We now move to the short debate. If Members are going, can they please do so quickly. No, sorry—no conversations in the Chamber. If you want to have a conversation, please go outside. I now intend to go to the short debate, and I call on John Griffiths to speak on the topic he has chosen. John.

Diolch, Dirprwy Lywydd. I'd like to take the opportunity today to discuss the third-biggest cause of deaths in Wales today, lung disease. Respiratory illness affects one in five lives in Wales, a higher rate than the UK average. Mortality rates haven’t improved greatly in the last 10 years, and, sadly, we have the fourth-highest figures in Europe.

The latest British Lung Foundation research has found that the cost to the UK is around £11 billion each year, a significant proportion of which relates to Wales. Fatalities account for 15 per cent of all deaths in Wales, and within this, COPD as the highest number. Chronic obstructive pulmonary disease is a group of conditions, including bronchitis and emphysema. The make it difficult to empty air out of the lungs because airways have narrowed, making it harder to move air in and out as you breathe, and lungs less able to take in oxygen and get rid of carbon dioxide. Medical professionals advise activity and exercise to help improve breathing, fitness and quality of life. Done regularly, this can help reverse the impact of the condition by strengthening muscles. It also benefits heart and blood pressure and makes people less likely to develop conditions such as diabetes and osteoporosis.

Pulmonary rehabilitation, or PR, is a programme designed for people living with COPD. It combines physical exercise sessions with advice and discussions about your lung health. Most people find it improves their quality of life, and the impact is often bigger than that of taking inhaled medications, though combining the two is likely to provide the most benefit.

Lifestyle is very important. The national survey for Wales 2017/18 reveals a smoking prevalence in Wales of 19 per cent, and a prevalence of overweight and obese adults of 59 per cent. Currently in Newport, 21 per cent of adults smoke, which is above the average for Gwent and Wales. These are major contributory factors. Smoking causes over 80 per cent of COPD and lung cancer and causes or worsens all other respiratory conditions. Respiratory illness is also twice as likely to be reported amongst individuals living in the most deprived communities compared to the least deprived—11 per cent as opposed to 6 per cent. These stark statistics are worrying, and co-ordinated support service delivery, measures and interventions across Wales are vital to ensure that all patients have access to the range of services and treatments available.

Smoking is still the biggest cause of preventable mortality and health inequality in Wales, and rates have stagnated at 19 per cent since 2015. Community-based actions at grass-roots levels must have the financial support they need to effectively help people quit cigarettes for good. It is this community-based level of support that is also invaluable to allow those living with lung conditions and lung disease to best manage their conditions. Cancer Research UK have highlighted that during the current financial year, well over 10,000 Welsh residents who are smokers were treated by smoking cessation services, representing 2.24 per cent of the population, significantly below the target of 5 per cent. Worryingly, the British Lung Foundation’s latest research highlights a current situation of worsening outcomes in Wales—an increase in the emergency hospital admissions, mortality rates and poorer quality of life. Lung diseases are responsible for more than 700,000 hospital admissions and over 6 million in-patient bed days in the UK each year. There is reduced access to education and exercise programmes that help individuals better self-manage their condition and maintain a good quality of life, as well as poor uptake of the influenza vaccine and stop-smoking services. Preventative measures are vitally important to help support patients and their families. Further investment in education, exercise and self-management provision is a tangible way to improve the lives of those living with lung disease in Wales. There is overwhelming evidence that development of self-management can increase independence, knowledge and positive change in behaviour, for example more exercise and more smoking cessation, which enables people affected by COPD to have better health.

Unfortunately, not everyone is able to benefit from pulmonary rehab, with just one in 10 people accessing services. Waiting times across Wales vary from 77 weeks to fewer than eight weeks, with as little as three programmes per year on offer to patients in some areas. Funding should and could be rebalanced away from expensive inhaler treatments towards more cost-effective interventions. The rehabilitation support does offer that invaluable help I mentioned and improves muscle strength. It helps patients cope better with breathlessness and supports better mental health.

