The next item, then, is the Member debate under Standing Order 11.21(iv), and I call on Hefin David to move the motion.

Motion NDM6682 Hefin David, Angela Burns, Mark Isherwood, Rhun ap Iorwerth, Dawn Bowden, Mandy Jones

Supported by Neil Hamilton

To propose that the National Assembly for Wales:

1. Welcomes Bowel Cancer UK and Beating Bowel Cancer’s recent report highlighting early diagnosis and its ambition to improve survival rates for people affected by bowel cancer.

2. Recognises the brave contribution of bowel cancer patients in Wales to raising awareness of the disease and of the healthcare professionals to improving outcomes in the face of increasing demand for diagnosis, within the constraints of the existing service.

3. Recognises bowel cancer as the second biggest cancer killer in Wales, the effect early diagnosis has on survival rates and the importance of encouraging the public to take up their bowel screening opportunities as uptake rates have fallen by 1 per cent in the last 12 months.

4. Welcomes the introduction of the simpler and more accurate faecal immunochemical test (FIT) in the bowel screening programme and its potential to improve bowel cancer survival rates.

5. Calls on the Welsh Government to deliver a bowel screening programme that can reach its full potential and to address issues around the:

a) proposed threshold of FIT to be introduced in 2019;

b) challenges that exist within endoscopy and pathology services to ensure FIT can be introduced optimally;

c) need to reduce the eligible screening age from 60 to 50.

Motion moved.

Diolch, Llywydd. Members in this Chamber may have noticed that I wear this signet ring. It was given to me by my father when I was 16 years old. It was actually my grandfather's ring. It's got tighter as I've got older, it's got to be said. My grandfather was diagnosed with bowel cancer in the 1970s, and survived into the 1980s. One of the things he said to me was, 'I just want to live long enough to see you go to university.' My grandfather died when I was 10 years old. I'm sure that many of us have been touched by stories of bowel cancer, and therefore I'm delighted to bring this debate to the Chamber today.

Screening for bowel cancer is now available nationally across the four nations of the UK, and in Wales it's provided for people aged between 60 and 75. We've witnessed major innovations in the treatment options available, which have seen death rates for the UK as a whole fall by 13 per cent. This is a tribute to the hard work of many healthcare professionals and researchers in both the national health service and the pharmaceutical industry. However, it's clear that we still have work to do, and the Bowel Cancer UK charity has helped us see where that work can be done. Around 41,000 people across the UK are diagnosed with bowel cancer every year. More than 2,200 of them are here in Wales. So, the heartbreaking and painful reality is that, of the 16,000 of these people UK wide, over 900 in Wales will lose their battle with this terrible disease. I'm sure that everyone in the Chamber today would agree that that is over 900 too many.

Put simply, the earlier diagnosed, the greater the likelihood you will survive five years or more. Early diagnosis is key and crucial to this is both raising awareness and screening, which I'm going to mention and raise with the Welsh Government in my speech today. People need to be aware of what the potential symptoms of bowel cancer are and I know that Members I've spoken to have plans to discuss that in detail. If you think you may have symptoms of bowel cancer, don't be embarrassed and don't ignore them, go and get them checked.

I recognise that five out of seven health boards in Wales are in breach of the Welsh Government mandated waiting times—over 1,800 patients in Wales are waiting more than eight weeks for a bowel cancer diagnosis. This is from a report published in February by Bowel Cancer UK, which we helped to launch. Mandy Jones and Andrew Davies AM helped to launch this in February here. The report also found that fewer than half the people eligible for bowel cancer screening tests in Wales took part, but screening is the most effective way of detecting bowel cancer. I wrote to the then Minister, Rebecca Evans, when she was Minister for public health in February 2017 on the issue of lowering the age of screening from 60 to 50, as is currently the case in Scotland. I was encouraged when she said, on 23 February 2017, 'the Welsh Government is committed to expanding the bowel screening programme in Wales to men and women aged 50 to 59 years, but our focus is on increasing the uptake in the current age range and reducing the inequities that we know exist before expanding the programme further.'

