The following amendments have been selected: amendment 1 in the name of Jane Hutt, amendments 2 and 4 in the name of Paul Davies, and amendment 3 in the name of Rhun ap Iorwerth. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected.

We’ll move on to the next item, which is a debate by the United Kingdom Independence Party on lung cancer, and I call on Caroline Jones to move the motion. Caroline Jones.

Motion NDM6128 Neil Hamilton, Caroline Jones

To propose that the National Assembly for Wales:

1. Notes that November is lung cancer awareness month.

2. Regrets that only 6.6% of Welsh patients who are diagnosed with lung cancer are still alive five years after diagnosis and that Wales lags behind the rest of the UK and Europe in cancer survival rates.

3. Calls on the Welsh Government to:

(a) take action to improve five year lung cancer survival rates in Wales;

(b) improve diagnostic services and speed up access to diagnostic tests;

(c) deliver improvements to end of life care;

(d) ensure that people’s individual needs, priorities and preferences for end of life case can be identified, documented, reviewed, respected and acted upon; and

(e) guarantee access to everyone who needs specialist palliative care services.

Motion moved.

I propose that the Assembly for Wales notes that November is Lung Cancer Awareness Month, and I’d like the motion to be proposed formally.

Formally? You don’t wish to speak?

Sorry, yes, I do wish to speak.

Okay; sorry. You carry on, then.

Thank you. Sorry, I’ve never done it before. Diolch, Ddirprwy Lywydd. We have tabled the motion before you today to mark Lung Cancer Awareness Month and to recognise that, although progress has been made, lung cancer survival rates in Wales remain amongst the worst in Europe. Lung cancer is the biggest cancer killer worldwide. Every year, more than 1.5 million people die from lung cancer. In the UK, one person dies every 15 minutes, and by the time this debate is over, lung cancer will have claimed another four lives.

Here in Wales, lung cancer claims the lives of around 2,000 people every year, accounting for a quarter of all cancer deaths. Thankfully, advances in diagnostics and cancer treatments mean that a diagnosis of lung cancer is no longer an automatic death sentence. More and more people are surviving, but, unfortunately, not enough are.

The UK Lung Cancer Coalition recently launched a campaign, 25 by 25, which seeks to raise the five-year lung cancer survival rates in the UK to 25 per cent by 2025. The campaign has the backing of Macmillan Cancer Support, who are founding members, and is fully supported by the UKIP Assembly group.

Our five-year survival rates are amongst the poorest in Europe. In fact, in the latest Europe-wide comparison study, Wales ranked twenty-eighth out of 29. Only 6.6 per cent of Welsh lung cancer patients are still alive five years after diagnosis, compared with 16 per cent in England. The Welsh Government have made improvements and investment in cancer care in Wales. Overall cancer survival rates have improved, and there has been an increase in one-year survival rates for lung cancer, but five-year lung cancer survival rates still lag behind other UK nations and our European counterparts.

We simply aren’t diagnosing lung cancer early enough. In Wales, only 12 per cent of lung cancer patients are diagnosed during the early stages of the disease. The vast majority of patients are diagnosed during stage 3 or stage 4, which significantly reduces their long-term chances of survival. The UK Lung Cancer Coalition recently undertook a survey, and found that access to investigative tests and referral are still the greatest delays to rapid diagnosis, with 36 per cent of patients surveyed waiting over one month for a definitive diagnosis after an initial suspicion of cancer, and 17 per cent waiting over two months. We welcome the Welsh Government’s commitment to improving access to diagnostic tests, but we must do more.

Cancer Research UK undertook a study of cancer services in Wales, and they found that issues with diagnostic capacity are delaying some patients receiving a definitive diagnosis, and therefore starting treatment. They also found that there is variation in GPs’ direct access to diagnostic tests. According to Cancer Research UK, further investigation is needed to understand the workforce and equipment capacity needed to meet demand. The rise in cancer incidence, as well as the National Institute for Health and Care Excellence’s decision to lower the threshold of referral for suspected cancer, will increase demand for diagnostic tests in the coming years.

