Questions now from the party leaders. The Plaid Cymru leader, Leanne Wood. 

Diolch, Llywydd. First Minister, can you tell us which areas of Wales have the highest rates of late-stage cancer diagnosis?

That's something that I would have to write to the Member about, but we do know that, as far as the targets are concerned in Wales, our figures compare very well.

Rich or poor, rural or urban, man or woman, cancer is an indiscriminate disease, yet diagnosis is anything but. Recent research by Macmillan shows that cancer diagnosis in this country remains a postcode lottery, and our poorest communities consistently face later stage diagnosis. Where stage is recorded, more than one in four people in Wales were diagnosed with cancer at its latest stage, which is stage 4. This is not only unacceptable in the context of our rates being the worst of any country in the UK, it's not acceptable full stop. For some cancers, the wait between first suspecting that something is wrong and diagnosis is the longest in Europe. We all know that catching cancer early saves lives. First Minister, you can save lives. Will you commit to setting and sticking to a 28-day cancer diagnosis target for all so that we can catch cancer early?

What medics tell me is that it can't be done for all types of cancer—that sometimes it takes longer for certain cancers to be diagnosed. Now, she makes the point that it's hugely important, for example, for people to be encouraged to present early, and also, of course, for GPs to refer people early on in the pathway. We know that the vast majority of cancer patients in Wales start their treatment within target times. We know that the incidence of cancer continues to rise, and treatment is increasing in complexity. The number of referrals for suspected cancer requiring investigation has risen by more than 36,000 over a five-year period to around 96,000 referrals a year, which I think is at least partial good news, because it means people are being referred on more quickly. We know, of course, that 85.5 per cent of patients newly diagnosed with cancer via the urgent suspected cancer route started definitive treatment within the target time of 62 days, and 97 per cent of those diagnosed not via the urgent route started definitive treatment within their target time of 31 days.

So, you're talking about treatment and I'm asking you about diagnosis. Cancer Research UK has championed it, clinicians are calling for it, England is doing it, and yet, First Minister, you continue to argue with the experts. You reject 28-day targets not for the good of patients, but for the good of your own public relations. You won't hit those targets and you won't meet those patients' needs.

First Minister, the evidence is clear: people in poorer areas are diagnosed later. Macmillan's data shows that stage 4 diagnosis in our poorest areas is up to 9 per cent higher compared to their wealthier neighbours. You can't afford to be poor and ill in Labour's Wales. An information campaign, more readily access to GPs and diagnosis services could turn this around. So, will you commit to creating accessible cancer diagnosis services in all parts of Wales so that, whether you are rich or poor, your cancer diagnosis is not left too late?

As somebody who is married to somebody who works for Macmillan, I'm lobbied on a daily basis in terms of the way cancer is dealt with in Wales. And I can say there is no clinical evidence at all to suggest that a 28-day target would work. Where has that come from? Where is the clinical evidence to say that 28 days is some kind of golden figure? Politicians love these figures, but, in reality, I don't see any clinical evidence for it.

There are the issues—[Interruption.] There's no point shouting. If you asked the question, I'll answer the question for you now.

Part of the problem is a reluctance in some areas for people come forward early, and that doesn't help. We need to make sure that all GPs are referring as quickly as possible, because access to treatment is the same for everyone. It's simply a question of encouraging people to come forward as early as possible and for GPs to refer as quickly as possible. And that is something that is hugely important in terms of the campaigns that we have run in terms of raising awareness of different types of cancer, because we know if people are asked to check their symptoms, they are more likely to present early, and that's the way to make sure that more people not just are cured of cancer, but live with cancer, making sure that people are aware of the different types of cancers and their symptoms. And the work that Macmillan does is exactly that. Part of their work is to raise awareness of different cancers and provide evidence to people. They will be at the Royal Welsh Show. One of the themes they've had at the Royal Welsh Show is they have dealt with skin cancer, melanoma, especially with a show that's held in the summer, and they focus very, very strongly on people identifying cancer at an early stage themselves, or what may be the symptoms of cancer, so they can present and so, then, of course, they can have a better outcome.

On behalf of the opposition, Paul Davies.

