The following amendments have been selected: amendment 1 in the name of Lesley Griffiths and amendment 2 in the name of Siân Gwenllian. If amendment 1 is agreed, amendment 2 will be deselected.

We'll move now to our next agenda item, the Welsh Conservatives debate on cancer services, and I call on Russell George to move the motion tabled in the name of Darren Millar.

Motion NDM7911 Darren Millar

To propose that the Senedd:

1. Notes the Welsh NHS COVID-19 recovery plan published at the end of the last parliamentary term.

2. Expresses concern:

a) that waiting lists numbers in Wales continue to rise, with nearly one in three patients waiting more than a year for treatment;

b) that Wales will soon be the only country in the United Kingdom without a cancer strategy.

3. Notes further concern at reports from the National Cancer Clinical Director for Wales that services will have to work at 120 to 130 per cent of previous capacity to deal with increased numbers of cancer patients.

4. Expresses disappointment that the 2021 quality statement on cancer lacks detail and only sets minimum standards for cancer services.

5. Urges the Welsh Government to:

a) urgently publish a workforce recruitment and retention plan for cancer specialists;

b) publish a full cancer strategy which will set out how Wales will tackle cancer over the next five years; and

c) support cancer patients through their treatment by, for example, introducing free dental care during radiotherapy and chemotherapy.

Motion moved.

Diolch, Deputy Llywydd, and I move the motion tabled in the name of my colleague, Darren Millar. For some people in Wales, they worry that they will die without ever getting the cancer treatment they need, and that's the view of the board of community health councils and Andy Glyde from Cancer Research UK. Today's debate, of course, is extremely important for many people across Wales, and our motion calls for a number of measures, such as support for cancer patients through their treatment, by, for example, introducing free dental care during radiotherapy or chemotherapy. We're also asking the Welsh Government to urgently publish a workforce recruitment and retention plan for cancer specialists, and to publish a full cancer strategy that will set out how Wales will tackle cancer over the next five years.

Current cancer treatment times suggest that Welsh cancer services are not catching up with diagnosis and treatment. Last November, just 58 per cent of patients newly diagnosed with cancer started their first definitive treatment within 62 days of first being suspected of cancer, far below the target of 75 per cent. Meanwhile, the cancer waiting lists in Wales continue to rise, with nearly one in three patient pathways taking over a year to treat, while the national cancer clinical director for Wales has said that services will have to work at 120 per cent to 130 per cent of previous capacity to deal with the increased numbers of patients.

Welsh cancer survival rates have been stalling for many years. Prior to the pandemic, the Welsh cancer intelligence unit data showed that Wales had the lowest survival rates for six cancers, and the second lowest for three, across the UK. So, although the pandemic has, of course, caused more strain on the system—that's understandable, of course—the system was already broken, I would suggest, before the pandemic.

Every other part of the UK has committed to implementing a robust cancer strategy, and it is sad to see that, soon, Wales will be the only UK nation without a definitive cancer strategy. Welsh cancer services are struggling to cope with a tsunami of missed cancer diagnosis and the appearance of later stage cancers as the direct result, of course, of pausing NHS services during lockdowns. And added to this, we've got five years—or many years—of chronic understaffing.

Now, the Government seem to think that their cancer quality statement is a strategy. Well, correct me if I'm wrong, but the Minister will no doubt confirm at the end if I've analysed that correctly, but cancer charities say themselves that the cancer quality statement lacks both detail and ambition and is not a national strategy. Wales needs a cancer strategy. Unfortunately, cancer workforce is also an issue in Wales. A specialist cancer workforce that is able to cope with demand and an increasing backlog should be a priority for the Welsh Government in order to prevent cancer survival rates from slipping further back. Wales already has a severe shortfall of cancer specialists—we know that, sadly—with some areas of Wales experiencing significant gaps across, and that's according to many, including the Royal College of Radiologists. Shockingly, despite these grave concerns, the latest 10-year NHS workforce plan fails to include a specific workforce plan for cancer specialists. In fact, the joint Health Education and Improvement Wales and social care strategy from October 2020 fails to mention cancer at all. Instead, the strategy has broad aims, including—I'm quoting here—to

'have a workforce in sufficient numbers to be able to deliver responsive health and social care that meets the needs of the people of Wales'.

