Questions now from the party leaders. The leader of the opposition, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, prostate cancer is a cruel condition, which, if diagnosed early enough, has remarkable success rates—90 per cent plus. Regrettably, obviously, screening in some parts of the UK leaves a lot to be desired. In particular here in Wales, regrettably, the ability to get access to the multiparametric MRI scanner for four health boards is non-existent, and people do end up having to pay considerable sums to have that scan undertaken. In England, for example, where that scan is available, it has a 92 per cent detection rate. With the four health boards, which total 700,000 men within those health boards, unable to attract that type of screening, what commitment can you give, as First Minister and as a Government, to roll out the screening so that, whatever part of Wales you live in, you will have access to that screening, so that, if you do require surgery or intervention, it can be done in a timely manner?

An important question, and one that deserves a detailed answer, if I may, Llywydd. I can say that health boards in Wales are able to offer multiparametric scans, in line with the current guidance from the National Institute for Health and Care Excellence. That guidance currently recommends the mpMRI for people with a negative biopsy, to determine whether another biopsy is needed, and whether the management of a proven cancer will benefit from staging of the tumour. The what's called 'PROMIS trial' indicated that people with suspected prostate cancer might benefit from having their mpMRI prior to biopsy. NICE is reviewing its guidance and is expected to issue recommendations in the early part of next year. In the meantime, evidence is being considered by the Wales urology board. It's fair to say there are different views among the clinicians about the implications of recent evidence, with some health boards implementing elements of a revised approach. What I can say is that, if NICE recommends pre-biopsy mpMRI for suspected prostate cancer, then we would expect all health boards to amend their care pathways accordingly. In the meantime, health boards will continue to consider the evidence and pathway reforms through the Wales urology board.

I thank you for that detailed answer, First Minister. Regrettably, 10,000 men a year die from prostate cancer—it's the biggest killer of men. And some universality around the screening programme must be a compunction on the Government because, actually, cancer doesn't rely on postcodes—it's universal, it is. On the bowel cancer screening programme that the Welsh Government have, it has been called, at the moment, a very postcode lottery-driven screening programme. In particular, one in four individuals were waiting in excess of eight weeks to have their screening procedure diagnosed, and actually put into practice if intervention was required. Nine hundred people a year die of bowel cancer here in Wales. If, ultimately, we had a better, more robust screening system and a wider screening system that actually took into account 40 years and above, then we could drive those numbers down even further. Given that we know the importance of screening and, in particular, bowel screening, what action is your Government taking to shorten the waiting times that will remove that one in four—25 per cent of people—waiting in excess of eight weeks to get the results that they require, because it cannot be right that, where the condition is treatable, just waiting too long on a waiting list has a detrimental impact on your outcome?

With screening, it's a question of who you target for the screening, because you can't screen everybody. Which elements of the population are particularly susceptible to a particular type of cancer, because it's not physically possible to screen everybody? We want, of course, to see consistency across the health boards. They're able to access the new treatments fund, if that's appropriate for what they wish to take forward. What I can say is that, when we look at our urgent suspected cancer route, for example, the vast majority of people started definitive treatment within the target time of 62 days—88.7 per cent—and 96 per cent of patients who are newly diagnosed with cancer not via the urgent route started definitive treatment within the target time of 31 days, in March 2018. So, the vast majority of people do get the treatment that they should get within the right amount of time. But, of course, we rely on specialists in order to advise us to make sure that we can see how we can improve screening where that's necessary. 

Those improvements are desperately needed. As I said, Bowel Cancer UK says it is a national crisis that one in four people are waiting eight weeks or more for that screening process to be undertaken. But what we do know from the weekend's announcement that the UK Government made is that there will be a considerable uplift in the spend available to the Welsh Government to spend on health and social care here in Wales—[Interruption.] These screening—. Well, I can hear the chuntering from the Labour backbenchers, but the reality is that money is coming over to the Welsh Government.

Now, it is perfectly right, under the devolved settlement, that you choose where to spend that money. From these benches, we believe that that money should be spent in the fields of health and social care to make those improvements in prostate, bowel and other treatments available to patients here in Wales. Now, will you commit today to making sure that any money that is made available to the Welsh Government is spent on those key areas, so that we can see the improvements that we desperately need in diagnostic tests, waiting times and staff recruitment, which other parts of the UK that are committed to delivering it in the health and social care budgets will see? We need that commitment, First Minister. Will you make it? 

