We move on to item 6, which is a statement by the Cabinet Secretary for Health and Social Services on the Public Health Wales review of sexual health services, and I call on Vaughan Gething to introduce the statement. 

Thank you, Deputy Presiding Officer. In November 2016, the then Minister for Social Services and Public Health, Rebecca Evans, commissioned Public Health Wales to undertake a comprehensive review of sexual health services in Wales. The year-long review was carried out in consultation with a wide range of stakeholders, and overseen by a sexual health programme board, chaired by the chief medical officer. The final report has been published today, and I'd like to thank Public Health Wales for the collaborative way in which they have undertaken the review, and, of course, all those people who contributed to the review.

The Welsh Government remains committed to the continual improvement of sexual health and well-being in Wales, and to the provision of services that meet the needs of our population. Here in Wales, we have made tremendous strides in recent years in reducing teenage pregnancies. There was a 50 per cent reduction between 2010 and 2016, from 2,081 teenage pregnancies in 2010 to 1,061 in 2016. But the number of sexually transmitted infections in Wales remains considerable. In 2016, there were more than 12,000 infections diagnosed in the 64,000 people who sought care.

Chlamydia remains the most common infection, although we continue to see both syphilis and gonorrhoea in those who engage in risky sexual behaviour. Sexual health services in Wales also continue to diagnose new cases of HIV. The maximum number of new diagnoses of HIV in any one year was in 2014 when 186 new cases were identified. By 2016, this number of new cases was 141. The downward trend needs to continue. Last year, I decided to begin a national trial in Wales to deliver pre-exposure prophylaxis for HIV. This has been very successful to date, and there have been no new cases of HIV in those receiving PrEP.

Studies show that the majority of sexually transmitted infections can be prevented. If prevented or treated early, the chances of experiencing medical problems can be greatly reduced. Those healthy outcomes can only be achieved if all individuals have access to responsive services. The Public Health Wales report acknowledges the significant contribution that sexual health services in Wales make to the prevention and the treatment of sexually transmitted infections, and the provision of contraception. The sexual health workforce in Wales are committed to deliver excellent services against ever-increasing demand. The recent successful introduction of PrEP in Wales is a further tribute to the professionalism and the dedication of that workforce.  

My vision for sexual health services in Wales is one of modern services meeting the needs of all users. The review identifies a number of areas for further improvement, which will help to achieve this, particularly in respect of access and inequality. And the review recognises the needs of particular groups and how they access services. It also highlights the variation in ease of access to services and in some service provision across Wales. There are some communities disadvantaged through a lack of service provision, in particular rural communities and prisoners, and there is an inequity of provision of termination of pregnancy services. The report recommends that, as a priority, health boards in Wales have a robust understanding of the needs of their population and systems, and put resources in place to deliver services to marginalised and vulnerable groups more widely.

In addition, all health boards will want to understand, and I would expect them to understand, the contribution that the implementation of new patient pathways and technologies—for example, online triage, self-testing and point of care tests—could make to improving patient experience and reducing some of our current service pressures. The report also points to the need for enhanced surveillance systems that support all-Wales data collection by having a common IT platform supporting specialist sexual health services.

An important element of the review was to consider the current arrangements in respect of sharing of patients’ sexual health records between sexual health clinicians and wider healthcare providers. The review concludes that relevant information should be shared amongst the healthcare professionals who have a relationship with the individual patient and that consideration should be given to revising or replacing the existing legislation governing information sharing.

Whilst there is a wide range of groups and partners that have a role to play in improving sexual health, the report highlights the potential for an enhanced role for primary care and community pharmacies in sexual health provision. An example could be in delivering over-the-counter oral contraception and to extend the provision of long-acting reversible contraception.

I have listened very carefully to the views of clinicians, women’s groups and the views from across this Chamber. I have instructed officials to start work immediately on how we can amend the legal framework to allow for the treatment for termination of pregnancy to be carried out at home, in line with recommendation 7. Termination of pregnancy is a legal healthcare entitlement in Wales and a woman’s right to choose must be respected and access to services improved.