I think today is an opportune moment for the Cabinet Secretary for health to update us on what progress has been made since February 2017 and what progress the Welsh Government intend to make into 2019, which is part of our motion. The Minister in her letter also stressed the importance of raising awareness amongst lower income groups, because they're statistically less likely to present themselves for testing—

Will the Member give way?

Yes, of course.

It's interesting only half of eligible people are getting the screening, but I've also had a constituent who's regularly gone for the screening, or done the screening test, and then, at age 75, it just stops, and it really causes a great deal of anxiety. I wonder if there is any evidence emerging that, actually, continuing screening beyond 75 is also beneficial.

Such evidence needs to be presented by Public Health Wales, and I'd like to give the Cabinet Secretary a chance to answer that specific question.

At the Senedd on 6 February, though, I also—and perhaps in answer to David Melding—I spoke to an oncologist who raised some questions about changing the age range. He wasn't talking about over-75s, he was talking about lowering it to 50, and his professional view was that the net could risk being spread too widely and too thinly if the appropriate support mechanisms were not in place if you lowered the age range. So, if you're going to lower the age range, you've got to have professional public health advice to say that the system is ready to support that. I think, if the Welsh Government could, they would lower it straight away to 50, but you've got to have sufficient support mechanisms being placed that won't disadvantage those who are already being tested. I'm mindful that there are other public health professionals who would take a different view, and they all form a valuable contribution, but I think the key is to listen to Public Health Wales's advice and see that the age range is lowered, I would hope, as swiftly as the Government can do it.

Colleagues will also want to contribute to the debate today about their own experiences, and Dawn Bowden has given me this faecal immunochemical testing screening kit, courtesy of Bowel Cancer UK, and I understand this is in the process of being rolled out in Wales, following pilot schemes that suggested a boost in uptake of 5 to 10 per cent. I can see yours on your desk there as well, Dawn Bowden. By bringing in examples of these screening testing kits, we hope to break the taboo of testing. That's part of what we're trying to do today—break the taboo of testing.

But I just want to finish with my personal stories of friends with bowel cancer. In the 2016 election, my UKIP opponent was a hugely engaging person by the name of Sam Gould. Sam's personality, energy and lust and love for life shone through in everything he did. He was struck down last year with bowel cancer and he died at the age of 33. Sam became my friend, I visited him in hospital, and I miss him. I think that Sam's courage is something we can take many lessons from. I'll never forget the time Sam brought Nigel Farage to Gelligaer during the Assembly election of 2016, and he even took a picture of me shaking hands with Nigel Farage, which is floating about somewhere on the internet. I think Sam would laugh now if that was ever to come to light.

I also speak for our very valued and great friend Steffan Lewis. Steffan is a wonderful individual and has made a fantastic contribution to this Assembly. He's currently off sick. We're thinking of Steffan today, with his illness, and I want to make my speech in his name. We wait for him to come back and we wish him the very best with his treatment and, please God, recovery. As I'm sure Members are aware, Steffan's sister has arranged a sponsored walk on 14 July in order to raise funds for Velindre Cancer Centre, and I can think of no better way for us to support him and his cause.

Therefore, I recommend this motion to the Chamber today, and I hope that the debate will set out in more detail and more depth the issues that we face, so that we can then work together to deliver the very best services for patients with bowel cancer here in Wales and do what we all want to do, which is to beat bowel cancer.

Well, my only own experience is that one of my grandmothers died before I had a chance to know her, because she was taken by bowel cancer when I was two months old. 

Bowel cancer is the fourth most common cancer in the UK. Around 16,000 people die from the disease each year—900 in Wales—making it the second biggest cancer killer. The scale is growing, where it is estimated that between now and 2035, around 332,000 additional lives could be lost to the disease across the UK, and this shouldn’t be the case, because the disease is preventable, treatable and even curable. Nine in ten people will survive bowel cancer if diagnosed at the earliest stage.

