The challenge to drive forward an excellent healthcare system for NHS Wales, within an era of severe financial restraint, continues to exercise Welsh Government, health boards and Trusts, not only in Wales, but in other health systems within the UK and internationally. The situation in Wales is particularly acute because of the progressive underfunding gap for NHS Wales. It therefore requires immediate and urgent actions to ensure that the resources we have at our disposal are being used to best effect, achieving the best outcomes for people at the least cost. This necessitates a comprehensive understanding of where resources are currently being invested and the impact and outcomes delivered, alongside a clear rationale for disinvestment and reinvestment decisions. It also requires a fundamental culture change to embed this not only across the health and social care systems but also with members of the public and the media.