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

We move on to the Plaid Cymru debate on cancer diagnostic targets, and I will call on Rhun ap Iorwerth to move the motion.

Motion NDM6172 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Notes that the independent cancer task force has called for a target of diagnosis within 28 days.

2. Calls on the Welsh Government to ensure that the extra investment in diagnostic equipment secured by Plaid Cymru in the budget negotiations helps achieve this target.

Motion moved.

Thank you very much, Deputy Presiding Officer. I’m pleased to open this debate, which calls for a focus on achieving a target of 28 days for diagnosis for those with cancer. This is a recommendation that was made by the independent cancer taskforce, which includes some of Europe’s finest clinicians, who said:

Rydym yn argymell y dylid gosod uchelgais y bydd, erbyn 2020, 95% o gleifion a atgyfeiriwyd gan feddyg teulu i gael profion yn cael diagnosis naill ai bod ganddynt ganser, neu nad oes ganddynt ganser, a bod y canlyniad wedi ei gyfleu i’r claf o fewn pedair wythnos.

The report also suggests that 50 per cent should receive their results within a fortnight.

Some of the more pedantic amongst us have drawn attention to the fact that the independent taskforce looks specifically at England. The suggestion, I suppose, is that we should never look at what happens elsewhere, or even that cancer changes its form when it crosses a border, but, of course, the recommendation has also been approved by Cancer Research as something that would be of specific value to Wales too. The health needs of people are the same and the need for early diagnosis is just as important.

Waiting times for diagnosis are longer here than they are over the border. Any reasonable analysis of data, I think, would demonstrate that. And because of new NICE guidelines, which do apply here in Wales, it will be easier for GPs to refer people for testing. So, an increase in capacity, I think, is going to be necessary.

We have seen improvements in diagnostic waiting times for radiology in Wales over the past few years, and clearly we want to see that continuing. But the figures are no better than they were back in October 2009, for example, so we are still trying to recover from that period between 2011 and 2014 when waiting times went through the roof.

It’s even worse when it comes to endoscopy diagnosis, which is crucial, of course, with colon cancer. Here, the median waiting time has gone from a little over three weeks in 2009 to a little under six weeks for most of this year. We haven’t seen any real improvement since 2014, and remember that is the median figure, which will mean that half the people are waiting even longer than that. So, you can see the challenges facing us in achieving a target of 28 days for diagnosis for 95 per cent of patients.

The Minister, I think, has claimed in the past that the target, to a certain extent, is being achieved, but that somehow it’s not being recorded. All I will say about that is that I’m sure it’s very frustrating for him that all of the targets that his Government does achieve aren’t recorded and published, when so many of the targets that are recorded show failures. Some people might assume from that that things aren’t perhaps going as well as the Minister would hope.

But let’s concentrate on something else that the Minister has said entirely accurately on a number of occasions: we need to look at outcomes. I agree 100 per cent with that. So, let’s emphasise the importance of having earlier diagnoses and what that can mean in terms of outcomes. Recent figures demonstrate that 93.2 per cent of patients who received a diagnosis at the earliest stage of colon cancer survived for five years, as compared with only 6.6 per cent where the disease had developed further. For liver cancer, between 50 per cent and 70 per cent of stage A patients will survive for five years with treatment, as compared with a median survival rate of between six and 11 months for those in stage C. More than 90 per cent of women diagnosed with breast cancer at the earliest stages do survive for at least five years, as compared with 15 per cent of women who are diagnosed at the most advanced stage of the disease. More than 90 per cent of women who are diagnosed with ovarian cancer at the earliest stage do survive for at least five years, as compared with 5 per cent of women diagnosed at the most advanced stage. The figures are very striking indeed. We know, of course, what they are, but it’s worth while looking at those bare figures just to remind ourselves of the importance of diagnosis and early diagnosis.

There’s often mention of comparing Wales with England. It’s fair in some contexts, not fair in other contexts, but, of course, we in Wales and England, together, should be looking at what is happening where performance is at its best. A few examples for you: the survival rates for breast cancer for five years, 79.1 per cent in England; 78 per cent in Wales—similar figures; in Sweden, the figure is 86 per cent, and that’s what our target should be. In England, 80 per cent of men with prostate cancer survive five years or more; the figure is 90 per cent in Austria; 78 per cent in Wales. Colon cancer, the survival rates for five years in England are 51.3 per cent; a little below 50 per cent in Wales; but in Germany, they achieve over 60 per cent—62.2 per cent—with the European average at 57 per cent. So, once again, we should be aiming to match the best, because all of these people in these other nations who do receive early diagnosis are people who benefit in the long term from that diagnosis, and the survival rates demonstrate that to us.

