We move now to item 5, a Member debate under Standing Order 11.21(iv): cancer diagnosis and treatment, and I call on Mabon ap Gwynfor to move the motion.

Motion NDM7842 Mabon ap Gwynfor

Supported by Altaf Hussain, Cefin Campbell, Heledd Fychan, James Evans, Jane Dodds, Janet Finch-Saunders, Joel James, Laura Anne Jones, Luke Fletcher, Mark Isherwood, Paul Davies, Peter Fox, Rhun ap Iorwerth, Rhys ab Owen, Sam Rowlands, Siân Gwenllian, Sioned Williams

To propose that the Senedd:

1. Welcomes the Welsh Government’s single cancer pathway approach.

2. Recognises:

a) that cancer is the leading cause of death in Wales and that 19,600 people are diagnosed with cancer every year in Wales (2016-2018).

b) that the challenges facing cancer services in Wales have been compounded by COVID-19, with around 1,700 fewer people beginning cancer treatment between April 2020 and March 2021.

c) that NHS Wales cancer waiting times for July 2021 show that the percentage of patients receiving their first treatment within 62 days of first being suspected of having cancer was at 61.8 per cent, which is well below the suspected cancer pathway performance target of 75 per cent.

d) that even before the pandemic, Wales was experiencing significant gaps in the workforce that diagnose and treat cancer, such as in imaging, endoscopy, pathology, non-surgical oncology and specialist nurses.

e) that without multi-year investment in training and employing more staff to fill current vacancies, Wales will not have the frontline staff and specialists needed to address the cancer backlog, cope with future demand, or make progress towards ambitions to diagnose and treat more cancers at an early stage.

f) that the Wales Cancer Alliance criticised the quality statement for cancer, published in March 2021, for not setting a clear vision to support cancer services to recover from the impact of the pandemic and further improve survival. 

g) that Wales will soon be the only UK nation without a cancer strategy, which the World Health Organization recommends all countries have.

3. Welcomes the successful rapid diagnostic clinic pilots in Swansea Bay University Health Board and Cwm Taf Morgannwg University Health Board, and that the Wales Cancer Network has provided funding to all other health boards to develop rapid diagnostic clinics.

4. Calls on the Welsh Government to:

a) provide an update on the next steps for the quality statement for cancer, including ambitious targets and mechanisms for tracking progress investment for staff, equipment and infrastructure;

b) address the long-standing staff shortages within cancer and diagnostic services;

c) consider how the recommendations in Professor Sir Mike Richards review of diagnostic services in England could be applied in Wales.

Motion moved.

Thank you very much, Deputy Presiding Officer, and thank you for the opportunity to table this motion today, and may I thank all the other Members who have supported it? The number of Members who have supported the motion is testament to the importance of the subject.

Cancer, of course, is something that is very close to us all—far too close, actually. My father is a cancer patient, and has been since late 2019. Back in the summer, my father had the good news that the cancer had disappeared, and that he was in remission. This was a cause for celebration, of course. Then, at the beginning of the autumn, when he went back for his tests, he found that the tumour had returned.

I can attest, therefore, to the fact that the diagnosis process, waiting for results, waiting for treatment, waiting for answers when something unexpected happens is very cruel, and I can't imagine the torment that my father and mother have had to endure through this without knowing whether this terrible thing is growing faster inside him, or if it's spreading.

However, I'm not alone in living these experiences. There are thousands of patients and families in Wales living these experiences every day and, of course, there are others in this Chamber who have also experienced it, I'm sure.

We all, of course, remember the late Steffan Lewis, who contributed so much in such a short time, and he was lost to cancer.

In tabling this motion today, I want to focus on the impact of COVID on cancer services, the workforce, waiting times and diagnosis.

Just under 20,000 people are diagnosed with cancer in Wales every year, and it's now widely known that cancer kills more people in Wales than any other disease. The good news is that the survival rate for this disease is increasing, with 60 per cent of patients diagnosed between 2014 and 2018 surviving their cancer for five years or longer, which shows that treatments are improving.

