Item 9 on our agenda this afternoon is the Member debate under Standing Order 11.21 on early cancer diagnosis. I call on David Rees to move the motion. David.

Motion NDM7238 David Rees, Angela Burns, Dai Lloyd, Mike Hedges, Jayne Bryant, Caroline Jones

To propose that the National Assembly for Wales:

1. Notes that early diagnosis of cancer improves survival chances.

2. Notes that the World Health Organisation recommends that all nations should have a strategy on cancer.

3. Calls on the Welsh Government to ensure that its new cancer delivery plan includes greater emphasis on earlier diagnosis for patients and for it to be in place when the existing plan ends in 2020.

4. Calls on the Welsh Government to take action to improve uptake of cancer screening programmes.

Motion moved.

Diolch, Dirprwy Lywydd. I move the motion, tabled in my name, this afternoon. I'd like to put on record my thanks to all Members who supported this debate, and particularly to Angela Burns, who will be closing the debate this afternoon.

Cancer Research UK have identified that one in two people in the UK born after 1960 will be diagnosed with some form of cancer in their lifetime. Presently, around 19,000 people are diagnosed with cancer every year in Wales. We all know someone who has received a cancer diagnosis. Some will be cancer survivors, but others are sadly no longer with us, having battled cancer with strength and dignity.

Over recent years we have seen meaningful progress in diagnosis, treatment and survival rates, with just over half of people with a cancer diagnosis living for 10 years or more, compared to one in four in 1970. However, Wales persistently lags behind comparable countries for cancer survival.

There is a direct correlation between the chances of survival and the stages of diagnosis across both year 1 and five-year survival rates. Cancer survival decreases when early diagnosis is not available. And that's something we need to remember: cancer survival decreases when we do not have early diagnosis. 

In Wales we have seen one-year survival rates increase, along with five-year survival rates. It is clear that early diagnosis is fundamental. This becomes evermore present when we look at harder-to-diagnose cancers, such as lung cancer or pancreatic cancer. Cancers like these have little to no stage 1 symptoms, or symptoms that are non-specific. It is therefore important that any strategy for cancer treatment must include a strong emphasis on early diagnosis. 

At the end of this year, the Welsh Government's cancer delivery plan, which was published in the fourth Assembly, comes to an end. The World Health Organization recommends that every country should have a cancer strategy, no matter what resource constraints it faces. As the current plan comes to an end, we need to ensure that Wales has a new, fit for purpose in a changing world, comprehensive cancer strategy, which will be in place when this current delivery plan ceases at the end of this year. A new comprehensive cancer strategy that meets patient need and, most importantly, improves patient outcomes.

Many of the cancer charities that I speak to on a regular basis feel that this is an opportunity for the Welsh Government, and for this Senedd, to set a new vision to improve patient outcomes, covering prevention, early diagnosis, access to treatment and cancer research that benefits patients. And they and I believe that the new cancer strategy must be underpinned by increasing diagnostic capacity, for faster diagnosis and treatment to improve patient outcomes.

At this point I want to praise the rapid diagnostic centre in Neath Port Talbot Hospital. It's a great example of how to use diagnostics at an early stage, and it's working well, with patients being referred by GPs upon suspicion of a possible cancerous condition, when a red flag is raised through non-specific symptoms. I visited the centre last week to see the fantastic work the team is actually doing in diagnosing cancers at an early stage. But it does two jobs. Whilst it can diagnose a cancer at an early stage, it can also reassure those who do not have cancer at an early stage as well. And we have seen a reduction for that team from an average wait of 84 days to an average wait of six days. What a dramatic change. And it's a primary-led function.

Now, as the motion states, early diagnosis is key to improving cancer survival rates, and we know that there are certain cancers that are more difficult to diagnose. We've mentioned them already: ovarian and pancreatic are just two examples of those diagnosed at a later stage. For the eight most common cancer types combined, survival is more than three times higher for those that are diagnosed at an early stage, compared to a late stage diagnosis. Diagnosing people at the earliest stage is critical to giving patients the best chance of survival. One of the major factors behind how likely someone is to survive lung cancer, for example, is how early they are diagnosed— 

Will you take an intervention?

