Item 3 on the agenda this afternoon is the statement by the Cabinet Secretary for Health and Social Services: progress on the new treatment fund. I call on the Cabinet Secretary for Health and Social Services to introduce the statement—Vaughan Gething.

Thank you, Deputy Presiding Officer. Last year, I launched the Welsh Government's £80 million new treatment fund. This was, of course, a key pledge to the people of Wales at the last Assembly election. My statement today highlights how the new treatment fund has delivered faster, more consistent access to new medicines. It marks a highly successful first full operational year of the fund.

The substantial, new investment in NHS Wales demonstrates the Welsh Government's commitment to ensuring that patients receive the latest recommended treatments quickly, no matter where they live in Wales. The underpinning principle of the new treatment fund is that all medicines recommended by the National Institute for Health and Care Excellence, or NICE, and the All Wales Medicines Strategy Group, or the AWMSG, must be made available to patients, where clinically appropriate, no later than two months from the publication of the recommendation. This represents a one third reduction in the required implementation timescale.

A positive recommendation by NICE or the AWMSG is a confirmation that the medicine has passed the rigorous test of both clinical and cost-effectiveness: the clinical benefits of the medicine are in balance with the cost that the manufacturer will charge to the NHS. This ensures good value for money for the public and, of course, our NHS.

The new treatment fund is providing health boards in Wales with £16 million a year to support that faster and more consistent access. To date, £28 million has been provided to health boards and Velindre NHS Trust to support the faster introduction of over 80 new medicines. 

These medicines have, of course, been approved by NICE or the AWMSG to treat a wide range of diseases. The list and scope of the therapeutic areas covered are too long for me to list here, but it includes medicines for a wide variety of treatment including arthritis, multiple sclerosis, epilepsy, asthma and rare conditions like Fabry disease. 

Just over 40 per cent of the medicines recommended are for the treatment of various cancers. Thirty of the recommended medicines were identified at appraisal as offering patients a new, more effective treatment option or addressing an unmet clinical need. These included new treatments for cancer, a serious sight-threatening disease, life-threatening genetic disorders and chronic lung disease. 

These illustrate the breadth and scope of the new treatment fund. They also highlight the importance that the Welsh Government has placed on ensuring rapid access to all recommended medicines for all conditions. That is not the approach taken across our border in England. All of the diseases or conditions that I have just mentioned have a very real impact on the quality of life for the individual and their loved ones, and that is why, in Wales, we ensure that the new treatment fund treats all diseases equally and does not prioritise the funding of one disease over another. The full list of recommended medicines is published on AWMSG’s website and a link has been provided for Members. 

I expect full compliance to now be sustained over the five-year period of the fund. In practical terms, this means all medicines recommended must be available no later than two months after the AWMSG or NICE recommendation is published. When I reported on initial progress in July, I advised there had been some variation in the availability of a few medicines recommended during the first few months of the fund. Since those early variation issues, I am pleased to report that our NHS has made rapid and much more consistent progress. 

Before the introduction of the new treatment fund, health boards were expected to make recommended medicines available no later than three months or 90 days from the NICE or AWMSG published decision. In the first six months of launching the new treatment fund, we have reduced the time taken to make medicines available by 81 per cent. In real terms, that meant the average time taken for health boards across Wales to make medicines available was 17 days in the first six months of the new treatment fund. We have now seen even further improvements during the second six months of the fund. The time taken to make a medicine available has now dropped to an average of 10 days across Wales. That represents an almost 90 per cent reduction in access time across Wales. The two-month time frame is the latest date by which a medicine should become available to prescribe where clinically appropriate. Our goal is to make these medicines available as soon as possible. I am pleased to report that nearly 83 per cent of recommended medicines were made available across Wales within 30 days.  

I welcome, of course, the effort and the achievement of our NHS in making our commitment a reality for patients across Wales. Chief executives and chairs of health boards are clear that the expectation is that they will continue to deliver consistent and sustained full compliance with the requirements of the new treatment fund. The citizens of Wales deserve nothing less. I will, of course, continue to scrutinise health boards and trust performance in delivering their obligations under the treatment fund and hold chief executives and chairs to account for delivery.

Making new medicines available to patients often requires detailed infrastructure and care pathway planning and that can be financially challenging, particularly in the first 12 months. The new treatment fund is designed to support health boards prepare sustainable plans for the introduction of new medicines. Safety, of course, is a paramount consideration when introducing each new medicine. That can mean changes are necessary to the way in which clinical services operate: for example, there may need to be additional or different monitoring of patients to be introduced; patients may need testing, for example, for their clinical suitability. Understanding all of the requirements to introduce a medicine safely and effectively at an early stage is essential and central to fast and sustained access.