My officials will now work with stakeholders to develop a fully costed and timetabled implementation plan. The sexual health programme board, chaired by the chief medical officer, will remain in place to support and oversee implementation of the service improvement recommendations over a two-year period. I will of course ensure that Members receive regular updates on the progress of implementation. 

I'd like to thank the Cabinet Secretary for his statement today. There is much to be welcomed in this statement. I was particularly pleased to see the reduction in teenage pregnancies because, of course, as we know, that can have significant long-term life barriers sometimes for young women who get pregnant at too early an age. So, that's really, really welcome. I was also very pleased to hear about some of the other comments that you've made, particularly about PrEP. That's proving to be a very successful trial and I do recognise that and welcome that going forward. 

However, reading the report, it does appear that sexual health services are still not really meeting the demands of the services. From my reading of the report, it found that the services that held drop-in centres or drop-in clinics were far more likely to be successful, and that artificial barriers, in terms of appointment times, inability to get hold of people via the telephone et cetera were putting caps in certain areas.

But I think what I really am concerned about is, as attendances at sexual health clinics have doubled over the last five years, why have we seen such a significant reduction in NHS expenditure on sexually transmitted infections and the Public Health Wales functions? According to my reckoning, since 2015-16, spending on STIs has fallen by some £10 million, from £17.774 million to just over £7 million. Public Health Wales has also received real-terms cuts to its budget, so could you perhaps just explain to us how you believe we can still deliver this level of service to the people of Wales with such a significant reduction in budget, and especially when you look at the fact that the need for sexual health clinics is growing rather than reducing in the round?

It's very welcome to hear that you're going to be looking at how pregnancy and termination of pregnancies may be able to be offered to people at home. However, there are still huge inconsistencies in health board provision of abortion services. They vary in terms of the gestation time limits and they vary in terms of what women are able to access at different abortion services. Abortion, under the 1967 Abortion Act on grounds C and D can be carried out until 24 weeks of gestation. However, obstetrics and gynaecology departments in Wales will only manage abortions on grounds A, B and E to the late mid trimester, meaning that women who don't meet grounds A, B and E have to travel to England for their treatment. So, whilst it's welcome that, on the one hand, you're allowing people to perhaps take their appropriate medication at home, on the other hand, we're actually making it more difficult for some women to be able to access abortion services and access those services in a coherent and cohesive way across the whole of Wales. So, I wondered whether you can just give us a real comment on that.

My last comment—and I'd be really interested to understand how the review came to this—is on the item where you discuss the fact that the review concludes that relevant information should be shared amongst the healthcare professionals who have a relationship with the individual patient. I know that, in Pembrokeshire, there was a move to relocate a sexual health clinic to a location that was in a far more prominent place, and it caused real worry and consternation because, for a lot of people, attending a clinic such as this is their most private of private business. They're reluctant to let the local chemist know because, actually, the local chemist knows their mum. They're reluctant to tell their doctor too much about it because, in fact, the doctor knows somebody else who knows somebody else. It's sort of that, if you're in a community, this kind of information you do want to really hold to yourself, or a great many people do. In Haverfordwest, it caused real problems, because people felt that people would see them just walking in and be able to pinpoint, 'Oh, so and so's going there and doing that.' So, I just like to understand what work the review did with patients about how happy they would be to have their information shared in such a manner.

I do have, Deputy Presiding Officer, one more final point, which is the fact that the review itself makes a comment about the inconsistency of the data and the data collection. So, I would ask you what faith you have and what store you can set by the data that's being put forward when the review very clearly says that all the data collection in this review needs to be leavened with a very strong dose of salt because they have not been comparable year on year even within health boards, let alone across the whole of Wales.

Well, on the final point, the data is the best available. It allows us to make the conclusions that we can. There will always be more to do to improve the evidence we have to base policy choices on. That's not just in this area but in every other one. I don't think it undermines the nature of the recommendations or the work we still have to do, actually. 

