The next item is on the agenda is a debate by individual Members under Standing Order 11.21, and I call on Julie Morgan to move the motion—Julie.

Motion NDM6311 Julie Morgan, Hefin David, Dai Lloyd, Angela Burns, Mark Isherwood

To propose that the National Assembly for Wales:

1. Congratulates the staff in the NHS in Wales for treating and curing an unprecedented number of patients with Hepatitis C.

2. Calls on the Welsh Government to confirm their commitment to the World Health Organisation eradication date of 2030.

3. Calls on the Welsh Government to consider new operational guidelines to support the NHS to work towards the eradication of Hepatitis C in Wales.

Motion moved.

Thank you very much, Deputy Presiding Officer, for calling me to move this very important motion, supported by Hefin David, Dai Lloyd, Angela Burns and Mark Isherwood.

We have started out on a journey in Wales in the last two years to identify and treat everyone who has the blood-borne virus hepatitis C. In this motion today, we are calling on the Welsh Government to reconfirm its commitment to eradicate hepatitis C in Wales by 2030, the date set by the World Health Organization. And we’re congratulating the NHS doctors and nurses for the work that they’ve already done towards treating and curing an unprecedented number of people with hepatitis C. We’re also calling for new operational guidelines to be considered by the Welsh Government that will help NHS medical staff in this difficult task. Great progress has already been made in enabling equitable and transparent access to new medicine in an affordable and responsible way. The new treatments are approved by the National Institute for Health and Care Excellence and the All Wales Medicines Strategy Group and are cost-effective. All patients in Wales are now able to access the new highly effective antiviral drugs, and, in fact, there has been a cure rate of 95 per cent, which is so encouraging. The work is being led by the blood-borne virus group, and I’d like to pay tribute to them and to Dr Brendan Healy, who is the lead consultant. He said: ‘I’m really proud to be able to represent such an amazing team. The work and effort they have put in is phenomenal’. My contact with this group, I think, does really show the NHS at its very best.

Hepatitis C is a blood-borne virus that affects the liver. Eighty per cent of people who are infected develop chronic hepatitis C, which can cause fatal cirrhosis and liver cancer if untreated. The estimate is that 240,000 people are chronically infected with hepatitis C in the UK, and about 12,000 of these are in Wales. But the exact figure is unknown because there are so many people who have it, but don’t know that they have it. And we know that it particularly affects people from disadvantaged communities; almost half come from the poorest fifth of society.

Hepatitis C is transmitted though contact with infected blood. And it is true that the majority become infected after injecting drugs. The latest figures from the Hepatitis C Trust show that 50 per cent of injecting drug users in Wales have hepatitis C. But the virus also affects those who could possibly have had overseas medical care, and people who have had a blood transfusion in the UK before 1991, which, of course, include haemophiliacs, as I know from my work as chair of the cross-party group on haemophilia and contaminated blood.

In many ways hepatitis C is a hidden disease because people can live without symptoms for decades after infection. I think we all know of the case of Anita Roddick, who founded The Body Shop, because she only discovered she had hepatitis C in 2004. She contracted it through a blood transfusion after giving birth to her daughter in 1971. So, she was actually living with this disease for 30 years without knowing it, and she died from a complication of liver disease in 2007.

I am very proud of the progress we have made so far in Wales thanks to the Welsh Government’s leadership and funding. The 2015 liver disease action plan set out a plan to eradicate hepatitis C, alongside treating other types of liver disease. A huge breakthrough came in September 2015, when the finance Minister, Jane Hutt, agreed the funding of £13.8 million for new, interferon-free drugs sofosbuvir, Harvoni and AbbVie. The funding was used to treat 466 of the most seriously ill patients with hepatitis C, and 432 were cured, including members of the haemophilia community in Wales. This has made an absolutely huge impact on these people’s lives, and the haemophiliacs have in fact been treated with the new drugs ahead of their counterparts in England, some of whom are still waiting to get help.