Since I launched the fund in January last year, I have talked consistently about the need for the pharmaceutical manufacturing industry and NHS Wales to work more closely together on this agenda. The Association of the British Pharmaceutical Industry Cymru Wales continue to be supportive of our approach to the medicines agenda and in particular, the principles of our new treatment fund. I welcome the work they are doing with NHS Wales stakeholders to improve the level and timing of information provided by manufacturers on new medicines. Strengthening financial forecasting and infrastructure planning makes absolute sense to everyone. The industry benefits when its products are adopted quickly, and most importantly, patients benefit from faster access.

The establishment of the new treatment fund is an explicit objective in the Welsh Government’s national strategy, 'Prosperity For All'. In the first full year that the new treatment fund has been in operation, we have substantially shortened the time taken to make medicines available by 85 per cent. We pledged to the people of Wales that our new treatment fund would deliver faster, more consistent access to new life-changing medicines for all conditions. We have kept our promise, and every part of Wales is now seeing the benefit.

Cabinet Secretary, thank you very much indeed for your statement. I'm delighted that the new treatment fund appears to be doing so well. It must be horrendous to be somebody who has some dreadful condition that is in dire need of innovative and radical treatments, and to have the worry of whether or not you can access it through your health board. This seems to be filling a gap in the planning process, and I truly do welcome it. I do have a couple of questions, which I'll ask you in the spirit of, perhaps, you being able to follow up at a later stage and ensure that we are really getting the absolute best out of this fund. 

I note that the reports by the All Wales Medicines Strategy Group and the new treatment fund show that in the last 12 months, the number of recommended medicines has dropped from 24 with eight superseded medicines in 2016, to 21 medicines with two superseded in 2017. Cabinet Secretary, would you please outline the reasons for this? Is it that, in order to access medicines faster, the number of medicines in the new treatment fund is being curtailed? Or is it more that, once in the system, that medicine goes off the books and, subsequently, there is an expected hope that candidate treatments for the fund will dwindle to much smaller numbers? Is this the thinking behind making the true new treatment fund a five-year programme?

Cabinet Secretary, you say in your statement that £16 million a year supports faster and more consistent access. It would be interesting, though, to see the patient and access data, to determine how widely the health boards are using the newly available medicines. The most basic information on access data provided last time was that all health boards were taking on the 17—then, it was 17—newly available medicines, but in terms of patient reach there was no detail, and I think that that would really help our understanding to ensure that we do have consistent access for all people throughout Wales, no matter where they happen to live in our country.

Finally, Cabinet Secretary, given the commitment to anticipate the licensing and adoption of innovative treatments, are you confident that health boards are able to horizon scan effectively, thereby improving infrastructure planning so that new innovations are maximised to the fullest extent, and that appropriate support services are also in place? Because I did note in your comments about the ABPI. However, for example, a case in point concerns the new drugs to treat hepatitis C, which have been made available through the new treatment fund—very, very welcome by patients and lobbyists alike. However, given that elimination of hepatitis C is the avowed aim, and given no hepatitis C strategy is in place, but simply renewed guidance, should the adoption of innovations, such as—I do hope I've pronounced this right—glecaprevir, be part of such a strategy? Because—this ties back to my earlier question about patient access—some people are very hard to reach, but with these new drugs, we can make astonishing strides in improving the quality of people's lives. But it's not just the drug alone in the case of something like the hep C drug; you actually need the support services, the counselling, the outreach and the lifestyle changes to really make that significant difference. The drug is only a part of it. So, I wondered if you could just comment on that as well, thank you.

Yes. On that last point about hepatitis C elimination, I don't think it's actually about the availability of the drugs. We're really fortunate in Wales to have a national strategy, and within the clinical community, the group of clinicians are very proud of having a national approach. Just because the centre is in Cardiff—. It is a genuinely national approach that people buy into and, to be fair, clinicians across the border think we've got it right as well. It's one of the stories you don't often hear about, but actually, people in England are looking at what we've done, how we've done that and why—and actually, it's not been a significant cost increase. But the point about elimination isn't so much about the drugs that are now available. It's really about reaching the harder-to-reach people who don't always engage in services. So, we recognise the reservoir of people still suffering with hepatitis C are people who are less likely to engage in health services per se. It actually is about the outreach part of it, rather than the innovation and the new drugs. 

