4. How is the Welsh Government improving prostate cancer diagnosis rates? OAQ52016

Health boards are expected to deliver care in line with guidance from the National Institute for Health and Care Excellence on referral for suspected cancer and the diagnosis of prostate cancer. Our approach to helping health boards and supporting them is set out in the cancer delivery plan for Wales.

Last month, I called for a Welsh Government statement on multiparametric—or mp—MRI scans for NHS patients for suspected prostate cancer. Subsequently, you wrote to a patient to say that Betsi Cadwaladr university health board does provide mpMRI scans in line with the current NICE guidelines for prostate cancer. The guidelines state that multiparametric MRI should be considered

'for men with a negative transrectal ultrasound 10–12 core biopsy to determine whether another biopsy is needed.'

One of those men you were writing to was one of many men who have contacted me in north Wales who were not offered an mpMRI scan following a negative biopsy, unless they paid around £1,000 to have it carried out at a private hospital. Given that Wrexham Maelor is the only centre in Wales that participated in the England and Wales PROMIS—prostate MRI imaging study—which found that whereas the painful transrectal ultrasound-guided biopsy offered by Betsi Cadwaladr is only 47 per cent accurate, the mpMRI scan is over 90 per cent accurate, how are you ensuring that men in Wales participate in or take advantage of the £75 million research project launched by the UK Prime Minister, which will recruit 40,000 men into trials for better diagnosis and treatments for the disease using mpMRI scans?

The pilot you refer to in England is a London-only pilot, so it's not a national pilot that takes in the whole of England in any event. We have pilots that are being run here in Wales in a variety of health boards. As I say, we will continue to provide a service that is in line with NICE guidance. The NICE guidance is due to be updated in April 2019. If we have the Welsh urology board—again, our clinicians here in Wales—if they reach a clinical consensus in advance of that, we can make different choices right across the service, but at this point, the provision is evidence based. Actually, there is a high satisfaction rate from prostate cancer patients here in Wales. I'm satisfied that health boards are doing what they should do, but, of course, we will always have more to learn from pilots in every part of the country, just as, indeed, pilots in north Wales will have much to teach the rest of the country in a variety of areas; for example, in a different area of the advanced paramedic trial in north Wales, where there'll be learning for the rest of the country to learn from there. It is entirely normal to have pilots to take learning from and then improve the whole service—that is exactly what we are doing with prostate cancer as well.

What's just been outlined in Betsi is also true of Hywel Dda, and I have a constituent who's also been told to pay £1,000 for a multiparametric MRI scan. The reason for that is that, as you say, the NICE guidelines talk about such a scan following a biopsy, but we have health boards in Wales—Cardiff and the Vale, Cwm Taf and Aneurin Bevan—that offer these scans as a routine diagnostic tool with, as has just been set out, improved pick-up rates of some 93 per cent, and less risk of bleeding, infection and sepsis following the more invasive other tools that have been used for prostate cancer following raised prostate-specific antigen levels.

I don't understand—I did write to you regarding this constituent—why it is we have this postcode lottery on prostate diagnosis in Wales. Yes, the NICE guidelines are there, but they are the minimum requirement. Since we have three health boards in Wales offering more, then surely all of those health boards in Wales should offer more, because, as you say in your letter to me, there is evidence that this is good practice. Well, if it's good practice and it's evidenced, offer it for everyone and offer it for my constituents in Hywel Dda as well.

As I said in my first answer to Mark Isherwood, there are pilots running in Wales. If there is a new clinical consensus, underpinned by evidence, in Wales, we can make a system-wide shift. That is where we are. There are pilots in the three health boards that you mention. The evidence base for that is gathering and growing, and we will then be able to make a choice on the basis of the evidence and on the basis of the very best clinical advice. Until then, I don't think any health Minister would say that they wish to direct the health service to offer a service that is not underpinned by the very best available clinical evidence and advice.