Jeremy Miles
Welsh Labour and Co-operative Party · Wales
“I think the Member is right to point out that there are challenges in recruitment, and that can affect certain disciplines within oncology. I think it’s a challenge that other parts of the UK also share. The Member shares statistics and numbers with us today that suggest this is a pattern not exclusive to Wales.”
“Byddwn i’n argymell iddo fe edrych ar y gwaith mae canolfan genomig Cymru yn ei wneud yn y maes hwn, yn aml yn gweithio ym maes canser—maes canser yr ysgyfaint yn ddiweddar; gwaith blaengar iawn wedi bod yn digwydd fanna.”
“I thank the Member for that question. I was recently able myself to experience first-hand the audiology services available on the high street and understand just how important that can be.”
“Well, I agree with the Member's enthusiasm for the project. I've been myself to the buildings that are currently there to see the vision that the partners, together with the Welsh Government, have for this development.”
“Well, I am disappointed that the general medical services contract negotiations this year have concluded without a resolution obviously, and equally disappointed that the General Practitioners Committee Wales have decided to ballot their members on the offer made.”
“Dwi ddim yn gallu rhoi amserlen benodol i'r Aelod, ond y math o beth sy'n cael ei ystyried ar y cam yma yw'r elfen weithredol, yr elfen o ran ariannu ac elfennau ymarferol eraill. Felly, mae'r gwaith hwnnw yn mynd rhagddo ar hyn o bryd. O ran ffynonellau ariannu, mae amryw o ffynonellau sydd yn bosib ar gyfer hyn.”
The complete record
Every one of 145 lines we hold for Jeremy Miles, in date order, each linked to its source. Free to read, in full, without an account. Page 2 of 3.
“I thank Sam Rowlands for the questions and for taking the time to attend the briefing earlier today, which I hope he found helpful. I would associate myself with the phrase that he used in relation to the examples that he gave of those individuals being in intolerable situations, which is actually entirely the reason for the approach that I've set out in this statement. I just want to say, I accept the challenge that he sets out, which is the need for a long-term approach. I think, in the context of the particular target that we're looking at, it was originally introduced 50 years ago this year, and the change in technology, in the range of services that can be provided in different settings, and in the blend and mix of demand over 50 years has obviously been enormous.”
“Dirprwy Lywydd, rŷm ni'n rhoi pwyslais mawr ar gefnogi pobl sydd ag anghenion gofal brys i allu cael gofal mor agos â phosibl i'w cymunedau lleol. Ein prif flaenoriaeth yw sicrhau canlyniadau gwell i bobl. I wneud hynny, mae angen gwneud yn siŵr bod adnoddau hanfodol y gwasanaeth ambiwlans a'r adrannau brys yn cael eu neilltuo i'r rhai sydd wir angen cymorth o fewn munudau ac oriau. Rŷm ni hefyd yn canolbwyntio ar wella'r llif drwy ysbytai.”
“Argymhellodd y pwyllgor y dylai Llywodraeth Cymru weithio gyda chydbwyllgor comisiynu NHS Cymru i adolygu'r targed coch, ac i ystyried a yw e'n dal i fod yn briodol. Fe wnaeth y pwyllgor argymell hefyd y dylid sefydlu proses werthuso gadarn i ddeall effaith cynlluniau'r ymddiriedolaeth ambiwlans i ddatblygu eu model ymateb clinigol. Mae'r gwasanaeth ambiwlans yn cyflwyno asesiad clinigol yn gynharach mewn galwad 999. Mae hyn er mwyn sicrhau bod pobl yn cael yr ymateb mwyaf priodol i'w hanghenion cyn gynted â phosibl i wella canlyniadau. Hoffwn i ddiolch i'r pwyllgor am ei argymhellion meddylgar, ac rwyf wedi eu derbyn yn llawn. Diolch hefyd i bob Aelod a ddaeth i'r sesiwn friffio dechnegol am y pwnc yma heddiw gyda gwasanaeth ambiwlans Cymru a'r cydbwyllgor comisiynu.”