I'm pleased to hear your welcome for the approach we've taken to approved medicines, which is an evidence-led approach. There's no curtailing of new medicines that the new treatment fund is actually delivering or suggesting. Actually, it's really about how and when medicines are developed. So, it's about the industry-led development that goes into it. I'm thinking I'll deal with your next point about horizon scanning. That's some of the things that we've—. We've actually managed to deliver an improvement in practical relationships. I've met with ABPI Cymru to have a conversation with them about the industry's approach, and I have made clear that, actually, we need to see better engagement with the healthcare system in Wales. So, actually, there have been better conversations between industry about making available earlier, information on those medicines that are likely—or more likely—to get to the point of coming to market and going to an appraisal process, to give health boards an earlier opportunity to plan for their potential implementation.

In fact, that's one of the points the ABPI themselves make in their press release today, which welcomes the fund, the establishment and, indeed, that particular point about being able to work together in a more grown-up way with the health service. Again, it points to the fact of having an evidence-led approach, and then particularly points to the fact that this fund covers all conditions, as opposed to just one parcel of conditions being covered in funding and access on a faster and more consistent basis.

I'll tell you how wide usage is: the point about having the new treatment fund available is that the treatments are available where they're clinically appropriate, and it's then down to a proper decision made between a healthcare professional and their patient about what's available. So, of the 82 medicines available, my understanding is that approximately 4,000 people in Wales have benefited from that faster access. So, I'm more than happy to return either to the Chamber or to committee in the future about the numbers of medicines and the spread and the reach of the new treatment fund. As we have more data available, I'm more than happy to make that available to Members and the wider public.

Firstly, any evidence that people are finding it easier now to get drugs that they are entitled to is to be welcomed, but a word of background: you may recall that, in 2014, Plaid Cymru announced a policy of seeking a new treatment fund that was specifically designed to fund the drugs obtained through individual patient funding requests. I'm very pleased that we are a step forward now, as a result of an agreement between the Government and Plaid Cymru on having exceptionality removed. I'm pleased that that has happened. Labour then, in 2016, announced its own new treatment fund, which wasn't the same. We were of the view—and it is important to point this out—that we shouldn't really need a fund to make LHBs do things that they ought to have been doing legally anyway, as welcome as additional funds are.

So, the first question to you: in the media this morning, it's been reported that, previously, officials suggested that it could take more than 100 days for an approved medicine to be rolled out. Is that an admission that the previous ministerial guidance that treatments should be available within three months following approval was being ignored? And, yes, there is additional funding through the new treatment fund for LHBs to pay for treatments, but it's worth asking this also: do you think that there's a risk, as a result of this policy, that LHBs will expect extra funds to implement other ministerial directions that they ought to legally be adhering to anyway?

Moving on to what you referred to as sustainable plans for the introduction of new medicines, perhaps you could elaborate a little bit on that; namely, how are you ensuring that this planning does take place, and that patients aren't left in the position of a drug not being available in the future?

And finally—it's a point I've raised on a number of occasions in the past—it isn't always just medicines that improve outcomes for patients. Other health technologies and sometimes even simple changes to guidance on how medicines are used can make a difference to patients. Increased awareness, even, of a condition can lead to better outcomes, and there are barriers here to the uptake of best practice across the NHS; for example, a lack of time for continuous professional development. Is this something that you would look at addressing also?

I'll deal with your last point first. I recently launched Health Technology Wales, which is a way of looking at non-medicines to look at technology within the health service and for its more rapid adoption. We have a range of different ways in which we've tried to do that in the past—the efficiency through technology programme has had a good record of having a range of things at pace and scale across our service. There's more of that to come in the broad approach. But Health Technology Wales is a way to appraise new technology and to give us an understanding of what we should then do, and how we should try and see that delivered across the service. I'll have more to say on Health Technology Wales as we've got a longer period of time to understand its having come into being, and then its impact across the whole health and care system. Of course, that is one of the challenges set to us by the parliamentary review, on how we deliver more innovation at pace and at scale.

