We now move to the short debate. I call on David Rees to speak to the topic he has chosen. David.

Diolch, Dirprwy Lywydd. Thank you for that. Clearly, this debate comes at a time when we've just finished a debate talking on a very similar topic, but I do not apologise for that. I did hear the Minister and I'm sure I'll hear some of the same answers again, but I think it's important we address this particular issue.

Every single one of us has been touched by cancer in some way, either ourselves or a loved one. It's hardly surprising when you consider that one in two of us is likely to develop cancer at some point in our lives. Every year around 19,300 people are diagnosed with cancer in Wales, and sadly there are around 8,800 cancer deaths. It's Wales's biggest killer, and continues to have a tremendous impact upon many people. However—. Sorry. When I spoke to the Minister—. My apologies, Dirprwy Lywydd. There is reason for optimism, however, because cancer survival has doubled since the 1970s, so that today, around half of us survive our cancer for 10 years or more, but we know that we can, and must, do better. International studies like the International Cancer Benchmarking Partnership continue to see Wales perform poorly in comparison to similar nations. If we could catch up with the best countries, many more lives could be saved.

When I spoke last in the Senedd about cancer, the world was very different. I spoke in person, rather than via technology; I was able to sit in close proximity to friends and colleagues when having a meal. Now, in a post-pandemic world, we have seen many changes to our daily lives to that we would have been doing only months ago; now no longer a responsible action to take. However, cancer hasn't gone into hiding during this pandemic. Just like the virus, it remains a threat to our health. Likewise, the approaches we take to treat cancer haven't changed, and the importance of early diagnosis hasn't changed either. The impact of COVID-19 has had a very serious, very real impact on thousands of people's cancer, and they may not even know it. Last month, Macmillan Cancer Support released a very stark report on the impact of COVID-19 on cancer care. It highlighted that during the peak of the pandemic, there were 31 per cent fewer patients than usual entering the single cancer pathway. Data from Cancer Research UK shows that for March 2020 to August 2020, there were around 18,200 fewer urgent referrals for suspected cancer from GPs in Wales, with the biggest fall in urgent referrals occurring in April—the height of the lockdown—when the number of referrals was 63 per cent lower than in April 2019. 

The latest cancer waiting times released from 19 November show that around 7,100 people diagnosed with cancer started treatment between April and September in Wales—a figure showing approximately 1,500 fewer people than in the same period the previous year. The same data identified that only 74 per cent of patients with an urgent referral for suspicion of cancer received a test and started treatment within 62 days in September, the target being 95 per cent. This compares to 80 per cent of patients with an urgent referral for suspected cancer starting the treatment at the same time last year. And lung cancer has been the slowest to recover, with regard to the number of urgent suspected cancer referrals—an almost 72 per cent drop in April, still down to a 26 per cent drop in August. Between March and August, the pausing of cancer screening programmes across the UK meant that 3 million people weren't invited to one of the three cancer screening programmes—bowel, breast, cervical. Modelling by Cancer Research UK suggests that every month, 55,600 people would normally be invited to take part in one of these three cancer screening programmes in Wales, leading to the diagnosis of at least 80 cancers, plus additional pre-cancerous changes detected and treated. Now, 40 per cent of Welsh respondents reported that cancer testing they would usually expect was delayed, cancelled or altered. About 27 per cent said that their cancer treatment was affected.

Like other Members, I have heard many experiences of people whose cancer tests and treatments were in some way affected by COVID-19. It has caused considerable anxiety and, most worryingly, concerns that cancer survival could be negatively affected. During the first wave of the pandemic, the number of people waiting for a diagnostic endoscopy increased from around 11,900 by the end of March to around 15,700 at the end of July. As we all know, early diagnosis is critical to improving cancer survival in Wales. For example, when bowel cancer is diagnosed at stage 1, over nine in 10 patients survive, but this drops to fewer than one in 10 if it is diagnosed at stage 4. It is estimated that this will lead to a backlog of approximately 2,900 missing diagnoses over this six-month period. It is vital that we increase cancer diagnostic capacity to at least the level it was pre-pandemic, in order to avoid too many patients entering the pathway but having to wait for diagnostics, which will—[Inaudible.]

I think we're having some problems with your connection.

[Inaudible.]—will still have those symptoms, which could be cancer. The worry is that when they do present, if identified as cancer, their diagnosis would be for a later stage, and a less treatable cancer. Reducing this backlog as quickly and safely as possible will add further strain to the diagnostic services. Additional capacity and plugging the workforce gaps is urgently needed.

Dirprwy Llywydd, last week the cross-party group on cancer here at the Senedd published a report on cancer waiting times that it initiated prior to the pandemic. Following the first pandemic peak, the initial inquiry terms of reference were expanded to include an understanding of the impact of the pandemic on cancer diagnosis and treatment. The report initially sought an assessment on the single cancer pathway, and it is still important to keep sight of the single cancer pathway as an intrinsically positive measure. Resuming the single cancer pathway reporting would present an opportunity to restart and reset, particularly for those conversations on where improvements for diagnostic pathways can and should be made.

