We now turn to spokespeople's questions, and the first this afternoon is from Angela Burns. 

Thank you, Deputy Presiding Officer. Good afternoon, Cabinet Secretary. Will you please outline what procedures are in place for hospital patients to administer their own routine medications? 

Are you talking about routine medication within a hospital setting? 

No. 

I'm not sure I understand the question, because for hospital patients and medication, there is medication that they receive when actually in a hospital, and if they have a secondary-care-led medication need, how they actually administer that themselves. It will depend, of course, on the condition and the medication. 

Let me clarify it slightly for you, Cabinet Secretary, as you seem to be struggling slightly there. I notice, for example, that the Member for Cynon Valley recently tabled some written questions seeking information around the procedures in place surrounding hospital patients self-administering their medication. It appeared that she received some fairly stock answers to it.

Now, let's have a look at the example of people with Parkinson's. They may enter hospital for reasons that may or may not be related to Parkinson's, and find that the hospital's drug round does not coincide with their own medication regime. However, as you will know, in Parkinson's, a minor change in medication timing can have major negative effects on symptom management and general recovery. The uneven release of dopamine can result in a person suddenly—in Parkinson's—not being able to move, get out of bed, or walk down a corridor, and it can also lead to serious complications such as pneumonia and bowel obstruction. Parkinson's UK have launched a campaign entitled Get It On Time to ensure that drugs such as levodopa, which are prescribed to treat Parkinson's, are administered at regular times of the day—a campaign that's been successfully introduced in Canada. What advice would your department be able to give health boards about implementing such a scheme in Welsh hospitals, because this is proving to be a problem where a person's tried and tested drug regime does not fit in with the drug prescription regime of a hospital when they're in a hospital setting?

Well, look, this is an issue that I'm aware of, the Get It On Time campaign. It's not a condition-specific campaign for one only because, actually, there are a range of other conditions—epilepsy, for example. My younger brother has epilepsy and I know on some of his hospital stays in the English system the non-administration of that has actually led to him having a seizure that would have otherwise been controlled by his medication regime outside of a hospital setting. So, I do recognise the challenges that exist in a range of conditions about having a regular medication regime that continues and is not interrupted by a hospital stay, whether that is for the main condition that those medications are provided for or for an alternative. And there's something here about our improvement programme in pharmacy management and in medication management in any event, both about the administration of medicines in hospitals, but also about not having an unnecessary gap when somebody is actually discharged from hospital as well, so they promptly have any medication that they then require to go back into their own homes. So, I recognise the campaign. There's work being led by the chief pharmacist with health boards and chief pharmacists in each of the health boards because I do recognise the challenge that does exist.

Well, I'm pleased to hear you say that, and, of course, the parliamentary review really recommended—well, had two key thrusts. The first was that we want the general public to begin to take more responsibility for their own health and to manage themselves in a more appropriate way, and the second thrust was that we want people to go into hospital less often, and when they're there to get out of there far more quickly, and we do have situations where people with conditions such as Parkinson's may end up staying in hospital through no fault of their own but because those regimes don't tie together.

I've witnessed first hand from my time in hospital that, actually, hospital staff can get really bowed under with all sorts of other pressures and, so, the drugs trolley doesn't quite make it down the corridor and so on and so forth. So, I really would like to ask you again to have a good look at this because we can't say on the one hand, 'Take more responsibility'—. Some people have had conditions such as Parkinson's—and, as you say, it's not the only one—for years and years and years, and they know what they need and they know when they need it. I appreciate that if you're in hospital for something entirely different there may be contraindications and so on—one always has to be really careful—but I think we can rely on the general public when they have something like this, when they will know only too well what suits them, because of course, as you will know, every individual with conditions such as Parkinson's will have a different reaction to it, will have a different set of meds, and will certainly have a different timescale. So, will you please undertake to look at this really clearly, so that we can say to people, 'We are asking you to take responsibility, we do trust you'? Above all, it's to keep them better in hospital, so that, hopefully, they can get out better from whatever reason they've gone in there.

I recognise entirely the point about people taking more responsibility for their own healthcare, but I actually think that the bigger gain to be made on that is how people take their medication in the community and how we enable that to happen. Within a hospital setting, it really is about how the health service make sure that is enabled properly. Some people don't have their own medication, it's often taken away at the point of entry. You need to make sure that their medication is provided on a regular basis so it can be—

But it's not, and that's my point.

—so it can be administered, and that is a challenge for us. There's also something about how we shift some of the work.