There's something here about the new treatment fund, and it's worth reminding all of us that politics is a business where we should have some principles and some values and beliefs, but it's also, ultimately, a practical business. I make no apology at all for recognising where we were, where some recommended medicines were not being introduced as fast or as consistently as they should have been. And we could either have said, 'We'll go after health boards and look to discipline people, and go after them', or we could say, 'How do we make sure that we get this faster and more rapid access?' We've taken a decision to actually do a number of things, and the new treatment fund is obviously part of that. It has also been part of a change in the way that health boards plan for new medicines to come into place. Part of the reason they found it difficult was actually the ability to make a financial choice in the first year of a new treatment being introduced. Actually, after that first year, it's much easier then to continue delivering within a budgetary framework. So, this is recognising the pinch point at the start of a new medicine becoming available, and it's also why—my point that I raised in response to Angela Burns about the improved relationship with the industry itself is really important for us too. All of those things matter in what we've done, and I'm delighted that the pledge that we've made to the people has been kept. This was a manifesto pledge that my party made, and it's a good thing that we're able to say that there are times that politicians really do keep their pledges. And, indeed, we kept our pledge on the agreement we reached with Plaid Cymru, but also the cross-party engagement, on the individual patients funding requests review as well. So, we're making real progress in these areas, and I hope that, in broader health service reform, and the opportunities to make a difference, we can continue some of that grown-up politics approach to doing that.

Thank you for your statement, Cabinet Secretary. As I said when you unveiled it, the new treatment fund is a most welcome addition to the NHS as it can speed up access to vital treatments for all patients, and not simply people suffering with a cancer diagnosis. I welcome the news that some medicines have taken just 17 days to become available under the new treatment fund, and this is wonderful news for patients. However, as with all such schemes, the devil is in the detail. Delivery never quite matches design. Not all local health boards are as efficient in introducing new treatments, and I welcome the steps you have taken to monitor compliance. Cabinet Secretary, can you update us on the how all the local health boards are complying with the requirement to make treatments available within the required timescales?

I welcome the fact that 82 new drugs have now been made available under the scheme, treating everything from arthritis to acromegaly. I must confess I had to look up that condition, but it is great news that people who suffer from this debilitating hormonal disorder can now get treatment in Wales. This highlights the massive improvement the new treatment fund is on the cancer drugs fund in England. This scheme can benefit all patients in Wales, as well as those suffering from cancer. I would be grateful, Cabinet Secretary, if you could outline how many patients have benefitted from the fund in the last 12 months.

Of course, the new treatment fund only supports the introduction of new treatments for the first 12 months. Health boards must accommodate ongoing treatment within their existing budgets. So Cabinet Secretary, can you update us on how health boards are planning to accommodate the additional expenditure of these new treatments during the coming financial year?

I also welcome the news that your Government continues to work with the pharmaceutical industry and that you are working with ABPI Cymru on the new treatment fund. I would be grateful, Cabinet Secretary, if you could outline the work being undertaken to improve horizon scanning within the NHS so that we are better prepared to maximise the benefits of future treatments.

Finally, Cabinet Secretary, this is a treatments fund, and while I greatly welcome 82 new medicines, the fund is not limited to pharmaceutical interventions. So, can we look forward to the fund being used to introduce new therapeutic interventions in the next 12 months?

I welcome your statement, Cabinet Secretary, and the news that patients in Wales can get early access to better treatments, sometimes just days after approval. I look forward to working with you over the next 12 months to ensure that these new treatments are available to every patient who needs them, regardless of where they live in Wales. Diolch yn fawr. 

Thank you for the series of points and questions. I'll try to be as brief as possible, including those points that I think I've tried to answer in previous questions. 

I welcome the recognition of all three other parties in the Chamber that the new treatment fund has delivered a significant improvement in access. It was in the first six months that the average time was 17 days—just to point out, in the second six months, that it's come down to 10 days on average for new treatments to be made available. 

As I said to Angela Burns, with the 82 medicines that have been made available with the new treatment fund coming into being, we think that benefits around 4,000 patients, and I also pointed out in response to Rhun ap Iorwerth that this is really about understanding the challenge that we knew existed within the first 12 months of planning for and delivering new medicines, and, thereafter, health boards have actually got a much better track record of managing within their resource budget for drugs. 

I also made it clear in my response to Angela Burns—at least I tried to—that horizon scanning has improved and the ABPI's statement itself has recognised that, and that's work to continue building on as well; I don't think that's simply a done deal. I also made it clear to Rhun ap Iorwerth that Health Technology Wales is there to help us in understanding how we take advantage of new non-medicines treatment as well. 

But, in terms of your point about compliance, there's a monthly monitoring system. My officials, together with the All Wales Therapeutics & Toxicology Centre, monitor how quickly health boards are putting new treatments on to their form, which will make them available for clinicians to prescribe. That's an area that we'll continue to look at to see if that compliance is being maintained throughout the fund. That's a very clear expectation that I have and the Government has of the new treatment fund—it's not just here to deliver in its first year, but to deliver throughout the term of this Government.

Thank you very much, Cabinet Secretary.