There are a number of reasons for late diagnosis: the unwillingness of patients, very often, to visit their GP with that persistent cough or a lump that doesn’t go away. Perhaps the patient has listened to Government advice not to visit a GP unless that’s entirely necessary. There are a number of reasons, of course, why people don’t go to their GPs. But longer waiting times are also a factor and sometimes complex symptoms need complex testing of the kind that we have seen being innovated in multidisciplinary centres in Denmark, and that is something that I’ve referred to on a number of occasions in the past. Once again, Cancer Research supports multidisciplinary centres of this kind. Here’s one quote:

Mae’n amlwg fod diagnosis cynnar yn hanfodol i wella cyfraddau goroesi mewn llawer o fathau o ganser. Mae hyn yn haws gyda rhai mathau o ganser, er enghraifft canser y fron a chanser y croen sydd â symptomau penodol. Mae heriau penodol yn bresennol mewn canserau pan fo’r symptomau’n annelwig.

We must provide all opportunities through diagnostic centres and by using the funding allocated through the budget, following discussions with Plaid Cymru, to ensure that that crucial target is one of the main priorities as we target scarce resource, but the resources that are available in order to secure the future health of the people of Wales.

Thank you very much. I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 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 and replace with:

Notes:

a) the emphasis on earlier detection of cancer set out in the refreshed Cancer Delivery Plan for Wales (2016-2020);

b) that more people than ever are being treated for cancer in Wales and survival rates are at an all-time high; and

c) that the Welsh Government will ensure that the extra investment in diagnostic equipment set out in the draft budget is used to improve cancer waiting times and treatment outcomes.

Amendment 1 moved.

Formally, Chair.

Thank you very much. I call on Angela Burns to move amendment 2 tabled in the name of Paul Davies.

Amendment 2—Paul Davies

Delete Point 2 and replace with:

Calls on the Welsh Government to improve access to screening services across the whole of Wales by acknowledging the role a national mobile cancer treatment service plays in supporting those with cancer, alongside reducing referrals to secondary care by making greater use of diagnostic technology in GP surgeries.

Amendment 2 moved.

Thank you, Deputy Presiding Officer. I would like to do just that. I’m very grateful to Plaid Cymru for bringing forward this motion, although I would say to Rhun ap Iorwerth that he shouldn’t be quite so sensitive about being ribbed for relying so heavily upon an English survey, when he normally eschews all things English. In fact, Plaid Cymru have taken me to task so many times for using English data when it comes to the NHS.

I think that having a target for diagnosis within 28 days is a really laudable aim, and I think it’s also a very humane aim, because I cannot think of much that could be more frightening than a GP telling you that you need to go off and have tests because they suspect you have cancer. I know from constituents’ stories, they tell me that it consumes them—the wait. And the longer they have to wait, the more worried they and their families become. I think that being able to answer people’s fears and either tell them of a battle they have to fight or to let them off and allow them to go back to their normal lives is incredibly important. And anything and everything we can do to bring that diagnosis time down is really, really welcome.

I’ve noted the Government’s amendments and I am pleased, Cabinet Secretary, to see that there is more emphasis on early detection, as set out in the cancer delivery plan. I couldn’t agree more with that, but I have to say that, overall, you are failing cancer patients throughout Wales. Independent research by Bristol University concludes that patients in England are seven times more likely to access modern cancer drugs than their counterparts in Wales; that, in Wales in total, there’s been a 6.1 per cent increase in those waiting for urgent cancer care. So, it’s very important to have the early detection, but your point (b) goes on to say that,

‘more people than ever are being treated for cancer in Wales and survival rates are at an all-time high’.

I welcome that. I think that’s absolutely excellent, but, again, we have to look at the fact that only 83.3 per cent of people who should have started their cancer treatment within 62 days are actually being able to do that, and none of Wales’s health boards are meeting this target on an individual basis. So there’s quite a big gap between the rhetoric of your amendments and the actual delivery out there on the street.

