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Mark Drakeford, Minister for Health and Social Services, reflects on the journey of prudent healthcare in Wales over the last year. There has been a lively engagement among clinicians and other staff within the health service in Wales, and we are beginning to see change ‘on the ground’. The biggest challenge is a cultural one – to rethink the way that we conceptualise the relationship between the way the service is provided and the way people use the service. The minister explains how he is committed to the founding principles of the health service and to keeping them alive, well and effective in Wales. In this age of limited resources and increasing demand, we have to think afresh about the way we provide services, to capture in a new way the contribution that the public make, to have a ‘new bargain’ between the citizen and the state. Prudent healthcare gives us a coherent set of ideas that allow us to continue to provide the health service that is so important to the people of Wales. We need, however, to continue the discussion and debate about the principles of prudent healthcare so that we can fine tune them and make sure they are adapted to the challenges we face. 1000 Lives Improvement website: http://www.1000livesplus.wales.nhs.uk/ Making prudent healthcare happen website: http://www.prudenthealthcare.org.uk/