Screening is the most effective method of detecting bowel cancer early and plays a key role in improving survival rates. Across the UK, bowel cancer screening programmes send everyone aged between 60 and 74 a home testing kit—and I note David Melding's comments earlier, in that context—every two years. In Scotland, they are also sent to people in their 50s. Referral by GP is still the route by which most people are diagnosed. Referral through primary care is a key route to diagnosis for those who experience symptoms that could be bowel cancer, and for those below the age covered by the screening programme. People who experience symptoms should be referred for the most reliable and accurate diagnostic tests for bowel cancer available: a colonoscopy and flexible sigmoidoscopy, which can detect cancer at the earliest stage of the disease. While effective public health awareness programmes can alert people to the symptoms of bowel cancer and encourage them to seek advice from their GP, it's also important that GPs are able to recognise these symptoms and refer appropriately and promptly.

However, as the symptoms of bowel cancer can be hard to diagnose accurately, and can also be symptoms of other less serious and more common bowel conditions, it can be difficult for GPs to know who to refer and when. This can result in delays to patients being able to access diagnostic services and, in some cases, patients having to see their GP more than five times before referral. NICE guidelines for suspected cancer, updated in July 2017, are in place to help GPs to make these decisions. These recommend that the faecal immunochemical test, or FIT, is adopted in primary care to guide referral for suspected bowel cancer in people without rectal bleeding, who have unexplained symptoms but do not meet the criteria for a suspected cancer referral pathway. Using FIT in this way could help GPs to better identify and refer the right patients quickly and detect bowel cancer early. We need to see this adopted in Wales before 2019, alongside England and Scotland, where it has already been piloted and used in some areas.

The annual cancer report recognises that a poor interface between primary and secondary care is a major cause of delays for cancer patients. In response to this, the Welsh Government included recognition and early referral of cancer as part of the Wales GP contract for 2017-18. This requires primary care teams to develop strategies to improve recognition and early diagnosis. These interventions should support earlier diagnosis of people with cancer who present in primary care, and may also potentially lead to a reduction in demand for colonoscopy services.

Jackie Hill from Wrexham was diagnosed with bowel cancer after repeated trips to see her GP. She said:

'my GP examined me but could not detect a lump. I was given laxative and told to go back in the New Year. I went back and told my GP that I was bleeding even more and felt very tired. My blood test came back normal. I went back again three months later as the bleeding was very heavy, but I was told there was nothing wrong. Eight months after my first visit, I returned and was referred for the camera to allay my fears, but never once was cancer considered as the blood tests had come back normal and I was told I was too young for cancer. At one time my GP even said to me: "And what do you want on this urgent appointment?" I was finally diagnosed with stage 2 cancer. I thought, very naively, when I was diagnosed that I would have the tumour removed and then back to normal. Because of the consequences of my treatment, I am constantly worried about going out of the house and many times when I am ready to leave the house I have to go to the toilet. My first thought when I go anywhere is where the toilets are and will they be clean.'

Wales must therefore optimise bowel cancer screening by using FIT at the optimal sensitivity threshold, expanding the age range and increasing uptake. Thank you.

I welcome this debate, and I thank Hefin David for opening the debate and placing bowel cancer under the microscope. Also, as this cancer is so common, I too have some family experience, as my father and grandfather suffered this condition over the years. As we have heard, there is a significant challenge in undertaking a proper diagnosis. The symptoms, such as stomach pains, diarrhoea, sometimes constipation, passing blood—all of those symptoms are very common symptoms. If GPs were to refer everyone who had those symptoms to our hospitals, then there would be no room to do any other work whatsoever.

Therefore, the patient history is crucially important. You need something in that history, the individual's story, to point the GP towards this dangerous diagnosis of bowel cancer. That's the art of the GP, of course, recognising as well, of course, that some bowel cancers have no symptoms at all. That’s the importance of a screening programme. Despite its imperfections at the moment—and I do support the innovative steps, as we've heard outlined by Mark Isherwood, that are being taken in this area to have a far more reliable test, and a far more detailed test in place. So, there is work to be done, and it needs to be done as a matter of urgency. That's why I am supporting this debate and supporting the motion this afternoon.