“Diolch, Dirprwy Lywydd. Ym mis Awst, fe wnaeth Pwyllgor Iechyd a Gofal Cymdeithasol y Senedd gyhoeddi adroddiad ar ôl sesiwn graffu gyffredinol gydag Ymddiriedolaeth Brifysgol GIG Gwasanaethau Ambiwlans Cymru. Nododd y pwyllgor y pwysau sydd ar y gwasanaeth, ond roedd yn cydnabod hefyd nad yw'r heriau sy'n wynebu gwasanaeth ambiwlans Cymru yn unigryw. Mae gwasanaethau ambiwlans eraill ar draws y Deyrnas Unedig yn chwilio am ffyrdd o reoli'r galw cynyddol am wasanaethau brys yn ddiogel ac yn effeithiol. Argymhellodd y pwyllgor ein bod yn asesu pa mor briodol yw'r targed ymateb coch ar gyfer ambiwlansys. Targed yw hwn ar gyfer galwadau lle gallai bywyd fod yn y fantol, fel ataliad ar y galon, ffitiau, llewygu neu fynd yn anymwybodol, geni plentyn, tagu, rhai achosion o gymryd gorddos, colli gwaed difrifol neu anawsterau anadlu acíwt.”
“In relation to any individual patient, I'm not a clinician—I'm not able to give that direct assurance—but I would anticipate that it depends very much on the individual circumstances of that individual patient, and I imagine in many cases the geography will be one consideration but perhaps not always the main factor. But these considerations have been part of the board's thinking in reaching the decision it has taken, based on the experience of the service it feels able to safely provide.”
“Well, I think the Member is correct to say that each individual affected will—you know, it's a serious issue for that individual. I wasn't seeking to minimise that, I just wanted to create come context to give his constituents the reassurance of the sorts of services that are affected and the numbers that are likely to be affected, so I hope my comments were taken in that spirit. Obviously, we've been in regular contact with the board as part of the special measures process in any event, and in the days leading up to the decision by the board in particular around this issue. I think the existing arrangements with the Royal Stoke hospital in relation to trauma in particular provides some experience to the board to inform its decision to take this—.”
“Dirprwy Lywydd, as the Member's question is not in fact in relation to AAA surgery at Glan Clwyd, I'm afraid I don't have the answer to his question in front of me. But if you'd like to write me, I'm sure I can provide the information that's available.”
“There have been improvements overall in the broad service since the previous Royal College of Surgeons review in particular, with clear evidence of clinicians working more collaboratively, and more of a role for multidisciplinary teams, but there is additional work that needs to be undertaken, of course, and the board is working its way through those recommendations on an ongoing basis.”
“So, the Royal College of Surgeons review, the Healthcare Inspectorate Wales review as part of its escalation and de-escalation mechanism, in addition, then, to the separate assurance review that the Welsh Government undertook, and then a case notes review as well. So, it is a set of services that has been under consistent oversight since the changes were first introduced. A number of recommendations were made in the course of the decision by Healthcare Inspectorate Wales to de-escalate the service last year, and those are being taken forward by the health board.”
“Well, I do recognise the point that the Member makes. In the context of vascular services at the health board, her constituents and others will be concerned to hear this news. I hope it's been helpful for me to be as specific as I have been about the services that are affected, because I want to reassure people about the particular effect of this particular decision, and to give a sense of the context around that, which I hope Members have found helpful. She makes an important point about the fact that, because of challenges in the vascular services at Betsi Cadwaladr, there have been a number of reviews of those services, which other Members have touched on as well.”
“In relation to developments in the future and the number affected, I should just say that the AAA screening arrangements that exist to identify those who may have the condition—because very often it's non-symptomatic until the point at which it becomes particularly problematic—are unaffected by the decision that the health board has taken, because it's a nationally commissioned service through Public Health Wales. So, it would be possible to identify those who are at risk of AAA through that existing service, which is continuing.”
