Key things emerged in our inquiry. We know, of course, that Wales is signed up to the World Health Organization's global health sector strategy, which aims to eliminate hepatitis C by 2030. One of the tragedies, of course, of the large number of people living with this condition is that it is now completely curable. Whilst this is welcome—the signing up is welcome—a number of witnesses to our inquiry expressed concerns about whether we will meet those targets. The committee heard that not all local health boards are meeting the targets, and that both diagnosis and treatment rates will have to increase significantly in Wales if we are to achieve the 2030 target. We heard anecdotal evidence of local health board finance directors discouraging hepatology teams from exceeding the treatment targets because of financial concerns. This approach will only result in greater financial cost in the long run, and is not compatible with Wales achieving the elimination target. It is vital that caps are not placed on local treatment targets by health boards. National treatment targets should be seen as a basic minimum floor, which health boards should be aiming to exceed. 

The message from witnesses is clear—that knowledge and awareness of hepatitis C amongst the public remains low, reflected in roughly 50 per cent of patients being undiagnosed. A UK-wide poll commissioned by the Hepatitis C Trust highlighted that, of the 80 per cent who were aware of hepatitis C, less than 40 per cent knew that it affects the liver, and less than 30 per cent knew that the virus is now curable.

The committee heard that outdated information is still prevalent amongst at-risk groups, and, as such, some patients are fearful about coming forward to access healthcare, because of the difficult nature of the previous treatments. Increasing public awareness and knowledge of the virus through the development of a Government-backed awareness campaign, targeted to specialist at-risk groups, may help to reduce the effects on those who are affected by the virus. Public Health Wales told the committee that, since the Welsh Government introduced a formal policy of opt-out testing for blood-borne viruses for all those on admission to prison in 2016, the uptake of testing has increased from 8 per cent to 34 per cent. This is encouraging, and it has been a big improvement, and, in time, hopefully, Public Health Wales will reach the target of 100 per cent. However, witnesses highlighted a lack of resources for testing in prisons, and stated that, in order to make prisons HCV-free, additional resourcing and staffing is required. Recruitment and retention were also issues that were highlighted by witnesses, with some stating that lack of staff was preventing prisoners from being tested promptly.

Knowledge and awareness amongst some health professionals is an ongoing issue that must be addressed. The committee heard that patients reported less positive experiences with health professionals, such as GP and non-specialist nurses, with many saying that they had not, in fact, been offered tests. Others stated that they'd encountered low levels of knowledge of the virus from health professionals, often being given inaccurate or outdated information and advice. The Hepatitis C Trust recognises that initiatives that have been introduced to provide educational support to healthcare professionals are valuable, but says that more needs to be done. Witnesses called for protected learning time for such health professionals, and for more awareness raising. We heard that such training does not need to be time-consuming and much of it can be delivered online.

The message from witnesses was that Wales has an excellent opportunity to become the first country in the UK to eliminate this disease. However, without urgent additional action to address the uncertainty relating to the strategy and funding post 2021, the fear is that the opportunity may be lost.

So, these were our four recommendations—that the Welsh Government should produce a comprehensive, national elimination strategy for hepatitis C, with clear and ambitious targets and workforce planning built in, and provide substantial funding until the elimination is achieved. This must be done as a matter of urgency, given that the current plan ends this year, and funding for dedicated posts is only available until 2021.

Our second recommendation is that the strategy must include a targeted awareness-raising campaign to reach out to at-risk communities, and to provide additional education and training for health professionals. The Welsh Government, for our third recommendation, must write to local health board finance directors and chief executives to emphasise that the national targets for treatment for hepatitis C must be considered as a minimum and be exceeded where possible. And the Welsh Government, for our fourth recommendation, should provide additional investment to improve hepatitis testing in prisons.

We are somewhat disappointed that the Welsh Government has only chosen to fully accept one of these recommendations. We're grateful that the other recommendations have been accepted in principle. But, in fact, the Government has only agreed to write to the finance directors and the chief executives, and their response says that there are other ways to address the issues that our report raises. I will be interested to hear what the Minister has to say today, but I would urge him to look once again at our recommendations, which are strongly evidence based, and the need for a strong central lead on this is vital.