So, part of our challenge in the hospital pharmacy service is actually that some of that work need not necessarily take place there, and that'll provide them with a greater length of time to do what they really do need to do, and only they can do for hospital-based patients. So, the link between the hospital pharmacy service and community pharmacy really does matter and I think there's more gain to be made from community pharmacies taking on additional duties in the future to make it easier for people to get out and to support people in administering successfully their own medication regimes, as well as providing more time for their hospital-based colleagues to do their job properly, in addition with other staff in a hospital system. 

Thank you. UKIP spokesperson, Caroline Jones.

Diolch, Dirprwy Lywydd. Minister, we have discussed previously the case of my constituent, Paul Davies, the Paralympian who was facing the real prospect of missing Tokyo 2020 due to a lack of social care. Minister, with your help, I'm pleased to say that Paul Davies now has the support he needs in order to train for the Tokyo Paralympics. So, Minister, will you join me in wishing Paul Davies every success in his endeavours and in hoping that he can bring back a gold medal for Wales?

Absolutely. And I think everybody here would join you, Caroline, in wishing Paul the very, very best. In some ways, I can say he is a local boy, a local man, in my neck of the woods, slightly out of my constituency. But we're delighted that the local authority and the local health board have come together, very much, I have to say, based on the idea that we say regularly here within the Assembly—that the Cabinet Secretary and I say—that it should be focused on the outcomes of the individual, not simply on care, but on independent living. And that independent living includes the ability to pursue activities and hobbies and interests—it's more than simply care. But I'm delighted that with the highlighting of the issue, Caroline, that you and others brought to it—I think you overstate my role in this entirely, I have to say, but I'm delighted that, on the ground, locally, they've managed to find a solution that will enable him to go forward and compete. I understand from my officials that they've been able to appoint two personal assistants now, which will mean that he can pursue, and, we all hope, fulfil, his dreams and ambitions.

Yes. Thank you, Minister. We were able to get a very satisfactory outcome in Paul's case. But what about those who don't have their Assembly Member fighting their corner? Minister, what is the Welsh Government doing to ensure that every single disabled person in Wales is able to pursue their goals, their dreams, unhindered by their disability?

Entirely. And, Caroline, if I can reiterate my earlier comments, which would be that the statutory framework in Wales is very different from across the border in England; it is very much—with the support of Members here, who took the legislation through—based on a person-centred approach, where that person should co-determine their package of support for independent living. It's not to be done to them, but it's to be done with them. It should be based on the outcomes for that individual to improve their quality of life and their ability—as we all take for granted—to do what we want and to socialise and to engage in wider society. There is also, of course, the statutory right to advocacy, either informal advocacy, or, failing that, a more formal type of advocacy, and so on and so forth. I think the challenge that local authorities and health boards and others face is the financial constraints they operate in. But that shouldn't stop them focusing on that approach of working with the individual, with their needs, to determine how they can best support independent living and a quality of life that we all take for granted, and so should they.

Thank you once again for that answer, Minister. Our future Paralympians are relying upon their carers—paid and unpaid—to support them while they concentrate upon winning the medals. But who supports the carers? Minister, sadly, we know that two thirds of unpaid carers have not been offered or requested a needs assessment, and three quarters of those same carers say they do not get any support from their GP. So, what is the Government doing to ensure that carers' needs are assessed? Thank you.

Thank you for that question. Colleagues may be interested to know that we convened the first formal meeting of the ministerial advisory group on carers today. I met them in the centre of Cardiff. All the relevant stakeholders, from a wide range of organisations, are there. And, in a similar way to the work that's been taken forward by our colleague here, David Melding, on the ministerial action group for looked-after children, which has provided such good results and work streams that have led to positive outcomes, we are very hopeful that the ministerial advisory group on carers will do the same. It is supported as well by an ancillary group, which is actually to represent the wider voice of carers. We can't fit everybody around that top table, but we have statutory providers, we have carers' organisations, older people's organisations, younger people's organisations. They can't all fit around the table—it's a very focused, targeted group—but, outside of that, there's an ancillary group that also gives those people who want to contribute their voices as carers into it as well—. And that will focus on issues such as how we support them—how we support carers with life beyond caring, so they're not defined entirely as carers and nothing else, because many carers want to work, to engage wider in society and so on. It is based on the identification of carers and the work we're doing with GP surgeries, with pharmacies, in schools with the schools toolkit, and it is also focused on the additional support, including flexible respite support, that we can give for carers going forward. This is a journey that we're on, not an end product, because we have to keep on improving the outcomes. But the £8.1 billion value of carers—the massive army of carers that are out there—it's not just their monetary value but it's also measured in compassion and the love that they provide, and I hope this ministerial advisory group will give me the direction of travel we need in Government and here in this Assembly to improve the lives of carers. 