Welsh Government is aspiring to increase access through the respiratory health delivery plan and I hope they and health boards will continue to invest in high-quality services across our country. Earlier this year, I was very glad to join the British Lung Foundation's Helping You Help Yourself programme in Newport, which ran at the Newport Centre. Around 1.8 per cent of the population in my constituency are living with COPD, the Welsh average being around 2.3 per cent, which is a higher average than the rest of the UK.

Working with Big Lottery Fund Wales, the foundation have developed a seven-week education and exercise programme to help participants better understand their condition. It will improve health and provide the tools to stay active and manage conditions independently. The programme is delivered by a BLF programme co-ordinator, a healthcare professional and a volunteer tutor with experience of living with COPD.

I saw at first-hand the difference these programmes make and made to people whose lives are affected by lung disease. To date, 123 participants in 27 programmes across Wales have taken part in the scheme, with the four programmes in Newport involving 20 people. In Newport, the number of participants who felt that they had a good understanding of their lung condition increased by 42 per cent and there was a 7 per cent uplift in the numbers who felt they had adopted more positive health behaviours, such as healthy eating and an improved social life. There was a notable increase in the average distance walked in six minutes, from 364m to 407m, with less breathlessness. And an overwhelming majority, 96 per cent, stated that they found the programme and the materials useful.

In fact, one of my constituents, Michael Taylor, described how this course freed him from a life sentence of living in ignorance in relation to his condition. He said that it had introduced him to others living with the condition and helped him understand how exercise would allow him to gain a complete understanding and improvement of his condition and provide him and others taking part with the chance to ask relevant questions and receive instant support, which enabled them to overcome any worries or concerns that they had. The most important thing that the course had taught him was that he wasn't alone in suffering in the way that he had and that there were organisations like the British Lung Foundation, medical practitioners and volunteers happy to give their time and care to improve the quality of life of those living with respiratory illness. I do believe, Dirprwy Lywydd, that his words serve as a reminder to all of us of the very real positive impact that pulmonary rehab can have on people's health and well-being, and I know that many other Assembly Members have visited programmes and had direct experience of their value.

To continue to improve this level of support and care, we need a long-term approach to funding the national exercise referral scheme to provide certainty to users and local authorities. It is a key part of ensuring that patients are able to improve their confidence with exercise and managing their breathlessness. We need to see greater investment in initiatives to reduce the risk of patients needing unnecessary, avoidable and costly hospital admissions, and this should include patient rescue packs that include a course of antibiotics and corticosteroid tablets to keep at home and self-manage with the advice and encouragement involved. And that would enable a prompt response to symptoms of an exacerbation. We also need to see better funding for community nursing support so patients can access support and advice services with the care involved and the better self-management it involves, and self-refer when needed to community-based services. This would, in turn, improve uptake of preventative measures.

People living with these diseases are at an increased risk of serious influenza-related complications, of course, but, despite this, uptake of influenza vaccine amongst those aged six months to 64 years in any clinical risk group was only 46.9 per cent in the 2016-17 flu session, against a target of 75 per cent. For those with chronic respiratory disease, the uptake was 46.5 per cent, which has remained static for the last five years. Were that to increase, it would reduce the risk of influenza-related complications and hospital admissions.

Dirprwy Lywydd, I support the aspiration of Welsh Government to increase access to pulmonary rehab through the respiratory health delivery plan. It is a cost-effective intervention for people living with chronic obstructive pulmonary disease and other lung conditions. Smoking cessation support with pharmacotherapy and pulmonary rehab interventions are arguably a more cost-effective way to help patients, rather than disproportionate spends on separate inhaler treatments. These illnesses and conditions are part of the wider public health agenda, including a growing awareness of the impact our actions are having on the environment around us.

