Thank you, Dirprwy Lywydd. I’m pleased to take part in this very important debate today on the Health, Social Care and Sport Committee’s report on endoscopy services in Wales. This is the first in a series of spotlight inquiries undertaken by the committee, and over the coming months we will bringing forward short debates on our findings in a number of areas, such as dentistry, hepatitis C and community and district nursing. The committee agreed to undertake a one-day inquiry into endoscopy services because, at that time, the majority of health boards in Wales were breaching waiting times for tests that can diagnose bowel cancer. We were also told that an alarmingly low number of eligible people take part in the bowel screening programme. Screening is the best way to diagnose bowel cancer early, but, between April 2017 and March 2018, only 55.7 per cent of people eligible to take the bowel screening test in Wales actually completed it. Uptake is higher in females compared to men. There is also a strong correlation with deprivation. Uptake in the most deprived areas is 45.6 per cent compared to uptake in the least deprived areas at 63.3 per cent.

In terms of the introduction of the FIT test, from January 2019, Wales began replacing the current screening test with a simpler and more accurate one called the faecal immunochemical test—the FIT test—which is expected to increase the uptake of screening. There are concerns, however, that endoscopy units in Welsh hospitals are already struggling to cope with demand, and so, even though the new screening test is a positive improvement, it could put more strain on an already overstretched service.

We recognise that demand has to be properly managed, but we are disappointed that the thresholds for FIT testing are lower in Wales, and we’re concerned that Wales, without a clear plan to optimise the programme, will fall further behind its counterparts in other parts of the UK. We would like to see the Welsh Government, through the national endoscopy improvement programme, set out milestones for achieving programme optimisation in terms of age and sensitivity, so that these can be measured and progress can be monitored in the hope of achieving full optimisation earlier than 2023. 

Turning to waiting times, in 2015, the Welsh Government committed additional funding to improve waiting times for diagnostic tests, including those waiting for endoscopy procedures following a positive screening result. Additional funding was also provided in 2016-17. However, despite this extra funding, waiting time statistics still give cause for concern, and there needs to be a clear commitment that health boards will deliver the maximum waiting time target for diagnostic tests, namely eight weeks, by the end of 2019.

Witnesses to our inquiry described the Welsh Government’s approach to tackling issues related to capacity as reactive and short-term. A number of health boards provided details of hospitals contracting with external private providers for insourcing services to deliver endoscopy procedures within the health board on weekends, as well as outsourcing, where patients are sent to private providers at sites outside the health board, to cope with demand. While more investment is needed to get waiting times under control, there also needs to be a more sustainable approach, as outsourcing and insourcing are expensive and do not deliver a long-term solution.

To the workforce now: changes are needed to the nature and skills of the current workforce, with a commitment not only to increase the number of gastroenterologists and other medical endoscopists, but also to develop nurse and other non-medical endoscopists. The committee was therefore disappointed to hear that some nurses are paid less than others in Wales to perform endoscopy. This needs to be addressed.

The message from witnesses was that focus and pace is needed to ensure that Wales doesn’t fall behind other nations. Bowel Cancer UK, for example, wanted to see a national action plan with key milestones, so that the Welsh Government could be held to account for delivery and implementation of the plan. Witnesses also made the point that there had been a number of reviews, and that the issues, or the problems, were clear. Actions and solutions are what is needed now.

We therefore made one overarching recommendation in our report: by October 2019, the Welsh Government should work with the national endoscopy improvement programme to create and publish a national endoscopy action plan that addresses current and future demand for services, with clear timescales and targets for improvement. I welcome the Minister’s positive response to our report, and I'm pleased to say that the Welsh Government has accepted this recommendation and has committed to publishing an action plan for endoscopy services within the six-month timeframe requested by the committee. I thank the Minister for the written statement, which provided an update on the progress of the national endoscopy programme, earlier today. I am pleased that the action plan has been drafted, and I look forward to its publication, in accordance with the committee's recommendation.

To close, as the Minister said himself, it's vital to maintain the sustainability of endoscopy services so that people can reach the examinations that have been set for them in order to have the best results possible. It's now time for progress to be made, and I'm confident that the Welsh Government will provide the strong leadership that is needed to deliver this agenda. Thank you very much.