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.