We’ve put forward an amendment that talks about improving access to screening services across the whole of Wales. We would like to acknowledge the role that a national mobile cancer treatment service plays in supporting those with cancer. We believe that we are so far behind in the first part of this motion that we could really move forward by using mobile cancer diagnostic treatment centres much, much more. Twenty point eight per cent of people across Wales are waiting more than eight weeks. In England it’s only 1.5 per cent. We have got more new cases of cancer and incidence is continuing to rise in men and women. When you think that four out of every 10 cases of cancer are preventable, where good diagnostics could make such an enormous difference, then we really want to emphasise the point that a national mobile cancer treatment service could make the world of difference.

We announced in the 2016 Assembly elections that we would establish just such a thing to prevent long round trips for patients accessing clinics and chemotherapy treatment. We also committed to reducing referrals to secondary care by making much greater use of diagnostic technology in GPs surgeries. It’s really interesting, because I went to a cluster group on Friday of last week, and they’ve actually got a critical reactor diagnostic test machine, and that is one of the keys that will actually tell you in your blood whether or not you might be having something going on that could lead to either a cancer or a sepsis. It’s a very rare thing for a GP’s clinic to actually bring that in and use that, but by being able to do that they’re playing their part in helping to move forward this early diagnostic.

There are an awful lot of things that we can do in terms of helping GPs to do much more screening at their level, to then get those referrals going on through into the hospitals. Mobile clinics are absolutely essential, particularly in rural Wales, where it is so very difficult for people to get backwards and forwards. We’d like to look at ideas such as having chemists being able to do blood tests—again, blood tests that can pick up the cancer markers, which can go forward. All of these things just help to speed up the system, and that’s what we need to do to be able to move this forward. If we want to be able to try and make that 28-day target, which I think would be absolutely critical for the mental well-being of a potential cancer sufferer, then we need to look at the whole broad-brush spectrum, and I’d be very interested in your views on some of those ideas, Cabinet Secretary.

I’m pleased to be able to speak in this debate. Yesterday I was able to ask the First Minister about the progress that the Welsh Labour Government is making in improving survival rates for cancer, and as I told the First Minister last week, the Member for Cynon Valley, Vikki Howells, and I had the privilege to tour the laboratories of Cancer Research Wales, where we were able to witness the exciting and groundbreaking work that is taking place today to increase scientific understanding of how cancer attacks the immune system.

Cancer Research Wales is a truly exciting example of the great work that is going on in Wales. They raise over £1 million a year in fundraising and contribute to cancer research within the many Welsh hospitals and university departments across Wales. As stated, I greatly welcome the ambitious Welsh Labour Government’s revised cancer delivery plan that has just been launched. All of us can applaud the fact that patient satisfaction remains positive. Indeed, investment in spending on cancer services has risen from £347 million in 2011-12 to £409 million in 2014-15. As the First Minister told me yesterday when I asked what tools the Welsh Labour Government could give the gifted scientists and researchers at Cancer Research Wales, he stated,

‘we are investing £4.5 million of funding over three years in the new Wales Cancer Research Centre, which was launched in October last year. In addition, roughly £4.7 million is invested annually in support of recruiting patients to trials or studies and supporting health board research activity.’

Indeed, the revised cancer delivery fund makes commitments to improve survival rates for cancer, reduce early death caused by the disease, close the gap with the best providers of cancer care in Europe, and the plan additionally covers the period to 2020 to provide very important continuity for the health service.

The Welsh Labour Government has set ambitious targets in this field for Wales. At least 95 per cent of patients diagnosed with cancer via the urgent suspected cancer route will start definitive treatment within 62 days of receipt of referral. Indeed, Wales has more stringent targets than England—95 per cent, compared to 85 per cent on this. At least 98 per cent of patients newly diagnosed with cancer, not via the urgent route, will start definitive treatment within 31 days of diagnosis, regardless of the referral route. These targets reflect advice from expert clinicians, patients and the third sector that patients should not wait more than 62 days from the point at which cancer is first suspected to the start of treatment.

A 28-day diagnosis target, which the Tory Government has announced as the target to be met in England by 2020, would not in itself guarantee faster access to cancer treatment. The whole pathway is important for people referred with suspected cancer, not just the first 28 days. The Welsh Labour Government has said that it is opposed to any idea that would potentially lead to patients being misdiagnosed or not being diagnosed at all to meet a new target or any proposal that would lengthen the time patients wait to start treatment. It should be recognised that we have a different health service and system in Wales, which is based on collaboration and the integration of primary and secondary care. So let there be no doubt: for us to achieve our aims, we do have to invest, and also let there be no doubt that the Labour Party, which created the national health service, the greatest achievement of any peacetime United Kingdom Government, here in Wales continues to ensure that the national health service here is funded and fit for use in the twenty-first century.