I will.

Thanks for giving way. You mentioned that some cancers are harder to diagnose than others and it's reminded me of a constituent's case that Angela Burns, our health spokesperson, has been involved in with me as well. The constituent that we saw, his wife sadly died of ovarian cancer; I don't think it was diagnosed until stage 4. Certain cancers like ovarian cancer are incredibly difficult to diagnose because they masquerade as other conditions quite early on, whatever those might be. So, would you say that—I'm delighted that you're bringing this debate forward—part of this means that the Welsh Government does need to look at some of those cancers that are harder to diagnose and maybe look at some of the evidence out there, particularly algorithms, for instance, which my constituent was looking at with an expert in Cardiff University, which can make that diagnosis process a lot easier so that you can get to these cancers a lot earlier?

I fully agree with Nick. Ovarian cancer is an example of where it is difficult, and very often, we find that patients with ovarian cancer are diagnosed at stage 4. Friends of ours were similarly in that position and unfortunately, she passed away. It is a situation where we have to address how we tackle the hard-to-find cancers. And I was just about to highlight one example of such a hard-to-find cancer, but it is important that we put the emphasis on that as well to ensure that we look at new and innovative measures and techniques that'll do that. I'll give one example, because one of the major factors about lung cancer is that 27 per cent of lung cancer diagnoses are made at the earliest opportunity—27 per cent—so that's three quarters that aren't, which means that three quarters are diagnosed at stages 3 or 4.

Now, the publication, actually, only this year, January 2020, of what is known as the NELSON study—a study undertaken between researchers in the Netherlands and Belgium—confirmed that evidence supported that targeted lung cancer screening can actually help identify it sooner. Now, it's new and it's a pilot scheme that is being operated, but perhaps we in Wales could take on such new, innovative schemes such as this where there has been research that has shown that, actually, this is an approach that can work. And this approach is actually early screening by CT scanning. That is one of the ways that are suggested are better; we used to do it by x-rays, but now CT scanning can actually do it better. Could we look at a pilot approach and at that example and take it on in Wales, and be leading on tackling the situation, be leading in the UK and be leading in Europe, looking at how we can use innovative techniques and modern technology to actually help us do that early diagnosis? I'm sure that we're going to find similar areas, whether it be ovarian, pancreatic and others, that have very late diagnoses as well.

So, since the introduction of the cancer delivery plan, the Welsh Government announced in 2018 its decision to implement a single cancer pathway, which came into operation in June last year. As a result, every Welsh health board is now developing a plan to ensure that the majority of their patients, from the very first point that cancer might be suspected, receive cancer diagnostic tests and start their treatment within 62 days. Equally, for those patients who do not have cancer, they will be reassured promptly, reducing unnecessary stress and worry for those individuals and their families. The single cancer pathway is the culmination of more than three years of work to change our health boards' identifying and reporting of cancers, and to improve patients' cancer experiences. For the first time, health boards record how long patients wait from the point when cancer is first suspected regardless of the way they enter the healthcare system. The next cancer strategy must build on this to identify areas of improvement under the single cancer pathway to diagnose and treat as many patients as early as possible. So, we have started, but we need to do more.

Additionally, we need to ensure that the screening uptake is improving. Now, cervical cancer is clearly one that we often talk about, or maybe not in this case, and we should do more. But when the Jade Goody effect took place, we saw a surge in screening requirements following her death. Unfortunately, that has now waned, despite the tremendous work of cancer charities, such as Jo's Cervical Cancer Trust. We must ensure that these vital tests are taken by all those who are eligible. Cervical cancer screening every five years has led to a 70 per cent reduction in deaths from cancer. So, we need to do more to undertake and get screening accepted by wider people. We often talk in this Chamber about bowel cancer screening and the low take-up on that and the high take-up on breast cancer screening. We need to press this and a strategy to address this far more.

But we can do more by moving with the times and using technological advancements for the benefit of patients, and ensure that all have access to the most up-to-date and most accurate test to ensure that those who are affected by cancer are treated swiftly and in the best manner for their diagnosis.

