4. What action is the Welsh Government taking to improve access to cancer treatments following the COVID-19 pandemic? OQ56492

We published 'Health and Social Care in Wales COVID-19: Looking Forward' on Monday 22 March, and the Member's already referred to that document. That sets out the approach the NHS will take to recovering services such as cancer. We've also published a quality statement for cancer that sets out the scope for continued improvement to cancer services in the years ahead.

And this probably will be the last question I deal with from the Member, and I do want to say that we have certainly not always agreed, but I have always valued an honest and a straightforward approach, and our agreements have always been on a trusted basis, where we know where we disagree and any matters that have been shared in confidence have always been treated in that way, and I wish her well for the future.

Thank you very much, Minister. I do appreciate your words. That's very kind of you, and I would reciprocate by saying thank you for your transparency and honesty on some of the occasions that we've had to look at some of the very tough situations that are facing our health and social services.

Of course, one of the very tough situations facing us is the provision of cancer treatments to people through the pandemic. Now, Wales has been without a cancer delivery plan since the end of last year, and, on Monday of this week, the Wales Cancer Alliance, who were hugely unimpressed with either your quality statement or your COVID-19 forward work programme, starkly warned that cancer care in Wales is at risk without a new cancer strategy. The delivery plan that you had was 21 pages long and it's been replaced by a statement that's around three pages long. I've had a read of it; it's full of nice commentary and very much little else. To quote the cancer alliance, 

'the quality statement lacks a clear roadmap for how cancer care can improve so that Wales can catch up with the best performing countries and, ultimately, save more lives.'

Most damningly, they go on to say that they do not believe

'this is a sufficiently detailed response to the current crisis in cancer care, nor does it point to a sufficiently bold ambition for cancer services in Wales.'

Minister, you talked about having a real ambition for Wales in your answer to Rhun ap Iorwerth, so can you please tell us a little bit more of what is that real ambition for cancer services, and how do you respond to this rather damning indictment of your Government's plans to treat cancer over the coming years, if you should be so fortunate as to form the next Government?

Well, we have actually already started on the path of improving outcomes for people with cancer. If you look at not just the numbers but improving outcomes in Wales, we've kept pace with other parts of the UK, and, bearing in mind that Wales is an older, poorer part of the UK, you would expect to see a potential gap in that improvement in outcomes. That shows the progress we've made. You'll also be aware of the choice that I have made to have a more transparent approach to understanding where we are on delivering people the care they need with the new single cancer pathway, and I think that will lead to improvements. We've worked on that with both cancer clinicians and the Wales Cancer Alliance.

We signalled in 'A Healthier Wales' that quality statements would be the next stage in making sure that separate delivery plans are sat within the centre of accountability, planning and progress within our organisations. So, the quality statement sets out the outcomes and expected standards that we will see. It's not intended to be a delivery plan, an operational plan in itself. There will, though, be an implementation plan developed in the coming months, with the Wales Cancer Alliance and clinicians contributing and taking part in that. The NHS exec will then ensure that that is delivered in the central part of where health boards deliver as well. Part of our challenge was in having a separate plan, separate to the other planning and implementation processes within the health service. This will make sure that cancer services are in the centre of that, and clearer accountability. So, you can expect to see the implementation detail from health-board level plans, from Velindre plans, and also from national oversight as well. So, you'll see two parts in taking this forward to replace the previous delivery programme, and I believe that will reinforce the ambition we all have for high-quality cancer care, and I believe that will be a trusted way to deal with the improvement we all want to see in cancer services and outcomes.

Minister, I heard what you just said, but I've got a constituent who has contacted me who has suffered with breast cancer, has now been diagnosed with secondary breast cancer—she's not yet 30—and has indicated her disappointment at the quality statement, because she indicates that there is no real data on people living with secondary breast cancer in Wales and there's only one specialist nurse on secondary breast cancer in Wales. Now, I've read the quality statement, and as you quite rightly pointed out, there is a reference to a rolling implementation plan to be developed—a three-year rolling plan. But, I suppose people want to know exactly what that means. So, when can we get exactly the detail of that plan so that people understand what delivery will be required by the health boards? And also, in the quality statement, it talks about the workforce, but the report from the cross-party group on cancer highlighted the concerns about the workforce; when can we have a detailed plan on how you're also going to implement and increase the workforce to ensure that these delivery services are there and working for the people?

Well, I think you're asking a number of different questions there, so I'll try to deal with where we are with the implementation plan first and its relationship to the cancer quality statement. The implementation plans will have to set out how they'll meet the outcomes and standards that we have set out in the quality statement, and that's the point. So, every health board will have to set out how they're meeting those expectations and the NHS exec will also have a role as, if you like, the central guiding hand that the parliamentary review called for, and we set out our response in 'A Healthier Wales', the long-term plan for health and care. So, that's the path that we're on and you will then see that framework and it will be open, because health boards will need to publish what they're going to do.

We'll then also have greater transparency and data from the single cancer pathway and the figures that we'll be providing on each stage. Cancer is a multifaceted challenge and it cuts across a range of other areas of treatment. So, when we talk about the workforce, it's not just the cancer workforce, because many of the surgeons we're talking about also undertake other surgery and the diagnostic workforce we're talking about undertake other diagnostics as well. For example, the centrally directed improvement programme on endoscopy, that will definitely benefit cancer services, but a range of other services too. So, I think sometimes it's difficult just to say that there is only a cancer workforce. We, of course, need to think about areas where we want to see continued improvement that are more specifically cancer, but it also affects the wider service as well.

I'm confident that, when you and I stand on a manifesto to seek re-election to this place, there'll be plans within there about reinvesting in the workforce and having more of our staff—taking account of the record-breaking levels of NHS staff we have already—that I believe will set out a pathway to continue the improvement in cancer services that we've seen over this last term, and to address the real and significant backlog that has built up in cancer services and the rest of our NHS, as a necessity in our response to the pandemic in this last year and more.