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.