Dirprwy Lywydd, I'm watching my time and I'll make sure that Angela has sufficient time to respond. So, I'll close a little earlier than I would have, but I want to close by reminding Members of the fantastic workforce we have in the NHS here in Wales. It's a workforce that works tirelessly to ensure that all patients have the best experience, no matter what their diagnosis. But we must recognise the pressures they're under. One of the things that we often heard in previous questions on the current cancer delivery plan was identifying the key worker in this whole thing, because that key worker is crucial to the patient and to the outcomes for that patient. Again, we must support both the patient and the workforce because they support the patient, and we must support the patient during diagnosis, during treatment and after treatment. Let's not forget when they survive as well. I look forward to the contributions this afternoon, Dirprwy Lywydd. Diolch yn fawr iawn. I hope that Members will support this motion.

I just wanted to pick up on that idea of innovation in all this and mention the rapid diagnosis centre at Neath Port Talbot Hospital, which I visited a couple of weeks ago—I know that David has as well—and to thank Helen Gray and Dr Heather Wilkes for the time they've given us there. They're pretty inspirational women, I've got to say. This facility just shows what you can do if you have the resolve to do something rather than just being presented with an expectation. I think it's worth mentioning as well that, certainly when I was there, we met a Macmillan doctor as well, and it was this getting all the medics in one room together, right at the beginning of a patient's journey, that seems to be the key factor in what turned out to be a completely surprising service.

I call it a surprise because it is a primary care service through which it takes just five to six days to diagnose and instigate the first steps to appropriate treatment. And that's to compare with what was there before, which was a process that took over 80 days to diagnose and instigate. Just think of the uncertainty and the worry for those individuals waiting for those 80 days, let alone considering the disease progression, which is to do with early diagnosis, of course. All that is swept away if you can get all this sorted within one week. Even if the diagnosis is one that you fear, you get that assurance very early on in the process that it might even be possible to survive this and to believe that early on.

The centre was opened just two and a half years ago to take action to reduce Wales's rather unhappy record on Wales's outcomes. Even within the developed world, the UK as a whole really, but Wales particularly, was quite some distance behind some much poorer eastern European countries. The Wales cancer network bid for a pilot after spotting a really good idea in Denmark, which was to do with vague symptoms, which we were mentioning earlier, and how those were treated there, which had resulted in early diagnosis and an impressive result on lowering mortality as well.

The key to Denmark's success lay in their different attitude to vague symptoms. So, to compare, in Wales where GPs refer a patient on with very common cancer signs, they will start on the familiar cancer pathway that we already know about. However, where those symptoms aren't so obvious—David Rees has mentioned a fair few of those—where they're not conclusive, those cases get downgraded in the system so that even when a GP has a gut instinct that an individual has cancer but no definite symptoms, they get lost in the system much more quickly. In Denmark, through setting up—I'll just call it a vague symptoms clinic, if you like. Thirty per cent of the people who came through those doors were there because of a GP's gut instinct, and I think that's something worth considering as we move more closely towards technology in healthcare. Because artificial intelligence may be able to do an awful lot of work with the discovery of those 50 per cent of cancers that present without prominent symptoms, but patients need to get into the system in the first place. They need to get that referral in the first place from a GP, even to get—

Will you take an intervention?

Yes, I think I've got time.

Thank you. I think, what you're talking about, it really is important, because people who are generally well are amongst the worst. I think of our colleague Steffan Lewis, who was a very fit and well person. It's only when he got very seriously ill, at stage 4, that he was diagnosed. Getting it early is so important.

Well, I can—. You pick perhaps one of the saddest examples of precisely that point there, Mike, because people will feel just unwell at various points, and just think, 'Oh, this must be a passing virus' or whatever, rather than taking this opportunity to get into a system that might actually save their lives.

One good thing as well about this system that they've got in Neath Port Talbot, apart from the fact that you get called in, is you get tested and you get your results interpreted and a diagnosis made within a week—a week, imagine that—and that's done because we have radiologists and nurses and GPs, perhaps other relevant medics, in the room right early on in the process. That's what seems to be the key to unlocking the delay problems, as I say. The fact that they're being done in such short order in Baglan—why on earth can that not be done elsewhere? Because, again, you know, I just draw that distinction between seven—well, six days actually—and 80 days. If it can be done there, why on earth can't it be done anywhere else?