I was pleased to hear you again welcome what we've been doing on PrEP and the significant reduction in teenage pregnancies. I recognise what you have to say on what's in the report about recognising that we do need to improve access. That's part of what was in my statement as well. That's part of what I expect to see worked through with that timetable for improvement.

I also come then to your point about spend and outcomes, because I'm interested in how we improve outcomes. We've had to make difficult budget choices, as everyone knows, but I'm especially interested in—. The reason why the review was commissioned by Rebecca Evans in her former role was to ensure that we are sighted properly on the way in which services are being delivered and where they're actually properly meeting the needs of citizens, because we were concerned that we weren't meeting those needs on a consistent basis. The reason why we will have a programme board with a sexual health steer in place is to have a properly costed implementation plan to try and understand not just whether we're interested in the recommendations but how we take them forward, what that means and who needs to do them and to have some clarity and consistency then between health boards and partners about what they will need to do.

I fully expect that once we come up with a costed implementation plan over the next two years, not only will I report back to this place, but I would fully expect that one committee or another and this place would be interested to understand whether that's been taken forward and then whether we've actually achieved what we set out in our plan.

I have to say that I recognise the points you make about Public Health Wales and their overall budget, and the point that I would politely but firmly make back is that we are in a position of having to make really difficult budget choices, and there is no getting around it. Even within the health service, which has been the area that has done better than every other part of the Government, there are still incredibly difficult choices to make, and simply saying that you want more money spent in one part of the health service than another is not going to be an answer to where we are. We've had a focused review to give us an idea on what to do to improve, we'll come back on outcomes, and we need to understand how we do that, and at the same time we always need to deliver the greatest value for the money that we spend in every part of the public service given that we are eight years and counting into austerity.

On your two final points, on the variation in abortion services and access, I recognise that and, in fact, I've had a conversation with Jenny Rathbone about pretty much the same point, about a variation in services between different parts of Wales and where we are, and I've committed to actually taking an interest in that and looking at what we could and should do to actually try and level up the variation that exists and to have a proper answer. It should not matter which part of the country you live in and it shouldn't make a real difference in terms of the service that is available to you.

And, finally, the point about—I recognise this is difficult—the current regulatory environment and how records are and aren't shared. On the one hand, you understand that people may feel that the local healthcare professional may know someone that I don't want them to know and I may feel difficult about them having access to parts of the record. The challenge is that, actually, there's a potential clinical risk in that as well, if the person who may be responsible for your care in another area doesn't know.

Now, we currently have the interestingly—well, the aptly titled the National Health Service (Venereal Diseases) Regulations 1974. Now, England have repealed and replaced those with different ones. We're now considering on the back of the review whether we could and should replace those with a different set of standards and measures. So, the recommendation in the report is the one that we'll take through, and we will need to consider and talk to stakeholders, including the patients, about whether we should change those and, if so, what the settlement should be and understanding those different issues between clinical safety and the choice of a person about how those records are used because, ultimately, our ambition across health and care is to have more sharing of health and care records between relevant healthcare professionals, both to eliminate the time that is potentially lost, for people not to have to explain the same thing more than once, and to eliminate areas of clinical risk. So, there isn't a finalised viewpoint on that, but there is a commitment to look at and to take advice on whether we should amend, repeal or do something different and how we actually take that forward here in Wales.

As much as in any discussion that we’ve had, I think that Angela Burns and I have thought along exactly the same lines, in terms of the questions arising from this statement, but I’m sure that there are a couple of things left that we would wish to ask. I’d like to thank the team chaired by the CMO that did this very important work, because it is an important area. We have seen, through this amazing figure relating to the reduction in the number of teen pregnancies, that genuine success can come when the policy does target the right people, and when it says the right things and takes the right steps. So, certainly, I would congratulate everyone who has been part of achieving that outcome.