However, despite these steps forward, the impact of COVID-19 and the shortage of staff in the health service are likely to lead to a first decline in survival rates. The challenges facing cancer services in Wales have been compounded by COVID, as in all sectors within the health service. Welsh Government figures show that 20,000 fewer people were given urgent referrals for cancer diagnosis between March and November 2020, compared with the period before the pandemic. We now know that 1,700 fewer people started their cancer treatment in Wales in the year between April 2020 and March 2021. Cancer services were significantly disrupted in the wake of COVID, jeopardising diagnosis and making it more difficult to treat, which then led to a decline in their chances of survival.

We also know that health service staff are exhausted after responding to the pandemic, as well as trying to maintain cancer services, while also trying to carry out more infection control measures. However, while many cancer services have now largely returned to the levels where they were before COVID, the reality is that cancer outcomes in Wales were not good enough even before the pandemic. We can't therefore go back to how things were. There remains a need to transform services urgently to improve cancer outcomes in the long term.

That brings me to the workforce. I want to place on record our thanks to the workforce, who have gone the extra mile time and time again over the recent challenging period. As the son of a cancer patient, I wish to thank them personally, and I am sure that that gratitude is echoed by everyone here in the Senedd today. However, the inconvenient truth is that the health service has relied on the goodwill of the workforce to keep the service going, with more than one in four doctors working unpaid overtime. Even before the pandemic, Wales was experiencing significant gaps in the workforce for diagnostic and cancer services, such as imaging, endoscopy, pathology, and non-surgical oncology.

These gaps have significantly affected our ability to identify cancer early, provide the most effective form of treatment, and improve the chances of survival. For example, while there has been an increase in the consultant workforce for clinical oncology throughout the UK and Europe, there has been no increase in five years in the Betsi Cadwaladr University Health Board area. In 2020, there were only 7.8 radiologists per 100,000 people in Wales, while the European average is 12.8. Indeed, Wales has half as many radiologists per head of population as France and Spain. And north and west Wales have the lowest number of clinical radiologists per capita compared to the rest of the UK.

There are steps that can be taken in the short term to address this situation, such as mixing skills. Innovations with new technologies can also help to maximise the potential of the cancer workforce as well. And, of course, we must look at supporting the well-being of the workforce in order to retain them. But, while these steps can help, it is only by addressing the crisis in the real workforce that we can find a solution to the broader question of staffing. We must therefore see the Government increase staffing levels in key cancer professions by investing in training and employing more cancer staff to fill current vacancies, and ensuring that the workforce has the capacity to meet growing demand, as well as time to innovate and transform services.

This brings me to the next point, namely waiting times. It's fair to say, as we've mentioned, that COVID has had a detrimental impact on these cancer services. Data for September 2021 show that 59 per cent of patients had received their first treatment within 62 days of the suspicion of cancer. This is well below the target of 75 per cent. This worrying statistic tells us that far too many patients are waiting too long before being diagnosed or treated. But we can’t improve the results unless we see an increase in the workforce and the equipment required to catch it early enough.

Now, the suspected cancer pathway, which was announced back in the spring, is to be welcomed. But more needs to be done to reduce waiting times and to give patients the best possible chance of early diagnosis, early treatment and survival.

I also welcome the quality statement for cancer, which was published this year. But it is an inadequate statement. It's not a cancer strategy, and the previous cancer strategy has now come to an end. Wales will therefore be the only nation in the UK without a cancer strategy, something that the WHO says that every Government should adopt. We therefore must strengthen the quality statement for cancer, and we must develop a cancer strategy for Wales urgently.

Finally, I want to turn quickly to the Richards review, undertaken by the health service in England. One of the key recommendations of the review was having diagnostic hubs for elective diagnostics, and taking elements such as scanning and testing out of acute hospitals in order to build capacity. But, of course, we require additional investment to create these, together with workforce, equipment and so on. The Government therefore needs to consider this fully, and I would urge the Government to explore the possibility of establishing a pilot scheme, with a view to developing hubs of this kind here in Wales.

So, to close, we recognise that the COVID crisis has made things very difficult for the cancer services and health services in general, and we officially thank the workforce for their bravery and their work during this period. But things weren't right before then. We recognise that steps have been taken in the right direction, but we need much more. We have to see investment in the workforce, which means increasing the training opportunities and increasing the numbers, particularly the specialist workforce. We need a cancer strategy that's clear, building on the statement that was made in the spring, setting out a vision and clear targets and accountability. And finally, we need to see a commitment to trial and adopt some of the recommendations in the Richards report. After all, we don't need to reinvent the wheel. So, by implementing these, we can be confident that more patients will have a quick diagnosis and that survival rates will increase. Thank you very much, Dirprwy Lywydd.