Well, that's why we're holding this debate today, and I would urge the Welsh Government to publish a workforce recruitment and retention plan and a full cancer strategy that includes specific targets, as well as support for cancer patients through their treatment to make easier the difficult side effects that cancer treatment often causes.

Given the prevalence of cancer, the people of Wales, I think, demand and deserve treatments that meet their needs and bring them into line, most importantly, with the performance of services elsewhere in the UK. So, I would urge the Welsh Government today to urgently publish a workforce recruitment and retention plan for cancer specialists, to publish a full cancer strategy that sets out how Wales will tackle cancer over the next five years, and to support cancer patients through treatment, for example, by introducing free dental care during radiotherapy and chemotherapy. 

I would hope this afternoon our debate is a sensible debate. It's a debate that I think is very worthy to have this afternoon, and I very much hope that we'll have positive contributions from other Members, and I very much hope we'll have a positive contribution from the Minister as she concludes at the end of the debate. I would urge Members, of course, to support our calls and our motion this afternoon. Diolch, Deputy Llywydd.

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Minister for Health and Social Services, Eluned Morgan, to formally move amendment 1, tabled in the name of Lesley Griffiths. 

Amendment 1—Lesley Griffiths

Delete all after sub-point 2(a) and replace with new point:

Notes:

a) the approach set out in A Healthier Wales, which includes the introduction of quality statements for the development of clinical services;

b) the Welsh Government’s approach to improving cancer outcomes was published on 22 March 2021 in the form of a quality statement;

c) the Welsh Government’s ‘Health and Social Care in Wales—COVID-19: Looking Forward’, which included cancer, was published on 22 March 2021;

d) nearly £250 million in year is being invested in the recovery of NHS services, including cancer;

e) the most recent official cancer statistics show the number of patients newly diagnosed with cancer who started their first definitive treatment increased to the highest level since comparable data was first collected in June 2019;

f) the expansion of NHS training places includes an additional four higher training posts for clinical oncology and an additional three higher training posts for medical oncology each year for five years;

g) health boards will be focusing on recovery of cancer services in their Integrated Medium Term Plans.

Amendment 1 moved.

Formally.

I call on Rhun ap Iorwerth to move amendment 2, tabled in the name of Siân Gwenllian.

Amendment 2—Siân Gwenllian

Add as new sub-point at end of point 5:

'complete the roll-out of multidisciplinary diagnostic centres across Wales as a matter of priority'.

Amendment 2 moved.

Thank you very much, Deputy Llywydd, and I'm very pleased to have an opportunity to contribute to this important debate and to formally move our amendment. In terms of the main motion, we will support the motion today, of course. As well as being a statement of very real concern about the state of health services in general after two years of pandemic, there are elements of the motion that I have certainly been emphasising over a period of years: how inadequate the cancer quality statement is as a way of driving improvements to cancer services, and the need to invest in the cancer workforce to support patients through their treatment, and so on and so forth.

But there are two things that I want to cover in the next few minutes. First of all, our amendment and the need to complete that work, as a matter of urgency, of establishing multidisciplinary diagnostic centres across Wales in order to ensure that that infrastructure is in place in order to diagnose and treat cancer as swiftly as possible. We can't overemphasise the need for swift diagnosis and the benefits that come from that, and of course the pandemic that we have lived through has created a broader crisis, possibly. According to the statistics, some 1,700 fewer people than we would have expected have started cancer treatment in Wales between April 2020 and March 2021.

Wales was the first nation—and we can take pride in that fact—the first nation in the UK to trial these diagnostic centres. There are some in existence, others are in the pipeline, and there are two other areas—Powys and Cardiff and Vale—where there are no plans in place. I would appreciate an update from the Minister this afternoon on the work to ensure that those centres will be available to serve the whole of the Welsh population. There is no room for any sort of postcode lottery when it comes to cancer services, and that is the emphasis of our amendment today.

The second element that I want to mention—and it is referred to twice in the original motion—is the very clear absence of a national cancer plan or a national cancer strategy that could ensure that the Welsh Government could build the kinds of cancer services that we need here in Wales. We should bear in mind that we are facing huge challenges here in Wales. Some 20,000 people are diagnosed with cancer in Wales on an annual basis, possibly 170,000 people living with cancer, and the level of health inequalities and social inequalities—things that we have discussed very recently in this Chamber—mean that the survival rates for certain kinds of cancer are worse in Wales than in the rest of these isles, and across Europe.