Of those who are discovered to have cancer at whatever stage, 85 per cent of them will get their primary cancer identified within that six days. That's amazing. Not all people presenting with vague systems, of course, end up having a diagnosis of cancer. At the moment, it's about 11 per cent in addition to the more obvious cases. But for every one of those people, it's an earlier diagnosis and a route to treatment—a faster route, I should say—than anywhere else in Wales.

I just want to finish—. Will you give me a little extra?

You carry on, and I'll tell you when you—.

That's great. Thank you. 

This does pick up other diseases as well, which then get differently treated, but also more urgently. But the one thing I wanted to bring to bear on the Deputy Minister is that this short road to diagnosis is considerably cheaper than the long one. It costs £500 to get this six-day diagnosis and referral to treatment, and five times that much on the 80-day road. So, if that alone is enough to persuade you to start rolling this out across Wales, then I hope it's done its job. Thank you very much, Dirprwy Lywydd.

I'm very pleased to take part in this debate. Can I commend David Rees, leading off in this debate—a very important issue, and I agree with all parts of the motion—and just make three basic points in terms of, obviously, as David outlined, we need a new cancer strategy this year now to take over from the current cancer plan that's coming to an end? That's a given, I would have thought, although we would like to see confirmation of that. World-wide experiences recognise countries have to have a cancer plan, so let's make sure we have one going forward, because the current one stops this year.

The second point I would make is that lots of this is to do with diagnostics—the most recent developments, they tend to be expensive but they're good—and also workforce elements. Obviously, with the health committee, we've done several reviews over the last few years that have highlighted workforce concerns. We don't seem to have enough staff in whatever specialty, from GPs upwards, but particularly diagnostic staff as well—not just the lack of kit, now, but the lack of diagnostic staff. We saw that with the endoscopy review that we did. There are not enough specialist endoscopists. They don't have to be all medics; specialised nurses can do that. But whoever has got the endoscopy in their hands, we need more of them to be able to diagnose cancers, be they early or late.

And, obviously, it is important—. Sorry, Huw.

The Llywydd took the Chair.

Dai, thank you for raising that very important issue. Would you note, in amongst this, the fact that one in eight of the population now are likely to be diagnosed, particularly as they age in years, with prostate cancer, and the work of Prostate Cymru, which actually works on that issue of diagnosis with medical professionals of all types at all stages of their career, to actually make sure that they're not only aware, but they're aware of how to actually do the diagnosis correctly—so, working with students and consultants to upgrade their urological knowledge so that they can do that diagnosis? Practical things like that really matter.

Absolutely. And there are some exciting things going on. You know, it's exciting times to be both a specialised medic, and a nurse as well, these days. It is an absolutely exciting field, in the diagnosis, the management and in the treatment of cancer. But, obviously, there are lots of challenges, and that's why we need a new cancer strategy going ahead, because one of the big issues as regards early diagnosis is uncertainty. This new rapid diagnostic centre in Neath Port Talbot is absolutely transformational, because, prior to that, as GPs, we needed to have at least one red-flag symptom. You'd come to see me, you'd have to have either rectal bleeding, pronounced weight loss, anaemia or specific pain to tick a box—that's a red flag—to justify a two-week referral. Even if I had a gut feeling that there was something dreadfully wrong with you, but you didn't have one of those tick-box things, I couldn't refer you within two weeks. Obviously, you end up having a cancer then, and people look back saying, 'Ah, those GPs—rubbish.' Daily Mail headlines: 'They just can't diagnose people in time'. But we couldn't, we were not allowed, to refer within the two weeks unless there was a red-flag symptom.