I'd like to firstly thank Mabon for bringing forward such an important debate today, and also say that I'm sorry to hear what his family is going through and to hear the personal reasons for him bringing this debate to the Senedd today.

The points raised so far will be both concerning and upsetting to people the length and breadth of our country. The Welsh Government's announcement of the new single pathway for Welsh patients to ensure treatment begins, if cancer is suspected, within 62 days is welcome news after years of growing waiting lists for cancer diagnosis and treatment. It has been a shameful reflection on successive Labour Governments' historic inaction to tackle excessively long cancer diagnosis and treatment times. Despite the introduction of the new single pathway, horrendously long waiting lists still blight Wales and are still only getting longer. Quite clearly, far more is needed to rectify the current cancer crisis that we face. A significant portion of the problem has been caused by the chronic shortage of hospital staff across our health board departments. Once again, we've seen successive Labour Governments allow our NHS to go upstream without a paddle.

It's all well and good introducing new strategies to bring down waiting lists and improve outcomes for patients, but it's being set up to fail. If we don't ensure that there are enough staff to deliver results, then this new strategy will just become a sticking plaster for a very deep wound. We know that the pandemic has had a significant impact since its inception in March 2020. We've all heard stories of various people suspected of having cancer going undiagnosed for far too long, thus exacerbating historic backlogs. Sadly, most of these problems were here long before the pandemic struck. I find it extremely concerning that, despite the World Health Organization's recommendation that all countries should have a cancer strategy in place, Wales is still waiting for a clear, multi-pronged action plan that can tackle the heart of this issue.

This Welsh Government needs to act and it needs to act now. We're in dire need of a short-term strategy put in place to tackle the immediate staffing issues facing the NHS. Without this, there can be no hope of bringing down waiting lists. Indeed, we may only see waiting lists increase otherwise. This needs to be coupled with the introduction of a long-term plan to drive down waiting lists, so that patients can access treatment as soon as possible, preferably before that 62-day target. The Labour Government can no longer rest on its laurels and bury its head in the sand under the delusion that problems will fix themselves. They can't just revert to blaming Westminster either, because the buck stops here, Welsh Labour Government.

These issues demand urgent and targeted intervention now. Rapid diagnosis is absolutely key. The situation needs to be brought under control, otherwise we will continue to have excessively long waiting lists and increased deaths caused by cancer, many of which could be entirely avoidable with appropriate action. Wales being the only nation in the UK without a strategy is just not good enough; the time to act is the time now.

Thank you to Mabon for bringing this motion before us today. The people of Wales wait too long for cancer treatment, and that impacts on the likelihood of survival. That's the fundamental truth of the matter that is the background to this motion today, and at the heart of the solution is the need for a new national cancer plan for Wales. The Minister has heard those regular demands from various stakeholders that we need such a plan; the quality statement for cancer doesn't provide us with the strategy, the clear action plan, that we need. We needed such a strategy before the pandemic, and that is so much more the case now.

In the first year of the pandemic, 1,700 fewer people started cancer treatment than we would have expected from figures prior to that. The Minister can come to the Senedd, as she did earlier today in responding to questions from myself, and say that cancer has continued to be a priority throughout the pandemic. I don't doubt that that was the aspiration, but the statistics tell another story, don't they? The Welsh Government's own figures show that 20,000 fewer people had an urgent referral for a cancer diagnosis during the first nine months of the pandemic, as compared to the period prior to that. The pandemic had a substantial impact. One would expect that, of course, to a certain extent, but today we're discussing the response to that. So, we need not to do more of the same thing even; we need to transform services in order to recover from COVID, and we need a new national cancer plan in order to do that. We need diagnostic centres as a matter of urgency. We need to see early screening strengthened, such as the lung health checks, which we know work. We don't need any more evidence that they work; we just need to provide them in Wales. We need a workforce plan. There were large gaps in the workforce prior to the pandemic, and filling those gaps is even more critical than ever now. The workforce is excellent. Anyone who's come across them can't thank them enough for the work that they do, but there are gaps in that workforce and there is huge pressure on those within the workforce that is unsustainable. We need to invest in that workforce, and we need to do that urgently.

