 Lleiddoedd am gael y cyflawnol, ac oedd yn yr ysgolwch, ac mae'n gwybod yw'r gweithio ymlaen nhw arall, yn cael ei gweithio y cyflawnol, ac mae'n gweithio eu cyflaceddau a'r cyflaceddau yn ymwylo'r cyfloddol a'r cyfloddol a'r cyfloddol i'r prinsidol a'r cyfloddol a'r cyfloddol a'r cyfloddol a'r cyfloddol. Ond yw'r cyfloddol wedi bod nhw'n mynd i'w cymdeithas, y maen nhw'n gweithio eu cyfloddol nad yw ydy'r swydd yn wneud o'r Brooklynd i'r ffordd, i ddyn ni'n yourr hwyl gyda gael안 cyffredinol, am how can we do that in a better way with people getting all together and addressing it? Felly, ydych chi'n sgwp yma sydd yma, ac efallai'n gweithio'r gynllun o'i gynllun o'i gynllun o'i'r gaf. Efallai'n gweithio'n gweithio'r hwn o'r gweithio, ac mae'n mynd i'r gweithio i gyd, mae'r gweithio'r gaf yn gwyfyn nhw, yn dweud, mae'r gaf wedi'i gweithio'n gweithio'n gwybodaeth gan GYsau Llyfr o'r Gwyrdd. Mae'r gaf' rhaid i gynllun o'r gweithio'n gweithio'n gweithio'n gweithio. Mae'r gwnaeth digon i gael ei ddefnyddio fy ngayl, ac so wedi am gyfwilio ar y dal o'ch gweithio gyda'i Edoedd, yn Helfkell, ac mae'r wneud, ac mae'n gwybod o gwaith o'r maean o'r gweithio i gweithio i gael. Mae'n gwybod a'r Gwyrddol i Gwyrdd o'r benedig, mae'r gweithio i gael o'r talus. Ond oedd yma, mae hynny'n gofio ar gyfer eu prif. When the NAFвIL report came along, it had confirmed to the figures in Alan commission, which we had shown in the Bevan commission, and added much more analysis and updated data to them. Then, that slide now has the welcome announcement only last week of additional funding for the NHS in Wales and that is going to make a difference, but not going to make a great difference…the great difference is up in our game, and having a closing gap, was I mentioned earlier am unig i gael ei wneud. Ond wedi cael ei gallu gweld i'r llunio ffondiol iawn, ac wedi'i gael ei wneud i'r llunio ffondiol iawn, ac mae'r ffondiol iawn i'r bwysig o'r ffondiol. Yn y Llywodraeth Berydebol, mae'n mhobos o'r ffondiol ffondiol, oherwydd i gael rhaid unrhyw i'r thwylo ymlaen, mae'n rhaid i'r bwysig o'r bwysig o'r bwysig, o'r bwysig o'r bwysig, a dwi'n mynd i'ch cymryd i gael y cwmniadau barnet ddechrau yn y gwybodaeth, – ac mae'r gweithio roedd yma yn fwyaf, yn gwybod o'r cyffredinol, roedd hynny ar y lles mwy fydden nhw'n oed pan wedi'i'n ateb ysbryd. Mae gydag i fyng Nesbynydig Scoll, ac mae'n ddiwedd a'ch ddwyledd, soeddwn i'n eich gweld i'ch bod gyda nhw. Flyny tu'nny fyddaent o ei wneud y ffordd ac yn gychydig i'ch gwybod i'ch gweld i'ch roedd o'r cwmniadau barnet, maen nhw'n gofyn yng Nghymru ac behaeth gwysig iawn, ac mae gweithio'r leol yn gyntafol â amser, yn gweithio'r leol, gan myfyrdd o'r lle ei wneud. Mae Yw Wales yn cael ei ddaeth yn cael ei ddweud, ac mae'n gymaint ar gyfer gyfio'r rhain i LHS. Mae'r rheswm yn ymddiynt i ddweud yr achwymru, gyda dwybr iawn ac mae'r cyflogol. Mae'r correu aroedd amlwgau atig yddi, a pethau ddysgu ymddill, 5% i ddweud y cap. That was a huge amount and the Nuffey report has sort of made that little clear out and has estimated what it is that the different funding gaps would be according to how much money is put into the system from various sources. Roedd hyn yn eistedd yn gweithio i wneud o'r reidio arna a dyn nhw'n cymdeithas, ond rhai llyfr am yr unigio i ddim yn dweithio'r gwaith, o ran wahanol ehlrif i ni ddoch i ymddangos mewn gwirionedd, dargarwch honno'n llyfr o oedlau'r ffrifwyr, a'r hunrfrif oes yn gwneud i ddim yn ei ddweithneud. Dw i'n mynd i ddim yn syniad i ddweithio'r gweithio a'n hyn syniad i rydw i ddweithio'r gwaith? Well that was about two years ago I think that the risk is far far less now because many things have happened some of which have been happening in the last year in connection with puppet healthcare. And of course in the release of the extra funding which the Minister referred to yesterday. But this is the statement that I still I think is relevant. To close the gap without additional funding NHS Wales will have to improve efficiency. and will have to improve productivity because they are not the same thing. at a record rate, and sustain this for a period not seen either in the history of the NHS or any other country's health system, so it's still a very formidable challenge. The gap being the funding gap and the gap between what we do now and what we are very capable of doing which would improve the delivery of the service. Felly, we thought at the time and we've been talking to the Minister about this and his visuals, that we should look at the thing which we then call prudent healthcare. So, I'd like to just give up the rest of my talk about that and why now. Prudent healthcare was defined, as you will see there. It's a rather wordy initial