 In terms of the people who are looking for advice and support with STIs, what we read, however, is that the figures have doubled within the last five years. The review does recognise barriers that there are for people attending clinics or centres where they are looking for support. So, it’s possible that there is an underestimation of the number of people who need support. What that suggests to me is that the education and the preventative agenda that aims to prevent people from having STIs in the first place is failing, and failing in a significant way. We’re not talking here about education in schools only, because it’s evident that there is educational work among the adult population as well. So, my first question, which possibly relates to a reduction in budgets, as Angela Burns suggested: why has there been a failure in terms of the preventative agenda, because that is evidently vital as we move forward?

One of the barriers that I mentioned to those people who are seeking support and treatment is that there is a lack of consistency across Wales, as the report and your statement today have confirmed. We heard Angela Burns mentioning the lack of consistency across Wales when it comes to services that are available in terms of abortion and terminating a pregnancy. A lack of consistency in regulation or rules—that’s what that is. What we have in terms of treatment of STIs generally is a lack of consistency in terms of provision, namely the postcode lottery that we always talk about. I’m pleased that you recognise that there is variation in terms of provision in different parts of Wales, and I’d like to hear more about what exactly you and your Government are intending to do to seek that consistency for people, wherever they are in Wales.

There is a reference to drop-in clinics. Those are important, but the opening times mean that, again, access—accessibility—can be difficult. Is that something that you want to see being responded to? I also noticed the services that are run in some areas of Powys, in particular, by GPs. That is a barrier, I do agree, in rural areas, and particularly if I can draw particular attention to the Stonewall review, which shows that there are still many—although a minority—NHS staff who have a prejudice against LGBT people, and because of that, possibly, are not confident in terms of meeting the requirements or needs of LGBT people. We are talking about LGBT people when we talk about people who need treatment, therefore I think that there is a strong argument for keeping services separate for GP surgeries. And one final question: given the opportunity here, and given that it is sexually transmitted, could we have an update on where we are in terms of the HPV vaccine?

On the final point about the HPV vaccine, we'll continue to take advice from the relevant joint committee on the evidence base for undertaking any additional steps. We've already announced in this term of this Government—I believe it was Rebecca Evans in her former role who announced the extension of vaccination for men who have sex with men. There is still an ongoing debate. I know there are active members of the medical profession engaged in sexual health work who believe that the vaccine should be extended, but that is not a view that is currently supported by the relevant expert joint committee that every Government within the UK takes advice from. If the position changes—and I've said regularly in this place that there are times when you absolutely must be led by evidence, and the very best clinical evidence and advice—if the position changes on the evidence and advice, then the Government will change its position. So, I'm happy to give that assurance.

I recognise what you say about education and prevention, and recognising that, actually, much of this is still about how we persuade people to reconsider the choices that they make. These aren't just adolescents making these choices, there are adults of a variety of ages who are making choices, and part of the challenge is how we have an effective education and prevention approach with those people. It's part of the reason why, in looking at the PrEP study, it wasn't simply about deciding to deliver the medication, it was also about looking at how that fits in with other services, about some of the conversations that need to take place about what is and isn't a risky behaviour and how to see that as part of it.

You'll recall the rather obnoxious Daily Mail attack that suggested that PrEP was a licence to be promiscuous. And that isn't what it is, it's actually a means of understanding how we successfully treat people to prevent further infection in very practical terms. I'm confident it would save the national health service money and would allow people to make different choices about how they're able to live and enjoy their life. But there is an honest need to look at how we persuade and have that conversation with people about the choices from a behaviour point of view.

I recognise what you and Andrew have both said about the demand on the service, about our levels of outcomes, our ability to maintain excellent outcomes, and we can't simply rely on the workforce being ultra committed and continue to run further and faster. Actually, the challenges around consistency and access were a large part of what persuaded the Government to undertake the review. So, that is work that we're absolutely doing, and if you look at the recommendations and the commentary in the review, we do see, not just the organisational challenge and a drop in the services, but a greater role for primary care, and the thing about how those services can be delivered and making better use of a whole primary care group of professionals.