And in England, Scotland, and in Northern Ireland very soon, there are cancer plans, cancer strategies in place that set clear targets and give a clear focus to the development and support of services. So, in Wales, we have a collection of plans and frameworks, and it's simply not good enough. If we are serious about tackling cancer, then we need a strategy. What we got from the Welsh Government in March of last year, once the cancer delivery plan came to an end a few months before that, was a cancer quality statement. Not a plan or a strategy to improve diagnosis, treatment and research in Wales, but something that doesn't have that detail that we need, doesn't provide the accountability that we need, or the action plans, or the objectives, or the timetable that we need, and which doesn't have the vision that we needed, never mind the vision that's needed now to restore services post pandemic. 

Deputy Presiding Officer, just a quick word from me on the Government's amendment. We will be voting against that amendment. It does nothing to provide solutions to the crisis that we're facing in Wales; it's a list of what the Government says they've done. And, although they're just asking us to note that list, how can we support it when all it is is a list of things that actually fail to get to grips with the task of putting a proper strategy in place? I am sure that the Minister wants our cancer services to be as good as they can be. Of course, we all want to see that, but I'm afraid that we won't see that without a robust strategy in place. So, I would ask her again today to listen to the over 20 charities and organisations that are part of the Wales Cancer Alliance that are encouraging the Welsh Government strongly to formulate a comprehensive cancer strategy for Wales.

I want to thank Russell George and my Conservative colleagues for bringing forward this important subject for debate today. Cancer is something that, unfortunately, touches everyone in society, whether it be through a family member, friend, someone where we live, we all have a story of how cancer has affected us or someone we love in one way or another. My own family has been affected by breast cancer and skin cancer, and my two best friends have lost their fathers to prostate cancer. So I, like many others in this Chamber and in Wales, know all too well the toll it takes on a family and how crucial it is to get that diagnosis early so that everyone has the very best chance of survival. 

Cancer is the leading cause of death in Wales, with around 19,600 people tragically diagnosed with cancer every year. We all have a responsibility to stand up for our constituents and ensure that cancer services in Wales are the very best that they can be. Whilst survival rates have vastly improved in recent decades, the UK still lags behind some comparable countries in Europe and internationally. The same can be said here in Wales. Survival rates have improved in recent decades, but they're still not good enough, with one-year survival rates for stomach, colon, pancreatic, lung and ovarian cancers well below the UK average. The challenges facing cancer services in Wales have, of course, been compounded and exacerbated by the pandemic, but we now know that, in the year between April 2020 and March 2021, as has been said, 1,700 fewer people began cancer treatment in Wales.

The challenges that cancer services are facing need this Government to respond and require urgent and decisive action, not just to recover services to where they were pre pandemic, but to completely transform our cancer services so that they're fit for the twenty-first century—services that are digitalised, online where possible, responsive and accessible—in order to improve cancer outcomes and survival in the future. To achieve this, as cancer evolves, we need to evolve too and we need to heavily invest in new technologies and treatments. We need to make sure that Wales, perhaps, is the leader in some areas of this, that we are the ones that develop these new treatments and new technologies. Innovation is absolutely key in tackling cancer and improving outcomes, and we also need to invest properly in funding and expanding the access to treatments fund here in Wales. The pandemic has shown us what we can achieve. We need to make sure that we think more ambitiously to fight this big killer. 

In my own region of South Wales East, we are seeing waiting figures for cancer treatment that are the worst on record. My constituents feel let down. I am pleased to see the announcement, though, in my region of a new breast cancer centre for excellence, which is very, very welcome. This will be a vital step as we all know that, without access to timely diagnosis and the use of the most up-to-date and effective treatments, outcomes for cancer patients in Wales will not improve. Accessibility is key, so we need to see more announcements like this, with centres equally spread across Wales, as has already been said from the other benches, but I feel it needs reiterating: we need access to treatment equally across Wales, particularly in rural areas, which are so often left out.