definition, but it's trying to get a grasp of what it is we wanted to do and what it is we wanted to define, and what it is we wanted to capture people's hearts and minds. That was the first definition, but it's changed, although the essential principles are still there. Caution, that doesn't mean slow, it means thought through. Safe, wise, which is what the word prudent means, and of course, careful budgeting, but that is an issue which is part of the whole, rather than the only issue that we're addressing. The main thing is achieves tangible, measurable, material benefits and quality outcomes for patients. Our provisional principles, and let me make it quite clear that these are provisional. I'm taking you through the history of the evolution of the principles. These were the first ones that we articulated and the Minister accepted as provisional ones, and we said they're not written in stone. These principles are things that will evolve, and not only that, we felt it was in the beginning, but they needed to be fleshed out. Different words can mean different things to different people. Words are very important. We understood what we meant, but a bit more work needs to be done in that area. So our principles were treating greatest clinical need first. That's an equity question. Do no harm achieve measurable good, and I'll go into that a bit more. Do the minimum appropriate intervention to achieve the desired outcomes. Again, I'll talk a little bit more about that because people have misunderstood what is meant by the minimum intervention. Choose the most prudent care openly together with a patient. Now that fits in with number six, which is co-produce health with the public, patients and partners. And then consistently and appropriately apply evidence-based medicine in practice. Those are the first six principles. What happened then was we tried to flesh out what some of them meant. And when doing that, we looked at the conversation that takes place between the clinician and the patient and articulated these words, that agreement between clinician and patient, that the intervention is likely to affect a tangible beneficial outcome compared with other possible interventions. So this was going beyond the do no harm, and you're all familiar with that by now, but it's a major change. It's sort of revolutionary because we're saying, we're not adhering solely to the hepocatic oath. We're saying just don't apply to no harm, but achieve some tangible good, which is part of good practice anyway. And the intervention must do more measurable good than doing nothing. Similarly, the objective of achieving optimum health, which the circumstances permit should the intervention be agreed and adopted. Those words can mean that various things to various people. We felt that if the intervention is justified, it should always be that which is the least necessarily required to bring about or to seek to bring about the agreed change. Many people have misunderstood minimum, meaning least, meaning minimal. It's not. It's the minimal, the least necessarily required based on the evidence which is likely to bring about a beneficial outcome. I think that explanation is what is needed with all the principles and any modification of them. The minister said policy-wise, two statements from recent speeches, which describes, to some extent, public health care. But the second one is, I think, far more important than the first one, because the first one is something that we were aspiring to anyway. We wanted to actually achieve this coming on. Let's go into limbo. To rebalance the NHS in ways to create a patient-centred system, we all talk about that, but we haven't yet achieved it. To remodel the user provider relationship on co-production. There have been conferences, there have been a thousand lives issued and the chief medical officer launched last year, I think it was, a paper on co-production. But that is a new issue, I think, that the minister wants to be included as prudent health care. We included in our first few principles. And the idea is, in another phrase that he uses, to redraw the relationship between the citizen and the state in Wales. Prudent health care action. Now, when I'm asked by the media to explain to them what prudent health care is all about, I can't really find the words to explain what I've been trying to get across to you. So I've tried to capture it in another way. And I call this Daily Mail Speak. Stop doing things where there's evidence they don't work. We don't always do that. We have been using interventions, not just in Wales, but across the developing and developed world, whereby we know that they don't work. There is evidence of inefficacy, and yet we still use them. Less so and less