People in towns and cities across Wales are breathing in levels of air pollution that are illegal and harmful to their health. It is an environmental issue, but an urgent public health matter too. Getting more people to walk and cycle on their daily commutes and the school run will ease peak-time congestion on our roads, reduce poor-quality air and make us fitter and healthier. The recent Welsh Government declaration of a climate emergency must now be followed with new ideas and further robust action. Across the globe, there is a growing feeling that more should and must be done—from the recent Extinction Rebellion protests in London to the powerful words from the likes of young activist Greta Thunberg, reminding us that we must all act quickly and do our part to protect our planet.

Reducing the levels of air pollution will greatly benefit everyone in Wales, particularly those living with respiratory illness and COPD. Active travel schemes and integrated transport networks, such as the south Wales metro, are an opportunity for much-needed change. They get more people out of their cars and walking and cycling, with all the benefits that involves. Welsh Government has led the way, I believe, by being one of the first countries to take forward groundbreaking legislation, such as the Well-being of Future Generations (Wales) Act 2015.

So to conclude, Llywydd, I am glad to have this opportunity today to ask Welsh Government to further support pulmonary rehab to combat respiratory illness in Wales and preventative measures like the flu vaccine, smoking cessation and further community and district nursing support. I believe concentrating on those sorts of preventative measures will result in the sort of progress that all of us want to see and make a real difference to those suffering lung disease in Wales.

Thank you. Can I now call on the Minister for Health and Social Services to reply to the debate? Vaughan Gething.

Thank you, Deputy Presiding Officer, and thank you to John Griffiths for bringing forward this topic for the short debate. The Welsh Government, of course, recognises the significant burden of respiratory disease on society—the impact it has on the daily lives of people with chronic respiratory conditions, the impact it has on respiratory care services within the national health service, and the attendant impacts upon social care, and the impact it has more broadly upon our economy.

For people with a diagnosed respiratory condition, often characterised by breathlessness, we need to ensure there is a range of appropriate services and opportunities that are easily and readily available to support them. This will range from social prescribing approaches, such as participation in local walking groups, to lower level guided interventions like the national exercise referral scheme that John Griffiths referred to, to more intensive and holistic pulmonary rehabilitation for people with more severe breathlessness, which was the main focus of the speech.

All health boards provide pulmonary rehabilitation, but I recognise that there are challenges in ensuring that the service is always available in a timely manner, and John Griffiths commented on this during his speech. We know that many people don't actually act on their referral to pulmonary rehab, given the length of time that it can take to access and the time demands it places on people. A significant number of people don't complete the course, which can last six to eight weeks before people step down into a less intense level of support.

The Welsh Government funds NHS participation in a number of national audits of respiratory services. These have analysed the provision of pulmonary rehab and made recommendations for health boards to improve. In particular, they highlight the importance of pulmonary rehab to those who've been recently admitted with an exacerbation of their COPD. That is why the national approach is to look at how people can be supported to access a programme that is more suited to their individual circumstances and preferences.

So, we are committed to developing and improving access to a range of tailored interventions, including pulmonary rehab itself. We have important work set out in the respiratory health delivery plan, which I was pleased to hear John Griffiths acknowledge, and that is being taken forward by leaders in the NHS and the third sector, in particular the Respiratory Alliance Wales.

Investment has gone into the service across Wales. Swansea Bay University Health Board is a good example—they've moved the service out of hospitals and into community settings. It's a service that has been recognised with an NHS Wales award, and also one that I myself have visited to see the range of work they undertake—not just the physical interaction and improvement but also the social improvement and interaction from people having a setting to go to, and the behaviour change that is, then, potentially embedded as well.

We know that smoking is responsible for much for the disability we've seen in pulmonary disease. It's important for us to consider the importance of smoking cessation for those with pulmonary disease as well as for the general smoking population, because smoking still causes over 5,000 deaths each year in Wales and costs NHS Wales more than £300 million a year. Smoking remains one of the main causes of inequalities in health, with smoking rates in our least well-off communities more than double those of our most well-off communities.