Investment from the Welsh Labour Government has meant that spending on cancer services continues to rise. Cancer now accounts for nearly 7 per cent of all NHS expenditure in Wales—the fourth biggest expenditure area. The Welsh Labour Government is investing £16.9 million in diagnostic equipment, such as MRI and CT scanners in 2016-17. There can be no better testament to the commitment that our party and our Government has than to ensure we continue to tackle the scourge of cancer than that of the new £200 million Velindre cancer centre, with £15 million allocated in the draft budget, in these times, for better diagnostics. The direction of progress and journey being made is good, and that is why I shall be voting against the motion as proposed and will be supporting the Government amendments. Thank you.

I would like to thank Plaid Cymru for tabling this debate today. The Welsh Government’s refreshed cancer delivery plan outlines the scale of the problem we face. Cancer care has vastly improved over the years and, as a result, more and more people are surviving cancer. However, we are failing badly when it comes to early diagnosis and have some of the worst five-year survival rates in the developed world. Eventually one in two of us will develop cancer at some point in our lives and, as Dr Crosby writes in the introduction to the cancer delivery plan,

‘Diagnosing cancer early allows for a combination of less aggressive and less expensive treatment, improved patient experience and quality of life, and cruciallybetter survival.’

We have to do better. We must learn from experiences elsewhere, and I’m pleased that the Welsh Government accepts that we are not performing well when it comes to early diagnosis and that they are prepared to look at how things are done across the world. The cancer implementation group’s visit to Denmark has led to an overhaul of GP cancer referrals and the piloting of diagnostic centres. Plaid’s motion refers to the work undertaken to develop the English cancer delivery plan, and UKIP would happily support Wales adopting the cancer targets set out in the report by the independent cancer taskforce.

The NHS in England have made massive improvements in their five-year survival rates and we would do well to learn from these achievements.

Will you take an intervention on that?

Yes, certainly.

I thank the Member for taking an intervention. Do you share the concerns, then, I have that the report today from Cancer Research UK highlights the possible chaos that’s going to happen in diagnostics and pathology within the NHS, because they see the numbers increasing but the actual section decreasing?

Thank you, David. It’s going to be very difficult to keep up with the demand, as one in two of us is going to get cancer, but we can only try our best.

We would also support the Welsh Conservatives’ suggestion of a mobile cancer treatment service, particularly for rural areas.

There is no single solution to delivering improvements to cancer care in Wales but many small steps we can take. We have to improve awareness of the symptoms, access to a GP, improve availability of diagnostics in primary care, speed up the referral process and ensure access to the latest treatments. If we incrementally improve every link in the chain, then we can deliver the best cancer care in the world and ensure more people survive cancer for longer. The new cancer delivery plan is a good start; let’s ensure that delivery matches ambition. Thank you. Diolch yn fawr.

‘It’s cancer’—probably some of the most dreaded words that people hear when they visit their consultant or their GP after investigations have taken place. Upon hearing those words, patients face a challenging time. It’s important that we do as much as we can to reassure them and ensure that the care that they will have will have a structure, an agreed plan and will be of the highest quality. But we must also be reassuring ourselves that the care they receive to that particular point meets the same high standards.

Today’s debate is about the importance of early care and undertaking those investigations as quickly as possible to be able to provide patients, either with the all-clear message, thus leaving the huge anxiety and the burden they’ve been carrying during that period or with a message that they have a condition that needs urgent treatment.

Statistics suggest that many as one in three— perhaps now it is down to one in two—will develop cancer during their lifetime. Just looking around this room, that means 10 plus of us maybe getting that message in the years ahead. It’s an issue that affects families and communities across Wales and it’s very likely that many in this Chamber have personal experiences of family members or very good friends who have heard those words and travelled through that diagnostic process and who may be able to relay some of their experiences directly from what we know.

I’ve also met constituents, as many of you have, who’ve raised concerns about the delays that they’ve experienced in the diagnostic process. It’s important to acknowledge that, despite the ongoing progress towards target achievement—and there is progress—people are still experiencing waits and I’ve got no intention of burying my head in the sand on this matter. But it’s also important to stress that I’m also contacted by constituents who tell me how much praise they’ve given to the NHS in Wales for the speedy treatment that they have received and the excellent care provided by the dedicated and committed NHS staff here in Wales.