I go back to what Angela Burns said earlier—not every person may want to go to their pharmacy to receive part of their sexual health and contraceptive services, but a range of people will do, because almost every pharmacy, particularly all those that have an enhanced service, have the ability for people to go and see someone in a private room within the practice. When I have my medication review at a pharmacy walking distance from this building, I go into a private room, no-one knows what we're there to talk about and so it is a private consultation space. There will be a range of people who I think will be confident in going to different settings to receive part of the service. That is consistent with our broader drive to get people to use other healthcare professionals and not simply default to go and see the doctor, whether that's in a hospital or in general practice.

So, I recognise the challenges that are real and are there and I'm confident that, in taking forward the work in response to the recommendations of the review, we will have a series of logically worked-through recommendations about how to do this, with a costed implementation plan. And the assurance that Members have is that the board is going to continue to be overseen by the chief medical officer; it isn't simply a matter of politicians deciding to do what we think is the right thing to do without the proper evidence base and without the best and most up-to-date clinical evidence and advice.

Thank you for your statement, Cabinet Secretary. I welcome the review undertaken by Public Health Wales on sexual health services in Wales. The report rightly praises the sexual health workforce in Wales. The take-up of services has doubled in the last five years. This increase, undoubtedly, will require adjustments and reform to existing services to best meet demand. The key issue is getting these reforms right.

I welcome the dramatic reduction in teenage pregnancies between 2010 and 2016. Furthermore, I'm sure that all in this Chamber welcome the continued decline of HIV diagnoses and applaud the Welsh Government's proactive steps to combat the virus. There is still much work to be done to remove the stigma surrounding HIV, however the high number of people coming forward for testing and campaigns to educate the public on the importance of regular sexual health tests should be celebrated. By increasing accessibility to PrEP, we are moving closer to beating HIV. It is indeed good news that there have been no new cases of the virus in those receiving PrEP.

By reducing high-risk sexual behaviour, we take another proactive step to tackling the diagnosis of sexually transmitted diseases. However, Cabinet Secretary, as you highlighted in your statement, diagnoses of other STIs remain high. While we must encourage people to use the preventative measures such as PrEP, they should not be seen as a gateway to high-risk sexual behaviour. Such behaviour, in turn, may expose people to other infections that consequently may add to the strain on sexual health services. Dr Giri Shankar or Public Health Wales has stated that much work needs to be done on reducing high-risk behaviour. Cabinet Secretary, what specific measures and initiatives do you have planned to respond to Dr Shankar's recommendations for more work in this area?

The statement mentions that prisoners are disadvantaged through lack of prison service provision. I find myself having to pause for thought here. There are already health services in prisons that all prisoners can access. Moreover, prisoners are educated on sexual health during their induction and they have their own healthcare department and everyone sees a healthcare specialist professional on a one-to-one basis upon arriving at the prison, and that is mandatory.

The statement rightly says that rural communities are disadvantaged through lack of service provision. Cabinet Secretary, could you state what specific and practical measures are being taken to improve access to sexual health services in rural communities? The statement states an aim to implement the Public Health Wales recommendation over a two-year period. It also states that demand for sexual health services has doubled over a five-year period and is putting pressure on existing service models. Therefore, what measures will be taken during the transitionary two-year period to ensure that demand for services is met? Online triage is mentioned, but could a full range of online services be implemented more rapidly to cover this two-year transitionary period? Thank you.

Thank you for those comments and questions. I am pleased to see a large amount of consistency in issues being raised by spokespeople. I'll try and briefly cover the issues, rather than repeating what I've said in responses to both Angela Burns and Rhun ap Iorwerth on some of the points. I will, though, remind people that I've already indicated there'll be a plan—it'll be costed, it will be timetabled—about how we'll take that forward, so I won't stand up and try and freestyle here now about how that'll be done, or the time and speed for it, otherwise there'd be precious little point in having a group work together to deliver an implementation plan.

