We now move to the questions from party spokespeople to the Cabinet Secretary, and, first this week, the Welsh Conservative spokesperson, Angela Burns.

Diolch, Lywydd. Cabinet Secretary, you’ll be aware that the incidence of cancer is rising, with one in two people born after 1960 expected to be diagnosed with cancer in their lifetime. So, I’m sure you will agree with me that early screening is vital. You will, no doubt, be aware that this week is Cervical Screening Awareness Week. Cervical cancer is the most common cancer in women under 35, but the good news shows that the mortality rate for this type of cancer is dropping and is lower than it was some years ago. That is why I share the concern of cancer charities, because screening rates across Wales for women of all ages in terms of cervical cancer is on the fall. Minister, can you tell me what your Government is going to do to encourage women in Wales to be screened for the potential of this disease?

Thank you for the question. It’s a fair point to raise about what we need to do, not so much about the health service responding to the significant rise in cancer referrals—in fact, in the last seven years, there’s been a doubling in urgent cancer referrals into the NHS, and it’s a remarkable achievement that it has managed to deal with those in such a timely manner, given the increase in volume—but there is a point about the understanding of healthcare messages by us as individual citizens and the risk factors that we have, and to take up the opportunity for screening that our programmes actually provide. So, there’s a need to understand where we are now, something that Public Health Wales will look at, and we always need to review and understand where we’re succeeding, what we need to do more of and, equally, where we’re not meeting our expectations. It is something that I’ve raised with them, not just on cervical screening but also on bowel cancer, for example, as well, in terms of what more we could do. Sometimes, it’s about the test and so it’s actually about persuading people to do more to safeguard their own healthcare, now and in the future.

Thank you for that, although, Minister, I think you and I both know where we are on this. The rates are falling and we need to make people more responsible for their own health. My question was actually what can you do to encourage people to have this screening test. So, if we move to bowel cancer, which you’ve already alluded to, one of the ideas is that, here, for example, in Wales, bowel cancer screening is currently undertaken every two years for those between 60 and 74; Scotland undertake this screening from 50; and England is currently introducing a second bowel scope screening, which is proven to reduce the risks of individuals developing bowel cancer by 33 per cent, and Scotland also intend to trial this. So, again, Minister, on another type of cancer, I ask you: why should those who have the highest risk of bowel cancer have a lower chance of an early diagnosis here in Wales? You and I both know we all have to take responsibility for our health, but what can you as a Government do to improve the screening rates for both cervical cancer and bowel cancer?

Well, I think there’s a fairly high awareness of both cervical cancer screening and also bowel cancer screening. The challenge is how we make it easy for people to take that up. On bowel cancer, in particular, it’s not so much about the advice people get, because we will follow the advice we’re given about where is the most appropriate point for people to be screened, but it’s about the test. Because, frankly, the test currently is not a very pleasant test to have to do; I won’t describe it. But the reality is that there is the potential for a new test—it will be easier to administer and we are much more likely to see a much greater take-up therefore, and a much greater surveillance and, actually, earlier warning for people. So, there is something about how technology and movement can actually help people to undertake screening, to avail themselves of screening resources that are available. So, we need to take account of that progress that is made and then understand if the evidence says it will be a better job, we then need to make sure it’s rolled out in a consistent way across the country.

I agree with you that all I’ve heard about the test is that it’s deeply unpleasant. However, test or having cancer, it’s a self-evident choice and I will do anything to support you to try and get this message out to people that they should be doing this. Because bowel, lung, prostate and breast cancers account for over 50 per cent of diagnoses in Wales. As you yourself said earlier, the annual number of cancer cases continues to rise. The target of 95 per cent for newly diagnosed cancer patients referred via the urgent route to begin treatment within 62 days of referral has not been met since 2008. So, how will you, Minister, seek to address these areas, when you draw up your new cancer delivery plan, which is scheduled for later this year? And, given that Welsh Government struggled to deliver on the previous plan, how can we have confidence that you will draw up and rigorously and successfully implement a new plan?

Well, thank you for the series of questions in there. I don’t share your optimistic assessment that if people understand there’s a test or the risk of cancer that people will undertake the test. I’m not even sure that a lot of people don’t make that choice. So, there are lots of risk factors for health outcomes that people ignore. There is often a very high awareness of health behaviours and their impacts. The challenge then is how we persuade people to change their own behaviours, and how we make it easy for them to do that, whether it’s smoking, drinking, exercise—a whole range of factors.

And, in particular in terms of the 62-day target, I recognise that we have not met our stretching target. It’s, of course, one of those things—we have a higher target than England; if we had the English target, we’d meet it on a regular basis. So, there is still something, not just about comparing ourselves with England, but about having some real ambitions for outcomes. Because one of the things we can take real comfort from, and optimism from, is not just the fact that more and more people are being diagnosed, being seen and treated, but also that cancer survival rates are improving.

