I'd like to thank the committee very much for doing this report. Unfortunately, I personally was absent on the day that you did the one-day report, but I've read your report, I've read the Government response, and of course I'm reflecting the commentary of many of my constituents who come to see me over these kinds of services. And I noted the Government's response to the recommendations made by the committee, and, to be frank, I found some of it—only some of it—very weak, because you have accepted the recommendation made by the committee. However, you say that endoscopy services are under stress because of population changes, a lower threshold for cancer investigations, an increasing demand for surveillance, and the need to expand the bowel-screening programme. In response, I would say that, as a minimum, the service should be able to respond currently to the objectives of the bowel-screening programme. Given the take-up rate is so low—a mere 55 per cent—there should be some slack already in the system in any event. To aim for a higher take-up rate without ensuring the tools are on hand to deliver the programme is a complete paradox. And I would also point out that, despite recommendations made as far back as 2013, there's been little progress made in addressing the challenges that endoscopy services throughout Wales are facing. Therefore, the challenges, Minister, that you identify in your response to the committee are nothing new. To imply otherwise is disingenuous and, above all, it allows those who are charged with planning services a measure of wriggle room that they do not merit. I see that the endoscopy implementation group wanted a more directive approach from the Government, and it's to your credit that you have moved in that direction. But it does beg the question as to the capabilities for planning and delivery within health boards. 

Given the crisis facing endoscopy services, Minister, are you able to accelerate the delivery of a national plan? The commitment in September 2018 was there, but, a year later, the terms of reference are still being finalised. It's hardly fast paced and, in the meantime, I'm concerned that services continue to stagnate and people's lives continue to be affected. If there's any way that you can see to moving that forward and increasing that pace and accelerating that so that we can deliver good endoscopy services throughout Wales I think that will be a very positive step forward. 

The welcome introduction of the FIT test has the potential to improve the uptake of screening. It should improve detection rates for bowel cancer and pre-cancerous polyps in the bowel—however, a paradox again, because there are unacceptable waiting times in play, and there needs to be a clear commitment from health boards to address this issue, because no programme can work without having the appropriately trained personnel and infrastructure in place.

The current workforce is desperately short of gastroenterologists and other medical and non-medical endoscopists. Nurses involved in delivering endoscopy services are on disparate and lower pay rates, and we need to see that the joint advisory group on gastrointestinal endoscopy accreditation—my goodness, doesn't the NHS come up with some exceptionally long words at times, shall I just say that little bit again? We need to see that the joint advisory group on gastrointestinal endoscopy accreditation is put in place so that we know, so that we can be secure, that all health boards are delivering services in line with best clinical practice.

But, Minister, the real frustration comes in the lack of planning and appropriate commitment by some health boards. Let me give you an example: Ysbyty Glan Clwyd had a stable team of three gastroenterologists: one retired, one moved, yet there was no forward planning to cope with this change; there was no plan B. Wrexham Maelor is struggling on locums; weekend capacity is struggling. So, this is a prime example of mismanagement. There's no contingency plan, there was no forward planning, and it has devastating consequences for individuals. A terminal bowel cancer patient received their invitation to meet the consultant in the same month that another consultant in another hospital said they would not make. How awful would that be to get the letter saying, 'Come along in this month to have your diagnosis confirmed' and somebody else has already told you, 'You're probably going to be dead by that point'. That health board needs to do better. The NHS needs to do better. We all need to do better.