“I can assure the Member that the reason it has been possible, as I understand it, for the health board to be able to develop the arrangements with the Royal Stoke hospital is because, as I indicated earlier, they have an existing relationship with the hospital in relation to AAA specifically, but also vascular more broadly and trauma as well. So, in the sense that the Member puts his question, it is part of that broader plan, if you like, already. He acknowledges the point that I know it is his view that, for the right reasons, for the right situation, it can be appropriate for people to travel in both directions across the border to get the treatment they need when the treatment, perhaps, is a particular level of specialism.”
“He's committed on behalf of the board to keep the public and key stakeholders informed of developments as they review the provision now, but as yet there is no date for when those services may restart.”
“The decision may impact people in the order of about 10 to 15 annually who need this particular kind of intervention. The fact that patients are being treated in England for something of this level of speciality is not new. It does, of course, happen for some AAA procedures already, as well as, as I said, for some trauma and neurological conditions. The board has developed and agreed a protocol for the safe management of patients, which will clarify the new pathway for clinical teams, and it is in discussion with each of those individuals who it expects will be affected by this decision. I had the opportunity to meet the health board chair, Dyfed Edwards, on Sunday, in the course of another meeting, to discuss this with him, and that was followed up later this week in my regular discussion with him as chair of the board.”
“I hope it's helpful if I provide some context to the decision that has been taken. The decision to suspend both planned and emergency open AAA surgery clearly highlights that further work is needed to improve the vascular service for residents in north Wales. The decision was taken, as Members would expect, on the basis of clinical advice from vascular experts in Wales and the wider UK, as well as clinicians within the health board itself. The kind of surgery that is affected by the decision is very specialist; it's complex and it is important. It represents less than 0.5 per cent each year of vascular services generally. As I said in my initial answer, arrangements have been made with the Royal Stoke University Hospital, which builds on an existing relationship with that hospital, both in relation to trauma and to vascular services.”
“Ar 15 Tachwedd, gwnaeth Bwrdd Iechyd Prifysgol Betsi Cadwaladr ddatganiad o'i benderfyniad i oedi llawdriniaeth wedi'i chynllunio ac ar frys ar gyfer open abdominal aortic aneurysm yng ngogledd Cymru. Mae wedi gweithio gydag Ysbyty Athrofaol Brenhinol Stoke i ddodi trefniadau yn eu lle ar gyfer y rhifau bach o bobl fydd angen y lawdriniaeth hon.”
“And I have said to health boards that if we see a picture emerging of pockets of challenge where we are off trajectory and there's no plan that we think is credible to bring that back—I obviously very much hope that we don't see that, and I don't expect to see that, but if that were to happen—I would look to reallocate that funding to make sure that we use every single £1 of that £50 million to reduce waiting lists.”
“This additional funding doesn’t operate by way of just a general increase to the allocation of health boards; it’s based on particular plans to reduce particular waits in particular areas, both geographically and in terms of speciality. So, we will have figures on a weekly basis to look at what's been undertaken over the course of the last week, and that picture will obviously build up over the course of the coming months, so that we can keep a close eye on performance to make sure that everyone is on the trajectory that they've said they can be on with that funding.”
“Yes, I think the Member is absolutely right; it is about funding, but it isn’t just about funding, is it—it’s about new ways of working. And we do know that, if you look at comparatively modest extensions to the theatre operating day, you can improve the productivity of the system, if you like, for that day by as much as 25 per cent in some specialities. So, I think it’s applying that sort of lens. Some of that does require additional funding, which is why we’ve increased the funding to £50 million. And that is based on ongoing discussions with health boards about what more they can do to meet the objectives that we all have to reduce waiting times. The Member is absolutely correct that it’s critical that we monitor this performance in detail.”
“And I hope it’s of some reassurance to him to know that the most recent time at which I discussed the Royal Alex with the health board was yesterday, and they are considering what they need to do in order to put together the most recent analysis so that we can consider that, together with them, as a Government.”
