 Byddwch chi'n meddwl, dyna'n ceisio yn gwybod, ac ynhewch yn bwyr i'r hoffa, ac mae'n hayfer gwahadwn i'w rhaid i'w gwleifach gweld i gyd, ac yn y bwysig o'r gwybod am gynnabau'r hoffa. Mae'r post exfoliwr yn ei wneud yn teimlo yma. Mae'n gydweithio rhaid i'w hoffa, mae hwn yn gweld i'w hoffa bwysig o'r hoffa a'i croffas mewn boedig. Rydw i'n meddwl i'r ein bod maen nhw, ac mae angen i gwaith i ymdyn鬼m, ond rydw i'n meddwl i'r anghyblyniad gyda'nma. Byddai'r arion i ddechrau, pwysig i ddechrau, ac mae'n ei fod i'n meddwl i gynnwys fel y ddechrau. Rydyn ni'n fwy o'r gwaith bod rwy'n meddwl i'n meddwl i'r unrhyw pwysig i ddechrau i ddechrau i ddechrau i ddechrau. Oes oedd yr hyn yn lleiwy eldestreitha i ddefnyddio bobl, rydyn ni'n lleiwyd digonwyr i'r NHS, I'm proud to lead a manager and to have worked with NHS Wales. Actually moving to the general role and the NHS Wales chief executive job really only just emphasises that it's a real privilege to have the opportunity to influence services. I mean, I hope it goes without saying that I firmly believe in the NHS, its inception, its values, and most importantly it's focused on patients and their experience and outcomes. In this respect, alongside my formal role, there is a set of values in place about wanting to do better and to do more. So although I'm an official bureaucrat, a great suit, an administrator, indeed even a big encounter, actually my values for the NHS will be on my sleeve. And it actually meant something to me, just in my most recent role, to be a chief executive of an organisation that was named after an R&B. For me it placed a responsibility on us to make sure that we could show real focus around patient care and experience. I hope that I've always and still retain an open, interested and outward looking approach to the way health services are provided. I'm interested in my own terms about what constitutes best in class, and I hope that I've looked to apply that in the different settings that have been worked, not least to try and set ambitions. And I think this means seeking good practice and innovation wherever it exists, so nationally in Wales, more broadly in the UK, internationally or indeed in other industries. And I know we all share the same high standards and impatience to maintain and develop the NHS for the people of Wales. Importantly, for me, it means a continuous improvement approach, a focus, a commitment to individual patient experience and balancing care and dignity alongside treatment and quality. And I think this is at the centre of the improvement healthcare line through which I believe we should be looking when providing the support, care and treatment that we deliver. I'm happy over the course of these last two days that we've had opportunities to listen to people sharing their own experiences of what it means to take a conceptual development, but actually hopefully start to show what it means practically and tangibly. And can I also thank Wendy for my personal masterclass last night to have managed to grab just a little bit of personal time just to learn and hear her own experiences about the choosing wisely campaign over in Canada. So thank you, Jo, very much for that as well. As I speak in a number of four across Wales, I'm trying to just draw out amongst the fact that the NHS, of course, is a comprehensive and all-encompassing service to focus on five different areas that I think could help us to lead through what remains a very difficult environment. And these five are framing some of the discussions that I'm having, but if it's okay with you, I'll just draw out three of these with reference to the discussions and the tone of this particular conference as well. Firstly, just around population health outcomes, I think to recognise that there is evidence of improvement that is taking place. I think actually, although we often talk about the demand placed on our services because we have growing older population, I think perhaps we should just pause and celebrate the fact that life expectancy improving is of itself a good thing. It's something that we should be allowing ourselves to recognise that although there's been improvement that we can do more on in this area. I think we should also recognise that generally our adult population does report good health, and that actually there's something for us there as a foundation for the way in which we want to take forward different discussions with the public. But inevitably there will be some still variation within some of the population's experiences, and particularly as we see an increase in multiple conditions of people managing these chronic conditions with the support of the NHS. So there actually remain things that we have to go out here. I think although we can track some milestones, we do need to make sure that we can push on and look to make a difference. We can look at harmful health behaviours, and although we're seeing that perhaps there's a little bit of reduction happening, we're not seeing that transform yet in terms of some of the discussions that we're having with the general population. Chronic conditions clearly are an area that we need to work on together and ensure that we can give support to allow people to be as independent as possible and not just defaulting into the hospital system. Actually we have to be open with ourselves that although there's been improvement in overall life expectancy, we are still seeing a significant variation between deprived communities and actually those populations that seem to have made much more and significant progress. We're working I think probably in the most difficult environment that I've experienced for NHS and public services, and even my last five years as chief executive in our own university health board have genuinely been the hardest and most challenging in my career to date, the greatest resilience and focus on things that matter, particularly I think in respect of values, and this environment feels no different to me today despite my change of role. So I make this as an open admission that as the responses needed to secure public services and quality in an all-steer environment are different from those where there is a growth in funding, we need to start to explore different approaches where we can make a difference to care but also with the resources that we have available. And it's very easy to batten down the hatches and of course we have to bring realism to public expectations and to our own flexibility to deliver. I also think at the same time we have to lift our eyes and look forward through this difficult period and look at our ambition to deliver