I do need to make this point too: we do need to ensure that we make the right investments for the long term for cancer services in Wales. I've written to the Minister recently asking her to look again at and to listen to the views of cancer specialists calling for the co-location of a new cancer centre in the capital city on the same site as the university hospital, following international patterns. Is she truly convinced that the decision taken so far is the best one? Because we must ensure that cancer patients in Wales today and for the future get the best possible services.

Deputy Llywydd, I'm very pleased to support this motion today, because it's another opportunity for us to emphasise the need for a clear focus on something that is such a key part of our health and care services. Mabon mentioned his own experience and his family's experience, and we wish your father well in his battle. Our experience as a family was that the diagnosis came too late for my mother, almost 10 years ago now, and there was no way of her having any treatment at all, so I wish anyone who has the opportunity to access treatment and to battle cancer well. But we can improve people's chance of having that early diagnosis and a timely referral and of having effective treatment and of surviving cancer, but it will only happen with uncompromising determination and a clear national plan.

Well, again, I wish to begin by extending my sincere thanks to Mabon ap Gwynfor MS for tabling this very important motion, as well as to the 15 Members who supported these important calls to address prolonged waits for cancer diagnosis and treatments. As this debate will make clear, NHS cancer waiting times for September 2021 show that 59 per cent of patients receive their first treatment within 62 days of being suspected of having cancer, and this is well below the cancer pathway target of 75 per cent.

Minister, March's quality statement for cancer was an opportunity for the Welsh Government to set out a strategy for improvements to cancer diagnoses, but it does lack further detail and accountability mechanisms. As Cancer Research UK have made clear, soon Wales will be the only UK nation without a cancer strategy, which the World Health Organization recommends that all countries have. I join with my colleagues in requesting an update on the next steps for the quality statement for cancer, and I ask that you detail what mechanisms are being considered for fast-tracking progress investment for staff, equipment and infrastructure.

Even before the pandemic, Wales was experiencing significant gaps in our workforce that diagnose and treat cancer, such as imaging, endoscopy, non-surgical, oncology and specialist nurses. These staffing gaps are resulting in concerning cases turning to my office for assistance, including instances where patients are being informed of such a life-changing cancer diagnosis simply by the telephone, rather than a personable, face-to-face discussion.

Alongside staff shortages, it is true for north Wales that the health board has to refer many patients back to England for necessary treatment. I know from assisting a constituent very recently that the process is not smooth, with delays encountered, for example, because multidisciplinary team meetings between Betsi board and the relevant English hospital sometimes only take place once a week. Devolution seems to be unnecessarily and unacceptably delaying cancer treatments. We need better cross-border and UK-wide NHS co-operation, so too that north Wales residents are not disadvantaged due to lack of specialism in the region. We know that disruption to services also risks later stage diagnoses, making it much harder to treat and worsening cancer survivals.

So, I wish to conclude by asking the Minister to use her reply to confirm whether and how the multi-year Welsh Government budget due shortly will be used as an opportunity for investment in the cancer workforce in Wales for the long term, and I strongly, strongly request that, certainly in north Wales, some action is taken on how patients are advised of such lifelong and life-changing illnesses. Thank you. Diolch.

I'd like to thank Mabon ap Gwynfor for bringing this debate forward today. I think it's an extremely important issue that I believe all parties care about in this Chamber, and I'm sorry I wasn't quick enough, actually, to put my name in support of the debate before it was tabled. But I'd like to put it on record that I will be supporting the motion today, and I agree with the points in the motion that Mabon has tabled. 

Cancer patients have been, I think, left behind in Wales, sadly. I think for too long we have delayed screening, delayed treatment, and the pandemic has placed significant strain on an already overburdened workforce, and a significant number of healthcare professionals are now suffering stress and burnout. If Wales wants to meet the growing demand and achieve world-leading outcomes for cancer patients, then it must invest in the NHS workforce as a matter of urgency. So, I strongly support the call on the Welsh Government to address shortages in the cancer workforce.

And I note that Wales is soon to be the only UK nation without a cancer strategy. And, as I think two Members have already pointed out, the World Health Organization recommends all countries should have a strategy. So, I hope the Minister, given that three Members have now mentioned that in this debate today, can address that point specifically. But I think the Welsh Government needs to act with some urgency in that regard, and Wales needs a vision that sets out how the Welsh Government is going to be working with the Welsh NHS and how it will support services to recover from the impact of the pandemic and improve cancer survival through innovation and transformation in the long term. 