“Well, I think the Member is very naive if he thinks there’s a magic wand to any of this. It’s a very complex situation, and I acknowledged openly in my statement that funding is one part of the question, and I think there will need to be other changes to service delivery in order to make services more sustainable. So, I hope you would acknowledge that. In relation to the point you made about structures, I’m not sure that the answer is a focus on structures. I think that can become a huge diversion of energy from the critical priority of driving up performance, and I think that’s where every part of the system needs to be focused. I will be very glad to visit Ysbyty Glan Clwyd again; I was there about a month ago, and I had a very, very informative visit, and an opportunity to see the emergency department there at work.”
“So, I think there's a need to apply a fresh lens to some of those questions, in the way that she suggests, and then as part of that to look at the most streamlined possible pathways. I think there's a case for the NHS executive to be very clear about its expectations of the health service about pathways of care in this area, and in others where we know there's a pathway that is effective and streamlined, to make sure that it becomes, in a sense, the universal experience of patients in all parts of Wales.”
“I thank Jenny Rathbone for that. I will follow up separately on the point about vasectomies because I don’t have the information, as she anticipated. But I think the broader point she makes I would not disagree with, in the sense that I think we need to look very rigorously at what more we can make sure happens in primary care, which will do two things: it will support long-term resilience of primary care as a critical—as most people's experience of the NHS, actually. But also it'll make it easier for people to get the level of treatment that they need, and it's also faithful to that principle that you have the level of clinical intervention that the situation requires. So, sometimes you don't, I think, need to see consultants in order to be able to have some of the other treatments.”
“The numbers have been going up very considerably, the level of demand has been going up very considerably, but, actually, the question of sustainability is a separate question and that does require services to be, you know, reconfigured and delivered differently in order to be able to make that longer lasting sustainable change. But the funding that we're announcing, which will certainly benefit residents in Powys, I think is a significant contribution to that.”
“I thank the Member for that. Residents of every health board are going to benefit from the funding that is being provided, as he says in particular, given the structure of health provision in Powys, where it depends very much on hospitals elsewhere. But for the neurodevelopmental assessment targets, every health board will be supported to reduce their longest waits in that area, and obviously that includes Powys as well. What I think is critical to bear in mind, though, in a way, is the point that Sam Rowlands was making to me earlier, I think. This is going to be a very significant contributor to reducing those longest waits for assessments.”
“I just want to reassure the Member—because another Member has asked on a similar theme about what the role of social care provision is, and what support we can provide—that I am planning on making a further statement on the 50-day challenge, which will set a little more out of that. But I absolutely accept the point that the Member is making, and to give her the reassurance that we are in discussions with local authorities about what more we can do to support them as part of that 50-day challenge, in particular as they face the winter pressures ahead.”
“Well, I do agree with the Member that the focus of this statement has been on how we’re allocating that £50 million transformation funding, and I do agree with the Member that, for some of the waiting list areas, there is a very high interrelationship between the performance of the health service and the availability of social care and support at home in that timely way. I think there are lots of other areas where there are waiting list challenges that probably aren’t dependent on the care sector, so in diagnostics particularly, but there’ll be many other examples as well.”
“We had the report from the Bevan Commission evaluating some exemplar projects in the planned care improvement programme, and the consistent message there was that, very often, the barrier to sharing those positive developments is sometimes funding, but it very often isn’t funding. It could be more complex questions around aptitude, leadership, the way parts of the system relate to each other, connect to each other. So, I think it’s incumbent on us, and it’s certainly incumbent on all parts of the NHS, to apply that principle of adapt, adopt or justify when we know there is good practice that is able to make a difference in the interests of patient outcomes.”