But our challenge, and our ambition, in the refreshed cancer delivery plan must be to make sure that our services are in a sustainable position, so we tackle the backlogs that exist on waiting times for treatment, and where the best available treatments are available on a consistent basis. Actually, our ambition is to have cancer survival rates that compare with the best in Europe because, right across the UK, we don’t do well enough, and there’s got to be some honesty and some recognition that that’s where we are now, to see the benefit and the improvement that we’ve had, and to recognise that too, but, at the same time, to have some real ambition about the future and then have a practical way to map that forward. The delivery plan won’t just be something that is in the hands of Government. We will have a cross-sector partnership, involving the voluntary sector too, as well as the NHS, as well as Government, on taking the plan forward, and then, hopefully, making sure we see a successful implementation across the board.

UKIP spokesperson, Caroline Jones.

Diolch, Lywydd. Cabinet Secretary, with one in eight people in Wales currently seeking help for a mental illness, what will the new Welsh Government be doing to improve waiting times for access to mental health care?

Thank you for the question. Mental health is a priority area for this Government. As I said yesterday, in response to a range of questions, we will be refreshing the mental health delivery plan. That will take place this year as well, so it’s not been forgotten. And, really importantly, in undertaking both the consultation and delivering the action plan, we’ll be talking with and listening to service users themselves. It’s been one of the strengths of what we’ve actually managed to do over the last few years, to understand the current impact of the service, and things that will make a difference for them. There are a range of things for us to do, and, actually, mental health is the biggest single area of spend within the national health service. So, it does receive very real priority.

We’ve changed our mental health waiting time standards to make them tougher and, in fact, we are in a better position than England. We have different waiting time standards—much more rigorous—and more people are seen within the target time. The challenge for us—and, following the earlier question—is to recognise the progress we’ve made, and, at the same time, to understand what more we need to do. There is something about recruitment and retention, both in the community service as well as in the secondary care service. So, our next challenge is to confront. But, again, working with the third sector, and service users themselves, I’m confident we will continue to see an improvement in mental health treatment and outcomes here in Wales.

Thank you for your answer, Cabinet Secretary, but part of the problem with waiting times for mental health care is around funding. Mental health is the poor relation in our NHS. Do you agree with me that mental health funding should be ring-fenced at a much higher level than the current spend?

Thank you for the question. I do wonder if you thought you were asking a question about the English system, because in Wales we have ring-fenced mental health funding, and as I said earlier, it is the biggest single area of spend within NHS Wales. I’ve seen campaigns that have taken place on an England and Wales basis, and, actually, they’re really talking about the English system. I remember responding to letters as a Deputy Minister and writing back to Members of Parliament saying, ‘You’re writing to me about England and we’re doing things differently here.’ The challenge is for England to catch up with Wales in this area, so I really do think we’ve got a good story to tell, and not just from the Government’s point of view, but so much of this flows from work done in the third Assembly when the Mental Health (Wales) Measure 2010 was passed. We took a view at that point in time that there needed to be greater priority given to this particular area of service and the impact that it has, and I’m really pleased that we’re delivering upon that. It’s not perfect, but we are making real progress, and the challenge is how we further improve what we’re already doing.

Finally, Cabinet Secretary, cuts to local authority spending are threatening community mental health services. What is your Government doing to incentivise councils in Wales to protect the mental health services they provide, and to make greater use of third sector mental health services?

I don’t think local government provide direct mental health services, but they do provide services that have an impact on mental health and well-being. We all recognise that. For example, the conversation earlier about physical health and activity. Being physically active isn’t just a good thing for your physical health; it’s actually incredibly good for your mental health and well-being too. And there’s an honest challenge here as well for all of us in this Chamber. Whenever we talk about budgets—and you mentioned cuts to local government—the honest truth is that to maintain a high level of spend in the NHS and social care, which we have done—and I’m proud of the fact that we’ve done that—we’ve had to make a difficult choice. And to do that, to have 48 per cent of the Government spend in this particular department, means there’s been less money to spend on local government. That’s an honest choice that we made. If people want to come to me or anyone else and say, ‘We want to see more money in local government,’ you’ve got to find it from somewhere else, and that means compromises in other areas of service.

I actually have great sympathy for people in local government of all political shades and colours, who are running local authorities, for the really difficult choices they will make. That is the honest reflection of having a falling level of funding available for public services in Wales, and across the rest of the piece: really difficult choices to be made. It’s not just about making services more effective with less money, but the honest reality that people are now choosing what not to do. So, I don’t want to give a glib answer by saying that local authorities just need to up their game; we all need to do what we can do to improve services and outcomes; we all need to face the reality that there is less money to spend, and we are making a choice to fund the NHS, and that means less money for local government.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Llywydd. Two years ago, Plaid Cymru highlighted the frighteningly long waiting times for MRI scans in Wales as compared to Scotland and England, with over 40 per cent of patients at that time waiting over six weeks here, as compared to 1 per cent in England and 2 per cent in Scotland. Following on from that and some press coverage of the issue, you did make an effort to tackle the issue and those waiting times have now reduced: some 17.6 per cent of patients are now waiting over six weeks for a scan. Is that figure acceptable to you and what assurance can you give that the pattern of reducing the waiting times for MRI scans will continue?