I was pleased to hear Caroline Jones mention the reality of the stigma of HIV, but more broadly about sexually transmitted infections, and that's still a challenge for us, in terms of persuading people both to take seriously their own choices, but also for them to seek help at an early enough stage for it to have the best prospect of being successfully treated and managed. Recommendation 9 in the report does refer to sex and relationship education. Now, the review didn't ask them to specifically look at the curriculum review that is taking place, but there's a recognition that's an important tool about how that's done and to make sure that young people growing up in the world are equipped with a range of information and are able to manage the choices that they themselves will make, although, of course, being an adult is no guarantor of being sensible or reasonable, as I'm sure we all know from various parts of our own lives.

I just want to refer back to the point about inequity of access in provision across the country in a variety of settings, and that is recognised in recommendation 1, about the reality that we will need to do more. So, when we see the plan on the improvement, I will expect health boards to be signed up to it and to be able to set out in response to that improvement plan how they're going about not just recognising the inequities that already exist, but what they will be doing about those in response to this report, but, as I say, to the implementation plan that will be drawn up.

I very warmly welcome your commitment to allow misoprostol to be administered at home. That's excellent news. I just wondered if you could elaborate on what work your officials will need to do and the timescale for doing it, as we're not talking about revising the Abortion Act, we're talking about extending the location of where a medical abortion can be administered, namely at home. As this has already been done successfully in Scotland and is already available to women who have an incomplete miscarriage here in Wales, it doesn't feel like a very complicated process, but I agree that it requires political commitment, and I thank you for that.

It's excellent to see that teenage pregnancies have halved, but there were still over 1,000 in 2016, and it does obviously beg the question about the quality of the sex and relationship education that is available in schools, which, obviously, your report indicates is not part of the review, but it's clearly an issue we need to take up with the Secretary for education, as it's vital that young women and young men understand when they're making informed decisions about relationships and where they can get contraception if they need it. I can see that that's a particular problem in a rural area, if a young person doesn't drive or hasn't got a car—very difficult to access the correct services.

I represent a very young constituency. I've got three universities in Cardiff Central, so I have, I think, the constituency with the largest number of students across the UK. I'm particularly concerned, and have already raised with the chair of the health board, about GP practices who're very keen to recruit students as their patients, but aren't necessarily providing the services that patients will need. It is obvious that young people arriving at university are going to need sexual health services, and they include rapid access to a clinic for sexually transmitted diseases, because things like chlamydia can obviously cause infertility if not treated. So, I'm a bit confused by recommendation 5, as to why it wouldn't be standard in a practice that has a large number of young people in it, which are the ones where there is an accumulation of young people, why they wouldn't, as standard, have those sorts of clinics available. Because I have had students telling me about real difficulty getting the medical advice they need, because they know they've got a sexually transmitted disease, and so delay in getting the right treatment, obviously, can make it worse in the meantime. 

In terms of access to pregnancy advice, if somebody falls pregnant, (a) do all pharmacies make the morning-after pill available? Because obviously people do make mistakes and realise very quickly that they might have got themselves pregnant by mistake. But I also want to understand why it's necessary to go via your GP if you think you want to argue the case for an abortion. Why is it not possible to go straight to the pregnancy advice and termination service? That is something that I also raised with the health board.

One of the issues that is quite concerning is the point that was flagged up in the report about the all-Wales data collection of sexual health diseases, because it seems to me essential that we have this information. Otherwise, how else can public health respond to an outbreak of chlamydia or gonorrhoea unless they've got accurate information about who is being treated for these diseases? 

And in terms of the really very welcome information that no new cases of HIV have been found in people who have been given PrEP, I wonder, then, what justification there is with continuing with a national trial rather than making PrEP available to anyone who is at risk of HIV. If it really is that good, why are we still doing a trial?

On the first issue raised, I just want to be reassured that there is no bar to being able to make the progress I've indicated that I want to. So, it's about 'how' and 'how quickly' as opposed to 'if', from my point of view, and I recognise what you've said; I think it is helpful to make clear that we're not talking about changing treatment. We're talking about the place in which that treatment is provided, and it is already the case, as you say, that for an incomplete miscarriage, this can be administered at home. And so, I recognise there will always be people who will raise objections to changing any form of abortion provision, but this is about trying to do the right thing, simply being able to move as quickly as we possibly can to make the right choice. I recognise what you say about teenage pregnancies. A 50 per cent reduction is, of course, welcome, but there is more to do and there is no hiding from that.