As we are also in coeliac awareness week, as I mentioned earlier, I will also say a few words about that. Coeliac disease is that condition where the body reacts unfavourably to protein in wheat, some sorts of oats, barley and rye. That protein is gluten, of course. People think that coeliac disease is slightly innocuous and insignificant, and in remaining on that gluten-free diet, then it can be innocuous, apart from all the difficulties involved with ensuring that individuals avoid gluten—gluten in bread, pasta, flour, pizza, cakes, biscuits, gravy, fish fingers even, sausages—the list can be endless—and anything where flour including gluten has been used.

But in not diagnosing coeliac disease, which is also a difficult diagnosis: again, the symptoms are common, such as tiredness, pains in the stomach, diarrhoea, particularly after eating bread, but not necessarily so—not necessarily at all—. We read about these symptoms in books, but everyone is different in the way they present to the GP, and that’s the art of the GP. But in not being on a gluten-free diet when you do have coeliac disease, there is a risk of developing anaemia, osteoporosis, neurological impacts such as ataxia, and also cancer of the small intestine, and a kind of lymphoma in the bowel. It is a risk factor in developing bowel cancer—that’s what coeliac disease is, and that’s why it’s important in this context. As I say, we all tend to look at it as something that's quite innocuous, but in neglecting the condition, coeliac disease can be very serious indeed, and it's a cause for concern that very often it can take many years to have that proper diagnosis. So, support the motion. Thank you.

The Deputy Presiding Officer took the Chair.

I’d like to thank every Member involved in bringing about this debate today. As highlighted by the motion, bowel cancer is one of Wales’s biggest killers. It's the fourth most common cancer in the UK, with one in 14 men and one in every 19 women developing the cancer in their lifetime. Almost 16,000 people die from bowel cancer in the UK every year, and many of those deaths could be prevented if only we could diagnose the disease earlier. We have a bowel cancer screening programme for men and women aged between 60 and 74, but we should be screening everyone over the age of 50. Many people refuse to take the test because of embarrassment or because of the complexity of the home test. 

Thankfully there is a much more simple and accurate screening test, the faecal immunochemical test, or FIT test. I have spoken many times in this Chamber about FIT, about the need to introduce it earlier, about the need to lower the age for testing and, more importantly, the need to introduce a more scientifically robust sensitivity threshold. The FIT test has already been introduced in Scotland and will shortly become the standard test in England. In Wales we have to wait another year. The test is much simpler as it requires just a single sample and is much more accurate—or it would be if the Welsh Government hadn’t opted to lower the sensitivity threshold. Wales is having a testing threshold that is half that proposed in Scotland and lower than that proposed for England. We are told that this is because we don’t have the capacity in endoscopy services to perform follow-up tests. How many cancers will be missed as a result? How many people will die because we took the easy route?

I hope, when responding to this debate, the Cabinet Secretary will outline his plan for increasing colonoscopy capacity in Wales, outline the actions his Government will take to accelerate increasing the sensitivity of the FIT test, and outline a timetable for lowering the screening age to 50. Screening saves lives and it's estimated that around 6,000 people in their 50s are being diagnosed with bowel cancer each year. As other members have highlighted, when bowel cancer is diagnosed early, 90 per cent of patients survive, as opposed to only one in 10 when diagnosed at a later stage. It makes sense to lower the age of screening to 50, given that nearly 95 per cent of cases are in the over-50s.

Unfortunately, here in this Chamber, we are keenly aware that bowel cancer can strike at any age—it has no respect for age—with one of our own battling the disease, and having lost a staff member, Sam Gould. Therefore, we have to increase awareness of the symptoms because, as we know, if caught early, this terrible disease can be beaten.

We also know that there are genetic conditions such as Lynch syndrome that can increase the risk factor of developing bowel cancer. All bowel cancer patients should be screened for Lynch syndrome and screening should then be offered to family members.

I urge the Welsh Government to do all they can to improve screening, to stop people dying needlessly because the disease was discovered too late. I urge Members to support this motion. Thank you.

I'm pleased to add my support to this motion today, and hope that this debate will play some small part in the important task of raising awareness on the issues around bowel cancer—particularly awareness of the symptoms, and the vital importance of taking up screening, as so many others have already mentioned. 