Earlier this month, President Biden stated that we can end cancer as we know it. Sajid Javid declared a war on cancer. Minister, it leads to me ask: what is our vision for cancer services in Wales? When will we see a comprehensive cancer strategy for Wales? The Welsh Conservatives have consistently called for a new delivery plan or strategy for cancer, a workforce plan for the cancer workforce with deliverable targets, a rapid roll-out of rapid cancer diagnosis centres, expansion to the access to treatments fund, supporting patients in such ways as providing free dental care, as has been said. We need a strategy, Minister. Quite simply, we need to see much greater detail and ambition from this Welsh Government and NHS Wales, and we need to improve on preventative measures as well—obesity, alcohol, smoking, you name it. We need policies that finally are moving towards a preventative agenda as well as a reactive one. Thank you. 

It's a pleasure to take part in this debate this afternoon, and I'm proudly wearing my Marie Curie badge, the daffodil, in support of their work. Sadly, 50 per cent of the population will receive a diagnosis of cancer at some point in their lifetime, and we all know someone who has had cancer, and tragically, far too many of us know someone who has passed away. Wales has some of the worst cancer survival rates in the western world, which is why we have to ensure that our cancer services are world beating. Our population can't afford a cancer strategy that lacks ambition. As my colleagues have alluded to, the problems in our cancer pathways predate the pandemic, and like many of the issues facing our NHS, many of these problems could be put down to staffing issues, or rather the lack of coherent workforce planning. 

We all know that early diagnosis is key to long-term cancer survival, yet we have the lowest numbers of consultant radiologists per 100,000 patients of anywhere in the UK. And what is worse is that, according to the Royal College of Radiologists, we are due to lose as much as one third of that workforce over the next three to four years due to retirement. I can't imagine the impact this will have on existing staff as they will be expected to pick up the slack in the system. We know that the national cancer clinical director for Wales has stated that the service will have to run at about 130 per cent of capacity just to catch up to where we were pre pandemic. But, we don't want to return the service to pre-pandemic levels and, to coin a popular phrase at the moment, we want to build back better.

In order to achieve that, we have to urgently address historical staffing shortfalls. We have critical shortages across the field, not just in diagnostics. We have gaps right across clinical oncology; nearly one in 10 posts remain unfilled. As a result of shortages, one in five cancer patients in Wales lack specialist cancer nursing support during diagnosis or treatment. This means we are struggling to provide proper care now, let alone allow for new or expanded services. Macmillan Cancer Support suggests that Wales will need to increase its specialist cancer support nursing workforce by a staggering 80 per cent by the end of this decade in order to meet the demand. And Cancer Research UK highlight that these gaps in the NHS workforce are a fundamental barrier to transforming cancer services and improving cancer survival rates. Yet, despite the well-founded concerns raised by the third sector and clinical cancer leads, the Welsh Government has no plan for the specialist cancer workforce.

In fact, the workforce strategy for health and social care fails to even mention cancer. One of the biggest health issues facing our nation and this Welsh Government has no plan to tackle it. Unless Ministers grasp the nettle and address these concerns, then cancer will continue to be a death sentence for far too many. Our cancer survival rates will continue to plummet, and Welsh citizens will continue to lose loved ones needlessly. It's time we had an ambitious cancer strategy with the aim of eradicating needless cancer deaths, and a plan to deliver a workforce to meet the future needs of cancer patients; a plan to support patients throughout their cancer journey from diagnosis to cure; and a plan that builds in capacity to meet the challenges of the COVID backlog and for future pandemics. I urge Members to back our motion today.

Minister, we all know that the battle against cancer will often be the most difficult battle that any person and, indeed, their family will face in their lifetime. It is society's solemn responsibility to provide them with the best care, treatment and support possible, in order to have the best chance of beating and surviving this truly devastating illness. However, on the watch of this Labour Government, thousands of residents across Wales have been let down in their time of need. We are seeing a tsunami of missed cancer diagnoses, and a growing number of later stage cancers as a direct result of pausing NHS services during the COVID-19 pandemic.

Ultimately, though, this issue has not crept up on the Welsh Government, with cancer waiting targets not met since 2008 and with only 56 per cent of patients receiving treatment within 62 days across Wales. Additionally, Wales cancer intelligence unit data shows that Wales has the lowest survival rates for six cancers, and the second lowest for three across the UK. The Welsh Government's failure to address this matter pre pandemic has only served to compound the issue. Alarmingly, just four months ago, it was reported that only 57.9 per cent of patients newly diagnosed with cancer started their direct definitive treatment within 62 days of first being suspected of cancer. That's far below the 75 per cent target.