our population health. I think in this respect our philosophy in Wales for an integrated system of care is taking us from the GP right through to specialist hospital services may ask different questions of our skills, experience and capacity. At a time of financial constraint it can feel sometimes easier to take our eyes off the longer term when we must not allow this. We particularly have to focus that on that in these difficult times. So what does it mean to be a prudent patient? CMO's annual report outlines still behaviour issues in terms of obviously the population and individual patients who are trying to support. The Cofili study in particular revealed substantial reductions in serious health conditions linked to five healthy lifestyle behaviours. Nonsmoking, a low BMI, regular exercise, a plant-based diet and alcohol consumption within guidelines. By adhering to four or five of these healthy behaviours there was a 73% reduction in type 2 diabetes, a 67% reduction in vascular disease, an 18% reduction in cancer and a 64% reduction in dementia. This sounds pretty convincing to me, but we need to draw our patients and our population into this critical discussion. We do need to ensure that co-production isn't simply a label, it's the way we do things around here in terms of the service that we're looking to provide to our patients across all services. So I think that governments have a responsibility to create the right conditions in which individuals can live full and healthy lives, taking responsibility for their own health, in other words developing the concept of a prudent patient. And a point which I was again highlighted in the Chief Medical Officer for Wales annual report last week. Each of us has a duty to look after ourselves, we must all become custodians of our own health and instead of handing ownership of our health to the nearest professional as we've traditionally done, is to take that individual responsibility. Of course the NHS is there to help in our time of need, but with that comes a responsibility to use resources wisely. The NHS is free from charge as the Minister has outlined, but not free from obligation. I think there are some distinctive Welsh characteristics again driven by our system that we can grab hold of and used to try and develop a way forward. So surely one of the distinctive features of NHS Wales should be its ability to show improvement and change in the area of health and prevention directly from the organisational structures and resources we've aligned. We set up organisations back in 2009 that had a first and foremost responsibility for public health and population health. For example the Minister and the Chief Medical Officer both presented back in June at the NHS Confederation Conference in Liverpool in terms of what we can push forward differently in Wales relating to public health change on the ground and alignment of minds and resources and actually an emerging approach to legislation. Similarly we had the privilege of hosting Professor Sir Michael Marmot in July facilitating sessions with Welsh Government ministers and officials, master classes and an evening seminar. In a world of complex population health assessment his clarity on focusing on the problem, aligning attention and resources and measuring improvement chimed with our aspirations for working better in NHS Wales and with stakeholders. He said that the opportunity to deliver a small country population health improvement is in our hands and an opportunity for us to genuinely lead the way internationally if we put our hands on this. And very rarely he felt that everyone was lined up on common ground from government to public services. We're just as one example, this is just a graph not necessarily in the health field about supporting young people not in education and employment. Actually some work that are drawn together with a group that I used to chair in reporting to ministers in Wales that was trying to learn from those organisations and local authorities who had actually managed to reduce their numbers from very significant and high baselines and develop an approach that was individual around these young people and actually improve things. And actually two areas of Wales, Swansea and Wrexham had demonstrated that they were able to go out the problem to make it an individual issue and to wrap the support that was necessary around us. Now it's not necessarily a health issue, I think it's about the broader health approach that we need to take for our populations but the reason I share this here is because this was a graph that was used by Professor Sir Michael Marmad as he's presenting on international approaches to show that you can make a difference by getting hold of your problem. I think we also have the chance about developing a clear and distinctive policy around public health and protection issues. We know that the public smoking ban has significantly changed attitudes about where it's acceptable to smoke and in many respects has been implemented much more smoothly with the support of the public than we could have expected. The first piece of legislation agreed by Welsh Government was in respectable organisation and a different path established in Wales to other countries and even the minister has reflected on the occasion when in the middle of international interest his interview with Russian Radio was showing how this different approach had attracted attention on a global scale. Our recent public health bill consultation had attracted interest and some controversy in respect of health concerns around e-cigarettes and a close challenge in scrutiny ended with some recent statements from the American Medical Association, the World Health Organization and a major BMJ study supported with and in line with a different approach taken in NHS Wales. So let's hold the ambition to assert a Welsh profile not least as a country focused on population health. And how do you make prudent healthcare happen? Or what are the levers we have to collectively available to us to make this happen? The publication yesterday of the online resource Making Prudent Healthcare Happen offers a number of different lenses on how prudent healthcare could be implemented in Wales and more to follow and really good to see the very end of the dual text and the videos that we're using there to try and make sure that this is something that instigates a discussion. I think that new proven prudent approaches are key, especially during these times of austerity. The status quo cannot be maintained and without change don't be surprised if the existing problems with our system still