When I first started looking at this issue I was particularly struck by the figures on the incidence of bowel cancer in many of the Valleys communities, including in Merthyr Tydfil and Rhymney. For example, Bowel Cancer UK report that those living in the Cwm Taf health board area have a significantly greater chance of being diagnosed with bowel cancer than those in the neighbouring Cardiff and Vale health board area. Similar variations in pattern also show at local authority level.

So this is clearly a health issue that's of significant importance in my constituency, and I therefore wanted to take this opportunity to mention Chris Daniel from Merthyr, who set out his story on the Bowel Cancer UK website. Chris is currently undertaking a virtual cycle ride of 18,000 miles around the world in memory of his wife Rita. I believe that today is day 167 of his ride, and Chris has just passed through the Canadian Rockies. In reality, Chris has actually been cycling inside Companies House, as he moves his fundraising effort around locations, but remarkably, through technology, his virtual ride includes simulations of all the terrain conditions, including all the climbs on his journey as well, and his daily videos suggest that the Rockies has been the toughest section of his ride so far. But, in the process, Chris is raising money for Bowel Cancer UK, Velindre Cancer Centre, and Cancer Research Wales—an amazing response to the personal tragedy that Chris has had to deal with. So, I'd just like to take the chance in this debate to thank you, Chris, for your efforts in this regard.

Because this is such an important issue, and due to the stories being told by people like Chris, I'm joining my colleagues Vikki Howells and Lynne Neagle this Friday, 18 May, in a day of joint campaigning with Bowel Cancer UK across our Valleys constituencies in order to help raise awareness, in an attempt to help beat bowel cancer. Our aim is to support the Bowel Cancer UK and Beating Bowel Cancer charities in raising the profile of the symptoms of bowel cancer, as too many people either don't know or just ignore the symptoms. It's a new venture for us, in which we're joining forces to host events to help the charity deliver their vital messages. It's not party political campaigning, but it is using our positions as AMs to host events and to help promote the public health messages. During the day, we will be holding events in Aberdare, in Rhymney, and in Cwmbran, and you're all welcome to join us. You can get details from my office if you're interested. It's also good to see that Lowri Griffiths from Bowel Cancer UK is talking to the Martyrs business network at Merthyr Town Football Club tomorrow morning, because employers also have an important role in helping to spread awareness of this issue to their employees. 

So, as Hefin said earlier on, let's break some of the taboos around it and let's talk about the symptoms. Let's not dress it up in polite language: we're talking about bleeding from your bottom, we're talking about blood in your poo, we're talking about a persistent and unexplained change in bowel habit. For me, there is an important message for everyone: don't be shy, let's talk poo, literally, and let's make sure that people take action to check for the symptoms of bowel cancer. Then, as a result, we might get more people recognising the vital importance of screening, because screening is straightforward, as we've already heard. As Hefin's already waved it around, I'll wave it around as well—the kits that are readily available. Screening kits are readily available and are automatically sent to everyone over the age of 60 every two years up to the age of 74. And of course we've heard calls as well for lowering the starting age for screening.

So, let's all play our part in raising the knowledge of the symptoms and encouraging people to take up screening. Let's hope that we can play our part in preventing more people like Chris's wife Rita, Sam Gould, Steffan Lewis, and their families, from having to go through the trials and tribulations of diagnosis, of treatment, and in some cases finality. I sincerely hope that Steffan continues to challenge his condition, because we're all with you—I'm rooting for you, comrade.

I would first like to thank the other Members who have co-tabled this motion today, and thanks also to Hefin David and Andrew R.T. Davies, who were co-sponsors of the Spotlight on Bowel Cancer event in the Senedd on 6 February. That event was part of a promise made to Sam Gould by Bowel Cancer UK when he was diagnosed with bowel cancer. On this day last year, Sam was still with us. He was our friend and colleague and worked with us here at the Assembly until he became ill. He died after a brave but very quick battle with bowel cancer. We miss him every day—excuse me.