“Yes, I absolutely, certainly agree with the last point the Member made in her question. When I was talking about innovation earlier, sometimes people don’t know what that means in specifics. And I actually think a lot of it is around how we can improve systems and operations at a ward level, or maybe a hospital level, and that is very often based on the insights that staff will be able to share with us about how to improve things, but also making sure that we provide the training, both from a management point of view and to the broader workforce, on the strategies that we already know, from success elsewhere in Wales, or beyond, are the most effective ways to adapt services, and just being readier, more open and faster in identifying that practice and sharing it through the system more quickly.”
“It echoes very much the speech that I gave to the confederation a couple of weeks ago, and the statements that I made in the Chamber last week. So, I very much look forward to his enthusiastic support for how I take forward that vision in the coming months.”
“Some of it involves scheduling staff time differently, to make sure that we are able to provide services better on the weekend. So, there are a range of options in the armoury, if you like, to be able to get to grips with the longest waits. He made the point that this money is front-line funding in the short term. In a sense, I don’t disagree with that. I have already made clear, I think, that I think that this is part of the solution. But the long-term solution for a sustainable service clearly isn’t simply going to be this. It’s about putting services on a better footing—I think he used the language of ‘upstream’. I note that he's published a report today that, I’m sure, sets out his view on how some of those things can be addressed.”
“We are already seeing that at play. Some of it is about including more diagnostic appointments at different points in the day. I was called by a friend in north Wales the other day, saying they had just been for a scan in the evening. So, that service is happening right across Wales. It's also about specific kinds of high-volume clinics, both for surgery—so, low-complexity surgery, as I was indicating—but also high-volume clinics and out-patients as well. So, there are a range of different ways in which the system is responding in this way, and we have proposals from each health board across each of the areas where they have the longest waiting lists, with specific plans about how we deploy those new ways of working—ways that we know will have an effect.”
“I thank Mabon ap Gwynfor for those questions. The Member criticises me for doing more than one thing to support the NHS. Let me just reassure him: I'll do whatever it takes to support the NHS. It’s important to be able to intervene to support the system in a range of different ways. He encourages me, I think, to have fewer targets. What I'm announcing today—there are no new targets. We are not changing the accountability measures that we are inviting people to scrutinise us on. We are setting out a path to improving our performance against our existing targets over the next few months. I answered, I think, in response to Sam Rowlands some of the ‘how’ questions. So, it’s about—. Well, the Member shakes his head. I did, in fact, do that. Some of it is about theatre optimisation, improving how we use theatre time to make it more effective.”
“But I think we would be cautious in painting a picture that suggests an NHS in Wales that has no capacity depending on an NHS in England that has a lot of capacity. I don't think that's the picture on the ground at all. It's a much more finely balanced picture than that.”
“That's part of the expectation of the system, as well, and making sure, as I spoke about in my statement, that we have a culture of improvement and innovation, looking in all parts of the health service in Wales for the best practice and adopting that quickly, and looking beyond the NHS in Wales as well. I think that's a critical part of how we can put the provision of services on a more sustainable footing into the future. Just to say finally on his customary point about cross-border working, health boards in Wales have commissioned treatments from trusts in England and vice versa for a long time, and that will continue. That goes up and down, depending on the availability of capacity.”
“That's why the funding that I'm putting in now—which I accept is not the whole solution, certainly—is critical, alongside driving the numbers down, getting more people seen more quickly, and that the way in which that is done more and more is the more sustainable long-term way that we know will make the biggest difference to service provision. It's about optimising theatre time, which we know we can do better, and there's already good practice that we need to build on in Wales. It's making sure that we have high-volume clinics for low-complexity surgery. It's making sure that we make access to diagnostics more flexible, providing evening appointments—things that we know will make the biggest change.”
“But I'm absolutely not complacent; he will not have heard any complacency in my statement today. He acknowledged—and I'm grateful for that—that I said that the funding in the system is critical, but on its own, it won't be sufficient. I also talked about the changes we're bringing into the system to improve the delivery of services overall. We've got the performance review, which is already under way, but we have the planned care transformation programme, and that has not been able to deliver at the pace we would've liked, despite the funding in the system, just because of the level of demand.”