remain. I think we have a chance to establish innovative and distinctive features for the Welsh NHS and from this articulate assertively and with confidence the Welsh way. For me these would include as a part of national and local responses a clear understanding and outcome of what a system based on prudent healthcare principles looks like not just the concept but as developed in the Minister's keynote address to conference yesterday with tangible practical actions that showed that this can release resources to be directed to patient care, improve quality and avoid harm. That we must see evidence of co-production in action focused on our patients, citizens and communities. The prudent healthcare approach very much assumes a different way of negotiating with patients as we've heard this morning with informed sets of choices and an NHS in listening mode. Finally maximising the benefit and impact of a planned integrated system of care with accountability held by population health organisations and prudent healthcare is a core organisation of approach. I think that we have a chance to work through and achieve something different through the model we have established and whilst perhaps recognising our organisations are still only five years into their existence we should have an expectation to demonstrate the benefits for population health delivery and partnership that originally arose from those structures. All of these issues require an agility and a drive to bring together the Welsh template and identity and using this to the advantage of national priorities and local delivery. I just want to reflect as well on team working which I think is about bringing the NHS together but of course broader public services as well and I believe that this also represents a way in which we can make prudent healthcare happen. All of us have worked in good teams we've probably worked in bad teams as well but we know that effective team working makes a difference to services, quality and patient outcomes and we are all part of different teams in our respective organisations. We have in Wales some of the largest health organisations in the NHS across the UK so if we know that team working works in terms of our own experiences on our own organisations why on earth wouldn't we push for this more consistently in support of NHS Wales? I believe that as well as needing to have strong individual organisations we also need to reassert our NHS Wales national identity. There is a danger of us allowing ourselves to become fragmented 10 organisations in existence in Wales working with Welsh Government when I think that our strength is about visibly working together and that means about developing relationships across boards, across organisations, across our staff but actually with our public also. Perhaps we're not always sharing the information of good practice and the things that really work but of course it still needs to find the right balance between national expectations and giving a flexibility for organisations to deliver locally. I think there's a need to energise ourselves in our respective roles whether these are in organisations or in national settings whether it's professional portfolios or our broader agenda but remember that we've heard the Minister speak at many events to remind us that the NHS is for national and I'm not sure we've quite lived up to his expectations here. I think this is also about ensuring that NHS Wales is visible on the broader public service agenda including supporting other public service organisations local community priorities and other central portfolios for other departments other than the health and social care department in Welsh Government. I personally believe not least with my upbringing in Wales from a very early age that we have a natural default in Wales to working together and with communities but it must be vested in expectations for improvement and not just words. I was lucky enough last year to be allowed to travel to Africa with my brother this is with permission of my family and I actually saw this excellent phrase on the wall of Johannesburg expert which you can see just behind you there that I believe must have been a Welsh origin and it just quotes that if you want to go fast, go alone if you want to go far, go together and from my perspective that's about grabbing the Welsh approach and mentality an opportunity to work collaboratively across different organisations and different groups and I'd like to offer it for NHS Wales but perhaps still tweaking it for some other pace of urgency that will get confidence back quickly in our delivery and our reputation. So my role is to just speak to you for 15 minutes but also to bridge you into your coffee break and also the breakout sessions as well and I've been asked if I could just flag for you the workshops that are taking place just after hopefully you can see those from the very back of the room as well. What I would ask people to do is we go into this particular break and I will say that there are a couple of the workshops that are happening over to the right-hand side of the building so they're not all necessarily in the same area we are looking for people to distribute themselves across these different workshops I think in public health terms it means it's going to be a slightly longer walk for some of you here but you'll get a reward from that particular focus and energy I would just make the point that the Minister has underlined recently that it's important for us to take improvement healthcare from theory into reality so from the page into practice and with that in mind just really to encourage you to take an active part in one of these five breakout sessions and I think what you'll get here is some first-hand experience of positive systems change which are very much in line with the ideas of improvement healthcare hopefully that would build on the ebook that we released with the video messages and the individual essays that are there to prompt and some of the discussion that we need to take place in Wales and hopefully to allow you a little bit of time to consider the principles in relation to your own areas of work and I think if we are all leaving here today just thinking of practical ways of making our systems more prudent, less wasteful and more beneficial to our patients I think we will have taken a step towards making improvement healthcare so I think the intention is to regather at 5-12 I guess that means mid-day at the very latest as people find their different places and I just wanted to wish you well for your day, for the sessions and thank you very much for this thank you