I very much welcome last week's announcement by the Minister to reintroduce the single cancer pathway, along with a target figure that health boards must achieve. This is clearly a positive step in the right direction. However, I am calling for the Welsh Government to accept all the recommendations from the report, and in particular prioritise cancer care and treatment by providing additional resources to cope with the backlog. The report calls for a COVID-19 cancer recovery plan to be published, detailing how the Welsh Government will support improved delivery of cancer services, and, in particular, how diagnostic services would be supported to reduce the cancer backlog that does exist. This could require COVID-secure green sites to shore up capacity and maintain services, although I do recognise the comments that the Minister made in the previous debate that there is no guarantee of COVID-free sites due to the nature of this virus.

Adequate COVID testing for staff and patients is necessary to sustain such sites and keep them as COVID lite as possible, and to give confidence to patients. Alongside this, a wide-ranging mass media communications campaign is needed to encourage people with concerning symptoms to seek help from a GP. And I know, again, that the Minister has indicated that they'll do that and they've agreed on it. It is needed to encourage people with those symptoms to continue seeking help from their GPs, as well as to provide reassurance that people can be seen and treated safely. A post-COVID recovery plan for cancer services is essential to tackle the short-term situation, but it is also critical that this acts as a forerunner for the longer term transformation that is required for cancer diagnostics.

The cancer delivery plan for 2016 was meant to end this year, and while Welsh Government have announced their intention to develop a successor to this plan, no further detail has yet been forthcoming. Now, I do appreciate that the pandemic has taken priority for officials and that a new delivery plan must now also consider how it would build upon both the existing delivery plan and the recovery plan. However, we urgently need a new comprehensive cancer strategy, with the single cancer pathway as a central component, which will be essential to drive the transformation agenda forward at a time when it's been recognised by the Minister that we are unlikely to see waiting times for many services return to pre-COVID levels for many years. 

I do not hide from the fact that the challenge facing cancer services is immense. There was a clear need to improve cancer diagnosis, treatment and cases before the pandemic hit. No-one will dispute that COVID-19 has set us back further. Therefore, a new cancer strategy needs to be bold and ambitious in tackling these challenges. Minister, like all my colleagues, I want to ensure that the NHS and local health boards are supported by the Welsh Government in meeting these challenges. The coronavirus has gripped the country and caused strain on our front-line health workers, but unfortunately, diseases like cancer continue to appear through a wide variety of symptoms.

We must all remember that patients suffering from cancer or the possibility of a cancer diagnosis require emotional support also, as treatment of the disease. We need to support our local health boards to take steps to ensure that these personalised principles remain at the heart of cancer care. All cancer care, both of the physical and mental health agendas, needs to be ring-fenced and remain untouched when considering workflow and staffing arrangements.

Finding cancer early means treating cancer early. To everyone across Wales, do not ignore your symptoms, please; do not fear visiting your GP; do not hesitate in seeking help. I wish to remind you that there are many resources, both online through the NHS website and others, to aid you in your decision to go to the doctor. You will not be wasting the NHS's time by having your symptoms diagnosed. The NHS is there to support you through diagnosis, right through to treatment. If your new symptoms do not go away, you do need to see your doctor, and write down changes that have occurred or questions you might have so that you are clear in the position.

I'll conclude my contribution today by expressing my everlasting gratitude to those staff across the NHS in Wales whose tremendous efforts have sought to maintain cancer services as much as possible in the most difficult of circumstances that they've probably ever faced. The past eight months have been like no other for them, and without their hard work, their dedication to their patients and their continued commitment to delivering positive outcomes for those patients, the adverse impact on cancer patients would have been even greater. So, together, let's ensure that our NHS is supported; let's ensure that our cancer support services are supported; and let's ensure that we support each other in getting that early diagnosis. Diolch.

Thank you. Can I call on the Minister for Health and Social Services to reply to the debate? Vaughan Gething.

Thank you, Deputy Presiding Officer, and thank you to David Rees for tabling this short debate.

I welcome the work of the cross-party group and its report that was published last week. The report sets out the challenges facing cancer care and outcomes in the context of the pandemic. I'm pleased to see that there's much commonality between the recommendations of the report and our own intentions for cancer services. For instance, last week, we resumed reporting of the single cancer pathway, as called for in the report and as mentioned by David Rees in his debate introduction.

The commitments that we set out in 2013 and 2017 in our cancer delivery plans to improve cancer services and outcomes still stand today. We are not stepping back from that commitment. Our new approach will be published by March, given the impact of the pandemic. A significant amount of progress has been made in recent years, and I'd like to highlight the steady improvement in outcomes. Again, David Rees acknowledged that there has been an improvement in outcomes here in Wales. There are very high levels of positive patient experience. We have the introduction of the UK's first single cancer pathway and the emergence of rapid diagnostic centres. But there remains much more to do. The scale of the challenge and complexity of the changes that we need are significant.

In normal years, we diagnose around 19,000 new cases in Wales, more than 450,000 people are screened, and we investigate more than 120,000 suspected cancer referrals. We rely on our primary care providers to identify symptoms; our radiology, endoscopy and pathology services to diagnose; our surgical, radiotherapy and chemotherapy teams to treat the disease; and our specialist nurse palliative care teams and third sector partners to support and care for people during the most difficult time in their lives.

