All my questions have been raised with me by members of the Wales Neurological Alliance and the cross-party group on neurological conditions, which I chair. The revised neurological delivery plan acknowledges that national guidelines set out the Welsh Government’s expectation of effective care for people with a neurological condition, and the National Institute for Health and Care Excellence has published a set of recommendations for the NHS in England and Wales, allowing health boards and healthcare professionals to set what level of service they’re expected to provide for people living with multiple sclerosis. However, according to the Multiple Sclerosis Society Wales, the standard is not being met. What steps will, therefore, you take to ensure that local health boards provide the necessary baseline data that would afford a better understanding of MS treatments and services across Wales and enable the effective commissioning of services, and to ensure that the NICE quality standard for MS is implemented consistently across Wales?

Motor neurone disease kills a third of people within a year, and more than half within two years of diagnosis, typically as a result of respiratory failure. The Motor Neurone Disease Association supports the publication of this neurological conditions delivery plan, but they ask the Welsh Government to ensure that local health boards make local delivery plans publicly available and that local, easily accessible neurological service user forums are established as a priority to engage in a co-productive dialogue—a term you used—and allow public scrutiny and monitoring of local delivery plans. They ask the Welsh Government to produce annual reports, or ensure that local health boards produce annual reports, demonstrating clear and robust evidence of progress against key actions in language that is easily understood by those affected by neurological conditions, and they ask for equity of consideration to be given to rare neurological conditions like MND, motor neurone disease, and to ensure that action plans and annual reports provide robust condition-specific evidence against outcome indicators and assurance measures. So, I would ask you to respond to the asks from the Motor Neurone Disease Association.

In 2016, the implementation groups, you say in your statement, worked in partnership to develop patient-related experience measures and the patient-related outcome measures, or PREMs and PROMs. Neurophysiotherapists have pointed out that the key work of the cross-party group on neurological conditions has been done in highlighting the importance of rehabilitation services, and emphasised that a sustained focus on rehabilitation cannot be a one-off. They’re grateful that some of the new investment from the stroke and neurological delivery plans was directed at rehabilitation services, and they emphasised they have exceptional staff and skilled clinical experts, but want you to respond to their statement that they need to see continued development across Wales to retain and reward these staff.

The physiotherapy profession is very keen to see outcome measurements that are meaningful to patients and service users, and they refer to the work to develop the PROMs and PREMs as a very important way forward where clinicians need to measure the right things to demonstrate outcomes. Again, how do you respond to their statement that, equally, patients and service users need to be able to provide feedback on the services they receive?

Since the delivery plan started in 2014, the number of people living with dystonia in Wales has doubled to 5,000, and due to the demand on services for dystonia, especially Botox injections, there’s been no plan to make the treatment of dystonia sustainable in Wales. The Dystonia Society are therefore very concerned that continued cancellation of appointments in north and south Wales will lead patients and service users to seek deep brain stimulation surgery because of the worry of losing their jobs and their financial situations. How, therefore, do you respond to their recommendations that Botox clinics in north and south Wales must include a specialist dystonia physiotherapist in the clinic, that more awareness is needed locally, especially in GP surgeries, to bring down waiting times, that there’s a need for more training in ophthalmology and ENT regarding administering Botox injections, and a need for better holistic approaches, including psychological and emotional support? Then, finally, how would you respond to their concern that Wales is the only UK country not to have specialised consultants in dystonia, and the only place in the UK not to have specialised neurophysiotherapists?

In 2016, the Wales cancer patient experience survey highlighted how more than a third of high-grade brain tumours are diagnosed through an emergency admission to hospital. Greater awareness of brain tumour signs and symptoms is, according to the Brain Tumour Charity, critical to driving earlier diagnosis and improving patient outcomes. Therefore, can the Minister ensure that awareness-raising of brain tumours is prioritised in the implementation of this delivery plan?

Along with paediatricians, Bobath Wales, the specialist centre for children with cerebral palsy, are trying to establish a register for children in Wales who have cerebral palsy. What support for this is the Welsh Government able to provide?

I’ll conclude by referring to a presentation to the last north Wales meeting of the cross-party group on neurological conditions on 28 July, a presentation by the Welsh Health Specialised Services Committee. How do you respond to their statement in relation to provision of services for neurological patients with mental health problems that they’d only actually had two referrals from north Wales, and that they were concerned about where patients in north Wales with those dual diagnostic conditions were going? They expressed concern that few recommendations of successive reviews have actually been implemented, and they particularly highlighted the development of a north Wales neurorehabilitation service and the integration of the neuroradiology services across south Wales. Thank you.