As a new era for Wales gets underway following the historic Senedd election in May, Aneurin Bevan’s legacy demands more than preservation – it demands courage. As Plaid Cymru set out in its manifesto: ‘The NHS, once the envy of the world and the pride of our nation, now faces relentless demand and overstretched resources.’ If the NHS is to resume its place as the jewel in the crown, we have a moral and ethical duty to ensure it is sustainable, resilient and genuinely fit for the future. That won’t be achieved by repeating what we’ve always done or waiting for permission to act.

Nearly 80 years on from its creation, the NHS is operating in a world its founder could never have imagined. Rising long‑term conditions, demographic change, workforce pressures and rapid technological advances mean that standing still is no longer an option. The question is not whether the NHS should evolve, but whether we are willing to shape that evolution together.

Some argue the NHS must remain untouched. But while its founding principles are timeless, the way we deliver care needs continually to adapt. The real challenge is how we bring people, professionals and communities into the conversation, so the system reflects the needs of today and tomorrow.

For decades, we’ve known what needs to change:

• a stronger focus on prevention
• smarter use of technology
• redesigned services
• new ways of working

Yet turning evidence into consistent practice across Wales remains difficult.

Wales has the ingredients to lead. We are the right size, with strong networks and a passionate, skilled workforce. Through our Bevan Exemplars and Fellows, we see daily the creativity and commitment that already exists. But without collective purpose, the risk is clear: the NHS will slowly wither while poverty, sickness and inequality deepen. So what is holding us back?

To move forward, we must shift our mindset. Health is everyone’s business. Around 85% of what shapes our health happens outside the NHS in our homes, workplaces, communities and environment. If we want people to live healthier for longer, we must make healthy choices the easy choices.

The NHS excels at treating illness, but lasting wellbeing depends on addressing the wider determinants of health: education, employment, housing and community resilience. “Health in all policies” must become reality, not rhetoric.

Change is never easy. Top‑down directives rarely create lasting transformation, and the public can be wary of change especially when it touches cherished local services. Yet our conversations with communities show something different: a real appetite for honesty, involvement and more radical thinking when people feel respected and heard.

We must get better at listening. Not just consulting but working with people as partners. When frontline innovators are trusted and supported, new ideas flourish, collaboration grows and change becomes something people own rather than resist.

We must also be more prudent, creative and integrated. Our recent work on system flow and “silly rules” shows how outdated practices still waste time and energy. If we are serious about improvement, we must stop doing what no longer adds value.

The ambition is clear: healthier, thriving people and communities across Wales. Achieving it requires collective effort; not passive observation, but active participation.

The future of health and care will not be secured by preserving the past unchanged. It will be shaped by our willingness to learn, collaborate and, above all, be brave enough to change. This is the heart of Health Matters: recognising that the choices we make today will determine whether our system survives, or truly thrives, tomorrow.

Health matters. It matters to every one of us from the moment we take our first breath, shaped profoundly by the people around us and the communities to which we belong. Across the world, governments are recognising that social connection is not a luxury but a foundation for health. The evidence is clear: belonging, supportive relationships, and meaningful connection are as vital to wellbeing as any clinical intervention.

If we want to unlock the sustained economic growth so often described as the Holy Grail of politics, we must do more than acknowledge this truth. We must enable health, social care, education, the world of work, and justice to operate as one system, working in genuine allyship with the people they serve. Allyship is not a slogan; it demands curiosity, courage, and commitment.

Nowhere is this more urgent than in mental health. A mental health ally is an informed, empathic person who listens without judgement, connects people to support, and champions understanding across the whole system. This is the cultural shift Wales needs—one that recognises that health is shaped not only in hospitals and clinics, but in homes, workplaces, schools, and communities.

And because health is shaped across the whole life course, we must pay particular attention to the environments in which children grow. Children live in families, families live in communities, and communities are anchored by schools. The Well‑being of Future Generations Act recognises that giving children the best start is essential to lifelong health. Supporting this vision requires a shift in how we train the workforce across health, social care, education, and justice.

But for all of this to happen we need to function as a system, we must learn to agree well and disagree better. Perceived complexity frequently serves as a justification for inaction. In many cases, what is seen as complexity is simplicity obscured by multiple demands and differing perspectives.  The goal remains simple: more people healthy and coping, and far fewer struggling or unwell.

In the current climate, it can feel as though we move from one crisis to another. But shifting from chaos to culture requires clarity about what culture truly is: the shared way of life of a group of people, their beliefs, customs, values, behaviours, and knowledge, passed across generations. It shapes how we see the world and how we act within it.

Wales is rich in visible culture, but the deeper layers matter just as much: the core values and assumptions that guide how we work together. These deeper layers are harder to change, but they are also where transformation begins.

Systems thinking helps us to distinguish between constant change and genuine transformation. As Gaius Petronius Arbiter observed in 66 AD, “We trained hard, but it seemed that every time we were beginning to form up into teams we would be reorganised.” Reorganisation can create the illusion of progress while generating confusion, inefficiency, and demoralisation. Wales must resist this trap.

If we are serious about moving from chaos to culture, we must recognise the tools already in our hands. Wales does not lack ideas, evidence, or goodwill; what we often lack is the confidence to use them boldly and consistently.

Collaboration is one of the most powerful levers, not the version that appears in strategy documents, but the kind that emerges when people genuinely work together with shared purpose. Collaboration is a mindset: leaders creating the conditions for trust; citizens treated as partners, not problems; organisations recognising they are part of a bigger whole, not competing islands. When collaboration becomes the norm, systems begin to move.