The very best thing that any smoker can do to improve their health is to stop smoking. Over 40 per cent of smokers tried to give up in the past year. It's important that as many as possible seek help to quit, as this significantly increases their chance of a successful quit attempt. So, our major aim is to see more smokers use our Help Me Quit single brand for smoking cessation services in Wales.

We have taken into account the evidence when deciding on the best way to support smokers to quit. People who want to quit, using evidence-based behavioural support plus medication or nicotine replacement therapy that NHS Help Me Quit services provide—if they do so, they're more than four times as likely to quit as those making an unaided quit attempt.

The integrated Help Me Quit service is designed to encourage smokers to make contact using the helpline, website or by text. A trained adviser will provide a clear explanation of the different services available locally and help the caller to select the service that best suits their circumstances and preference—that may be by a group run locally, usually in a health service or community venue. For instance, in Newport, groups are held in Newport leisure centre and the Bettws Civil Service Club as well as in a number of primary care facilities, or the smoker could opt for support in a local pharmacy or for telephone support. We also have a Smoke Free—Quit Smoking Now app to help people obtain additional support.

I'm pleased to share some further examples of good practice from Aneurin Bevan University Health Board. Pulmonary rehab services in the health board ensure all patients who are smokers are offered a referral to Help Me Quit in order to gain access to both behavioural support and pharmacotherapy. In particular, for those patients receiving pulmonary rehab in Newport over the past year, as part of their programme of care, patients have received the smoking cessation service from pulmonary rehab nurses. These nurses have been trained by the National Centre for Smoking Cessation and Training and have the knowledge and skills required to support patients who smoke to help them to successfully quit, in order to both help improve their health and manage their existing lung condition. As with Stop Smoking Wales services, these NHS pulmonary rehab programmes are delivered in a variety of venues.

It is important that referral pathways are strengthened across the NHS so that all smokers are encouraged to think about making a quit attempt. My officials, working with Public Health Wales, have been developing two new NHS performance measures. The first would require primary and secondary care practitioners to report on the percentage of adult patients in specified categories who are screened for their smoking status. The second measure would require reporting on the percentage of smokers in those categories referred to NHS smoking cessation services. In the first year, we propose that those measures would apply to pregnant women, pre-operative patients and people with lung disease.

It is, of course, not only the NHS who can help spread the word about Help Me Quit. The third sector can have a role too. So, Public Health Wales officials have linked with the British Lung Foundation, and, as a result, Wales-based visitors to the British Lung Foundation website who seek help to quit will now be directed onto the Help Me Quit site. In addition, British Lung Foundation practitioners working on the Helping You Help Yourself pulmonary rehab programme will be trained to provide brief advice on smoking cessation. We hope this will lead to more referral to Help Me Quit’s specialist services from this group of people.

All of us are keen that our messages are part of a caring and supportive approach. It is important that smokers realise that there is no stigma to getting support, but it is, in fact, a sign of strength. The Help Me Quit services are here to give smokers the best chance to quit for good, and, every year, some 15,000 smokers across Wales accept that support. I am pleased to note that a recent Royal College of Physicians report was complementary about smoking cessation services here in Wales. It notes that the rising number of smokers active in the services are in contrast to other parts of the UK.

In summary, the Welsh Government is supportive of the NHS and third sector working even more closely together to support patients with COPD. I welcome the programme from the British Lung Foundation and the links being made and improved upon with Public Health Wales. We know how important pulmonary rehab is to people with chronic respiratory disease and we are working to further improve access to NHS provision. When we do, it is vital that people act upon their referral and complete the course of support that is available to them. We recognise the timeliness of that support needs to improve. So, the Welsh Government remains committed to working with partners to drive further improvement. We can all work together to give people the very best quality of life. Thank you.

Thank you very much. And that brings today’s proceedings to a close. Thank you.

The meeting ended at 17:43.