Cancer Research UK recommended that the Welsh Government conduct an urgent review of the state of direct access to diagnostic tests for GPs. However, one of the biggest barriers to improving lung cancer survival rates remains a lack of awareness amongst patients. In a recent survey of lung cancer patients, only 27 per cent of patients saw their doctor because they recognised that they were experiencing signs and symptoms of lung cancer. Over 40 per cent of patients did not know that chest pain, weight loss and tiredness are possible symptoms of lung cancer. This is why debates such as the one we are having today and events like Lung Cancer Awareness Month are so vital. We must do all we can to increase awareness of the signs and symptoms of lung cancer among patients.

This summer, for the first time, the Welsh NHS ran a lung cancer awareness campaign. The Welsh Government are to be congratulated for taking this step. I hope the Cabinet Secretary will commit to running this campaign annually. England have been running the campaign since 2010 and have been successful in raising awareness and increasing the numbers of patients diagnosed at stage 1. Perhaps this is why England has been so successful in increasing its five-year annual survival rate, which has almost doubled since 2004 to just over 16 per cent.

Improving early diagnosis is just one of things we have to get better at here in Wales. We also have to ensure that, once diagnosed, patients get the best level of care possible. The recent Wales cancer patient experience survey showed that people with lung cancer had poorer experiences than people with other kinds of cancer. One in 10 Welsh patients do not have access to a clinical nurse specialist. Macmillan Wales have called for better support when people are diagnosed and awaiting treatment for lung cancer. They have also asked that we ensure that everyone who is diagnosed has their needs assessed and addressed in a written care plan, as outlined in the current cancer plan.

The UK Lung Cancer Coalition report makes a number of recommendations for the Welsh Government. These include conducting a public consultation on the current national cancer standards for Wales, which should then be updated based on the recommendations provided; reviewing cancer diagnostic services in Wales with a focus on lung cancer; ensuring all patients have access to a lung cancer clinical trial nurse in all aspects of their care; and working with other bodies to address and assess local variations in lung cancer treatment. I hope the Cabinet Secretary will take these recommendations forward. Even if we achieve 25 by 25, we will still have the majority of lung cancer patients dying from the disease and we must ensure that those patients who do not survive die with dignity. It is a sad fact that only 46 per cent of those who died from cancer received specialist palliative care.

A recent Marie Curie survey found that seven out of 10 people with a terminal illness do not get the care and support they need. If current trends continue, 7 per cent of the Welsh population will be living with cancer by 2030 and the number of people dying in Wales will increase by 9 per cent. We know that around 6,200 people who die each year don’t get the palliative care they need, but these figures come from Marie Curie—they are not coming from the NHS and therefore don’t feed into workforce planning.

In England, the NHS conducts a survey of the bereaved, called ‘VOICES’, which shows the level of care and support given to families at the end of the lives of their loved ones. We don’t conduct this survey in Wales. If we are going to ensure that everyone who needs specialist palliative care gets it and we are going to ensure that people’s individual needs, priorities and preferences for end-of-life care can be identified, documented, reviewed, respected and acted upon, then we must conduct a survey of the bereaved here in Wales.

Finally, I would like to address the amendments. We will be supporting both of the Welsh Conservatives’ amendments. It is regrettable that there has been a stark increase in the number of women with lung cancer. Incidence rates in men are now a third higher than women, compared with double 10 years previously. However, I urge you to reject the amendments from Plaid Cymru and the Welsh Government. We are not criticising the Welsh Government or the lack of investment. Yes, progress has been made, particularly on one-year survival rates, however there is a lot, much more, for us to do. The main reason for holding this debate today is to raise awareness of the issues and to work together to improve lung cancer survival rates.

Wales should not be in twenty-eighth place; we should be leading the way. We have a wonderful health service with hugely dedicated staff; let’s give them the tools to improve cancer care. Let us ensure that everyone with lung cancer gets an early diagnosis with appropriate treatment. Let us also ensure that everyone who needs it has access to specialist palliative care and ensure that everyone can die with dignity should the time come. I urge you to support our motion. Diolch yn fawr.