Delivering cancer services involves multiple specialities and interventions, with patient pathways across and recross organisational boundaries. This requires close working relationships, integrated pathways of care and particular attention to maintaining person-centred care. It's important that we have a shared understanding of how to improve cancer services and outcomes. We know that we need to drive down the rates of smoking and obesity to detect cancer at an earlier and more treatable stage, to consistently provide the latest evidence-based interventions and therapies, and to support people properly throughout the treatment pathway. These are fundamental aspects of our approach. They're supported or enabled by changing service models, developing a sustainable workforce and, of course, the best use of digital systems and data.

There's been genuine and close work around this agenda from stakeholders for many years in Wales, and there is much consensus about the best way forward. The challenge now is to capitalise on that in the years ahead and to make the significant improvement in outcomes that we all want to see. There is, though—and again, to be fair, David Rees acknowledges—no escaping the impact of the pandemic. The chief medical officer has been clear that the pandemic causes harm in several ways. Access to normal healthcare, including in this instance cancer care, is one of those ways where indirect harm is caused. From the very beginning, our approach has been to try to protect as much cancer care as possible. NHS Wales worked incredibly hard to do so and provide as many people as possible with the urgent care that they need. However, we have seen capacity and productivity in cancer diagnostics and treatment significantly reduced. This has meant that the number of people waiting for treatment is rising and there is likely to be an impact in terms of outcomes in the years ahead.

Among the recommendations in the report is the development of a cancer recovery plan for the rest of the pandemic. I understand the desire for clarity on a national level, setting out how many procedures need to be done, how many will be done, and how long it will take to treat those who are waiting. The reality is, though, that as soon we put those figures to paper, the pandemic changes what is possible. The difference between a well-controlled and a poorly controlled pandemic in terms of how many people it's possible to treat is a significant one. It goes to highlight where effective control of the pandemic is just as important to cancer and other urgent life-threatening conditions.

I know some have called for ring-fenced capacity for cancer care, and I do understand that, but, as we all know, and I certainly recognise, I'm the Minister for Health and Social Services and not exclusively the Minister for cancer care. I do not wish to oversee or live in a health system where the Government says, 'If your life-threatening illness is cancer, then you will be treated, but if your life-threatening illness is heart disease or something else, then your life is of less value.' That's exactly the same ethical dilemma that meant that we rejected the previous attempts to have a specific cancer guarantee that would have trumped other conditions. I do not believe that this is what cancer clinicians themselves would want to see either. So, I do want to be clear, health boards have detailed plans for the winter on how they'll balance the competing needs that they have to manage. They'll prioritise patients according to their clinical need, whether that is COVID or non COVID, cancer or non cancer. We must and will remain fair and equitable in how we use the available capacity we have to care for people right across Wales.

This Government committed, in March of this year, to replace the cancer delivery plan, as well as the heart and stroke plans, with a successor approach by December. Now, clearly, the pandemic has made that impossible. Whilst it has not been possible to develop such a detailed approach as set out in our existing cancer plan, we have continued to work with stakeholders to set out our aspirations for the next phase of service development and improvements.

I'm keen that we learn the lessons of the delivery plan approach and the pace of implementation in particular. We need to continue to evolve and build on our previous approach, rather than necessarily stick to exactly the same model. The commitment made in 'A Healthier Wales' to a national clinical framework and to quality statements presents us with new opportunities that can push the cancer agenda further and faster, and an approach embedded in these commitments would allow cancer services to benefit from wider developments and improve relative performance of disease pathways in NHS planning.

This is not a step back in approach, but, in my view, a leap forward in ambition. This would include exciting new developments around the cancer workforce and the planning of cancer services, to be underpinned by the development of the new cancer information system and the continued embedding of the single cancer pathway.

We want to double down on our work with primary care, and, more broadly, on earlier detection. There is vital work to be done through our endoscopy and imaging programmes. I want to bring forward our approach to cancer research, and realise our ambitions around holistic support, and these are all, of course, consistent with the recommendations in the cross-party report.

But it did take nine months to refresh the previous cancer delivery plan last time, and we can't afford to wait a similar length of time now before we give direction and to continue the pace of improvement. It's vital that we set out these ambitions and move quickly into determining how they'll be delivered. The scale of the challenge facing us before the pandemic was significant enough, and the case for greater pace and focus on implementation is where we now need to focus our attention.

So, once again, I want to thank those who worked so hard on the report, and, as ever, my thanks to all those people who are working right across our health and care system, in our NHS, in social care and in our third sector partners too, for all that they continue to do to meet the needs of people affected by cancer. I will give careful consideration to the recommendations in the report, and I will be happy to write and provide a full response to the cross-party group regarding its recommendations. Thank you very much for the opportunity to respond tonight, and thank you for your time tonight, Deputy Llywydd.

Thank you very much, and that brings today's proceedings to a close. Thank you.

The meeting ended at 18:57.