“That's why we place the focus that we do on the length of wait and making sure that we can reduce those, because that's what actually supports most people to get the care that they need in that timely fashion. I will just say for the record that he makes a number of points of comparison, in his question, with England. He will know as well as I do that the measures for waiting times in England are very much narrower in what they record than they are in Wales. We've chosen for a long time in Wales to include many more pathways in the reporting that we make, because we believe in transparency and providing Members with the opportunity to challenge us. So, I don't shy away from comparison, but I just think it's important for us to bear in mind that we are not comparing the same things.”
“I thank Sam Rowlands for those questions. Whilst we absolutely disagree on some of the analysis, I'm grateful to him for the constructive tone in which he presents the challenge that he does. I think he is right to say, when residents get in touch in a constituency capacity or otherwise, that anybody waiting too long for treatment is a person too many waiting too long, clearly. We don't want to be in that position. As he says, this is about people; for each data point on the statistics that we share frequently, there is an individual story, isn't there? For me, that is the most important aspect. I think most residents are more concerned about the length of time that they and others they know have to wait than the number of people waiting at a particular point in time.”
“Mae byrddau iechyd wedi gwneud llawer iawn i geisio lleihau amseroedd aros. Mae’r ffigurau perfformiad diweddaraf yn dangos—a bydd ffigurau newydd allan ddiwedd yr wythnos hon—fod yr amseroedd aros hiraf wedi gostwng traean ers eu lefel uchaf ym mis Mawrth 2022. Mae amseroedd aros hir ar gyfer profion diagnostig wedi gostwng 30 y cant o'u lefel uchaf yn Awst 2020. Erbyn hyn, tua 3 y cant o bobl ar y rhestr aros sy'n aros am fwy na dwy flynedd, o gymharu â bron i 10 y cant ym mis Mawrth 2022. Ond mae gormod o bobl yn dal i aros yn rhy hir am driniaeth, ac mae'n rhaid i ni fynd ymhellach.”
“Dirprwy Lywydd, fe wnaeth atgyfeiriadau gofal wedi'i gynllunio gronni yn ystod y pandemig. Mae'r gwasanaeth iechyd wedi gweithio’n galed i'w lleihau yn y ddwy flynedd diwethaf wrth i’r galw am ofal wedi’i gynllunio ddychwelyd i'r lefelau blaenorol. Mewn rhai achosion, aeth y galw y tu hwnt i'r lefelau hynny. I gefnogi’r gwasanaeth iechyd, rydym yn darparu mwy na £1 biliwn o gyllid adfer yn ystod tymor y Senedd hon. Ond dydyn ni ddim yn gorffwys ar ein rhwyfau. Yng nghanol y cyfnod ariannol anoddaf ers dechrau datganoli, a waethygwyd gan gyllideb drychinebus Liz Truss, rydyn ni wedi parhau i fuddsoddi mewn gwasanaethau iechyd rheng flaen i helpu i leihau amseroedd aros a chyflymu mynediad at ofal. Dros y ddwy flynedd diwethaf, rydyn ni wedi darparu bron i £900 miliwn yn ychwanegol i'r gwasanaeth iechyd.”
“Mae torri amseroedd aros hir a sicrhau mynediad amserol at ofal wedi’i gynllunio yn flaenoriaeth i’r cyhoedd ac i’r Llywodraeth hon. Ers y pandemig, mae hyd y rhestr aros a faint o amser y mae pobl yn aros am driniaeth wedi cynyddu'n sylweddol. Mae hyn yn wir ar draws y Deyrnas Unedig, nid dim ond yng Nghymru. Cafodd y pandemig effaith enfawr ar wasanaethau cyhoeddus, gan gynnwys iechyd. Gwaetha'r modd, roedd y camau a gymeron ni i flaenoriaethu gofal pobl â COVID ac argyfyngau difrifol eraill yn golygu y bu'n rhaid i bobl ag anghenion, efallai, llai brys aros yn hirach. Cyn y pandemig, ar gyfer gofal wedi'i gynllunio, tua 10 wythnos oedd yr amser aros ar gyfartaledd rhwng atgyfeirio a thriniaeth. Cododd hyn i 29 wythnos ym mis Hydref 2020—y lefel uchaf erioed. Ond roedd wedi lleihau i 23 wythnos yn Awst 2024.”