Sam only mentioned symptoms to colleagues during March last year, and, at 33, his GP wasn’t too concerned as he was far too young to get bowel cancer. Very soon, he was in too much pain, he went to A&E and was admitted and diagnosed with stage 4 bowel cancer. So, he wasn’t too young at all. Sam was our friend, but he was and always will be the adored son of June and Tim, who are watching this debate from the public gallery today, brother of Mim and Lizzie, husband to Caroline, and daddy to Olivia, Louisa and Pippa. The reason I mention their names is that we are not talking in the abstract here. This is not about statistics, charts, trends or someone else. This is about us—our lives, our husbands, our friends, our mums, our children, the people we love, the people we know and the people we are here to serve. 

Everyone lost to bowel cancer belongs to someone. Their loss affects someone—it devastates someone. But, if caught early enough, the outcomes can be good. We hope that this debate today will raise further awareness of bowel cancer and, more importantly, encourage conversations in families and amongst friends about health and well-being in general.

What I specifically want to highlight here is the genetics of bowel cancer. A relatively simple and cheap test can detect Lynch syndrome. This is the genetic predisposition to bowel and other cancers. Wales and the UK are bound by National Institute for Health and Care Excellence diagnostics guidance DG27, which requires the testing of bowel cancer patients for Lynch syndrome, but we just don't do it.

Bowel Cancer UK published this in April this year, in Bowel Cancer Awareness Month. The UK is not covering itself in glory here, but in Wales no screening for Lynch syndrome goes on—none at all; absolutely zero. We know from the event on 6 February that the professionals are beyond frustrated with this situation. They point to a lack of leadership and health service budget silos. I haven't had any response from Betsi Cadwaladr about this, but I assume from the amount of e-mails from constituents that they too are very concerned.

So, no screening for Lynch syndrome takes place in Wales—none of it—despite the requirements and the clear clinical, financial, economic and human benefits of doing so. I find this shameful. If you have Lynch syndrome confirmed, you can take preventative measures like watching your diet, exercising and, more to the point, having regular screening—it's a no-brainer.

Screening for Lynch syndrome costs £200, compared to the cost of treatment for more advanced bowel cancer, with estimates coming in at around £25,000, not to mention the human cost, which is without measure. I mentioned the names of Sam's family—his mum and dad are up there—and his girls earlier for this reason. I know that they have had no follow-up from NHS Wales—no offer of testing for Lynch syndrome either. I have no idea why the Welsh NHS and you, as the Cabinet Secretary with responsibility, are not making this happen. It makes no sense.

I urge you, as Cabinet Secretary, to finally show some leadership here and make this happen. As part of your reply to this debate, I would specifically request an answer to this question: has a single individual in Wales been identified to take responsibility, and given the budget necessary, to implement NICE DG27? Diolch yn fawr iawn.

Thank you. Can I now call the Cabinet Secretary for Health and Social Services, Vaughan Gething?

Thank you, Dirprwy Lywydd. I'm happy to respond to today's debate, opened by Hefin David, and happy to note that the Government will support the motion. But, in particular, I want to start by recognising the direct human impact and the experiences of people who are not just taking part in this debate today, but are outside watching, or will look at it afterwards—not just about the direct impact here of people who worked with or knew Sam Gould, or those of us who know Steffan Lewis, but, as Hefin David and Mark Isherwood indicated, people that we will ourselves have known who have had bowel cancer. 

We also welcome the report from Bowel Cancer UK and Beating Bowel Cancer. We actually have a good relationship with the Wales cancer charities, who I meet on a regular basis. In fact, I last met the Wales Cancer Alliance on 19 April and we discussed that report at that meeting and with several of the NHS's leadership groups, including the cancer implementation group and the endoscopy implementation group. What isn't in doubt is the importance of improving bowel cancer outcomes and equally the scale of the challenge facing our services. We remain absolutely committed to improving cancer outcomes. That's evidenced in our updated cancer delivery plan, which we published in November 2016, and that plan recognises the importance of early detection, a point made by a number of Members in today's debate.

The cancer implementation group has a national programme called detecting cancer early, which looks at access to diagnostic testing, symptom awareness and screening uptake. That group is funding two pilots in south Wales, covering the whole of Cwm Taf and ABMU health boards, that aim to identify early stage cancers that typically present with more difficult to identify symptoms.