In that same month, it was reported that over 27,000 people were waiting for radiology services after being referred by the consultant for cancer diagnostic work, with one in eight of these people waiting more than 14 weeks. A further 30,000 people were waiting for radiology diagnostics after being referred by their GP. As it stands, Wales will soon be the only country in the United Kingdom not to have a cancer strategy. I urge the Minister to ensure fast implementation on this. Furthermore, it is recognised that radiotherapy and chemotherapy can have a detrimental impact on dental health. However, free dental medical assistance is not currently offered to these patients, leaving these individuals in more pain and feeling rather unsupported. As we emerge from the COVID-19 pandemic, this is a golden opportunity for the Welsh Government to review, and for you to amend your approach.

Cancer Research Wales has highlighted that Wales needs a futureproofed, sustainable cancer workforce. They highlight the significant gaps and variation within the diagnostic, treatment and nursing workforce. Consultant radiologist posts remain vacant. They advise that developments such as the single suspected cancer pathway are welcome, but can only achieve so much without the right staff in situ. So, Minister, will you listen to these organisations that work extremely hard, trying to support people with cancer? Will you publish a workforce recruitment and retention plan for cancer specialists? And will you publish a detailed and comprehensive cancer strategy to set out how Wales will tackle cancer over the next five years, aside from bringing the relevant legislation before this Senedd to provide free dental care to patients undergoing radiotherapy and chemotherapy? I think that we all know, stood here today or sat here today, that considerable change is required, and urgently. The people battling cancer now and their families do not have the time to watch this Government continue to fail to meet its targets.

I am going to make a personal plea. I have raised this with the First Minister, Minister. I have had situations where my constituents have approached me, where they have received a very fatal diagnosis on the telephone. One of them was at 3.20 p.m. on a Friday afternoon. The family were devastated by this, and that then impacted on the person's well-being. The First Minister said that it's up to clinicians to decide how they tell their patients that they have cancer. In this instance, they weren't clinicians, they were administrative staff. That is not the way to learn that you have cancer. Certainly, at 3.20 p.m. on a Friday afternoon, imagine their defeat and their fear. When asked, 'Well, what's the next stage?', it was, 'We'll be in touch.' Three weeks later, they approached me, and believe me, I was able to then say to the health board, 'Please help these people.' That should not happen, and that is first-hand experience of what is happening. I thank you for listening, Minister. Diolch.

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

Diolch yn fawr. I'd like to thank Russell and the Conservatives for bringing forward this important debate about cancer services and outcomes. I can tell you that I've listened very carefully to everything that's been said and I will go away and I will consider your deliberations and make sure that I give some serious thought to what you have been talking about this afternoon. I'm afraid I won't be able to support the resolution on a number of grounds, and I'd like to explain why. But I do acknowledge that we need to do better on cancer. It is genuinely a matter of life and death. I accept that the quality statement has got to be the start of the story, not the end of the story, and certainly there's a lot more work to do in this space. 

One of the problems with the motion is that it conflates overall waiting times with cancer waiting times. The waiting time for normal elective care is very different from the 62-day cancer pathway. Cancer patients have always been treated with clinical urgency in Wales. Cancer was designated an essential service at the start of the pandemic, and, whenever possible, we've maintained and we've prioritised cancer services throughout. This has resulted in new pathways and seeing patients differently. Some of those lessons are genuinely positive and we need to embed them. 

The motion also implies that a cancer strategy is the only way to improve cancer outcomes and alleges that Wales is an outlier across the UK. But I'm afraid that that's just not the case. At the moment, England includes cancer in its long-term plan, Northern Ireland doesn't have a strategy, and Scotland's strategy predates the pandemic. It is self-evident that in order to recover cancer services we will have to deliver more cancer treatment than we have historically, but the difficulty is that we're still in the middle of a pandemic where productivity is reduced by infection controls and by staff having to isolate.