so, but nonetheless we do. Invest only in what it gives, what gets tangible benefits. That's important to just try and identify and classify the various pieces of evidence that support a particular action. Improve quality and clinical outcomes that's obvious and involve patients and citizens in co-production. Another emphasis upon that. How do we do this in Wales? Well, I use the word Big Bang, and the Minister also picked that up. Not place you'll change, but Big Bang does not mean everything will be sorted out by tomorrow. Will it? It won't. What it means is we're not going to slow down on this. We're going to progressively and progressively more and more develop prudent health care and get it spread across all Wales nationwide at once, not just having it developed in one particular area or one health board, get it across the whole spectrum of the country. And it's easy to be on. And cultural change. This is not going to happen unless there's cultural change. And I think I'm teaching my granny to suck eggs by telling you that because you're all very well aware of it. Fashioning the principles. What we did, first ones, as I mentioned, were developed by the Bergman Commission as provisional principles. We then had the Minister's speech had added flesh to some of those and clarified some of the others. And in April 2014, there were prudent health care workshops to test the principles. This was done and there by a thousand lines in Public Health Wales. And there were four workshops, 30 delegates, as you can see the people involved there, identify opportunities, indicate methods, comment on principles, the original Devon Commissioner principles. Those were workshops dealt with adult aid management, medicine prescribing, adult hearing loss, disneyers and dentists, and knee and hip problems. We thought we'd better look at those in the first instance and how did prudent health care, did prudent health care, have any basis in taking forward these issues and better and more quality driven and patient safety manner? Sorry, yes. These were reported in a paper that was published by Pete Bradley and Alan Wilson and a number of co-authors and it looked at achieving prudent health care in Wales and I'm sure you all see that and you should refer back to that if you wish to gather any further information. And then what was launched yesterday and let me remind you, those of you who haven't got it, this is the booklet, this is the one about the e-learning that gives the comments of people who produced the 10 chapters where they talked about what prudent health care meant to them and how it related to their area. And I think this is a very important document and has already been referred to quite a lot by the Minister and I hope you will pick up not just this but actually use the website itself. And last of all I think the latest five for the moment but let's remember these are not yet in concrete. They are the ones that should drive us forward undoubtedly but they may need some change and the Bevan Commission has been asked if they would look at these principles are there other ones that need to be added and do we need to flesh out and identify what we mean by some of them? Now these are there and already there is one principle that is this five list which when we go out and talk to the people to people who are not informed to people in the third sector they do not understand or organise the workforce around the only do what only you can do principle. We understand it because we interpret it in our language, in our climate, in our culture they don't understand it and if they don't understand it we've got to look at it. So one of the things that we will be looking at is looking at that principle to see if we can articulate it in the way it's meant and intends to be. So those are there and the two metal officers showed us those yesterday. This is the most important slide I think and that is the prudent approach is not and should not be confined solely to the provision and management of healthcare. Prudent healthcare was the words that we used in the beginning it must also be applied to social care, health improvement achieving a step change in the health of the people in Wales and remodeling the relationship between citizens and NHS where it was based on co-production. It goes beyond that. I was very pleased yesterday when the Minister referred to some remarks that I maintained about let's have a social movement I think it's extremely important for everyone to own. There is a need for a social movement. So we have still a huge real financial challenge. We must develop and adopt the prudent healthcare and the prudent approach. It's everyone's business and we must develop and encourage a social movement.