Thank you. I have selected the four amendments to the motion. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected. I call on the Cabinet Secretary for Health, Well-being and Sport to move formally amendment 1, tabled in the name of Jane Hutt.

Amendment 1—Jane Hutt

Delete all after point 1 and replace with:

Recognises the significant improvement in Wales for one year survival rates for lung cancer and the lung cancer initiative being delivered as part of the Cancer Delivery Plan.

Welcomes the £240m of additional investment in health services in Wales proposed in the recent draft budget including an additional £15m for diagnostic equipment and £1m for end of life care.

Notes the Welsh Government’s commitment to further improve lung cancer survival rates and intention to:

a) publish a refreshed Cancer Delivery Plan by the end of November 2016 and continue to focus on improving lung cancer outcomes;

b) publish a refreshed End of Life Care plan by the end of January 2017;

c) continue to work closely with the Wales Cancer Alliance on the development of cancer services in Wales and with hospices on end of life care.

Amendment 1 moved.

Formally, Chair.

Thank you. I call on Angela Burns to move amendments 2 and 4 tabled in the name of Paul Davies.

Amendment 2—Paul Davies

Add as new point 3 and renumber accordingly:

Regrets that the number of female lung cancer cases in Wales has increased by more than a third over the last decade.

Amendment 4—Paul Davies

Add as new sub-point at end of point 4:

‘improve access to screening, education and awareness.’

Amendments 2 and 4 moved.

Thank you, Deputy Presiding Officer. It gives me great pleasure to take part in this debate tabled by UKIP today. I’d like to move amendment 1 and amendment 4 tabled in the name of Paul Davies.

Amendment 2 regrets that the number of female lung cancer cases in Wales has increased by more than a third over the last decade. In fact, the rate for women in Wales is amongst the highest in Europe and has climbed from 54.8 per cent cases per 100,000 to 69.2 per cent, which is, by anybody’s standards, quite a significant jump. We also move amendment 4, which is to ask that the Welsh Government should improve access to screening, education and awareness.

Now, in the Welsh Government amendment to this motion, I note, Cabinet Secretary, that you mentioned that there is an extra £1 million for end-of-life care. May I ask you to clarify if that is just for lung cancer, for cancer services, or for all end-of-life and whether it would include adults and children, because, of course, that would predicate the amount of money that we might think might come towards people who are suffering with lung cancer? In the amendment, Cabinet Secretary, you also mention the cancer delivery plan and I’d be most grateful if you would clarify what weight, in the refreshed cancer delivery plan, will be given to lung cancer outcomes, because, as Caroline Jones so ably put it, there are more deaths in Wales from lung cancer than breast or bowel combined, and yet it’s a far less well known cause in terms of raising funds for research.

Cabinet Secretary, I’m not arguing that lung cancer should have special treatment—far from it. However, as such a huge cause of illness, especially in those from less affluent areas, it does deserve to receive equitable treatment. We need to break the stigma that lung cancer is a smoker’s disease. We need more awareness in the public and within the medical profession to ensure that better early diagnosis that would ensure better survival rates. As Caroline has already mentioned, one-year survival rates in Wales are among the lowest in Europe, and yet stage 1 lung cancer can be survived if diagnosed early enough.

Sadly, the postcode lottery does exist in lung cancer diagnosis. Potentially treatable stage 1 lung cancer survival rates are 90 per cent in the least deprived areas of Wales and that’s something to be applauded and something to be very grateful for. Yet, if you are a poor person, if you live in one of the most deprived areas of Wales, your chances of surviving lung cancer drop to only 74 per cent. That is a vast gulf—a vast divide—between those who are more affluent and those who are far more deprived. One-year survival rates are the lowest in all of the UK and the second lowest in Europe.