If I thought you were ill, yet you didn't have a red-flag symptom, I couldn't do anything about it. Now I can. That's the beauty of this rapid diagnostic centre. It realises and it makes much of that gut feeling that we've always had as GPs. You know, by and large, after we've been in general practice for quite a while, we can tell whether there's something wrong with you, basically because we've known you for years—No. 1—and even though your symptom might not come up on some chart as being a red flag or the blood tests haven't changed yet, 'You don't look right', and that justifies—. That gut feeling, for the first time, has enabled us to make an urgent diagnosis. That is the leap forward that we've been asking for for years in GP land, to get early diagnosis. It's absolutely transformational.

Because ovarian cancer—we talk a lot about ovarian cancer—one of the earliest symptoms for that is bloating—bloating. Well, most of the adult middle-aged and elderly population are bloated at any one time. Yes, I could refer you all, but that wouldn't help the diagnostic rates of early ovarian cancer. But there's something additional with ovarian cancer—you are non-specifically not looking well to me, and I would get you seen. And it's only recently have we as GPs in the Neath Port Talbot area had that ability. We need it all over Wales, because in other places we're still waiting for those red-flag boxes to be ticked. We need that service now rolled out and we need a new cancer strategy. Diolch yn fawr.

I'd like to thank David for bringing forward this extremely important debate. As a cancer survivor, I can attest to the fact that early diagnosis saves lives, because, without an amazing consultant, backed up by a team of nurses and diagnostic staff at Neath Port Talbot Hospital, I would not be here today. Because having had a mammogram, after which I was dancing out the door because they said there was nothing that had shown up on it, an eagle-eyed consultant called me back and said, 'Can you come back, because something just doesn't seem right, even though it is clear?' And this was because the tumour I had in the breast was a translucent tumour and couldn't be shown up then at that time.

So, I'd like to thank that eagle-eyed consultant for saving my life, as well as all the friends, family and my fiancé then, who has now become my husband—we had a wonderful wedding to celebrate that, and Suzy Davies can vouch for what a happy, wonderful occasion that was, and a celebration for surviving cancer, Suzy, as you can say. So, I thank everyone that was involved in helping me to recover, and it's been 13 years since, so I think this should give an awful lot of people confidence to go forward in the early stages.

Unfortunately, not everyone is as lucky as me, and I don't take any day for granted. In Wales we see just under 20,000 people diagnosed with cancer each year, and, sadly, only 50 per cent of those diagnosed with cancer survive more than 10 years. We perform poorly for cancer survival rates compared with other nations, which is why it is vital that we have a comprehensive and ambitious cancer strategy that addresses our shortfalls in the route to early diagnosis.

Early diagnosis is essential for long-term survival and detecting cancer early enough means that survival rates are around 90 per cent. Late diagnosis results in those rates dropping to under 10 per cent. We have an amazing opportunity to do something about that, but changes won't happen overnight. The current cancer delivery plan comes to an end this year, and we can therefore ensure that its replacement is more ambitious, meets the needs of more patients and improves survival rates. There have been amazing developments in cancer diagnostics, such as multiparametric MRI for prostate cancer and the faecal immuno-chemical test, or FIT, for bowel cancer. Both of these improve detection rates and therefore aid early diagnosis, but, due to staffing shortages and regional variation, they're not as effective as they could be. In the case of MPMRI, not every health board provide an MPMRI with dynamic contrast enhancement.

My husband went through two invasive and painful biopsies, twice contracted sepsis and twice went through weeks of painful recovery to try and stave off the increase in sepsis diagnosis, if you like. My husband was told that he had prostate cancer. The words used were, 'It is definitely malignant', after the MPMRI scan, 'and it is located in the right-hand side of the prostate'. Now, nearly two years later, we are still unsure whether he has cancer because, after yet another biopsy, we were told good news—it's not cancer after all. So, he is still going through the diagnostic stage, which—. This is almost—I think it's 18 months to two years now. Sadly, his case is far from unique.

So, we have some slow progress, but efforts are hampered due to a lack of trained radiologists. The Welsh Government have put more money into improving MRI provision, and have created a Welsh imaging academy that will lead to improvements, but does little to improve survival rates in the short to medium term. The lack of strategic workforce planning has also impacted bowel cancer survival rates. The new FIT test has the potential to revolutionise bowel cancer care, but, due to workforce shortages, we have set the testing threshold much lower than other parts of the developed world. It is therefore little wonder that, for bowel cancer, we are 25 out of 29 in Europe, behind many poorer former Soviet bloc countries.