Well, the first thing we have to see is how much money we'll actually get, because there are two important points to make here: first of all, we have been informed that that money, whatever money we get, will be the source of funding to deal with pay increases. So, the lifting of the pay cap will have to be financed through any money that we get via the source that he has mentioned. So, that's the first thing to mention. There's no extra money on top of that. Secondly, of course, it's never the case, is it, that we get a lump sum of money to pay for a particular area, such as health or education? What happens is, of course, as he knows, is that it's delivered via the block grant. What we don't know is that, if we get the increase in health, whether we will then see decreases everywhere else—in local government, in education, in all those areas that are devolved. Now, those, of course, are removed from the figure that he's just mentioned. So, until we know firstly how much money net there will actually be—we know about the £1.2 billion—and until we know, of course, how much money—we've got a fair idea—that the pay deal will cost, we won't know how much money is available to spend. Until those factors are resolved—and nobody is able to do that yet because we don't know what any increases or not in our block grant will be in the autumn—and until we know the definitive net sum of money, it's very difficult to make any commitments at this stage. 

The leader of the UKIP group, Caroline Jones. 

Diolch, Llywydd. First Minister, the Prime Minister announced over the weekend that there would be a £20 billion a year birthday present for the NHS in England. As a result of Barnett, Wales is expected to receive £1.2 billion. On Sunday, a Welsh Government spokesman said that a decision on the allocation of funding would be made by your Cabinet in the usual way. So, First Minister, have you made that decision yet, and will you be using any extra moneys we receive for health and social care? 

Well, the only commitment that we have made is that we will lift the pay cap—unusually, because normally we don't make those promises before we know how much money is allocated. So, that will have to be paid for from whichever sum of money we get from the UK Government; there's no extra money for it. And as I said in the answer earlier on, it's not going to be £1.2 billion. We don't know whether there'll be cuts elsewhere that will bring that figure down. Until we know what the final figure is, it's very difficult to give any commitments in terms of spending. 

Thank you for that answer. My concern here is that mental health issues account for around a quarter of all health problems, yet we're spending as little as over 11 per cent of the entire NHS Wales budget. We have seen a 100 per cent increase in demand for child and adolescent mental health care services. We know that depression affects 22 per cent of men and 28 per cent of women over the age of 65. We've seen a large rise in instances of self-harm, and each year around 300 people in Wales die from suicide—this is about twice the number of people killed in road accidents. We are clearly not doing enough to tackle mental health in Wales. So, First Minister, will you commit to using some of this additional money, whatever it may be, coming to Wales in order to ensure that mental health funding is based upon a robust assessment of healthcare needs? 

Yes, and in particular, of course, to look at prevention. That's hugely important. With CAMHS, she is right to say that there was a significant increase in demand for CAMHS and we met that demand by allocating—if I remember—£8 million a year towards CAMHS in order for them to meet the demand that was there. Mental health, as she will know, is a key priority for us in 'Prosperity for All'. We want to make sure that mental health is seen as something that is a priority for all governments in the future, and that will shape any spending decisions that we take if there's any extra money on the table. 

Thank you for that answer, First Minister. As I've highlighted before, many times, one in four of us will suffer from mental ill health. A friend or a work colleague could be battling depression for years—we wouldn't know about it, because, unfortunately, there is still a stigma attached to mental health issues. We all have to be more open about mental health: we wouldn't try to hide a broken leg, but we will try to hide depression. Sadly, as a result of stigma, many people end up taking their own lives. If we recognise the signs and offer non-judgmental support, many lives could be saved. So, First Minister, will you commit your Government to ensuring that as many people as possible are trained as mental health first aiders, and will you look at adding the training to the school curriculum and encourage large employers to have mental health first aiders alongside the normal, required first aiders? Thank you. 

I'm not sure that first aid is the way to deal with it. That suggests something that is acute, something that's just arisen. I think it's more long term than that. I take the point that the leader of UKIP is making in terms of how we deal with people who don't exhibit any external signs of depression. I've seen it at close hand, I've got a fair idea of how it operates in people, but it's not always obvious to those who are not familiar with the individual involved, and that is difficult, of course, because the external signs are not there. If you break a leg, it's obvious: the signs are there. That's why I want to make sure that when we look at mental health, we don't just look at it as a service designed to help people when they get into crisis, that we do look at ways in which we can help young people particularly—that's important, we have a counsellor in each secondary school in Wales—but at what more could be done, for example, to look to help people who are not obviously in need of help. They are the people, quite often, of course, that the system needs to identify. How that's done, of course, we will take forward with practitioners, to see how we can create a service where there is more focus on prevention and less on dealing with symptoms when they become obvious. 

Plaid Cymru leader, Leanne Wood. 

Diolch, Llywydd. Does the First Minister agree with the environmental lawyers ClientEarth that the Welsh Government's plans for air quality lack clarity and detail?

Well, we are looking at air quality and how to improve it. I'm not going to agree with a firm of lawyers, obviously, that are not Welsh Government lawyers, but there is a challenge, of course, to improve air quality in the future. 