Early diagnosis can deliver a dramatically different outcome. I just want to tell you a brief story of somebody who has been in correspondence with me. His wife was lucky enough to receive early diagnosis because, as he puts it, it was a GP who thought outside of the box and therefore treatment was speedy. Initially, his wife was given a terminal diagnosis—an awful thought, given that she was only 43 years of age. But there was a great response to radiotherapy, a proactive oncologist who found a great surgeon and the inoperable became operable. Currently, the scans, 18 months later, are clear. I share this story, because he says, ‘I am internet savvy; I pushed for treatment; I paid for scans in England and I spent a lot of time following NHS paper chains to find the right treatment or the right specialist, and I had outstanding support from the Roy Castle Lung Cancer Foundation’. Cabinet Secretary, many people are not as lucky as this man and his wife.

The third point that I really want to raise—. We’ve talked about getting rid of the stigma, we’ve talked about the importance of early diagnosis leading to greater survival rates, and finally, Cabinet Secretary, surely, we need to see a greater proportion of research funding going towards lung cancer. Lung cancer contributes to 22 per cent of all cancer deaths, but only receives 7 per cent of total cancer research funding. Surely, this is yet another inequality we need to try to right to stop those in poorer areas being more likely to die from it, to give more research funding towards this less fashionable cause, a smoker’s cause, with that stigma attached to it, and yet a cause that kills more people in Wales than bowel cancer and breast cancer put together.

I call on Rhun ap Iorwerth to move amendment 3 tabled in his own name.

Amendment 3—Rhun ap Iorwerth

Delete point 3 and replace with:

Notes the investment in diagnostic services and end of life care achieved by Plaid Cymru in negotiations on the 2017-18 draft budget, and recognises more work needs to be done to improve these services.

Amendment 3 moved.

Thank you, Deputy Presiding Officer. I move the amendment tabled in my name. We have a great deal to celebrate in Wales, without doubt, in terms of cancer treatment. There are people surviving today who would not have done so just a few years ago. There is innovative research going on in our universities, but there is so much more to do and so much more room for improvement. Unreasonably long waiting times for diagnostic services are a problem that has existed over many years, and that’s contributed to the fact that cancer survival rates in Wales are lower than the European average. We also know that the picture is at best mixed in terms of end-of-life care, and we do note those two areas as priorities in our brief amendment today.

Although I do agree with much of what’s contained in the amendment tabled by the Labour Government, we cannot support the wording as it currently stands. With Wales at number 28 in a league of 29 European nations, as we’ve already heard, in terms of survival rates, I don’t believe that the Government can truly talk about significant improvement in Wales. Survival rates are improving generally for cancer, and that reflects improvements in treatment and it reflects hard work by doctors and nurses across the whole of Europe. The truth is that here in Wales diagnosis still happens at too late a stage in too many cases and survival rates are lower here than in nations that have far higher rates of smoking.

Of course, we can’t talk about lung cancer without mentioning smoking. It is worth noting here that the interim leader of the party that has tabled this motion today has denied, apparently, this link between smoking and cancer, and has said that doctors have got it wrong. If we so choose, we can choose to ignore those comments and look at them as an effort to garner attention and nothing else, but there’s a very serious point here. The tobacco industry spent decades and spent many millions of pounds denying that their products killed people, similar to what we see with climate change deniers today, as we’ve seen in another example by the party opposite here in the Assembly this afternoon. As a result, the message about smoking and cancer took far longer to permeate the public consciousness and there was far too great a delay until governments took action. The results were that millions of people lost their lives in the interim. It still happens in some nations where the tobacco lobby can still buy influence. So, when a prominent politician makes these kinds of comments, it undermines the efforts to prevent cancer and puts lives at risk. The party opposite should consider that along with its attitude towards scientists and experts more generally.

The number of smokers has declined, of course, and, hopefully, is likely to fall further, but it has taken decades to actually get to this point. If you will forgive me for just a second while I go on something of a tangent, there is a lesson that I think we can learn from that on the issue of obesity and other problems that are often seen as problems that emerge from lifestyles. The lesson is that we can’t simply tell people to change their lifestyles; we have to assist them to do that. Willpower alone is often not enough to enable someone to give up smoking. People need help from patches or, yes, e-cigarettes in order to give up, and other steps, such as higher taxation, bans on smoking in public places in order to denormalise smoking and so on and so forth. Perhaps we should be thinking about obesity in the same way. Willpower simply isn’t enough to tackle obesity—people need help. Governments need to take action.

