieve the biggest impact. Once the actions are agreed, they will be used to develop performance measures. These performance measures will be used to hold organisations to account for their respective roles in delivering against the population indicators.

It's now time to share the work more widely and to co-produce the details behind each indicator with our partners. We will work with stakeholders to identify the most effective actions to improve delivery and to make a difference to individuals and communities. Over the summer we will be engaging with stakeholders from all parts of Wales to test the chosen indicators to identify the right actions that we need to deliver.

While the indicators are for the whole population, we know from the initial work and the lessons learned from COVID-19 that the impacts are different for different population groups. We are strongly committed to addressing inequality, therefore stakeholder engagement will involve organisations representing key population groups, such as children and young people, older people, black, Asian and minority ethnic backgrounds, and people with learning disabilities. For each indicator, a standard set of enablers will be applied, which will consider key aspects, such as the Welsh language, quality and value, the workforce and digital transformation.

A finalised framework will be published in October to support the NHS Wales planning framework for 2023-24. The finalised health and social care outcomes framework will be used to provide progress reports to the Senedd on how 'A Healthier Wales' is making a difference. Thank you, Dirprwy Lywydd.

Thank you very much for your statement today, Minister.

And now the premature statement, and I'm glad that I'm on the ball this afternoon. And I welcome the shift in emphasis from managing systems towards delivering better outcomes for those reliant on our health and care systems, namely every single one of us, and I sincerely hope that this framework will help the shift in focus towards better outcomes for the citizens of Wales and, at the same time, help with integrating health and care and removing the artificial barriers to care that have been allowed to grow. Focusing on the lives of our citizens should always be our top priority but, sadly, Governments at all levels too often lose sight of that fact.

Minister, I appreciate that this is not the end of the process in developing this framework, but there is very little detail on how the framework will operate. So, when will we be able to see the details of the outcome indicators, and what role, if any, will the various UN rights principles play in driving the shift to a citizen-focused, outcomes-based approach?

Minister, while I welcome the emphasis being given to ensuring that this cuts across health and care, I do question why you have chosen to run this framework alongside the framework for people who need care and support, and for carers who indeed need support themselves. Do you not agree that having a single integrated outcomes-focused framework that cuts across health and care would be a better option? And by that same token, why do we also need a public health outcomes framework, or the whole raft of other frameworks that we have? My fear is that, by duplicating responsibilities across the multiple frameworks, we will not see a shift in emphasis towards outcomes. Are we not adding to the systems approaches that we tried to move away from initially?

I also have concerns about how we will be measuring progress against the aims and indicators that will form the final framework. So, Minister, how will progress be monitored on this and what instruments are we indeed going to use to monitor this progress? Will you once again be reliant on the national survey for Wales, and do you think that reliance upon a glorified opinion poll is an adequate way of assessing improvements to the delivery of health and care? Have you had any discussions with Cabinet colleagues about how best to utilise technological improvements to capture a wider range of views and year-round monitoring of outcomes?

Finally, Minister, I note that you'll be engaging with a wide range of stakeholders over the summer, and I hope that includes the most important stakeholders, which are, indeed, the citizens of Wales. I look forward to seeing the framework in greater detail and working with you to deliver a truly integrated care system that is focused on the individual. Thank you.

Diolch yn fawr. I'm pleased that we're on the same page on this. So, I'm very keen to stop being in a situation where we're just constantly looking at how much money do we put into the system. What we've got to start measuring is what comes out the other end. What difference will it make to the public and to patients? And if we can do that in an efficient and effective way, measuring what matters to people—that's the other thing. It's really important that it's not just constantly trying to make sure that people are—that we're fixing people, but actually missing the point of their lives.

That's really what's fundamental in 'A Healthier Wales'. It's really trying to make a system that really focuses on what matters to people. I can assure you that what we're trying to do here is to avoid duplication. Now, there are lots of things going on here, but this is the kind of umbrella framework underneath which some of the other things will be measured. So, we already have legislation, for example, in the social care Act that we have to comply with, but which will come under this umbrella now, in the sense that we'll need to know where they meet. So, there are responsibilities on social care, for example, to make sure that people are cared for in their own homes, but that can't be dissociated from the fact that, actually, at the moment, people are stuck in hospital, they can't get out of homes—we're going to look at the whole integration of the system. Accident and emergency—there's an issue there.