Air pollution is responsible for 2,000 deaths per year in this country. It's a public health crisis, and it's your Labour Government's environmental legacy. That's why Plaid Cymru this week has launched a campaign, clean air week, and my colleague Simon Thomas yesterday launched a comprehensive report on hydrogen's role in the decarbonisation of transport. Now, I would urge the First Minister to read this expert-led, in-depth report and to take heed of its recommendations.

First Minister, this crisis warrants urgent action. Given that a road in Caerphilly is the most polluted outside of London, will you support our calls for a clean air Act for Wales that would phase out the sale of diesel and petrol-only vehicles by 2030?

I think that's too early; I don't think the technology's ready. I do look forward to a time when electric cars become the norm. I don't think the technology's there now in terms of the range, but I think it will become available very, very quickly.

If I remember rightly, 2040 is the target the UK Government has set, is, I think, probably pessimistic, but such is the development of the technology in this field, I think we will get to a position where it will become a realistic option. As somebody who has been driving a hybrid car, the battery in my car only gives me a range of 28 miles. Now, that's the problem. We need to make sure that the technology is right to move ahead, in the way that she has described—she's right.

In the meantime, what do we do? We can't do nothing. Well, firstly, we need to make sure that we remove areas where traffic is idling with engines on—that affects air quality—and, of course, to see more modal shift, and that means, of course, moving ahead with the improvements we're going to see in our rail infrastructure, to make it more comfortable for people to travel by train, in air-conditioned trains that are more frequent, and also, of course, moving forward with the Active Travel (Wales) Act 2013 to make sure that where we see new developments—at cycle paths, for example—they're an integral part of those developments, so that people feel they don't have to travel by car.

So, there are two things: first of all, creating that modal shift, and, secondly, of course, looking to encourage ways to ensure that battery cars have a much longer range in the future, and that it's much easier to charge them, as well, than it is at the moment. I think that's when we can get the real change.

I take it, then, from your answer, that you disagree with Labour-led Cardiff council that has called for a ban on polluting vehicles by 2030? Why is Labour so unable to be consistent on any single policy area? The lack of urgency, willingness and the lack of being able to do things differently is costing people's lives. You can laugh and mutter—it is costing people's lives.

Now, you have already lost a case against ClientEarth and you face further legal repercussions if solutions aren't found quickly. Let me once again emphasise the scale of the problem here. Air in Cardiff and Port Talbot is more polluted than air in Birmingham and Manchester, despite the huge differences in population. This is the environment that your Government is creating for future generations. First Minister, as a very first step, you could ensure that the planned automotive park in Ebbw Vale focuses on the development of hydrogen and electric vehicles, putting Wales at the forefront of the clean transport revolution. Will you at least do that?

I wonder if she or others on the Plaid benches drive a hybrid car or an electric car? Silence. Well, practise what you preach—that's what I would say.

Try doing it in Aberystwyth. When you put in the infrastructure, we will do it.

Well, Simon Thomas—[Inaudible.] [Interruption.]

Allow the First Minister to respond, please.

Simon Thomas is right. He is right to say, 'Try doing it for Aberystwyth.' He's quite right, I don't dispute that all, which is why the technology isn't ready yet. But it does need to be moved forward. Of course, I notice that nobody even drives a hybrid—it's something I've been doing for three years.

Anyway, look, the point is this, isn't it: how do we create clean air? That's an important point. Port Talbot has a steelworks in it, and that means, inevitably, that the air quality there may not be as good as it would be in places where that industrial operation isn't there. But we need it to be there, and, in fairness, Tata have made a great deal of effort and taken many strides in reducing their emissions over the years, and that has had an effect on Port Talbot. Port Talbot also has a traffic problem that is not easy to resolve, which will need to be looked at in the future. Cardiff—well, yes, I think it's right to say that it's probably easier to drive an electric car in Cardiff if people are commuting a short distance, and that's something to encourage and the infrastructure is being—[Interruption.] Well, she makes the point about the ministerial fleet when nobody in her own party is driving that kind of car, given the long distances. [Interruption.] Yes, but I am not the one, am I—? [Interruption.] I am not the one saying that we should move to battery-operated cars as quickly as possible. They are. 

Cardiff city council is.

Practise what you preach.

The second thing is, of course—and in the short term—that the way to do this is to encourage more people out of their cars, and also, of course, to ensure that people are able to use the public transport network as conveniently as possible. We are doing that, despite the criticism that Plaid Cymru launched at the rail franchise—the only people who criticised it. We will make sure that the whole of Wales has the best rail structure in Britain. We've shown the way for the rest of Britain. It's no longer any good for people who use the Valleys lines services to travel on ancient trains with no air conditioning and an unreliable service. That's going to change. People will have the trains that they deserve and people will be able to access the cycle routes that they deserve. People will see, as we've taken powers now over buses, an integrated bus and train and light rail network. That is what we offer the people of Wales—a real vision to plug that gap until such time as the technology is available and the range is available for battery-powered cars.