Mabon pointed out at the beginning of this debate his own experience in terms of his own family situation, and it made me think that I suspect every Member of this Chamber has been affected by cancer in some way, and that will be the same for people across Wales. So, I think it's of great concern to us all, isn't it, when we have longer waiting lists, and I think that will impact on every person across Wales in terms of being concerned about longer waiting lists in terms of cancer. I know that colleagues will no doubt agree with that.

But, through the pandemic, we have seen, of course, record waiting times. NHS cancer waiting times for September showed 59 per cent of patients received their first treatment within 62 days of being suspected of having cancer, and this is well below the cancer pathway of 75 per cent. So, we won't improve cancer outcomes unless we reduce waiting times in Wales. And the Welsh Government, I think, has got to act urgently in investment in the staff and infrastructure needed to help more people get a timely diagnosis and treatment, as Mabon pointed out in his opening comments. So, I'll certainly be supporting the motion today, as tabled, and I hope that the Government will respond accordingly to this debate this afternoon. 

I very much like the tone of the discussion today, because this is a really emotive issue. We've all got family or friends who have had or have cancer, so it's really important we are very measured in the way we discuss this.

I think one of the biggest problems with cancer is that people are often very slow to come forward. People really do need to listen to their bodies and think, 'This is not normal, perhaps I need to go to the doctor.' And I think it's a well-known fact that men are much less likely to come forward quickly than women. But also I think people who have poor self-esteem, who have low expectations of what services are going to be able to do for them, just assume that it's part of their story and they just think, 'Well, I'm not feeling well, but nobody's going to do anything about it.' I think it must be really difficult for clinicians to be able to distinguish between the worried well and the reluctant visitor to the GP who may or may not be telling the clinician the full story and be thinking, 'Oh, I don't want to bother the doctor.' So, I think it is really, really difficult, and there's no point in everybody being sent off for a cancer test, because obviously that would completely clog up the services that people who really do have suspected cancer actually need. But it also requires the GP to think intellectually, 'Is this just something that a simple medication will resolve, or is there something more going on here? Has this person lost weight recently?'

So, I think it's a very difficult issue and, in the end, we all die of something, and often we die of cancer because we've outlived our usefulness. But clearly, the worst types of cancer are those that are suffered by very young people, including children and young people generally, because the cancer is so much more virulent. I know somebody who's been living with prostate cancer for 15 years; this is quite normal if you're elderly. People do live with cancer perfectly okay with the support of appropriate treatment.

I've got a friend, a close friend, who is dying of pancreatic cancer, which I'm aware is one of the most difficult cancers to treat, and so I was particularly interested in taking up the offer of a meeting with Pancreatic Cancer UK recently, and there was an expert witness involved who was the wife of somebody who had died of pancreatic cancer during the pandemic. It was really, really useful to listen to this person about the way in which her husband had been treated, how he had finally got round to seeing the GP during lockdown, but it was only at his insistence that he got to see the nutritionists, so I was very interested to read the national optimal pathway for pancreatic cancer, which unfortunately was published in February 2020—not a good month for instituting change, for reasons we're all aware of. But I am very pleased to see that that pathway states really, really clearly that people should not wait for a local multidisciplinary team discussion before referring somebody to the local upper gastrointestinal cancer group, but also to the nutritionists. This is absolutely key in order to consider the administration of pancreatic enzyme replacement therapy, because by nature of having pancreatic cancer, your body is not capable of digesting food. It seems blindingly obvious, but I want to understand from the Minister why she thinks it is that only three in five people—according to the Pancreatic Cancer UK organisation—are getting PERT, which is the prions that you need. Because although it didn't save the life of the person whose widow was in the discussion, it did enable this man to have a reasonable quality of life while he was able to, in order to share meals with his family, and I think that that is absolutely crucial and is a good illustration of how treating cancer isn't just for the physician who is a specialist in cancer, but is for a whole multidisciplinary team of people, because it affects so many people. Thank you.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr. I'd like to thank Mabon for bringing forward this Member's debate and say how sorry I am to hear about his father's situation. We do all wish him well with his situation.