So, bringing all this together and making sure everybody knows what their responsibility is is going to be crucial, and I can assure you there are going to be lots of different ways of monitoring. So, one of the things I've been doing today is going through in meticulous detail the integrated medium-term plans in each of the health boards. I don't think they've seen anybody go through it quite with the tooth comb that I'm going through it with at the moment. And this is just looking at: what is it that's in your programme? What's not in your programme? I'm going to be absolutely clear about what is missing from those programmes, but also trying to make sure that we've got the emphasis in the right place. On top of that, there will be the chair's letter—the letter that I send to the chair, and I will hold chairs to account on the basis of that. And obviously we have targets as well, which we will be monitoring, and I'm sure, as a committee, you will be wanting to monitor as well. I can assure you we won't be just taking our reports from the Welsh survey. I think it is important that we get under the bonnet a bit more of that, and I'm absolutely determined that we measure progress. But this is about prevention. A lot of it is about prevention and, in the past, I don't think—. Because prevention is a longer term programme, we haven't measured it in quite the same way. I'm absolutely determined to try to get to a place where we're measuring prevention so that we see the shift in focus from all of our services onto that. 

Thank you, Minister, for this statement. I don't disagree with the wording or the content, and I don't disagree with the aim here. Who would disagree with the aim of trying to create a healthier nation? What concerns me a little is that we could be tied up here talking about what we're trying to deliver but we don't see those robust steps that will take us step by step towards this aim. The Minister is quite right to say:

'Prevention at all stages needs to be embedded in our actions'.

That is so true, but I don't see the signs of the kind of revolution I would like to see. I remember, after a recent statement, I accused the Minister of having missed a nought from the end of a figure that was being spent on preventative measures, and I mean it. We have to aim, ultimately, to spend less on healthcare, and the way of achieving that is that we are a healthier nation because large sums will have been spent on the preventative agenda in all of its forms, but also that there is a change of mindset around the kind of health, care and well-being systems that we're looking for. So, yes, there's no disagreement on the importance of the preventative.

I wouldn't disagree with the second of the three principles: equality. That's crucially important. And in a series of recent interventions, Plaid Cymru has been emphasising the way in which inequalities have been getting worse, rather than improving, here in Wales. And that third principle—in terms of enabling the individual to take responsibility and to make the right decisions—of course that's important, but there are so many people who can't make the right decisions because of the circumstances that they find themselves in, because inequalities lock them into a vicious cycle, if you like. So, we need to identify the blockages. We need to identify what prevents the Government from truly operating in an integrated manner and bringing all of the elements of governance—housing, health, education, socioeconomic issues, all of those—together, and the solutions to those don't exist within a framework of this kind, although the objectives are there. So, the one question is: does the Minister agree with me that it is impossible to improve outcomes unless we eradicate the inequalities that are holding us back as a nation and as a society?

Thank you very much. Well, in response to the final question, whether it's impossible to see a difference being made to outcomes, well no, that's why doing something about inequality is a key part of what we're measuring here. And I'm very eager not to just talk here; what we need are things that are measurable. And I'm determined to ensure that that is possible in the preventative arena, as well as clearing waiting lists and so on. It's so easy to count how many hip operations need to be done. It's much more difficult to say, 'Well, we're going to see fewer children who are obese going to school.' But I do think that it's important that we focus on that aspect, and I think there will be pressure on us to focus almost entirely on clearing these waiting lists, but I think that would be a mistake, because, if we don't do that, the system will just fill up again. So, for me, it's important that we focus on these preventative measures at the same time as clearing those waiting lists.

And with regard to individual responsibility, it sounds good, but, actually, we spent two years telling individuals exactly what to do, exactly where to go, exactly when to leave their homes, exactly whom to meet, how to meet them. So, that shift is going to be quite difficult to achieve, because we've been quite paternalistic over the past two years. Now, we need to get people to take responsibility for their own actions. That doesn't mean that we're going to leave them entirely alone to do that. We acknowledge that some people can do this better than others, but I do think that we have new things to help us with regard to digital measures, for example, where we can help people to help themselves too, and there's no reason why we can't use those new modern measures to assist us with tackling some of these issues.

I thank the Minister.