Nonetheless, I don't wish to dismiss the concern that we all feel about how the pandemic has impacted on cancer services. I've said on many occasions how concerned I am about the impact on cancer services. That's why we brought forward our new approach to cancer services during the pandemic. That's why cancer was the only disease that was singled out in the March 2021 recovery plan. It's why I'm making recovery in cancer services a key focus of health board planning. It's why I'm investing in recovery activity, new equipment, training more cancer clinicians and new facilities across Wales. It's my intention to publish a planned care recovery plan in April, and this of course will include a range of actions and measures that will support cancer patients. 

There has been much criticism levelled at the concept of a quality statement for cancer, but I'd remind Members that our intention to publish a series of quality statements was set out in 'A Healthier Wales'. It was the response to the parliamentary review. It said that quality statements would describe the outcomes and the standards we'd expect to see in high-quality, patient-focused services. 

Will you take an intervention?

Of course.

Thank you. I do appreciate your willingness to take into account the debates and the conversations this afternoon, and your openness to what's been said this afternoon, Minister. I think, on the quality statements, the issue is that—tell me if I'm wrong—there are no targets in there. There is no vision in there. It's just a series of statements. Surely you recognise that that is needed if we're going to have a—. I'm just asking: do you accept the need for a cancer strategy above and beyond the cancer quality statement?

Thanks very much, Russell. What we don't lack is a target. We've got the target; we're just not meeting the target yet. What we need is a mechanism to reach the target, and that's certainly something we need to make sure that we can deliver on. Many people have talked today about the need to make sure that staffing is in place, for example, and training is in place. Before Christmas, we announced £0.25 billion to focus on training within the NHS. It has been interesting to look at the English planned care proposals that came out yesterday. A massive criticism of that is: where's the plan in terms of training? Well, we've got training plans in place; Health Education and Improvement Wales is on this, they know what needs to be done. I can give you chapter and verse in terms of how many people are going to be trained in each different area of cancer.

So, we are doing quite a lot of work. The difference is that we haven't packaged it up, in a way, and there's a reason for that, and the reason for that is because what we've got is an integrated set of policy commitments that were described in the national clinical framework, and what you need to understand is the context in which this cancer plan needs to work. Let me remind you what we're trying to do: we want a clearer, more effective, less duplicative set of policy arrangements that our NHS bodies who actually plan and deliver cancer services can then respond to effectively. I understand the attraction of setting out minute detail in one document on how we're going to solve cancer, but that's just not how a really complex health system is delivered. We've heard today about the need to look at prevention. Well, do you want a whole obesity strategy set out within the cancer plan? It doesn't seem to make any sense to me. We've got a smoking plan as well; we've got lots and lots of different plans that all contribute, so I think we've got to understand how complex this is.

At the heart of improving cancer outcomes is identifying someone at risk and getting that diagnostic test done. If we look at who delivers that part of our cancer pathway, they're not cancer services. So, where would we put those? Do we put them in the cancer plan, or do we not put them in the cancer plan? Because they are not cancer specialists; they are general practitioners who first identify whether it needs investigation. They're dentists, they're opticians, they also include screeners and outpatients and emergency department teams. This is where that initial clinical suspicion of cancer arises, and from where people are referred. And when they're referred for an investigation, where do they go? They go to pathologists, they go to radiologists, they go to endoscopists. Do you want all of that? Your plan is going to be massive, Russell. So, I do think that there was an approach that was clearly set out in 'A Healthier Wales', and that's why we've taken this approach.

But, Minister, it's not just myself and other opposition parties calling for a cancer plan. I appreciate the detail that you mentioned—that not all this can be included in a plan—but you're also saying that the 20 charities that have also suggested that there should be a cancer plan are wrong as well and have misunderstood the approach. I'm just trying to grasp the opposition to having an overarching plan here.

I'm trying to explain to you that, actually, the system—. Why should all that be set within a cancer strategy, if, actually, it could be something where there could be implications for stroke? What are we going to do there? Do you separate them out? Do you put everything—? It's about duplication; I think we've got to be very careful not to duplicate different strategies. What we can't hope to improve is cancer outcomes unless we see the recovery and transformation of all of those different services, each of which is subject to important national policy programme support and local planning arrangements.