One example of a Welsh patient is David Thomas, who is a constituent of the Cabinet Secretary and is a member of the cross-party group on haemophilia and contaminated blood. He contracted hepatitis C through contaminated blood when he was a teenager in the 1980s and lived with it for 30 years, but was one of the first to have treatment with the new drugs, which have absolutely transformed his life, lifting a massive cloud, as he said.

So, obviously, one of the challenges now is to convince people to come forward again for treatment for hepatitis C who may previously have had failed treatment using the interferon drugs. I welcome the fact that health boards now have £25 million a year that allows 900 people a year to be tested over five years. We must ensure that that money is used to fund all the associated costs of doing this. More than 700 people were treated in 2016-17, but I understand that the problem now is finding the people who need to be tested at this point. There are currently no waiting lists for treatment. The funding and the drugs are there, but we need to identify the 50 per cent of people who have got hepatitis C but don’t know it.

The other great challenge we face in trying to eradicate hepatitis C is to reach people who are unaware of the virus because they may not be regulars at their GP surgery. As I’ve said, 50 per cent of people who have the virus are undiagnosed, according to the Hepatitis C Trust. Other groups that may be at risk of this are gym users who take performance-enhancing drugs; drug users with hepatitis C; prisoners who get tested during their sentence and may not get the results in time for their release; asylum seekers, migrants and homeless people. Everyone working on eradicating hepatitis C says that one of the biggest problems is the stigma that is attached to it, and I’m very pleased that there’s going to be a public awareness raising campaign that will be launched in Wales here in the Assembly on 11 July.

One way of tackling the lack of awareness and stigma around hepatitis C is by using peer mentors, which have proved very successful. We also need a programme to educate other health professionals about hepatitis C, not just members of the public, because it’s very important that GPs pick up on the signals and recommend testing and refer people for treatment. There is need for more health professionals to have training. Pharmacies need national agreed targets and training in dried-blood-spot testing. Community pharmacies could play a major role, as well as drug outreach projects and needle exchange centres. All the people involved in treating this blood-borne virus agree that tackling the issue in the community where they live is the key. There are lots of examples of how this is done: for example, they are testing asylum seekers and people in accident and emergency in Cardiff; in Tesco at Fforestfach in Swansea, there is a community testing room next to a gym, so gym users are getting tested; and there’s a form to improve patient management and collect data automatically that is being developed in Cardiff and in other centres.

The motion also calls for new operational guidelines to be considered to support NHS staff working to eradicate hepatitis C. We need to streamline the paperwork involved. We need to use electronic referrals to speed up the whole process of getting people treated. The medical staff would also like to see a strategic plan specifically for the elimination of hepatitis C, with all the elements fully funded, including the cost of extra lab testing and community testing.

I would like to end, really, by praising the health professionals, public health officials and the third sector organisations who are so committed to tackling this blood-borne disease. There has been a tremendous positive movement in Wales to get to the stage where we can eradicate it. It’s been the wonders of modern science, along with the commitment from the Welsh Government, to ensure that this will happen. But we do need more people to come forward for testing and I think we’d all welcome some high-profile celebrities to come out and say they have hepatitis C to help de-stigmatise the disease. So, I’m very pleased that we have begun this process of eliminating hepatitis C and I hope that the journey will end with a hepatitis C-free Wales.

An estimated—we heard—12,000 to 14,000 people are currently living with hepatitis C in Wales, around half undiagnosed. It’s one of three main causes of liver disease and the only one of the five big killers in Wales and England where deaths are rising. It therefore represents a significant public health challenge. As I said in January’s debate on the contamination of blood, in the 1970s and 1980s, a large proportion of blood products supplied to patients by the NHS was contaminated with HIV or hepatitis C. Around 4,670 patients with haemophilia were infected and over 2,000 have since died in the UK, including 70 in Wales, from the effects of these viruses. However, evidentially, hepatitis C primarily affects people from particular groups, such as injecting drug users, homeless people, gay and bisexual men, and migrant populations from high-prevalence regions.

The Presiding Officer took the Chair.

The recent Hepatitis C Trust report, ‘Hepatitis C in Wales: Perspectives, challenges & solutions’, concludes with a number of key recommendations for action as follows: the inclusion of a commitment to eliminate hepatitis C

‘as a serious public health concern…within the Welsh Government’s forthcoming Public Health Bill.