We have to ensure that our new cancer strategy has more ambitious targets, better workforce planning, and strategies to improve screening, uptake and end the postcode lottery. After all, the statistics I have quoted are not entries on a spreadsheet—they are real people: our husbands, our wives, sons, daughters, mothers and fathers, friends and colleagues. So, we owe it to them, to every person with cancer, to do better, and I urge Members to support this motion. Thank you.

I also welcome greatly this debate brought forward by David Rees AM. It is factual that we are making real advances in this country, but it still remains the case, as has been said by many, that Wales is behind comparable countries for cancer survival, despite a decline in death rates. Late detection of many cancers is thought to be the main factor around this lag, and it has been stated by Cancer Research Wales that late diagnosis is both complex and multifactorial, and can result from the lack of awareness of symptoms, patients embarrassed to see their GP, or, commonly, having to make several visits over a large period of time before the GP refers the patient for specialised examination. The red flag system, as has been mentioned by Dai opposite, will aid that medical profession doing that particular task.

The Welsh Government and its health Minister, Vaughan Gething, have understood the importance of this area of delay and also will act to address this very real challenge. The important single cancer pathway introduced in June 2019 as a new metric to measure cancer waiting times will also be an additional factor. But it is imperative that we do build underlying systems and diagnostics within the single cancer pathway to diagnose and treat as many patients as early as possible, and a new cancer strategy, as has been outlined by many, will supersede the current delivery plan—it's a point in time where we could focus on and emphasise this critical early diagnosis as well, and, equally, specialised workforce planning and training around specialised cancer routes, for example, endoscopy and many others.

The new focus on prevention and early diagnosis will be key in catching symptoms of disease early, treating early and improving survival rates, and the new treatment fund and the implementation of the specialist key worker to support cancer patients will aid and improve, again, those current survival rates. But this debate today is not about statistics. As others have stated, this is about real people, like my Dad, who was recently with early-stage bowel cancer. Due to this early diagnosis and an excellent patient-centred care plan, he is now in remission. He is lucky, and his journey must now be further replicated through all new approaches across Wales. 

The Deputy Minister, Julie Morgan. 

Diolch, and thank you to Members for bringing forward this very important debate. I think one thing we can all agree on is that cancer needs to be a priority for any Government, given the number of people affected by cancer, as David Rees said in his introduction, and of course the often devastating impact of a diagnosis and the wider impact on our NHS. 

Members will be aware that we've had a cancer delivery plan in place since 2014. This has a significant focus on earlier detection, and we have for some time met the World Health Organization's call for its members to have in place a cancer control programme. But you will be aware, and several of you have referred to this today, that a number of national disease-specific plans are due to come to an end in December this year, and we've been giving significant attention to what should replace them. So, I am pleased to confirm today, perhaps somewhat earlier than intended, that the Minister has asked officials to press ahead with developing a successor approach to the cancer delivery plan. The Minister has also asked for the successor approach to heart disease and stroke to be developed and, for those other plans coming to an end in December, that a one-year extension is granted in order that we can phase in successor arrangements. So, I'm pleased to be able to respond to you with that information today.

An important consideration has been the development of a number of commitments in 'A Healthier Wales' that have implications for how we approach improving outcomes for major conditions such as cancer. These include the development of the NHS executive, the national clinical framework, the quality plan and the introduction of quality statements. It's very important that these commitments link together robustly in the context of cancer so that we can deliver improvements in services and outcomes at a greater pace and with greater impact in the years ahead.

It will be the case that the successor approach to the cancer delivery plan will have an enhanced focus on the earlier detection of cancer. The current plan recognises that earlier detection is likely to improve survival—and lots of Members have made that point today. The two key components of this primary care referral practice and access is access to diagnostic care. We have significant amounts of activity in place targeted at these two components, but we want to go further and faster in the years ahead. It's been very pleasing to hear the praise of the Neath Port Talbot rapid diagnostic centre here today, and the dramatic drop in the waiting time. 