I didn't quite hear all of the comments you were making about the challenge about access to treatment for your students and primary care. That may be something that we may be able to have a longer conversation about, and I'm happy to meet with you and/or constituents to actually run through their current view on what's happening and how they'd want to see that provision improve. Because, generally, in urban environments, in city environments, access is better and isn't the challenge that we're especially worried about and that the report highlights. But if you think there is a particular challenge within your constituency, I'd be happy to discuss that further with you to see what we could and should do.

And on the broader points about pharmacy, of course, there are enhanced contracts in place for the provision of services. One of the things the review recommends, though, is actually about using pharmacies not on an enhanced contract, but actually to look at the regular provision of regular oral contraception. So, there is a variety of different ways in which that can be done to ease access as well, and that should also mean that it should be easier for general practitioners, in terms of an extra area of demand being taken away from them, that the report authors consider that our community pharmacy is perfectly adequately set up for and able to do, and will improve access to people.

A final point about PrEP: the initial results are that PrEP is highly effective. The reason why we're running a three-year trial is we want to be assured over a longer term period of time that that remains the case, and it's also about seeing not just the provision of PrEP, but changes in behaviour as well. So, we're looking at all aspects of that to try and see a sustainable and deliverable improvement. Then, of course, whoever is in this fortunate position—me or another person in the future—will then have to make a choice about the longer term provision. But the results so far are significant and encouraging. I look forward to being able to report back at the end of the three-year trial, not just about the results from the trial, but about the longer term choice that we all make, here in Wales.

Thank you. And finally, Julie Morgan.

Thank you, Deputy Presiding Officer. I'd also like to thank the Cabinet Secretary for listening to the voices of women and that he will act to allow the termination of pregnancy at home. So, I'd like to thank you very much for that.

I also wanted to say something about inequity and inconsistency. Last year, the Cardiff abortion rights group had a fascinating exhibition, actually, to mark 50 years of the Abortion Act, along with a conference over in the Pierhead. To me, one of the staggering points that came out of that conference was the fact that, in Cardiff, it's six or seven weeks later in terms of getting access to a consultation about an abortion than in Gwent—the neighbouring area—and there always has been a difficulty in Cardiff in getting access to abortions. So, it came out as a clear signal of the inequities that do exist. So, I do urge him to address that point very strongly.

Finally, I just wanted to flag up the barriers that there are for women getting a termination, particularly in Cardiff, where a group of anti-abortionists do gather during the period of Lent outside the clinic on St Mary Street, and make it very uncomfortable for women who are going in to seek a consultation. I know, over the last month, in one of the London boroughs there has been an exclusion zone set up so that nobody can demonstrate in any way, either against or for, and I wondered if the Cabinet Secretary could make any comment about that development because I do believe this is a public health issue, because it is a barrier to women seeking to have a consultation and they should not be in the position of feeling that they are being criticised and pressurised by a group who have different views.

On the first point, I'm interested in the Cardiff issue that both you and Jenny Rathbone have raised, so I'll be happy to meet both of you at the same time to try and run through the localised challenges that you're both expressing.

On the second issue that you raised, I too noticed the exclusion zone around providing abortion advice in clinics. It is something that concerns me about the manner in which people will feel pressurised unfairly into making one choice or another, and I do not think that the protesters are simply there to try and have a polite conversation or to provide pastoral support or guidance. I think it is plainly something that I would personally, myself, view as being intimidatory. So, I'd be happy to think again about what powers are available and to whom, to think about how we make sure that people are able to access healthcare services in a manner that is not judgmental, and they're able to make choices that each of us would want to make about any aspect of our own health and care treatment.

Thank you very much, Cabinet Secretary.