‘The implementation of a public awareness campaign aimed at tackling stigma around hepatitis C and at encouraging individuals to access testing.

‘A continuation of, and long-term commitment to, the successful all-Wales hepatitis C treatment protocol, which ensures equal access to new, highly effective treatments for increased numbers of people.

‘An increase in the number of community-based treatment services…to ensure access to treatment for groups who traditionally find services difficult to access.

‘Full implementation of an opt-out approach to BBV testing in substance misuse services, as set out in the Welsh Government’s Working Together to Reduce Harm: Substance Misuse Delivery Plan 2016–2018.’

And,

‘The utilisation of opportunities, such as mandatory GP education days, to deliver BBV training to key primary care professionals.’

The approval of new drug treatments by NICE and the All Wales Medicines Strategy Group means that the elimination of hepatitis C as a serious public health concern in Wales is now a wholly achievable goal. To seize this new opportunity, we must find the 50 per cent of people currently undiagnosed by widening access to testing and further investigating which groups can be cost-effectively screened. By increasing diagnoses we will be able to treat and cure more people. With effective and accessible new treatments now available to all who need to them, it’s easier than ever to treat and cure patients, presenting a great opportunity to achieve the elimination of hepatitis C in Wales.

The key steps that the Hepatitis C Trust believes will help to drive progress in this, and reflecting what I said earlier, are increasing testing in primary care, antenatal care and pharmacies in order to find the undiagnosed; implementing a strategy to re-engage patients who have tested positive for hepatitis C but disengaged from the care pathway; launching a public awareness campaign to find undiagnosed patients, particularly those who may have contracted the virus a long time ago and are unaware that they were ever at risk; making treatment available to hepatitis C patients in community settings, such as drug services and GP surgeries, to widen access to patients traditionally considered hard to reach; providing training and information about hepatitis C to healthcare professionals, particularly GPs; and, making the use of buddy schemes more widespread and ensuring the provision of peer education in substance misuse services in order to tackle barriers to patients engaging in treatment and to spread key messages to at risk groups.

Backing calls for a hepatitis C elimination strategy, a global research-based biopharmaceutical company, AbbVie, has contacted Members calling for this to set out the steps to elimination, including annual testing, screening, diagnosis and treatment numbers. The strategy should have ministerial oversight and be driven by the hepatitis C sub-group of the Welsh liver plan implementation board, with a mandate to ensure that ambitious targets are met across all local health boards. And the Welsh Government and NHS, they say, should continue its open approach to engagement with all partners involved in delivering care and treatment to people living with hepatitis C, so that flexible and innovative care models can be established, including peer-to-peer support in community settings. As they say, changing models of care will require a renewed approach to education, training and workforce development. And as today’s motion therefore states, we call on the Welsh Government to confirm their commitment to the World Health Organization eradication date of 2030, and to consider new operational guidelines to support NHS Wales to work towards this. Thank you.

I’ll keep my contribution today short. I just want to state my support, very simply, for this important motion. The aim is very simple too, and it’s also extremely exciting, I think. The aim is to eradicate hepatitis C in Wales in its entirety. Yes, there is a commitment from the World Health Organization to eradicate by 2030, but we, here in Wales, could move according to a tighter timescale than that. The first part of the motion before us shows that a great deal of the infrastructure, in terms of health, is available to us already, specifically the people within our health service, and I’m very pleased to be able to thank them for the major steps that have already been taken in that regard.

I’d also like to thank Julie Morgan for the work that she does in this particular field. It’s been a pleasure to collaborate not just on hepatitis C and the eradication that we hope to see in the years to come, but also on the subject of contaminated blood. It’s struck me, as it has the Member for Cardiff North, that the problem is a lack of patients, almost, at present. That’s a tribute to the staff that we have within the health service. It sounds very strange, but we have more capacity than we have patients to go through the system. It’s fair to say that we don’t talk about that very often when we talk about the NHS, but it is true in this particular instance. The truth is it’s about finding those people who haven’t yet received a diagnosis, who don’t know that they’re in an at-risk group, who don’t show symptoms. That’s the challenge in front of us, to be able to move forward towards eradication.