It is good news that the cancer survival rates in Wales continue to increase year on year, and I’m sure that the statistics will be repeated again. However, with regard to diagnostics, at the end of September 2016, just 11,000 people were waiting over eight weeks for specified diagnostic tests and endoscopies. Cabinet Secretary, I’m sure that you would agree that this is 11,000 too many. Although, I accept that not all of these were suspected cancer and that the figure is 36 per cent lower than in 2015.

We all want an end to long waiting times in all areas of our NHS in Wales, including cancer care. This ambition has been reflected by the recently published revised cancer delivery plan. My colleague, the Member for Islwyn, has stressed the positives of that plan already this afternoon. It focuses on early detection of cancer through better access to diagnostics. I welcome the recent announcement of the investment of £6 million in the hub at the Royal Glamorgan Hospital in Llantrisant—they’re replacing a CT scanner, a new, second CT scanner and MRI scanners at that hospital—all expecting and helping to deliver more MRI scans, over 7,000, and more CT scans, over 6,500 per year. They will undoubtedly improve the diagnostic testing across south Wales.

The Government’s commitment to improving cancer diagnosis targets, as well as treatment for those suffering from this horrendous disease, is clear: detecting cancer earlier is not only a matter of diagnostic tests following referral. We must also continue the national screening programmes and work hard to improve the screening uptake through improving public awareness of the importance of these screening programmes. That’s been one of the problems. The uptake sometimes has not been very good. In 2015-16, 77.8 per cent of women in the target age group attended cervical cancer screening at least once in the past five years. This figure has, however, been slowly decreasing over the past 10 years. We need to see it increase and not decrease. Breast screening saw a small increase of 0.3 per cent, and there is currently 72.4 per cent of those women within the target age group being screened.

However, bowel screening is actually very poor. They’ve seen a decrease in people being screened, with only 50.8 per cent using bowel screening. We must improve these screening figures because they are a way in which we can identify at an early stage people who need care. And why are we helping people? Rhun ap Iorwerth highlighted other issues that perhaps cause some concerns, of delayed attendance at GP surgeries, and one of those, possibly, is men. We are terrible at going to a GP. We don’t make the effort. We think we’re big enough and don’t have a problem. We need more of us to actually identify the fact that we should attend a GP when we believe that something’s going wrong. And we often know it’s going wrong, but we just don’t want to admit it to ourselves. So, we must educate people better about taking the steps of self-awareness and screening processes, so we can actually do the early identification.

Dirprwy Lywydd, progress is being made, but there’s much more to be done, and we must all work together to achieve greater success.

Thank you very much. I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Thank you, Deputy Presiding Officer. I’m happy to respond to today’s debate, and begin by acknowledging the comments already made, that earlier diagnosis of cancer will allow for that less aggressive and less expensive treatment, and, in particular, improved patient experience, but also quality of life that, crucially, should lead to better outcomes. But I don’t agree with the central implication of the motion, which is that a target time for diagnosis is the way to go about improving detection or necessarily outcomes. I accept that targets have a part to play in any healthcare system, but they can create perverse behaviours in different parts of the service, including in complex cancer care pathways. And on cancer waiting times to start treatment, we continue to do better than England, but our challenge is how we do better still rather than simply comparing ourselves with the English system. And I do acknowledge what’s been said about the English cancer taskforce recommendations that Plaid Cymru refer to in their motion. They don’t apply to Wales, and we do have a different health system. It isn’t being pedantic; it’s one that is delivered differently on the base of integrated primary and secondary care, health boards, on a planned rather than a commissioned model, on the basis of collaboration not fines, targets and tariffs.

Now, earlier diagnosis is a major focus of the refreshed cancer delivery plan that was published and launched within the last two weeks. We know that the Cancer Network is working with primary care on implementing the NICE suspected cancer referral guidelines, and that, in itself, is a real challenge for the whole service. The network is looking to reform diagnostic pathways, learning from their visit to Denmark, about additional referral pathways for vague symptoms. We know that is a significant challenge as well. And, through the GP contract, clusters are analysing the learning from GP referral practice. And the framework for cancer programme is developing support for GPs to better diagnose, refer and support people who have a diagnosis as well.