“There will obviously be, in different parts of Wales, a different underlying level of capacity and choices and decisions that are being made in the way that she describes examples in her own region. But just to give her the reassurance, all the data in relation to the availability of care home places is taken fully into account in the discussions that we've been having with our partners.”
“I don't know the circumstances of the individual residents, naturally, as the Member would not expect me to, and I don't know where the consultations are in relation to the particular care homes, but what I can tell the Member is that Rhondda Cynon Taf council, as all councils, have been very, very fully engaged in the development and taking forward of these plans. The Minister for social care and I have met with each of the health board regions and the local authorities in partnership to discuss both their plans generally, but specifically in relation to the 50-day challenge, and part of the discussion has been around the availability and the capacity in the care home sector in each of those regions, so just to give the Member reassurance.”
“And doing that successfully is what gives us the best chance of making sure that the benefits, both for individual patients and for the system, are sustained, which is obviously what we want to see. So, the 50-day period is, if you like, a period of intense working to put the new arrangements in place and help as many of that 25 per cent cohort as possible. But the success of this will be judged by whether that progress is maintained into the medium and longer term beyond that.”
“Well, we know that the period at which the NHS and care is under the most intense pressure is during the winter, and so it's 50 days between now and the end of the year, and typically we see the most intense pressures at the start of the new year. So, the period, if you like, is dictated by the timescale available. We've tried to project how many individuals we think it is reasonable to try and support within that context. But the Member's last question, I think, in a way, is the most important. Critically, as I was saying to Mabon ap Gwynfor, what we want to see—. It's not a 50-day job-done approach, it's a 50-day period to put these provisions in place.”
“So, there are some hospital-located interventions, if you like, and there are others in the plan, as he will have seen, which are really about making sure that, for example, we make greater use of care home and community beds for continuing healthcare assessments. Those don't have to then happen in a hospital setting. So, some of it is about the location in which the intervention takes place, but some of it is about, if you like, the underpinning support in the system for this range of interventions. So, a focus on reablement is critical in order for that to succeed. Whichever the interventions you put in place, they will all basically benefit from enhanced reablement. So, I think it's probably not that scientific to rank them; I think they play a different role in that sense. Why 50 days?”
“I thank Sam Rowlands for those questions. I think each of the 10 steps plays a different role, actually, in supporting the system overall. So, some are, if you like, hospital-based interventions. So, the integrated discharge service that the Minister for social care and I saw in action in Cardiff last week, but also works in other parts of Wales, is really about how existing resources can be co-located in a hospital setting, to make sure that the patient's journey, really, ideally, from the moment at which they cross the threshold or are admitted, is increasingly understood and responded to.”
“So, this challenge is about putting new ways of working in place and targeting support on that 25 per cent, and making sure that as many as possible of those can be returned home. But, critically, the point here is to make sure that that success is sustained. It's important for those individuals to go home, but, actually, what we want to make sure is that delays come down across the system. And so actually making sure that that is sustained is important, so we are having conversations with partners during these 50 days about what resources might be required to make the intervention sustainable in the longer term. And that will be looked at in light of the experience over the coming weeks.”
“And I think that's been a challenge that partners have taken up with real commitment, actually, over the course of the last number of weeks. I'm afraid I didn't hear what the NHS Confederation had to say, but what I do know is that we work directly with their members, who are actually involved in delivering on the ground. And I'm grateful to them all, because they have engaged very constructively with us in relation to this work. The Member I think was in the Chamber yesterday when the point was put to the First Minister about the target. Of course, she answered, as I did in my initial question, that the support is aimed at 25 per cent of the longest waiters, and so that's roughly 350 people.”