I thank the Member for the question and for highlighting an area where we’ve made real progress over the last calendar year. Because at the high point that we reached in summer last year, we had a real challenge in understanding what could and should take place to reduce the diagnostic waiting times. We’re now in a much better place and MRI is a good example: there are a number of health boards—at least two—where it’s practically at zero, so no people wait above the target time, but we do have a very real challenge in particular in the south-east of Wales, where far too many people still wait too long. So, I fully expect that it’s a message that the service understands perfectly well. The progress we made, in particular in the last six months of the last year, will continue into this year, and I’m looking forward to the figures in the first quarter, and in particular in the second quarter of this year, to understand whether that ambition within the service is being made real, because that is certainly what I expect to see.

What the improvement does demonstrate, of course, is that effort pays off and that we should never accept that budgetary limitations or increases in demand will inevitably lead to longer waiting times. As I said, MRI scans were given some press coverage a few years ago; there are other diagnostic tests that aren’t as headline grabbing, perhaps, where there are major problems that remain, for example, colonoscopy or cystoscopy. Performance in those areas is as poor now as it was two years ago, with around half of patients waiting over six weeks, as compared to 6 per cent in England and 12 per cent in Scotland. The equipment is cheaper for these tests, there is less demand for them and some GP surgeries can actually do the tests themselves. Apart from waiting for newspaper headlines, what will make you give the same attention to colonoscopy and cystoscopy tests as you gave to MRIs?

I thank the Member for his second question on the area. On this, there are two points that I would make: the first is that in some of the areas on diagnostics where we have waits, it is tied up in workforce. So, there are challenges for us, for example, in training more sonographers in Wales. Where they’re currently trained, you tend to see better outcomes. For example, Swansea and west Wales do better on this than the south-east of Wales and lots of the training is undertaken in Swansea. So, that shouldn’t be a surprise. There’s something about our workforce planning and understanding where and how we train more members of staff, as well as attracting people to come into the country.

The second point that I’d make is that, in terms of the attention given to it, it isn’t really about the headlines because, again, from my previous role and into this one, it is something that I regularly discussed with health board chairs and chief executives and there was certainly no lack of focus on the need to see improvement. That’s what we saw in the last half of the last year. I’m really, really clear with health boards and the public that I expect to see further improvement. There’s something about understanding how we improve our headline rates in the here and now and what we need to do to improve the system that lies underneath it—so, improving diagnostic treatment and where that should take place, because you make a fair point in that some of these could take place within primary care. That is what we have to do at the same time. They’re not necessarily easy things to do: to maintain headline performance at an acceptable level and to reform the system, which does mean making some difficult and, at time, imperfect choices, but it is absolutely what I expect the service to do.

But there are innovative steps that could be taken. Last week, Cancer Research published a report on the next steps that they would want to see taken for a cancer strategy for Wales. They are asking for the introduction of a specific target of 28 days so that we can improve survival rates and, through that, they are adding to the chorus of authoritative voices supporting our policy, as Plaid Cymru, for the introduction of a 28-day diagnosis target.

Before the election, your Government rejected that target, although all the main oncologists in Britain, more or less, are calling for it. In order to achieve such a target, we would need improved waiting times for a number of tests, including better direct access to GP services, to the testing system and to expertise in testing. Will you, therefore, look again at Plaid Cymru’s policy of establishing three multidisciplinary diagnostic centres of the kind that have been very successful in other nations, including Denmark, as part of a strategy to reduce waiting times for these vital diagnostic tests?

Thank you for the third question. There’s been a clear recognition across parties and within the service for some time that to improve cancer outcomes, we need to improve access to diagnostic certainty, but what we’re not doing is actually implementing a different target on diagnostics within the cancer pathway. I’m not persuaded that that will actually help us to get where we want to in terms of focusing on the time it takes to get to first treatment, but also then for outcomes for cancer patients as well. That’s where our focus is going to be.

We’ve already been to—. Officials have already been to Copenhagen to look at the work that they do to understand how they have a different pathway and how that speeds up access to treatment and to outcomes, so there’s nothing new in that sense and it’s part of what we’ve been doing over the last year in any event. Our focus, though, will be on outcomes to understand what we need to do to improve outcomes for patients. Some of the really interesting work that I hope you will see when you see the refreshed cancer delivery plan is actually looking at a single pathway as well, which actually will require a different focus and a change in the way in which we look at and understand our targets. It should mean that we have a more focused and more appropriate look at what will make a difference on the cancer pathway that the clinicians will support and also that the patients will support, which is really delivering improved outcomes that all of us in this Chamber will want to see. Diagnostics are one part of improving that pathway.