2. Will the Cabinet Secretary make a statement on the Bowel Screening Wales programme? OAQ52035

Thank you. We have a well-established national population bowel screening programme in Wales, with nearly 147,000 men and women screened during 2016-17. We continually look for ways to increase uptake, and recently announced the introduction of a better and more user-friendly testing system, which will be rolled out from January 2019.

The Cabinet Secretary will know that, in the latest year for which figures are available, the uptake of those eligible decreased from 54.4 per cent to 53.4 per cent, so a 1 per cent reduction. I hope this does not become a trend. And, also, at the moment, screening is not offered to anyone over 75. And I have a constituent who's been very anxious about this because he has taken part in the programme. They arrive at their 75th birthday then they cannot get the screening kits, and I do think this aspect of the screening programme should be reviewed. 

I recognise the concern. This is part of the difficult choice and challenge in making decisions. We, as every UK nation, are advised by the UK National Screening Committee, and that does recommend routine screening up to the age of 74. The Wales Screening Committee actually recently considered whether to offer bowel screening for those people who self-referred over the age of 74, but their recommendation to us is that the evidence does not support doing that; the position remains unchanged. Part of our challenge, as always, is where we have the greatest impact on health, and that is difficult because individual circumstances will arise where people say, 'I would like a different choice to be made by the whole system.' Our focus is on the successful roll-out of the newer and better test to the population that we currently have, and, actually, on increasing the uptake. The positive news is that pilots of the new test have shown an increased uptake in those pilot areas. So, I look for a significant improvement as we roll out the new test, and, of course, we'll continue to be guided by the best available advice and evidence. And, if that changes, then I'll be happy to consider changing the choice that the Government and the national health service make. 

Cabinet Secretary, I also look forward to the uptake being increased, because the new faecal immunochemical test is obviously more sensitive and a better test. But there are two issues. I also look forward to you perhaps looking at the age 50 to 60, because we don't have that age being accepted, but there may be individuals who have a history in families doing that, which you may want to specialise in. But those types of things mean more referrals, and, if you actually you do the FIT test, which is more sensitive than currently being proposed, you will definitely have more referrals and we have a problem with endoscopy and nurses and doctors in that area—we have a problem with diagnostics. What's the Welsh Government going to do to, basically, attack that problem, so that we can ensure that, if we get more referrals, they will be seen as quickly or quicker than they are now?

I recognise the issue that David Rees raises on both points, both about the fact that we don't currently offer the test for people who are in the age bracket between 50 and 59—. And, again, our ambition is clear: we want to be able to do that. But, actually, our challenge is that, when we're seeing a falling level of uptake in the screening for the current population we provide screening for, we need to understand better how to implement that more successfully as we then are ambitious to actually roll out to the younger age group as well, which is in line with the advice we've received. So, we have advice not to roll out for 75-year-olds and above. We do have advice that we need to get the position where, with a successful uptake, we then roll out to people over the age of 50 up to 59. 

On your second point about diagnostics, we've actually made significant progress on reducing diagnostic waits more generally, but it is recognised that, with the new test, we'll expect more demand. That's why health boards have been investing in endoscopy services over a number of years, and we're also expecting to see that the endoscopy implementation group will come up with more plans and proposals on improving both the efficiency and the quality and the capacity within those services—it's not just in this area, but on the greater diagnostic capacity.

Last week, we had a meeting of the cross-party group on cancer, where we were looking at the diagnostic workforce in Wales, and the issue that David Rees has brought up came up strongly, about the lack of endoscopy nurses, with a vacancy rate of 11 per cent. And, with evidence given about nurses leaving to go to private companies, I wondered what more the Government could do to try to ensure that we do manage to keep these nurses, who are obviously vital if we're going to develop our screening programme in the way he's described.

Well, there are two points. One is about what we do to retain our current workforce into the future, and the second is our planning for the future, both in terms of increasing our capacity and actually being able to have training numbers that match that future capacity. And that is the work that Government is already undertaking. I reported on this issue, actually, in a meeting at the start of this week to the Wales Cancer Alliance. They raised concerns they'd raised within the cross-party group, so I recognise the issue that exists, as I said in answer to David Rees. We will need to come forward in the next stage of our planning—and the work of Health Education Improvement Wales is part of this in understanding what we need to do to plan for that future, as well as making sure that the current working environment is one where we'll retain more and more of our staff and, of course, our experience in this area of work.