I won’t repeat some for the comments that have already been made with regard to how to do that, by tightening up primary care, by searching for groups that might be at a higher risk—more testing in prisons and for drug users, and in the antenatal system, and so on. The good work and the foundations have already been laid, and I’m very grateful to the Government for the strides taken in this regard already. But I’m pleased that the motion is before us today, and I’m pleased to be able to support this motion to give that extra push towards reaching that aim that is genuinely achievable in Wales. It’s something that I know that we, as a nation, will be very proud of when we do achieve it.

I’d like to start my comments by saying how glad I am to see Julie Morgan back in the Chamber, and it’s a real privilege to work with her on these issues, particularly the contaminated blood, and to support her lead here on this issue with regard to hepatitis C—a real privilege.

I support the motion because of the work that has been done by the Welsh Government and health boards in Wales, and agree with what Rhun has said and Mark Isherwood has said that we have more work to do. I’d like to give some examples from the Aneurin Bevan health board, which serves my constituency and the area of Gwent, particularly the recognition that they’ve made that it can take decades to identify those people who are suffering from this disease and to treat them. The Aneurin Bevan health board’s hepatology service works with partners in a variety of settings to increase the diagnosis of hepatitis infection and on the phased introduction of new hepatitis C drugs. The Aneurin Bevan health board prison healthcare team have implemented an opt-out blood-borne virus testing policy at reception appointments at HMP Prescoed in Usk. In 2016, they reported to me—I’ve investigated this in preparation for this debate—a significant increase in the number of prisoners tested and the percentage of admissions tested, and there’s been a steady increase in Prescoed.

There’s also been, within the Aneurin Bevan area, targeted action to increase access to needle exchange services and blood-borne virus testing in people who inject drugs—those people at risk who’ve already been mentioned by other Members. Public Health Wales are working with area planning boards on a proposal to develop a five-year costed action plan to increase the investment in needle exchange to ensure 100 per cent coverage, which means that clean needles are used for every injecting occasion.

A key policy development in Gwent has been the pharmacy pick and mix pilot, which provides drug-using paraphernalia and harm reduction literature, together with increased interaction with clients to allow for harm reduction messages and signposting for blood-borne virus testing. The Gwent area planning board commissioned an integrated Gwent drug and alcohol service for adults, which went live in May 2015. This includes the delivery of specialist needle exchange, with a small dedicated budget for the provision of needle exchange paraphernalia. And Aneurin Bevan health board have also reported to me the Gwent specialist substance misuse service for people with more complex needs, and this service also offers needle exchange and BBV testing.

But, also recognised by other Members, one of the major at-risk groups for hepatitis C infection are people of South Asian origin. Aneurin Bevan’s public health team has had discussions with religious leaders about promoting blood-borne virus testing in mosques in Newport. In addition, the ‘Living Well Living Longer’ programme will also be raising awareness of hepatitis C through its programme of health checks in Newport.

These are all examples of what the Aneurin Bevan health board is doing to help with harder-to-reach individuals who are at risk of hepatitis C, and I’d like the Cabinet Secretary to be aware of these practices. The Welsh Government can build on this good practice, and, when it comes to the final point of the motion, consider new operational guidelines to support the NHS in Wales in eradicating hepatitis C. This is something that can be done, and, again, I say it is a privilege to champion the cause that has been pioneered by Julie Morgan in this Chamber. We’ve come a long way, and eradicating hepatitis C is within our reach.

UKIP fully support this motion and efforts to eradicate hepatitis C by 2030. As others have highlighted, hepatitis C is a disease that affects about 2 per cent of the world’s population and is responsible for hundreds of thousands of deaths each year. It is therefore unsurprising that the World Health Organization wants to eliminate the disease.