If I can return to the topic that we’re discussing this afternoon, we should, of course, bear in mind that lung cancer actually does also affect people who don’t smoke and have never smoked. The Conservatives highlight the issue of women specifically in their amendment 2, and we will certainly support that amendment. We will also support amendment 4. Increasing awareness and fighting the stigma that the Conservative spokesperson referred to are things that we must address. Whatever the cause of the disease and whoever suffers from the disease, I hope that each and every one of us would agree that providing the best possible care is always the aim, aiming towards that day when we can say in all earnestness that we have made significant ground in this battle.

That there has been an improvement in one-year survival rates is obviously to be welcomed, but the statistics on the five-year survival of lung cancer patients do rather detract from that achievement. It is shocking that lung cancer survival rates in Wales lag so far behind those of the rest of the UK. Early diagnosis is key. Waiting times to see consultants to have tests and receive assessment for treatment urgently need to be minimised. I acknowledge the increased funding of the NHS in Wales proposed in the draft budget. However, those funds will only bring real benefit to cancer patients if they are spent on additional front-line staff rather than fancy initiatives, talking shops and backroom non-medical staff.

Whilst end-of-life care is extremely important to any patient with a terminal illness, the goal is obviously to keep cancer patients alive in the first place so they don’t need that kind of end-of-life care. Government proposals in this regard, however compassionate, cannot address the poor survival rates of cancer patients.

We look forward to seeing the detail behind the Government’s refreshed cancer delivery plan and, in particular, to see whether that plan contains innovative thinking or whether the plan will be a rehash of things tried before. It is the responsibility of the Welsh Government to ensure that the infrastructure is in place to support medical professionals in their efforts to increase survival rates in Wales. I don’t for one moment think that these poor results are caused by a lack of compassion on the part of the Welsh Government or anyone in this Chamber or by neglect on the part of our medical staff. However, it is clear that the strategy tried up to now is not working. It is time for some fresh, imaginative and pragmatic thinking on the part of the Welsh Government, and I look forward to hearing its new proposals in due course.

I’m very pleased to take part in this debate. Lung cancer is a huge challenge for the health service in Wales, as it is throughout the UK and throughout the world, but I think it’s very important to remember that progress can be made and is being achieved. I think you’ve only got to look back on the survival rates for other cancers. Do you remember what it was like for breast cancer a relatively short time ago? The survival rates for breast cancer have dramatically improved. Every small step that is taken with lung cancer takes us forward to getting much better survival rates. I think we’re all aware that many cancers now have become chronic diseases, that many people live with cancer, and that is the position I think we must be moving towards, and we are moving towards, with lung cancer.

I work very closely with Velindre cancer centre in Cardiff North in my constituency, and they’ve highlighted for me the opportunities that are available with the new treatments for lung cancer and the improvements brought about by research and by access to national clinical trials. I think it’s important to remember as well, when we do talk about lung cancer, that there are different types of lung cancer. But examples of the new drug treatments for lung cancer, which are going to be made available in Wales over the next few months for the different types of lung cancer include crizotinib, which, in September 2016, was approved by NICE, and the All Wales Medicines Strategy Group approved osimertinib in October. That was only last month; these are two very recent approvals. Pemetrexed maintenance has now been approved by NICE in August, and we will soon have that available. So, it is very exciting that we have these new developments for treatment.

Patients at Velindre also benefit from access to clinical trials and increased opportunities to have treatments such as the matrix clinical trial, which is about delivering personalised targeted medicine, based on genetic testing of their cancer. These are all developments that are happening very swiftly, and we must make sure that we are able to take advantage of them, as I know that we are, and with the new treatment fund that the Welsh Government is committed to, access to new drugs will certainly be helped.

I think it’s also important to say that we do carry out outstanding research in Wales. I wanted to highlight just something that has come from Velindre in my constituency. PhD students from Velindre have carried out research that has led to cell-free DNA testing for lung cancer patients, and that’s using blood tests instead of biopsies. This testing is done for English patients as well as Welsh patients and is carried out in Cardiff, in the regional genetic hub. So, I think it’s important; we don’t want to talk ourselves down. This really innovative stuff is happening in Wales and it’s important that we do acknowledge it.