Although the Government will abstain, it's a vitally important matter, as reflected by the contributions of Members today, most importantly in terms of how it affects our constituents, but also how it has affected the lives of families and friends of Members themselves. I think there are very few people who haven't had some kind of personal experience of seeing the effects of cancer, and we saw that all too clearly in the Chamber, as was mentioned, in the incredible contribution that Steffan Lewis made in the short time that he was with us in the Chamber. I sadly lost my sister-in-law, Polly, at a very young age to cancer two years ago, to this cruel disease.

Now, in more normal times, we would be talking about cancer as the leading cause of death, the leading cause of years of life lost as a result of premature death, and the leading cause of disability adjusted life years in terms of the ongoing physical impact amongst survivors of cancer. That's why it has such a significant profile and why it is such a major focus for any Government.

Cancer is, of course, more than 200 diseases rather than one thing. It's primarily a disease of the ageing process, but a significant proportion of cases are preventable, particularly through tackling rates of smoking and obesity. Prior to the pandemic we had a number of iterations of national strategies and delivery plans, and we saw many successive years of gradual improvement in cancer survival and mortality, as well as very high levels of positive patient experience. We had invested heavily in radiotherapy equipment, had introduced the UK's first complete overhaul of cancer waiting times, and had established excellent national leadership around cancer service development. And I'm pleased to note that part 3 of the motion recognises one notable success of this approach, which has been the establishment of the rapid diagnostic centre concept. This shows how a national approach can really help identify opportunities for new service models, fund high-quality pilots, develop an evidence base and then support the upscaling of this and spread it across Wales.

The pandemic has inevitably had a significant impact on cancer care. Early on in the pandemic, significantly fewer people came forward for investigation. The screening programmes were temporarily suspended, some people did not want to attend their appointments, and some people's therapy was altered to reduce their risk. We issued essential services guidance immediately, which included cancer investigations and treatment, and our cancer services rapidly came together to change how they delivered services.

Towards the end of 2020, thankfully referral activity recovered as people started to come forward in normal numbers, but figures indicated fewer people than would normally be expected were seen last year. From early 2021 we have seen referrals for most cancers increase significantly above normal levels, and this is combining with restricted capacity resulting from staff absence and infection prevention controls. This above-normal demand and below-normal capacity is what is driving the cancer waiting time performance described in the motion.

Our NHS staff continue to work incredibly hard to investigate and treat people with cancer, and they're treating more people than in previous years. As a Government, we're providing additional resources to the NHS to undertake as much cancer diagnostic and treatment activity as possible, and I've made cancer recovery a planning priority for the NHS, as reflected in our approach to recovery, 'COVID-19: Looking forward', supported by nearly £250 million of additional resources.

Although we don't currently have any clear evidence of poorer cancer outcomes, we think that the disruption of the pandemic is likely to have an impact in the years ahead. Pandemics, unfortunately, do much indirect harm in terms of access to normal healthcare, as the chief medical officer has set out at length.

As well as our wider approach to recovery, we published in March this year the quality statement for cancer, as many people have referred to. And can I just be clear that I understand the concerns that have been raised with regard to this new approach? But I think it's really important that we consider how we got to that point, and this goes back to the Organisation for Economic Co-operation and Development and parliamentary reviews, which led to commitments made in 'A Healthier Wales', and 'A Healthier Wales' committed us to introducing a series of quality statements for the NHS in Wales. We can't deliver this commitment and stay true to its rationale whilst clinging to the old way of doing things.

What we're trying to achieve is a better integrated, more effective, quality-based approach for a number of clinical services; an approach that is more attuned to the planning framework for local NHS bodies and better informs the accountability arrangements that we use with all local NHS bodies. And this approach is described in significant detail in the national clinical framework. This is the approach that we have determined will work best for Wales and for our health system. It's a completely new way of doing things, but it does build on what has been achieved in recent years.

The approach for cancer is grounded in enabling quality improvement. It has a heavy focus on enabling earlier detection and access to treatment. There’s also an important focus on introducing a new cancer informatics system, enabling better cancer workforce planning and supporting better service design.

The boards and health trusts will respond through their local plans to the quality statement. We, of course, will steer the development of those plans and also monitor the development. The Wales Cancer Network board will support the health boards with the pathways that work most effectively on a national level—those that need to be adopted. They will also assist health boards in drawing the data down to deliver services and bring them together. These national pathways are included in the quality statement and many of the service specifications have been included already.