The vague symptoms pathway, which we discussed before, in fact in answer to a question from Hefin David, is halfway through a two-year test and it's being delivered on a one-stop basis. I think that really will give us lots of learning to be developed and implemented across a whole system that really should lead to greater early detection, and obviously that should lead to better outcomes for people.

But, of course, much of today's debate has focused on population screening, which is a core component of our early detection efforts. Our bowel screening programme in Wales has now been in operation for 10 years. Men and women aged 60, as has been said, are sent a screening kit every two years until the age of 74. The age range that we apply, and not continuing to screen people above the age of 74, comes on the advice, for example, of Public Health Wales, but, in particular, the United Kingdom National Screening Committee, who advise all four nations in the UK about where to have the greatest benefit and having early detection to avoid premature death. 

The current kit, as has been said, requires people to collect multiple samples to be posted back to Bowel Screening Wales for analysis. In 2016-17, more than 280,000 people were screened as part of that programme, and that identified more than 1,600 people needing a follow-up, and ultimately it identified 216 people with bowel cancer. But, as has been said in this debate, those numbers only represent 53.4 per cent of the eligible population who returned a kit in 2016-17. Our priority was increased uptake, as the evidence indicates that the benefits will outweigh the risks at a population level, for this age range.

There is a difficult part here, because you can't ignore the human impact of what happens, but we have to make evidence-based choices about the whole population and whole-population screening. That's why we'll continue to follow the best advice available to us. But, bluntly, the current test isn't necessarily a very popular or easy test to administer. I'll say more about a new test shortly.

The point about Lynch syndrome has been mentioned more than once, and, in 2017, NICE introduced new guidelines that recommended that all bowel cancer patients are tested at diagnosis. Now, we initially thought we could do that through a specially commissioned service but that hasn't proved possible, so, following advice and discussion with the Wales cancer network, we're looking at the best way to implement the guideline. It's currently commissioned through the All Wales Medical Genetics Service for those who are at the highest risk. In a change to move beyond that, we're looking at recommendations that have been delivered on implementation that have been received from the Wales cancer network and the chief scientific adviser for health will now be looking to discuss that with health boards and the pathology network that exists. So, we will have more to say on how we will be doing more to deliver against that NICE guideline.

But, of course, it's for individual people to take up the offer of screening. It's a matter of choice. We can't force people to do so. We recognise, as I say, that the impracticalities of the current test discourage some people, but I do welcome the work that Dawn Bowden highlighted in her contribution—not just about the recognitions that others make that there are socioeconomic differences in uptake of screening, but also the need to try and raise awareness of symptoms and encourage people to undertake the test. So, a really positive initiative for Dawn Bowden, together with Vikki Howells and Lynne Neagle, to campaign on this issue.

We should see a real difference in January 2019 when we will introduce the new faecal immunochemical test, or FIT screening test. The test only requires one sample to be taken and is shown in pilots to improve uptake by 5 to 10 per cent, a significant and positive improvement. As well as being easy to use, as has been said today, the test is more accurate as well. The threshold for sensitivity for the test need to be carefully considered. Public Health Wales, through careful modelling, have advised us that the threshold in Wales should be 150 mg per gram initially, and, at that planned threshold, the advice is that the test is more sensitive and will identify more cancers as a result.

We intend to increase the sensitivity of the test over time in line with the ongoing expansion of diagnostic and treatment services, and we'll do that in a safe and sustainable manner, acting on the advice of Public Health Wales and health boards, because it wouldn't be any good to test people and refer them to a service that just isn't ready to see them. Other health services, in fact, have put themselves in a difficult position and are now having to reduce the sensitivity of the test because their follow-on services aren't in place, and, in relation to reducing the screening age, we are committed to reduce the age range in line with the advice from the UK National Screening Committee as soon as is practical to do so. We'll do that progressively over time. But, as with the introduction of FIT, increasing the age range will increase the demand on other services, and we need to ensure that health boards can safely manage and sustainably manage that additional demand. In the meantime, our focus must be on improving the screening uptake for the current group of people we have at the greatest risk of developing bowel cancer.

