5. What discussions has the First Minister had with the Minister for Health and Social Services about reducing waiting times for surgery to treat pancreatic cancer? OAQ54849

Llywydd, I thank the Member for that. The Minister for Health and Social Services has made a commitment to consider the introduction of a rapid access model to treat pancreatic cancer. Discussion of these matters has already been held with the Wales Cancer Network. 

Thank you, First Minister. Following our very well-supported cross-party debate on this, I was contacted last week by a lady who'd just had a diagnosis last week of pancreatic cancer, but had been told she would have to wait two months for surgery. She was upset and shocked by that. Her husband was understandably very angry and I really felt for both of them, because we know that pancreatic cancer is one of the most lethal cancers and really needs to be treated within 21 days. I'm very grateful for the update that you've just provided and that you are already taking action following the debate that we held here, but what assurances can you give that, in the interim, while we look at that rapid access issue, we also look at urgently commissioning operations across the border in England for patients who are well enough to be able to make that journey to have their operation in a timely way? 

I thank Lynne Neagle for that supplementary question. Of course, she is right that pancreatic cancer is one of the cruellest of cancers, that early diagnosis of it is particularly difficult because of the vague symptoms, as they call it in the clinical world, that it tends to present with. She will know as well that, even when early diagnosis is possible, a significant proportion of patients who are suitable for surgery also have jaundice at that point in the illness' path, which has to be treated before the surgery can take place. So, there are some real clinical challenges in dealing with pancreatic cancer through surgery.

So, we've got two issues to deal with here in Wales, Llywydd. There is the current pathway to which Lynne Neagle referred—and she'll be pleased, I know, that Swansea Bay University Local Health Board is aiming to recruit a fourth pancreatic surgeon to increase operating theatre capacity from two all-day sessions at present to three all-day sessions in the future, that they're expanding their clinical nurse specialist workforce at the same time. While that is happening, they are already referring patients across our border to capacity elsewhere, and patients from Wales who have been offered surgery, for example, at King's College Hospital in London—patients have already accepted this offer and undergone surgery there. So, there is work to do and more work to do in making sure that the current pathway works to the maximum extent and then there is—as I know the Member discussed during the debate that we held here just a week or so ago—the latest advice from the National Institute for Health and Care Excellence, producing an evidence appraisal earlier this year so that surgery can be offered more quickly to patients whose cancer is detected at the earliest stage. That is the discussion that has already been held with the Wales Cancer Network since that debate took place. The Minister is meeting next week with the Wales Cancer Alliance and the UK pancreatic cancer charity is part of that alliance. They have been very supportive of the single cancer pathway that we've developed in Wales and we will now we be looking to see ways in which that latest NICE advice can be incorporated into the way that that single cancer pathway is being developed.

First Minister, Pancreatic Cancer UK has said it's

'disappointing to see the Welsh Government refusing to acknowledge the fact that pancreatic cancer is a cancer emergency when other UK Governments have accepted the need to act faster when there is a clinical need'.

Now, I do welcome what you've just said, because it does seem quite a change in emphasis in terms of rapid access to surgery, but it's a general approach that we need, because this is a relatively common cancer and the prognosis remains really very disappointing, whereas, in the last 40 years, many other common cancers have increased the survival time and the chance, indeed, of going into permanent remission. That's what we need, and I do hope that this is the first step you're making to really focus on pancreatic cancer so that it is brought to the same sort of level that we have, in fairness, achieved for other common cancers. 

I thank the Member for that. The Welsh Government absolutely does recognise the significance of pancreatic cancer and the challenge that is faced in providing successful treatment for it. In the middle of the first decade of devolution, survival rates at one year for pancreatic cancer in Wales were 18 per cent. In the middle of this decade, they were 28 per cent. Now, 28 per cent is still at the bottom end of what other cancers are able to achieve, but it's nonetheless a 10 per cent increase in one-year survival rates within a decade. And if you are able to detect pancreatic cancer at stage 1, then the one-year survival rates are higher than 60 per cent. So, we do know that where we are able to get an early response to pancreatic cancer, there are successful things that can be done. The challenge lies, as I said in my answer to Lynne Neagle, as we know, in making that early diagnosis, because the symptoms aren't easy to detect and they are masked because they look like they might be a different condition.

We've done enormous things in Wales over the last five years to increase the early diagnosis of cancer. Llywydd, of 100 patients who are referred by a GP as having suspected cancer, 93 of them turn out not to have cancer at all. But the reason that that is a good thing is that it demonstrates that we have widened the number of people coming in to the system in order to get that maximum chance of the earliest possible diagnosis. Pancreatic cancer is not the easiest cancer by any means to make that work and we now know that where you can make it work, surgical interventions have a more important part to play. We go on being determined to work with our cancer network here in Wales to improve early detection and diagnosis and then to put in place the services that respond to that with the maximum clinical effectiveness. 

I accept what the First Minister said in the sober and serious answers that he has given to earlier questions, and in contrast very effectively with the pantomime that we had at the beginning of questions today. The fact remains that Wales does have one of the lowest cancer survival rates in the world amongst countries of comparable data. For surviving five years we're thirty fourth out of 36 in the latest figures that I've seen from Pancreatic Cancer UK, whose ribbon I'm wearing today.

I'm sure the First Minister will accept from me that if we look back 10 or 15 years, we looked at prostate cancer in much the same dim light, but tremendous advances have been made in the treatment of prostate cancer in that time and the same could be true with greater priority for pancreatic cancer sufferers as well. I know the Government has been swift to declare a climate emergency; I can't understand therefore why it's feeling in any way inhibited from doing the same thing for pancreatic cancer because this is going to make a tremendous difference potentially to the lives of a large number of people given the incredibly distressing news that this brings to people who suddenly find that they are sufferers. The survival rate for a month is only about 25 per cent, or whatever it is—for a year it's only 25 per cent or so. So, the greater the degree of priority the Government can give to this the better it will be.

I thank the Member for that serious question and I'll try to continue to give him a serious answer. The reason why I think we are reluctant to pick a particular form of cancer and to declare that an emergency is that, for every patient who has a diagnosis of any form of cancer that is an emergency in their lives. We have been reluctant, I think, for very good reasons to go down a route in which we have a hierarchy of different conditions, in which we try and pick out a particular condition and try to say that it is somehow more important and more significant than another condition.

That's not to say that I don't understand the case that is made because of the very particular impact that this cancer and the difficulties of early diagnosis have. So, I'm not for a minute dismissing the case that is made, but in a serious answer that's the reason why we've been reluctant to go down that route. Pancreatic cancer for anybody who is suffering from it is an emergency, but so is it for somebody who has a liver cancer or a lung cancer or a breast cancer. And I'm reluctant to say that one form of cancer is somehow more urgent or more of an emergency than another because, from the patient's point of view, I really don't think it looks like that.