We've already announced that around £100 million is to be invested in imaging equipment—equipment such as CT, MRI and PET/CT scanners. This is a huge investment, and to support this investment, there will be more training placements available for radiologists and radiographers. This is all possible thanks to our imaging academy. We have significantly increased the number of our training placements in oncology. This is also the case in related specialist areas that treat people who have cancer, such as urology and gastroenterology. There is more work still to be done in terms of cancer workforce planning and diagnostics, but the work is already under way through the relevant national plans.

We will invest almost £6.5 million in a new cancer information system. This is a very ambitious programme of work that touches upon every health board and trust. We want to introduce a robust integrated patient record for people affected by cancer. We are investing millions in new linear accelerators. These are devices that provide radiotherapy treatment. In addition to that, we are progressing with the development of a new cancer centre in the south-east of Wales and the possibility of establishing a sub-centre in the area for radiotherapy in order to increase access.

Next year, we will also introduce a new framework for health and social care outcomes and a health service delivery framework. As soon as the final agreement is in place, we will update the quality statement with the relevant targets and metrics on cancer. The Wales Cancer Network board will be part of the NHS executive. This will ensure that in the future, this agenda will benefit from the support of leaders working at a very high level and that all parts of the system will work in a more integrated manner. This is a very ambitious agenda—an agenda that I am confident will help mitigate the impact of the pandemic and allow us to improve outcomes for patients once again.

I call on Mabon ap Gwynfor to respond to the debate.

Thank you very much, Deputy Presiding Officer, and I thank everyone for their contributions to the debate this afternoon. We heard at the outset from Laura Anne Jones. I thank her for her very kind words, and she emphasised once again the lack of staff and the long historic waiting lists, but that things have not necessarily improved with people going without diagnosis for long periods.

Rhun then talked about a very sad family history, and I extend my sympathies to Rhun and to everyone else who talked about their personal circumstances. But he talked about the need for a national cancer plan and emphasised that need for a clear strategy and focus, and then that we see the need for diagnostic hubs, early screening and a clear workforce plan and so forth—that need to have the strategy in place.

Janet Finch-Saunders mentioned the number of people getting treatment being lower than the target, as we heard, and emphasising the need for a strategy and also emphasising the need to have clear advice for patients in this case.

Russell George—thank you very much, Russ, for your very kind words, again emphasising the impact of the pandemic and calling for the need to reduce waiting times and emergency responses in order to have a quick diagnosis, and to ensure that people do survive because of a rapid diagnosis. Thank you very much to Russell George. 

Jenny Rathbone made some very important points, particularly at the end, talking about the pancreatic cancer situation and the important role played by nutritionists and nutrition for patients, and multidisciplinary teams when it comes to detecting cancer.

And then, finally, I thank the Minister for her response. You mentioned the investment that is being made. Of course, we do recognise the impact of the pandemic and we offer great thanks, evidently, for any additional investment. You’re talking about figures that are beyond my understanding—£0.25 billion; very great figures—and you talked about a clinical framework, but, again, what we didn’t hear was the word ‘strategy’. We heard ‘framework’ and the different ‘frameworks’, but you didn’t talk about a national strategy, which does mean that Wales will be without a clear cancer strategy. Are these frameworks together going to constitute some kind of strategy? That’s not clear, so I’m looking forward to seeing what the cancer strategy of the Government will be in its entirety.

And despite this investment of millions of pounds in capital funding mainly—that’s what I think that is—there’s been no mention made of funding to fill this gap in the staffing, which continues. As we mentioned, the number of radiologists is far lower in Wales than in other countries on the continent, and we need to fill that gap and ensure that we have those staff. So, I’m looking forward to seeing what investment you will be putting in to this in order to fill that gap. Because if we are going to tackle this issue and ensure that people do have an early diagnosis and then can survive this illness, then we have to have the staff in place in order to recognise the illness in the first place.  

There was no mention made of the Richards review and the lessons that you’ve learned from that review in England. There are important lessons there, I think, that the Welsh Government should pick up on. So, could you give some consideration to those lessons? If you make another statement in the Senedd, maybe you can talk about the lessons that you’re learning from that review. Thank you very much, Deputy Presiding Officer. 

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

Voting deferred until voting time.