The UK Government has pledged its support for the World Health Organization’s eradication goals last year and I would urge the Welsh Government to follow this example. The Welsh NHS has made significant strides in treating people with hepatitis C in recent years. Nearly 900 patients were treated last year in an attempt to clear the backlog of patients awaiting treatment. However, with up to 7,000 people in Wales unknowingly infected with the hepatitis C virus, much, much more must be done to identify and treat people living with the disease.

Wales urgently needs a hepatitis C reduction strategic action plan to ensure that local health boards prioritise elimination of the disease within the Welsh liver disease delivery plan. The strategic action plan should, as an absolute minimum, implement and build upon the recommendations contained within the Hepatitis C Trust’s 2016 report on hepatitis C in Wales. In preparing that report, the Hepatitis C Trust found that hepatitis C sufferers in Wales are disproportionately drawn from some of the most disadvantaged and marginalised groups in society, and three quarters of people with the virus come from the lowest two socioeconomic quintiles. They also found that their disadvantage was compounded by the stigma of hepatitis C. The Hepatitis C Trust found that those who were diagnosed in the 1980s were told by health professionals not to tell anyone else of their diagnosis, and many commented on the years of internalised guilt and shame that resulted. Thankfully, our NHS has moved on from that shameful period. However, the stigma perpetuates. We still have far too many people with hepatitis C who report the sense of guilt and shame they feel or how, in some way, they feel dirty. Unfortunately, this often results in those individuals disengaging with care entirely, despite being aware of their diagnosis—a decision that greatly increases the risk of liver cirrhosis or cancer.

In order to tackle this pervading stigma and the incredible harm it does, the Hepatitis C Trust report recommends action be taken to normalise the disease by undertaking positive media campaigns to highlight the cross-section of people living with the virus. I hope that the Cabinet Secretary will work with his counterparts in the rest of the UK and the Hepatitis C Trust to deliver such a campaign. However, if we are to fully eradicate the stigma, we have to ensure that those living with the virus have positive experiences when dealing with all health professionals. People with hepatitis C have reported always being booked in for the last dental appointment of the day, apparently to allow time for dental practices to undertake additional infection control practices. Such practices left people feeling as though they posed a danger to others and were in some way distinct from the rest of the population. This has to stop. Additional infection control measures should be unnecessary—dental practices should have sufficient infection control measures in place with every patient to prevent transmission of every blood-borne virus.

We have to educate not just the public, but also our health professionals, about hepatitis C. I urge the Welsh Government to adopt the Hepatitis C Trust’s recommendations and I urge Members to support the motion. Together, we can eradicate this terrible disease. Diolch yn fawr, Llywydd.

Can I also thank Julie Morgan, in particular, for bringing forward this debate, as I know how much work, Julie, you’ve done on this issue and I fully endorse the sentiments and proposals set out in the motion? I think we can all be proud of the record here in Wales of the diagnosis and treatment of hepatitis C, and, of course, welcome a continued commitment to achieve the eradication of the disease by 2030.

But it’s on the third point of the motion that I would like to focus my comments, and, in particular, to look at the issues of screening healthcare workers, particularly surgeons. To support this, I would like to refer to the case of a constituent of mine who was diagnosed with a rare form of hepatitis C in 2012. She’d been suffering symptoms for a number of years, but was only ever tested for hepatitis A and B. When she was eventually tested for, and diagnosed with, hepatitis C she was on the verge of liver cirrhosis. But her treatment—despite the debilitating side effects, and the stigma that she suffered and the precautions that she had to take within the family in terms of use of toothbrushes and other equipment in the house—was very quickly effective. She responded to the treatment within a matter of weeks, having been told to expect that it would take many months, and has had nothing but praise for the treatment that she received at that point. But what had remained a mystery was how she contracted the illness in the first place. It was only towards the end of her treatment that the specialist nurse who was treating her identified that she was also treating a surgeon who’d operated on my constituent in 1997.

So, once the source of her infection had been identified, NHS Wales wrote to some 5,000 patients treated by this surgeon, offering to test them for hepatitis C. Around 3,000 of those patients responded, and, from that subsequent testing, a further four patients were identified as having contracted the virus, almost certainly from the same surgeon.