Diolch, Llywydd. First Minister, the report published by independent examiner, Donna Ockenden, last week provided a frightening picture of the delivery of services in north Wales. The damning report showed that leadership at the health board has been wholly inappropriate and significantly flawed since its creation, and that mental health services are chronically understaffed at a time when patient numbers and acuity were increasing. First Minister, are you ashamed of your Government's management of Betsi Cadwaladr University Local Health Board?

Well, there will be a statement on this further on on the agenda this afternoon. What I can say is, of course, this is a difficult report. The report did highlight areas of progress in the presentation of the board last week. BCU now has a different executive leadership team in place. Since 2016, a new chief executive, seven executives, including a medical director and a director of nursing and a new director of mental health, have been appointed to lead on the improvements needed. A new chair will take up post shortly. I know that the Cabinet Secretary has published a written statement. He will, as I say, make an oral statement on the review later this afternoon and he has been clear about what he expects of the board.

First Minister, you should be ashamed of the way that you've actually run this health board. It will be three years ago this summer that the Welsh Government put Betsi Cadwaladr health board in special measures, and the Ockenden report has shown that, over that period, progress has been slow and significant improvements have yet to be made. Lessons simply haven't been learnt and people in north Wales will rightly feel anger and outrage at the lack of progress over the past three years in addressing these serious failings. This is a health board that is only eight years old, and has been in special measure for three of those years. It's your Government's responsibility to run this health board. You are responsible. Your Cabinet Secretary is accountable to you for the delivery of health services in Wales. What are you doing to make sure that he sorts this mess out and how are you performance managing the health Secretary to make sure he improves Betsi Cadwaladr health board? You clearly have no targets for improving the health board. Have you set any targets for your health Secretary?

I can say that Donna Ockenden was commissioned by BCU in 2015 to review the governance arrangements relating to the care of patients in Betsi Cadwaladr. She presented her findings to the board on 12 July. The report runs to about 500 pages, with the executive summary alone running to 50 pages. I wonder if he's read that report. The findings are consistent with previous reports. In many cases, it's a summary of previous reviews since 2009. What's hugely important, now that we have that report, is that we can now build on that report, as the Cabinet Secretary will outline this afternoon, and now that we know what the challenges are, we can meet those challenges.

Clearly, your Cabinet Secretary has failed when it comes to Betsi Cadwaladr university health board. The Welsh Government's record of delivering health services in north Wales speaks for itself. Let me give you some examples, First Minister: 93-year-old Margaret Megan Evans waited on a concrete path for more than three hours after falling and breaking her hip, and then was not seen by an emergency department doctor until almost 11 hours after help was initially summoned; 46-year-old Ester Wood waited five hours in an ambulance before being admitted to hospital, where she then died; 78-year-old Neville Welton passed away following a delay in treatment because of capacity, staffing, administration errors and patient flow problems. First Minister, these are real people. Warnings that lives remain at risk have been issued by the coroner's office following deaths in hospitals, and in the past 12 months, the health board received 294 new claims for either personal injury or clinical or medical negligence. There's clearly a culture of deny, defend and dismiss at the heart of Betsi Cadwaladr health board and your Government. First Minister, when will your Government take responsibility for the catalogue of failures in care at Betsi Cadwaladr university health board since it has been in special measures? Will you now apologise to the people of north Wales for the shambles of a system that your Government has presided over and for the lack of accountability in handling these services?

This contrasts, doesn't it, with the way his party approaches things in England, where if there is an issue like Gosport it's always the fault—[Interruption.] It's always the fault—[Interruption.] I know it's the leadership contest, but perhaps he'd like me to answer the question.

Allow the First Minister to respond, please. Allow the First Minister to respond.

All these things are brushed off towards the health boards; it's never the fault of the UK Government. We take responsibility for what happens in Betsi Cadwaladr because it is in special measures. It is the report that we will use in order to create that improvement. We are diverting and putting resources into health as best we can, despite the austerity—[Interruption.] Well, they can moan about it, but it's despite the austerity that has been put in place by his party. If he stood up and demanded the same for Wales as his party has given to Northern Ireland, he would have more credibility in the arguments that he puts forward. As I say, the Cabinet Secretary will make a statement on this this afternoon. It's time he and his party apologised for fleecing the people of Wales for the past eight years.