So, there are encouraging developments, but we all know that the key issue is prevention and early diagnosis, which has been well aired here today. I think it is accepted that there is a link between smoking and lung cancer, and I congratulate the Welsh Government on its work to reduce smoking and to prevent young people from taking it up in the first place, because I think that that is vital—and to protect them from second-hand smoke. I think the legislation that has been carried out in these particular areas has been absolutely groundbreaking. It’s really transformed the health service. I am particularly pleased that from 1 October 2015 it was illegal to smoke in private vehicles when someone under the age of 18 was present. I’m looking forward very much to the public health Bill, when we know that cigarette smoking will be further restricted in parks, hospital premises and other areas. This has all gone along with the agreement and support of the public.

So, we have been working on prevention. We do need to have early diagnosis, and I also am very pleased that we saw the launch of the Be Clear on Cancer campaign to help raise awareness on lung cancer by diagnosing and treating lung cancer earlier. So, there was a lot of work going on, and I’d like just to end, really, by thanking the Welsh Government for its big commitment to developing the new cancer treatment centre at Velindre, where there is a huge amount of capital going in to ensure that the sort of services that we will be able to offer to all cancer patients, including lung cancer patients, who have to go into hospital as in-patients will be having first-class treatment.

Thank you. I call on the Cabinet Secretary for Health, Well-being and Sport to make a contribution. Vaughan.

Thank you, Deputy Presiding Officer. I’d like to start by thanking Members for tabling this debate and for helping to raise awareness and draw attention to lung cancer awareness month. I, of course, recognise the impact that lung cancer has on individuals and their families. As has been recognised today, lung cancer kills more people than bowel cancer and breast cancer combined. It has the highest age-standardised mortality rate of any cancer, and the gap between the most and least deprived areas has actually widened. However, the motion doesn’t take account of the latest data, which shows that one-year survival for lung cancer has increased by a third in women and by nearly a quarter in men. Given the high and rapid mortality of lung cancer, and the difficulty in diagnosing, which has been recognised in some contributions today, in its more early and treatable stages, this actually is a real success to recognise and build upon that increased rate of survival.

Will you take an intervention?

In fact, dealing with the challenges of diagnosing in its earlier and treatable stages, part of the challenge is that it’s difficult to recognise. Part of the big challenge in improving survival rates is actually getting earlier diagnosis and recognition. It’s why we’ve been running with the third sector campaigns to raise awareness on this and, in particular, with partners in primary care. The early symptoms may include a persistent cough, coughing blood, persistent breathlessness, unexplained tiredness and weight loss and an ache or pain when breathing or coughing. So, an awareness of those symptoms and actually seeking help if those actually arise is a key part of actually raising awareness and improving earlier diagnosis.

Just a point of clarity, Cabinet Secretary. I appreciate that the survival rates in women have gone up if they’ve been diagnosed early enough, but overall, would you not agree that there are more women now suffering from and getting lung cancer than there have been in the past?

Indeed. We recognise that more people are being treated and more people are being diagnosed with cancer, and that’s the reality. It’s something about the population we have, and it’s also about the greater recognition of the fact that people are being diagnosed later in life than they otherwise would have been. We recognise that we’re not the only post-industrial country with an ageing population to have a problem with lung cancer. However, survival from lung cancer is poor relative to many other cancers in most countries, but our ambition, as set out in the cancer deliver plan, is to close the gap with the best in Europe. We recognise that we are not there now.

The 2013 cancer plan is currently being refreshed by the Wales cancer network, and I will endorse and publish a new plan by the end of this month. The Government amendment and the contribution from Rhun ap Iorwerth recognise that we’re going to provide £15 million of capital funding for 2016-17 for diagnostics, and this will support work to improve cancer diagnosis in addition to the £10 million we’ve already invested in replacing linear accelerators and our commitment to a new £200 million Velindre Cancer Centre mentioned by Julie Morgan in her contribution. Of course, the £15 million capital funding was agreed as part of the budget agreement with Plaid Cymru, recognising our shared priorities to improve diagnostic services.