Llywydd, since 2007, all NHS staff involved in exposure-prone procedures are required to be screened, but there is no screening requirement for current staff who have been practicing since before 2007. Now, obviously, where any practicing surgeon is found to have hep C, he or she is taken off current duties. But there is no automatic process of looking back at the practice of the affected surgeon to identify and contact patients who might have been at risk. Such a look-back only happens when it’s approved by the UK advisory panel, as happened in the case of my constituent. As I understand it, the UK advisory panel guidance for pre-2007 healthcare workers places a clear expectation on surgeons to put themselves forward for testing if they believe that they may have been exposed to a communicable disease.

Now, hepatitis C has been referred to by some as the hidden killer. Now, whether that’s an appropriate description is debatable, but it has gained that tag because those who have it often don’t know, as we’ve already heard, and, as we’ve also already heard, we have an estimated 12,000 to 14,000 people in Wales who carry the virus, the majority of whom remain undiagnosed. Often causing no symptoms and no sickness, hepatitis C can lie dormant in a person’s body for decades. In this context, it’s quite likely that many health professionals will not actually be able to identify themselves as a carrier of the hepatitis C virus.

Now, I recently wrote to the Minister for Social Services and Public Health regarding the particular circumstances pertaining to my constituent, including issues around the limitation of compensation arrangements for hep C sufferers, whereby patients infected by their surgeons have no access to compensation, unlike those infected by contaminated blood. Now, I’ll come back to that at another time, because today I want to concentrate on the eradication aspect.

So, given the widespread recognition that one of the biggest challenges to achieving eradication by 2030 is the extent to which the disease goes undiagnosed, I’d like to think that, building on Mark Isherwood’s theme of expanding screening, if a regime of screening healthcare workers on a more comprehensive basis, including those practicing before 2007, could assist in identifying latent cases amongst practitioners, and therefore potentially their former patients, I’d suggest this is something that the Welsh Government should give serious consideration to when developing its strategy for reaching the ambitious but very achievable target of eradicating the virus by 2030.

So, once again, can I thank Julie for bringing forward this motion and for the debate today, and ask Welsh Government to consider all measures available that might help to attain the eradication of hepatitis C in Wales?

I call on the Cabinet Secretary for Health, Welfare and Sport, Vaughan Gething.

Thank you, Presiding Officer. I really am pleased to respond to today’s debate across Members, and I thank people for the thoughtful way in which they’ve approached the issue. We, of course, recognise the importance of this issue for people right across Wales, and I’m happy to say that, together with the NHS, the Welsh Government has made major advancements in the treatment and management of viral hepatitis, a number of which have been recognised by a variety of Members across the Chamber, and I’m pleased to have the opportunity to talk about that some more today. The Welsh Government, of course, has been committed to tackling the burden of blood-borne viruses for more than a decade. We funded the blood-borne virus action plan for Wales up to 2014, and laid the foundations for the even more successful hepatology services that we now have.

When that funding was made available, it was on the understanding that health boards would invest in these services and develop the resource to prevent and treat viral hepatitis, and I really am proud that Wales has a strong and effective clinical hepatology network led, as Julie Morgan said in her introduction, by Dr Brendan Healy. That network co-ordinates the treatment of those identified with both hepatitis B and C. I want to pause there for a moment to recognise not just the work of Dr Healy but, actually, the whole network, because this is something that colleagues in England don’t have—they don’t have the same unified approach to treatment, the way in which we’re using best value treatments, both in terms of finance and outcome for the citizen, and some of the colleagues in England look on with a degree of, I wouldn’t say just envy, but they think it’s a standard and an approach to aspire to that is being pioneered and led successfully by our clinicians in Wales, and absolutely benefits the patients in so doing. It’s a model, in many ways, for services across the country—they need to collaborate and co-operate across the whole country to have a unified approach that is actually focused on improvement.

The all-Wales hepatitis C roll-out programme was initiated in 2014, and part of this is to make the best use of the new wave of more effective antiviral medication, in particular, as Julie Morgan said, interferon-free medication. That started by being initially very expensive to treat, but, actually, there’s a much longer term saving, both in financial terms, but also—mentioning my constituent Mr Thomas, who has a young family—a significant improvement in the overall well-being, not just in the medical sense, of people who receive the treatment, with quite startling cure rates for people as a result of that successful introduction. That has received both national and international recognition.