We also want to ensure our screening—

Just on that particular point, we've heard how successful that particular diagnostic hub is. I'm sure you'd agree with me that it would be great to have more of them, especially in north Wales. Will the cancer care plan—will that be looking at that particular aspect as well?

There will be an enhanced focus on the earlier detection of cancer. That is going to be part of the new plan. 

We also want to ensure our screening programmes are optimised. Many people have mentioned the screening programmes here today. I accept that more needs to be done to encourage those who are eligible for screening to take part. Public Health Wales has a dedicated screening engagement team, whose role is to raise awareness of screening and promote informed choice. 

It's important, I think, to remember that the target uptake for each screening programme is not a target for the number of people we'd like to see screened; these are standards that the programme must achieve in order to be viable and provide overall public health benefit at a population level. Obviously, taking part in screening is a matter of individual choice, because screening is for people who don't have symptoms of the disease, and nearly all participants won't have cancer who take part in screening. So, it is important for each person to consider the balance of potential benefits and harm from having a screening test and any subsequent investigations and treatments. We must always be mindful of the potential for harm and particularly the need for robust evidence of overall benefit when considering the introduction of any new screening programmes, but we have had significant successes in screening in Wales.

Breast Screening Wales was the UK's first fully digital mammography service. We're also the first UK country to introduce the more accurate human papillomavirus test into the cervical screening programme, and uptake has since increased to 73 per cent. We've also fully rolled out, as Caroline Jones said, a more accurate test for bowel screening, and will this year take the first in a series of steps to optimise the programme in line with national guidelines. Uptake has improved to 57 per cent, and I'm hopeful that we will meet the standard of 60 per cent for the existing age cohort. 

Our ambition remains to deliver cancer outcomes that are comparable with the best in Europe. We have made significant progress in recent years in outcomes and in service delivery, and I would like to point to the—[Interruption.] Yes, certainly. 

That's very kind. Caroline Jones also made reference to prostate cancer, and during business statement yesterday, in calling for a statement, it was suggested I raise this with you during this debate today by the Trefnydd. 

Prostate Cancer UK have used freedom of information to access data on the current situation. Three of the seven health boards in Wales have not yet introduced services equivalent to the National Institute for Health and Care Excellence recommended standard for multiparametric magnetic resonance imaging scans. There is a plan to have that in place across Wales by 1 April, but they say that radiology units will need resources to enable them to do that. I wonder if you could comment in light of Caroline's comments and that data from Prostate Cancer UK. 

I thank Mark Isherwood for raising that important point and, certainly, I will go away and look at what is causing that delay in those health boards. So, thank you for raising that. 

I would point, as I think David Rees highlighted as well, to the fact that the single cancer pathway is the standout achievement, a platform for improvement that is unique in the UK. But I would also point to the development of a new cancer informatics system, to our investment in new radiotherapy equipment, the impact of the new treatment fund, and many more things beside. Perhaps most of all, I should point out the dedication and professionalism of our managerial and clinical staff, who work day in and day out to provide excellent patient care. 

I think the important point in terms of today's debate is that we ensure that we build on the success and momentum built up in recent years—a lot has been done, but there's a lot more to do—that we realise the potential of what has been developed through the cancer delivery plan, and we go even harder at the systemic issues that hold back our cancer outcomes. This means, as has been repeated in this debate: prevention, earlier detection, high-quality care, better service planning and workforce provision, as well as new service models and harnessing the potential of geonomics, digital and research. 

So, the Minister and I do look forward to updating Members further on progress later in the year, but once again thank you very much for bringing forward this debate to give us the opportunity to discuss these very important issues. 

Angela Burns to reply to the debate. 

Diolch, Llywydd. I'd like to thank everyone who took part in today's debate, and I'd particularly like to thank David for drawing us all together, cross party, to make representations. I think we have to be crystal clear about that word 'cancer', it is something that still today strikes fear and panic in most people's hearts. We still see it as 'the big C', the thing that can come out and get us. And yet, as both Caroline and Rhianon very clearly have shown, there are opportunities out there, there are success stories, there are pathways that lead to better outcomes than we used to have. So, it's not just a gloomy story; there is real progress being made.