Kindness is another lever, not the soft version, but what Ballatt and Campling call intelligent kindness. It recognises that our wellbeing is interconnected and that compassion is a driver of quality and safety. When leaders act with intelligent kindness, it changes the emotional temperature of a system. People feel seen, able to speak up, and able to care. When that happens, everything else becomes possible.

We must also understand the power of identity and belonging. Decades of social science confirm what practitioners have long known: people stay well when they feel part of something. Belonging, whether to a family, school, workplace, neighbourhood, or cultural community, gives people the psychological and practical resources to cope with life’s challenges. When services nurture belonging rather than erode it, we unlock what the Haslams call the “social cure”.

These levers are not abstract theories. They are the foundations of a health and care system that works. They are also deeply Welsh values. If we choose to centre them, they can help us build a culture that supports people to thrive, not merely survive.

In these times of political flux, the words of Aneurin Bevan resonate: “Illness is neither an indulgence for which people should pay nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.”

The risk today is that competing needs push essential actions into the “too difficult” box. But health matters too much for that.

We must ask:

• Are we meeting the needs of the Welsh population?
• Are we delivering the best care everywhere, for everyone?
• Are we eliminating unwarranted variation?
• Are we choosing wisely and ensuring value for money?

This is prudent healthcare in practice. Quality improvement is not a luxury; it is the solution to our current challenges. As Sir Don Berwick, a fellow Bevan Commissioner, states the aim is simple:

• No needless deaths
• No needless pain or suffering
• No helplessness in those served or serving
• No unwarranted variation or waste
• No one left out

These principles are not abstract ideals. They are a practical blueprint for a fair, effective, and compassionate health and care system.

Wales stands at a crossroads. The pressures on our health and care system are real, but so too is our capacity for innovation, collaboration, and collective courage. If we act with intention, guided by evidence, compassion, and shared purpose, we can build a culture that supports people not only to survive, but to thrive.

Health matters. Culture matters. And the decisions we make now will shape the Wales that future generations inherit.

Where would we be without the social care workforce in Wales? It is a question we rarely pause to ask, yet the answer underpins the safety, dignity, and independence of thousands of people every day. If we are serious about building a fair and thriving Wales, we must start by recognising that health matters — and that social care is inseparable from the health of our nation.

The primary role of social work and social care is to empower and protect those children and adults who may be at risk of harm or loss of independence. Those risks can arise from neglect, abuse, frailty, illness, disability, or simply a lack of support.

For many of us working in the public sector, it is easy to take for granted that our children will eat healthy food, live in warm homes, receive a decent education, and be free from neglect or abuse. As adults, we expect to manage our own personal care, finances, and daily lives, and to enjoy social, educational, and leisure activities without assistance.

But this is not the reality for everyone. And in this piece, I am focusing on adults.

Most adults want to experience “what matters” to them — a core principle of the Social Services and Well‑being (Wales) Act. Many can achieve this through their own networks of family, friends, and colleagues. But for adults who are frail, living with illness or disability, or at risk of harm, support becomes essential.

When those natural networks are absent or insufficient, the adult social worker steps in, assessing what outcomes the person wants to achieve, offering advice, and arranging the right support. Their task is to protect human rights, maximise independence, and ensure the person retains voice and control wherever possible.

Yet the system they work within is not always aligned to this purpose. Tensions often arise between NHS professionals and social workers when a vulnerable adult is deemed “medically fit” to leave hospital.

The political and operational focus on hospital activity does little to support the social worker who must ensure safety and independence beyond the hospital door. Rushed discharges can create real risks when care and support plans are not yet in place, plans that may require coordination across families, voluntary organisations, and commissioned social care workers.

Contrary to much of the public narrative, Social Services is far more than a discharge mechanism for the NHS. It is a critical public service, rooted in local government, with the ability to connect seamlessly with housing, education, leisure, community services, and the third sector. This local reach enables holistic assessments and coordinated responses that reflect the full complexity of people’s lives.

If we are serious about improving outcomes, the system needs a stronger focus on community‑based health and social care, preventing hospital admissions rather than managing delayed discharges. Many regions already have intermediate care services and community hubs that bring the third sector into preventive and supportive roles. With an ageing population in Wales, strengthening these out‑of‑hospital resources is essential, and funding must follow that ambition.

Some argue that formal structural integration between health and social care is the answer. But there are many ways to achieve better coordination without the disruption of major reorganisation. Wales already benefits from regional partnership arrangements that could be strengthened to deliver shared outcomes.

As Dr Hugh Alderwick’s analysis of OECD health systems reminds us, there is no perfect structure, social and economic factors are too complex. The priority should be improving the system we already have, not chasing an elusive ideal designed far from the frontline.

Language also matters. The NHS often talks in terms of patient flow, pathways, and process, shaped by political pressure on waiting times and treatment numbers. Social Services has its own performance measures, but far less public scrutiny. The result is predictable: political and public pressure drives funding toward the NHS, squeezing local authority and third sector budgets. Yet it is precisely that local capacity, the community support, early intervention, and preventive services, that reduces demand on the NHS and helps Wales cope with an older, less healthy population.

So where does this leave us? With a truth that is both simple and urgent: Wales cannot deliver the health and wellbeing its people deserve without a strong, valued, and properly supported social care workforce. They are the quiet infrastructure of independence, dignity, and safety and their contribution is too often invisible until the moment it is missing.

As Wales approaches the next Senedd elections, there is an opportunity for every political party to recognise this reality. Not through slogans or structural upheaval, but through a clear commitment to strengthening community‑based care, investing in prevention, and valuing the workforce that holds so much of our social fabric together.

Because health matters. Social care matters. And the choices we make now will shape the Wales we become.