We’ve treated more than 1,000 patients in the last 18 months, and I’m proud to say we’ve now treated all of the patients who are known to services in Wales and who are still accessing care. That is a remarkable step forward made by our service. We recognise, though, that there are individuals at risk of both hepatitis B and C who do not access traditional healthcare settings, and there are numerous projects already under way in development across Wales to address this—again, recognised in the comments of people earlier in the debate on how do we get to those people who are harder to reach and don’t always access care services, either individually or even consistently. Those projects will look at ways to increase awareness of hepatitis C infection, to provide access to simpler diagnostic tests in community settings for those at risk—and, again, there’s a point here about developing and not just standing still in our service—and also to ensure that individuals who are infected are able to access treatment.

These projects, along with the all-Wales hepatitis C roll-out programme are led and guided by the Welsh viral hepatitis sub-group that Julie Morgan, again, referred to. They’re a sub-group of the liver disease implementation group—one of our, again, short, snappy titles in the world of health. But the importance of this group—and it is really important—is that it’s comprised of clinicians, nurse specialists, patient representatives, the third sector, pharmacy, laboratory staff, substance misuse services, health protection staff and Welsh Government officials. Again, that’s a feature of our approach here in Wales—genuinely taking advantage of the fact that, as a small country, we should be able to bring together the right group of people within the same room to make genuinely national choices and then expect that to be got on and delivered on a national basis. I want to thank all of those who have led on this work across all sectors and who have contributed to the very real success of the programme so far.

On 28 May last year, the World Health Assembly, the decision-making body of the World Health Organization, adopted a global health sector strategy on viral hepatitis. That strategy introduced the first ever global targets for viral hepatitis B and C control, including the goal of elimination of viral hepatitis by 2030. Achieving these targets will mean that the diagnosis and treatment of viral hepatitis is prioritised in public health services.

I am pleased to confirm again today to Members that Wales has signed up to and is committed to the World Health Organization target to eliminate hepatitis B and C. To reflect this, the Welsh viral hepatitis sub-group has amended its own term of reference to reflect the leadership and guidance that will be required from it to ensure that the elimination targets are achieved. We’ve already made huge progress against these targets, and the sub-group is developing a draft framework of actions that will be required over the coming years to achieve our goal. Officials in the Government will receive the draft framework this month. I expect them to include consideration of how to identify and test hard-to-reach groups; testing and treating in community settings; and an assurance that all those with the infection will have the opportunity to be tested and treated. The framework will provide the basis for guidance on the next steps, which will be issued to the NHS this summer.

We have what it takes here in Wales to prevent hepatitis B and C, and Wales, amongst other UK countries, has a strong preventative agenda. We have effective and targeted hepatitis A and B vaccination programmes, and the current uptake for those vaccinations is 95 per cent. From September this year, the hepatitis B vaccine will be incorporated into the routine infant programme, and all babies will be offered it at two, three and four months of age. All pregnant women are offered hepatitis B testing as part of antenatal screening, and all babies born to mothers who test positive for hepatitis B are managed according to clinical guidelines. We’re able to effectively prevent mother-to-child transmission of the hepatitis B virus through timely hep B virus birth-dose vaccination.

As Hefin David mentioned, we already have a well-established needle exchange programme in community pharmacies, ensuring access to sterile injecting equipment and effective drug dependence treatment, in order to prevent and control epidemics of viral hepatitis B and C. The majority of the current ongoing transmission of hepatitis C occurs within people who inject drugs, and we therefore prioritise the identification of individuals with hepatitis C within these communities and in providing treatment.