The national cancer implementation group has already been taking forward a lung cancer initiative over the past year, and I was pleased to hear this mentioned in the opening contribution from Caroline Jones. This includes a symptom awareness campaign that ran over the summer, and a programme to help improve lung cancer surgery outcomes, a really important part of improving survival rates. We also want to help people to be ready for surgery, so prehabilitation before surgery, and to provide enhanced recovery.

Through NHS Wales’s participation in the British lung cancer audit, we have already seen improvements in the quality of services, including increases in our lung resection rates. There’s still more to do, but some of our services do perform incredibly well against several elements of those national standards. For example, treatment by a specialist nurse in Wales is 88 per cent, compared to a British average of 78 per cent, and the management of the condition in an individual being discussed at a lung cancer multidisciplinary team is 99.6 per cent in Wales compared to a British average of 94 per cent. So, all is not lost. There are some areas where we perform very well compared to UK counterparts.

The specialised services committee in Wales is also reviewing thoracic surgery services here in south Wales with a view to improving the model available. Cardiff and Vale health board was also partnered with Novartis to redesign and shorten the lung cancer pathway, and improving the pathway was a really important part of improving outcomes for patients across the board. The GP contract includes a national priority area for cancer prevention and detection, but also includes an analysis of all cases of lung cancer in 2015 to inform practice development and cluster action plans. I hope that deals with one of the points made in the opening speech.

We have of course partnered with Macmillan to support improvement in identifying suspected cancer in primary care, as well as post-diagnosis support and treatment. This Government will continue to implement regulations on environmental hazards such as asbestos and air pollution, but as has been recognised in a number of contributions today, smoking remains the highest risk factor for lung cancer. With smoking rates of up to 29 per cent in our most deprived communities, we can see the importance of continuing to have a focus on tobacco control and smoking cessation to address the biggest preventable cause of lung cancer and the inequalities in cancer incidence and outcomes.

The October United Kingdom Lung Cancer Coalition report stated that

‘significant steps have been taken in Wales to improve outcomes for those diagnosed with lung cancer’.

I’m happy to say I met representatives of the coalition in February and my officials met them again in June. Work is already progressing against many of their recommendations. This is an area where we recognise more improvement is necessary, but we continue to invest over £6.4 million annually in specialist palliative care services, and we are committed to ensuring people approaching the end of their life here in Wales have access to high-quality and specialist palliative care. That’s why we’re focusing on supporting hospice-at-home services, developing a consistent approach to advanced care plans, and rolling out the care decisions document for the last days of life. Also, we’re ensuring comprehensive paediatric palliative care arrangements are in place.

I’m happy to say that, this week, I’ve had conversations with stakeholders about how we do we improve both paediatric and adult end-of-life care services. One million pounds of funding is already available to both cancer and end-of-life implementation groups. The end-of-life implementation board is funding support for hospice-at-home services to enable people to die comfortably in their preferred place of death. We recognise that far too many people still die in a hospital bed, where it’s not the choice of where they want to end their days and equally not the most appropriate place for that to happen. One hundred and fifty-nine thousand pounds has also been allocated to support staff with advanced communication skills involved in end-of-life care.

The end-of-life care plan is also being updated and I expect to publish the new plan in January. Working with other parties in the Assembly, in particular with Plaid Cymru following our budget negotiations, we’ve included an additional £1 million for end-of-life care within the draft budget. This is for all end-of-life care services, rather than a specific section or a specific set of conditions, which I do not think would be either manageable or, frankly, ethically desirable.

These priorities do include the further expansion of hospice-at-home services and extending the reach of serious illness conversations, but I do think that we should recognise that, here in Wales, we’re in a better position than our UK counterparts on end-of-life care. However, there is more, of course, that we could and should do. The Government amendment confirms recent improvements in one-year lung cancer survival and the approach set out in the cancer and end-of-life delivery plans. We also highlight the important partner arrangements we have with the third sector, in particular the Wales Cancer Alliance and hospice sector, and the additional £240 million for the health service in the draft budget.