Leader of the UKIP group, Caroline Jones.

Diolch, Llywydd. First Minister, the outgoing Auditor General for Wales has been highly critical—[Interruption.]

Allow Caroline Jones to ask the question. Caroline Jones. 

Diolch, Llywydd. First Minister, the outgoing Auditor General for Wales has been highly critical of the Welsh public sector's inability to adapt to reduced budgets. In evidence to the Public Accounts Committee, Huw Vaughan Thomas said that public services could be reforming for the better, but their only response to austerity has been cutting costs. He also said that he was frustrated that devolution hasn't led to a fundamental rethink on how we deliver public services in Wales. The reality is that, regardless of who is in power in Westminster, we will not see massive increases in public spending because the UK is now nearly £2 trillion in debt, which equates to around 85 per cent of GDP. We can't borrow our way out of this mess, so we have to spend smarter. So, First Minister, do you agree with the outgoing auditor general that we need a radical rethink for public services?

We always look to put in place the best system for public services that we can. For example, we took three Welsh Government-sponsored bodies and turned them into one—Natural Resources Wales—and we reduced the number of bodies delivering health to make sure that there were fewer organisations that people had to be in contact with. The reality is this: we have protected the Welsh public services budget. Local government in Wales is far better financed than is the case in England. We haven't seen the destruction of social services that is happening under a Tory Government in England. We have put resources into social care and into health. We've also, of course, put resources into education. We have seen the cut in education funding that we saw in England last week, where schools have been starved of money by a Conservative Government. Why is this relevant? Because if they were in charge, they would do exactly the same in Wales—exactly the same in Wales. We have fought against the austerity that the Welsh Conservatives have greeted in Wales, and we know what would happen to our older people, to our young people, to schools, to hospitals and to social services if ever—God forbid—they got their hands on power.

I agree with the former auditor general that austerity is the biggest challenge facing public services in Wales, coupled with the rise in demand. These services are facing incredible pressure. While NHS spending has continued to rise, local authority cuts are impacting upon social care, which, in turn, impacts upon healthcare. We spend more per head on health than they do in England, yet we have to wait longer for appointments and longer for treatment. So, First Minister, your Government's long-term plan for health and social care will help us prepare for future challenges, but what about now? How do we meet the challenges of today? Huw Vaughan Thomas said that public services in Wales need to think more radically about how services are delivered, with a focus on outcomes rather than structures. So, First Minister, is your Government too focused on structures as opposed to outcomes?

No, because, for example, in the field of health, that would mean that we would be looking at yet another reorganisation, and that's not something that would cause stability in the health service. It is down to resource, it's down to ensuring that we can allocate as much resource as we can to health and other public services, but it's a hugely difficult task against the backdrop of austerity that we face and what we've faced over the past eight years.

Thank you, First Minister. Huw Vaughan Thomas said that the Williams commission report clearly sets out the nature of systemic problems that need to be fixed. He added that he finds himself both frustrated and increasingly concerned that many clarion calls for action that Wales has heard over the last decade or so have not yet generated the tangible changes that are now urgently needed, and that we have not used devolution as an opportunity for fundamental rethinks. So, First Minister, does your Government lack the will to do what is necessary to drive forward change in Wales's public services, or do you truly believe that the changes proposed by the Williams commission and others are unnecessary? Thank you.

I'm not sure whether it's now UKIP policy to back what was in the Williams commission in terms of local government reform. If that is the case, then that's interesting. We have seen a situation in Wales where we have seen the development of consortia, for example, in education, which has led to far better outcomes for education than was previously the case. At one point, we had six local authorities in special measures and we had one local authority that collapsed completely in Anglesey—we're far from that position. So, we've worked to make sure that our local authorities have become more sustainable. There are still challenges to make sure that that happens in the future, and that is where, of course, it'll be interesting to hear other parties' views in terms of what the structure of public services should be in the future, rather than simply saying, 'Well, we don't like this.' What are the views of other parties? Let's see whether there is a consensus—we've had the parliamentary review on health—in terms of how public services might be structured in the future.