On screening, it’s been mentioned that more than 400,000 are routinely screened in Wales each year as part of our highly regarded breast, bowel and cervical screening programmes. We’ve already extensively modified the breast cancer screening, and we’ve recently agreed to implement better and more acceptable testing for cervical cancer and bowel cancer screening. And, in fact, that is one of the big barriers to improving the number of people who actually attend and undertake a bowel cancer test. Now, the NHS workforce strategy, and the imaging and pathology programme boards are addressing key workforce shortages in both pathology and radiology. The introduction of national informatics systems will better integrate care across sites and organisations with common pathology and imaging systems.

So, there is no complacency on our part that we have everything perfect in our system. We continue to challenge, to reform and to progress different aspects of cancer care right across Wales. And I’m pleased that points have been made on diagnostic waits, and in particular the recognition by David Rees that we’ve improved our performance on diagnostic waits over the last year. I expect to see more improvement again through the end of this performance year, and I did recently announce a £6 million investment in the diagnostic hub in Cwm Taf. We’re already making use of some mobile diagnostic services as well. But, we will, in the future, invest again heavily in replacing and in providing new diagnostic equipment, including CT, MRI and PET imaging techniques, as well as a further £15 million earmarked for diagnostic equipment following the draft budget agreement with Plaid Cymru.

We have a national endoscopy implementation group working to reduce waits and improve quality, and I’ve recently announced an extra £3 million in capital spending on decontamination equipment for these units. And I’m pleased at this point to recognise the points made by Rhianon Passmore about the investment we already make, and continue to make, on an increasing basis, for cancer services, and our backing of the new £200 million Velindre cancer centre. Now, I understand the sentiment and the drive behind the motion, and the recommendation it makes, but I simply don’t agree that an arbitrary 28-day target makes a meaningful contribution. I don’t think it’s the right way to take up the time, energy and effort of people within the service for them to make the best contribution to actually improving outcomes for cancer patients, because most patients on a 62-day pathway will have their definitive diagnosis already by that time, but some complex lung and oesophageal cancers can be hard to stage and diagnose within the 28 days. I don’t think it’s helpful to try and break up the pathway, rather than getting support in having a definitive diagnosis and definitive treatment actually starting. I think we need to give our clinical teams the time to interpret and use the diagnosis to agree and then begin that person-centred treatment plan within 62 days.

I’m really happy to refer back to the fact that one-year and five-year survival rates are at all-time highs. They continue to improve, premature mortality continues to fall, and patient experience is exceptionally high. None of this means that we are complacent about where we are and where we want to be. And on diagnostics, as Tom Crosby, the medical director of the Wales cancer network said,

‘We must lead a relentless drive towards earlier diagnosis.’

There is no suggestion that we don’t think diagnosis is important. But in Wales, I believe we already have a sound approach and a plan in place to do just that, and this plan is welcomed by both clinicians and the third sector. If you like, the previous cancer delivery plan was written for the service and given to them to get on with and deliver, and it was welcomed at the time. But the new cancer delivery plan has been written with the service and with the third sector, and we’re working on the basis of evidence that we’ve gathered on what the right thing is to do to improve what we already do within Wales. The plan is widely supported, and it has a shared ambition to continually improve outcomes. And I look forward to working together with the service, the wider third sector and the public to do just that.

Thank you very much. I call on Rhun ap Iorwerth to reply to the debate very briefly.

Diolch, Ddirprwy Lywydd. We tabled this motion to give the Government an opportunity to align itself with clinical opinion, and to use the extra investment in diagnostic capacity to prioritise achieving this 28-day diagnostic target, which I haven’t plucked from the air; this has come from the people who know something about this. This could clear a bottleneck in the system and lead to faster treatment. I regret that the Government won’t take this opportunity. They seem to suggest that it’s the treatment time that’s more important. Well, of course, the treatment time and the timetable is important, but of course, the earlier the diagnosis, the earlier you can begin treatment and the earlier you can begin treatment, the better the hopes are for survival for the patient. So, we won’t be supporting, clearly, the Government amendment.

We can’t support amendment 2 from the Conservatives either, because it takes out our call for the focus of diagnostic spend in this particular area. Yes, screening is very, very important. If my mother had been screened, she’d still be alive today. She died because she found her cancer too late. But it takes away that key part of our motion today. Support the motion. Twenty-eight days is what, we are told by experts, not just in Wales but further afield, we should be aiming for. I can’t for the life of me see why we wouldn’t want to set that as an ambition.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Thank you. Therefore, we will defer voting under this item until voting time. It has been agreed that voting time will take place before the short debate, and unless three Members wish for the bell to be rung, I am going to proceed directly to voting time. Okay, thank you.