We should recognise and celebrate the progress that has been made, but we will continue to work with and welcome the constructive challenge of the third sector and will continue to work with our clinicians right across the NHS. So, this Government recommits itself to the further improvement that all of us would wish to see.

Thank you very much. I call on Neil Hamilton to reply to the debate.

Thank you, Deputy Presiding Officer. I hope everybody will agree that this debate has been conducted in as non-partisan a way as we possibly could. That was the spirit in which UKIP has put this motion on the order paper today and the way in which my honourable friend, Caroline Jones, opened with in her speech. I regret the fact that the Government has put down an amendment that seeks to delete the bulk of our motion and replace it with a wording of its own. We would have been quite happy to accept the bulk of the wording of the Government amendment were it not for their wishing to delete our amendment in the first place.

It’s very noticeable that the health Secretary in his speech of course concentrated on the areas where he could point to improvements, but you don’t actually succeed in making as many improvement as you can by ignoring or seeking to hide the areas where you’re failing. Yes, it’s all very well to talk about improvements in the one-year survival rates of cancer, but what about the figures for the five-year survival rates that are referred to in our motion itself?

In the ‘25 by 25’ 10-year strategy document produced by the UK Lung Cancer Coalition, the figures are given that, in England, it’s a 16 per cent survival rate after five years, Scotland is 10 per cent, Northern Ireland is 11 per cent and Wales is 6.6 per cent. There is room for vast improvements in that figure. I believe that this Assembly is right to draw attention to the current situation with five-year survival rates and it’s wrong for the Government to seek to remove that from the motion on the order paper today.

We accept the amendments of the Conservative group. I listened with care to what Rhun ap Iorwerth said in his speech. Of course, there is much that we can approve in his motion as well, but because he referred to the achievement of Plaid Cymru in its negotiations in the 2017-18 budget, I think that goes against the kind of non-partisan spirit in which we have introduced this debate today. So, we will therefore oppose that amendment.

He did mention Nigel Farage in his speech as somehow being a smoking sceptic. I’ve no idea if he is or not. As Rhun ap Iorwerth knows, we don’t talk to each other. [Laughter.] But, Nigel Farage isn’t right about everything. [Assembly Members: ‘Oh.’] For one thing, he didn’t want me to come to this place. So, if honourable Members think that he’s wrong about everything, then that’s an implied welcome of me as a Member of this house, and I thank them for that. But it’s been an interesting and a useful debate, because our motion is predicated, of course, on point 1, which notes that November is Lung Cancer Awareness Month and this debate, I hope, has helped to improve awareness.

Everybody, virtually, has mentioned today the importance of early diagnosis in the successful treatment of cancer, and Julie Morgan made a very important point, I think, that the diagnosis of cancer today is not necessarily a death sentence or, indeed, an early death sentence, and it was very interesting to listen to what she had to say about the important work that is being done at Velindre and the successes that they’ve had in the research work that is being done there. And I pay tribute to the Cabinet Secretary for health as well, because he has certainly made a significant contribution towards the improvements in the health service in Wales, and I applaud his ambition further to close the gap between the survival rates for cancer of all sorts in Wales and the rest of Europe. We approve of, of course, and welcome all the extra investment and other improvements that he mentioned in the course of his speech.

Angela Burns made some very important points in her speech as well, about the necessity for earlier screening, greater awareness through education et cetera, and very importantly made the point about the postcode lottery that still does, unfortunately, exist in diagnosis of stage 1 cancers. So, whilst we commend the Government for their successes and achievements so far, there is much more to be done, but because they are not prepared to own up to their failures in the past, I hope that, in the course of the vote this afternoon, our motion will pass and the Government amendment will be defeated.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Thank you very much. Therefore, we’ll defer voting under this item until voting time.

Voting deferred until voting time.

It has been agreed that voting time will take place before the short debate. Therefore, unless three Members wish for the bell to be rung, I will proceed directly to voting time. Okay, thank you.