Thank you. Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch, Dirprwy Lywydd. Now, Cabinet Secretary, I met this morning with a group concerned with Barrett's oesophagus, which is a condition that, left untreated, can lead to cancer. But it's possible to use a treatment called radio frequency ablation to treat this, before it leads to cancer. In fact, it is clinically proven and its cost benefits are very, very clear. But Wales doesn't have this service, so patients have to go to England. Now, costs for providing treatment in England, paid for by the Welsh NHS, have increased dramatically in the past year—increased by something like 150 per cent. So, the lack of access to this technology in Wales is costing the NHS here more and more. Can you tell me what the barrier is to preventing that service being provided in Wales? And can you report back to me and the Assembly on work being done to introduce RFA treatment in Wales as quickly as possible? 

Yes, I'm happy to respond on this. I've actually had direct correspondence from one of my constituents on this matter, as indeed from a wider interest group, and, coincidentally, this Saturday, in Margam, I had the pleasure of meeting people from the Bangladeshi Gastroenterology Association. I also met the president of the British Gastroenterology Association, who said he was imminently due to write to me on this very issue. Because I do recognise that there is a NICE recommended treatment available that we currently commission over our border, in particular in south Wales. We do now think that we could and should be able to provide the service here in Wales. Cardiff and Vale University Local Health Board are leading work on that to provide that service. I'll be happy to provide an update to Members in the future on where that is to be clearer about the timescales for doing so, but I do expect us to make that treatment properly available, as the evidence suggests, and to make it available here in Wales, as opposed to continuing to have to commission a service across our border. 

Yes, that's positive. I look forward to that update.

Turning to another issue linked to the slow pace of the introduction of new technologies, the use of multiparametric MRI in the diagnosis of prostate cancer, you will be aware—very aware—that the clinical consensus is that this is a game changer, a real game changer, in the diagnosis of prostate cancer. But only two health boards in Wales are providing mpMRI to a high enough standard to avoid the need for biopsy. The result is that many men have chosen—have been forced, in effect—to pay upwards of £900 for private mpMRI scans.

Now, when asked about this before, you said that you were waiting for updated guidelines from NICE, but they won't be published until April next year, and at the same time England and Scotland have introduced this generally. Now, why is it in cases where I suspect you know really that the conclusions of NICE will be to propose pressing forward with this, and where other NHS services in the UK are using new technologies—why is it that you're content for Welsh patients to wait until the judgment and then wait for the implementation period?  

Well, I don't share his summary of the position. In particular, the very clear advice I've had is that this service is not available consistently in England. I'm not aware of the position in Scotland, but this is not available in every part of the NHS in England, and we don't yet have a clinical consensus. There are a number of advocates who do say that it is a game changer; that is not yet the clinical consensus view. That can either come from NICE guidance or it could come from the Welsh urology board, who are now examining the issue. If the Welsh urology board give us advice, that would then draw on the basis for a clinical consensus and we could have a service that is then planned and delivered across the country, as opposed to the current pathfinders in two of the health boards, which, of course, are adding to our evidence base. So, I want to see the issue resolved so we do understand if there is clinical consensus. Then, as I've said on a regular number of occasions, if the evidence and the advice changes, I would expect our healthcare system to act on the very best available evidence and advice to us.

All the evidence I've seen suggests that we already know what we need to know—that this is a potentially life-saving procedure. 

Now, the recent parliamentary review emphasised the role that new technologies can play in providing treatment closer to home, with the emphasis on preventative health through earlier diagnosis. Both of those examples that I've given today are cases where our NHS, I believe, should be far more proactive in adopting new technology to achieve these ends. Waiting for NICE, which has a lengthy workload and can't possibly remain up to date with everything, is going to become a bigger problem over time. So, will you look, therefore, at reassessing the approach your Government is taking to the earliest possible introduction of technology to ensure that treatment in Wales can remain or be at the cutting edge, and that patients in Wales get the very best treatment possible?

We've actually got Health Technology Wales to do just that, Deputy Presiding Officer, in the same way we have the All Wales Medicines Strategy Group to allow us to have faster access to, actually, properly appraising new medicines as well. So, we do have a process that is available to us on new technology as opposed to new medicine. And, with respect, the clinical consensus that we could get on the mpMRI could be delivered in the here and now by the Welsh urology board if they provided that advice to us. If they provided that clinical consensus, we'd have a different place to act.

It's fine for politicians to be persuaded about what they think is right, but, actually, I think to run this significant public service we do need to have proper clinical consensus on the appropriate way forward. We have means to do that already, but I'm always interested if we can improve the way in which we make those choices, because part of my regular frustration—and it is borne out by the parliamentary review and the plan we have—is that changing the way our healthcare system delivers and improves is far too slow. So, that is why the twin aims are to have pace and scale in the change and transformation that we all recognise needs to take place.