We will continue to work with health boards to improve colonoscopy capacity so improvements can happen sooner rather than later, and the endoscopy implementation group, a national leadership group, is working on that very issue. That's had additional focus in January from the national executive board, with recommendations due to go back next month.

I recognise that we need to get this right, and not just about screening capacity, but the far larger— [Inaudible.]—relating to people with urgent suspected cancers, cancer surveillance patients, as well as some others, such as inflammatory bowel disease. Addressing this issue will require significant focus from health boards on productivity, workforce arrangements and service models, and, increasingly, the appointment of non-medical endoscopists is helping to alleviate pressures in the system.

There is also—before I finish, Dirprwy Lywydd—the important potential of FIT to be used as a safe means for triaging referrals to colonoscopy, with a number of health boards actively considering this, and it may significantly reduce, in a safe way, the referrals made to services to allow them to better meet demand and screen outpatients. I look forward to reporting back on the progress we will make in Wales in meeting the aims and objectives outlined in the motion today.

Thank you. Can I now call on Rhun ap Iorwerth to reply to the debate? Rhun.

Thank you very much, Deputy Presiding Officer, and I thank everyone who has contributed to this debate this afternoon. I am very pleased that we have had the opportunity to put this on the Assembly’s agenda this afternoon. A series of contributors from across the political parties have described very clearly the need to ensure an early diagnosis and the importance of raising awareness, the need to recognise and celebrate the excellence of our staff, who do everything they can within the NHS in this field, and have emphasised, of course, the key role that screening can play in tackling this cancer, one of the most cruel kinds of cancer, which takes more lives in Wales than almost any other cancer. But we all believe—and you have heard us today, Cabinet Secretary—that it is possible to do more.

The motion, and all speakers, have reflected the importance of early diagnosis, whether that comes from screening or getting people referred for testing a lot more quickly as a result of symptoms that they approach a GP with, and both of those routes to diagnosis and getting more people on that road to diagnosis are going to be vitally important parts of how we improve survival rates. I think there needs to be something of a culture change from both the public here and the Government and our health service. The public understand that they need to take up the screening opportunities—you're quite right, Cabinet Secretary, to point out that this is voluntary. I should be told off at this point by Dawn Bowden for forgetting to bring my testing kit down to the Assembly Chamber with me today; it's upstairs in my bag. But we have to be willing and eager to talk about these issues, and when we have the opportunities to check on our health we should be grasping those opportunities with both hands, no matter how embarrassing or difficult we may perceive those issues to be to talk about.

The public also need to understand that they have to go to see their GP earlier when experiencing symptoms—again, not ducking embarrassment. And the Government also needs to understand that well-meaning campaigns asking people to stay away from the GP unless absolutely necessary can be counterproductive; it's something that I've warned about in the past. And those changes will inevitably lead to increased pressures on primary care, increased pressures on diagnostic capacity, but, in budgetary terms, I have no doubt at all that savings of early intervention will far outweigh the costs. And, to put a financial costs to one side, of course, we owe it to those for whom bowel cancer is a reality to give them the best possible fighting chance. We've heard Sam Gould's name mentioned on a number of occasions; we're thinking about Steffan Lewis this afternoon.

Steffan, we're thinking about you and we wish you every strength. We will be there on 14 July walking in Cwmcarn, raising funds for Velindre hospital.

We will show our support on 14 July in that walk to raise money for Velindre in your name, Steffan.

But, you know, we cannot tackle the issues that we are addressing today at a walking pace; we have to tackle bowel cancer head-on. Our message to Government—I think we've made it clear: bring down the screening age, give more people the opportunity for early diagnosis, really address with new vigour the challenges in endoscopy, in colonoscopy and pathology, all those parts of the diagnostic system that need strengthening, and always prove to us that you are keeping the sensitivity of the new FIT test under review when that is brought in next year.

Bowel cancer, I think, has had the upper hand for far too long; it's time we fought back.

Thank you. The proposal is to agree the motion. Does any Member object? No. Therefore, in accordance with Standing Order 12.36, the motion is agreed.

Motion agreed in accordance with Standing Order 12.36.