For those already infected, new oral, well-tolerated medicines and treatment regimens for people with chronic hepatitis C virus infection are achieving cure rates of over 90 per cent, as Julie Morgan mentioned in her remarks. And that effective treatment is also available for people with chronic hepatitis B virus infection, although for most people, such treatment needs to be lifelong. Suppressing the virus limits damage to the liver, and often it is liver damage that causes people to lose their lives. These treatments reduce the risk of long-term complications of hepatitis B and C, including cirrhosis and liver cancer. As a consequence, cost to the NHS is reduced, as these conditions are very expensive to manage. It also reduces the requirement for liver transplantation—again, a costly and complicated procedure and a resource that is in great demand. The most recent data suggest that we’re at least seeing a downward trend in liver transplants and deaths. We’re fortunate in Wales that we do have generally excellent services, with a proven expertise to lead and support these, and that those at risk can be confident that every opportunity will be taken to provide for their care. I will receive updates on progress through the viral hepatitis sub-group, and I will of course keep Members informed of this work.

I call on Dai Lloyd to reply to the debate.

It’s a pleasure to reply to this debate, which has been an excellent debate. May I congratulate everyone who’s participated in it? What we have before us is the story of great success in the health service in Wales. Back in the day, when I was a young medical student with a bright future—just a few years ago—we were talking about hepatitis A and hepatitis B and then hepatitis non-A and non-B. We have since then found a number of other viruses: hepatitis A, B, C, D, E—all different sub-strains of that virus.

Not only have we discovered these, but we’ve also been able to treat them. Many years ago, we would find hepatitis but we couldn’t do anything to treat it. The landscape has been transformed. Amid all of these complaints about our health service, we forget about the bigger picture: that there is wonderful work happening in the background. We have the ability now to eradicate hepatitis C and hepatitis B. We have the technology and we have the drugs available to us.

I’m particularly grateful to my fellow Members for supporting this motion, which naturally congratulates the staff of the NHS, calls on the Welsh Government to confirm their commitment—and I’ve heard the words of the Cabinet Secretary and I thank him from the bottom of my heart for those words—and also the other considerations before us in this debate this afternoon. First of all, I’d like to thank Julie Morgan for her expert opening of this debate and congratulate her on her work as the chair of the haemophilia group. Many of the aspects here are crosscutting in terms of these issues. I also congratulate Mark Isherwood on his contribution, as well as Rhun, of course.

In recalling Hefin David’s contribution, well, yes, it can take many years for this disease to emerge, because it is very difficult to identify. You can question people and they simply don’t remember if, at some point in the past, they suffered extreme tiredness. People simply don’t remember; they forget. Therefore, it is difficult to carry out that diagnosis, unless you focus on those people, as many people have already mentioned, in prisons and those injecting drugs, of course. That is why those needle exchange programmes are so crucially important in eradicating this disease. That was also mentioned by Hefin David.

May I also thank Caroline Jones and Dawn Bowden for their contributions and, as I’ve already mentioned, the Cabinet Secretary, who told us about the excellent system that we have here in Wales? We’re in the vanguard. We often compare ourselves unfavourably in this country with other countries, but Wales is in the vanguard when it comes to issues such as hepatitis C. Because the challenge remains, despite our ability to eradicate it. Because, as we’ve already heard, we are treating those people who are already identified. The point is we’re not identifying 50 per cent of the people. So, there is some work to be done in identifying those people who carry this virus.

We have to deal with stigma, of course. People often fear going to their GP because they have lives that are often difficult and chaotic, and they feel that people will criticise them for what they’ve done in the past. Therefore, there is a challenge there for us to deal with all those systems.

But ultimately, when one can identify exhaustion with the possibility that they have been infected by contaminated blood, we have to then start to think about the possibility that hepatitis C is the cause, and that’s the challenge for us, as doctors and nurses: to be aware of that. But also, there is a challenge, once we’ve identified those people, to ensure that they continue with the treatment. When you do have difficult, challenging lifestyles, which are often chaotic, then it’s difficult to maintain that treatment too.

There are a number of challenges, but, whilst I welcome all of the contributions that we’ve heard this afternoon—and I also welcome the Government’s response—this country is in the vanguard when it comes to issues related to hepatitis C. We have the technology, we have the treatments available, and we should go for it. Please support the motion. Thank you.

The proposal is to agree the motion. Does any Member object? The motion is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.