I would just like to give a quick shout out to some of the researchers that we have at Cardiff University. I would particularly like to name Professor Andrew Sewell and the Cardiff University team, because they've discovered this T-cell inside blood that has the ability to cruise around your body and go, 'Aha, that is not a good cell heading our way.' And if they can just harness it—and they think they can—then they can use it to really target in a highly specific way a wide number of cancers, in a way that the current immunotherapy can't do. And so, we've got great scientists here in Wales who are really working on positive outcomes for Welsh citizens, and I think that we need to, Minister, really try to support these people and make sure that they have funding. 

I'd also like to briefly talk about immunotherapy, because it is one of the modern medicines. Dai, in your contribution, you referenced modern techniques, modern medicines, but unfortunately you can still have situations where the National Institute for Health and Care Excellence will say you can only access immunotherapy once you've gone through chemotherapy. Then, your consultant will say things to you like, 'But I can tell you now, because you've got a very nasty bladder cancer and we've only just discovered it and you're T4, you've got to go through the chemotherapy to get to the immunotherapy, which can probably prolong your life, but the chemotherapy's not going to do anything for you.' That's nonsense. We need to really work on that, so that if there's something that can help somebody they get access to it without having to jump through a useless, painful hoop of chemotherapy. So, Minister, I'd be very grateful if you might take that one away as well and talk about it. 

I was delighted with your response about the cancer delivery plan. This is wonderful because, actually, the questions I was going to ask you were about the NHS exec not being formed; were we going to have to wait; what was the gap; and of course coronavirus pulling officials away to concentrate on this and not being able to concentrate on that. So, it's very good news, not only that the Welsh Government's going to start it, but, actually, that it's also applying to the other delivery plans. And those that you haven't been able to work on yet will be extended for one more year. I think that gives real comfort to people. 

There were some great contributions. Dai, again, you made that point about the rapid diagnostic centre, and about the fact that GPs who have trained for years and years and years, and then have loads and loads of experience in their clinics, don't get that kudos; they don't get that, 'Right, Dai Lloyd, if you say that this person needs to be looked at, I'll go and have a look at them.' It's this form filling, red box ticking. But a rapid diagnostic centre: six days, as Suzy said, as opposed to 84 days—what a difference.

And, of course, Suzy went on to look at best practice in other European countries. And not only did she make the point that that best practice saves lives because you can get in more quickly; you can get your result quicker; you can start your treatment more quickly; but, of course, when you've got that kind of NHS service offering, you've got more staff who want to come and work for you. I think you were saying that, in Denmark, which was one of the areas that they were looking at, they were actually having staff queuing up wanting to work, wanting to work at best practice. So, we can do that. We're small enough and agile enough.

And thanks to the Welsh Conservative secretary for finance, in his budget statement today, there will be more money coming to Wales. So, Minister, I would really ask that you consider deploying that extra money in things like rapid treatment. Because, again, Suzy made that point—if we can help somebody, make them well, give them a good outcome—actually, long term, it's going to save the state so much more money, and they will have a so much better quality of life. 

The other great cry of the heart was not enough diagnostic staff, and that is something we absolutely need to address: our workforce shortages. David, you made that point with passion and conviction, and it's very, very key. So, again, Minister, I would urge that, when you go back from this debate, you work with Health, Education and Improvement Wales and that they really plan the shortfalls that we have. 

I'm very keen to end, because I'm sure the Llywydd is very keen that I should end, but I just wanted to say one comment, just to put that into context. The cellular pathway workforce: 36 per cent of the consultants in Wales will be retiring in the next five years. We've got to replace them. We've got to make the plans, implement the plans, and get the new blood coming through.

So, Minister, thank you for your very positive response. David, thank you very much for, as I say, collecting us all together to debate this. But I do look forward, Minister, to you perhaps confirming back to us—and what I think we'd really like to have is a Government debate on this issue, about how we can really get to grips with something like the diagnostic workforce. Thank you.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer voting under this item until voting time. 

Voting deferred until voting time.