A similar story could be told for access to surgery, the dominant intervention for curative treatment, and for our vital palliative care services, all of which sit alongside specialist cancer parts of the pathway such as radiotherapy and chemotherapy, which are clearly areas of specialisation for cancer. Once we understand the breadth of the wider services involved in the cancer pathway, then I'll hope you understand why I think we need to take a more nuanced approach.

The quality statement for cancer is not some sort of lightweight delivery plan; it's an entirely new construct that is designed to work within the Welsh context, and its rationale is described in the national clinical framework.

It's worth noting that the quality statement for cancer includes 19 care paths for different kinds of cancer. So, truth be told, there is a great deal of ambition and detail here, more than we saw in the previous delivery plans, and in that regard, we're further ahead than the United Kingdom. We have more to do, and we do need to go further; I accept that. We will be updating the quality statement, adding pathways, details of service and metrics as they are agreed, and we'll be working on a national level through the new cancer network to focus on the cancer workforce that so many of you have mentioned—

Minister, you need to conclude now. I've given the additional time for the interventions.

Diolch yn fawr. I'll just finish by saying that I accept that, actually, there's a lot more we need to do in this space. I don't accept that, actually, a cancer plan is the answer, but what I do accept is that we need to provide some real focus to lots of the areas that you've touched upon, but actually we need somebody to make sure that the delivery of that statement, that quality statement, is driven much more readily. And, of course, that hopefully will be easier, as we come out of the pandemic.

I call on Mark Isherwood to reply to the debate.

Diolch. I've been busy scribbling notes. I thank everyone for their contribution and the Minister for her response. The Minister told us that she had listened very carefully, doing lots of work because it's all very complex, but, as Russell George pointed out, there's no targeting, no vision. Twenty expert charities are also calling for a cancer strategy. At least the Minister accepted, quote, 'There's a lot more we can do.'

Having listened to the Minister, I have to say it is scandalous that they're seeking to delete a motion calling on them to urgently publish a workforce recruitment and retention plan for cancer specialists and to publish a full cancer strategy, setting out how Wales will tackle cancer over five years. Instead, they offer us a quality statement for cancer that lacks detail, sets only minimum standards for cancer services and avoids quantifiable monitoring and accountability. It also avoids public understanding. The public understand words like 'strategy', but nobody understands what a 'quality statement' is, unless you're in the upper echelons of, for instance, human resource management or setting corporate goals for publishing at the front of your annual accounts and reports to your shareholders. That is not a term that is accessible to the people we're trying to help.

As we heard, Wales will soon be the only country in the United Kingdom without a cancer strategy—will soon be, Minister. The public understand a strategy, but, as I said, a quality statement is a cop-out by those who wish to avoid accountability. Despite progress in recent months, the Welsh Government's targets remain unmet and waiting lists continue to rise. Even before the pandemic, cancer waiting times had not been met since 2008 and four times the number of people were waiting over a year for treatment in Wales than the whole of England. Even before the pandemic, the Welsh cancer intelligence unit's data showed that Wales had the lowest survival rates for six cancers, and the second lowest for three, in the UK. 

Last month I hosted the online Wales ovarian cancer awareness meeting, organised by Target Ovarian Cancer and the National Federation of Women's Institutes, where we heard that, prior to the pandemic, only 37 per cent of women with ovarian cancer in Wales were diagnosed at an early stage. And I acknowledge and thank the Minister for the letter I've received today from her regarding that. And, yes, the number of women diagnosed with the condition has fallen, but it is still scandalous that 63 per cent of women were only diagnosed at a later stage, reducing their chances of survival. 

Two weeks ago I met with Macmillan Cancer Support. Our discussion included the increase in benefits applications by people who are terminally ill, reflecting both increased later stage diagnosis during the pandemic and forecasted future growth in demand. We discussed the need for the Welsh Government's quality statement for cancer to include milestones and community services. 

Two weeks ago I met Prostate Cancer UK. Our discussion included the many risk categories of early-stage prostate cancer not diagnosed since the pandemic. I do welcome the news that they're launching, with the NHS, on 17 February, a prostate cancer awareness campaign, aimed at men in the highest-risk groups. 

Cancer Research Wales states that, even prior to the current crisis, Wales performed poorly on many measures relating to the diagnosis, treatment and survival of cancer, adding that the impact of the pandemic on cancer services, especially its workforce, is concerning. And the Less Survivable Cancers Taskforce is continuing to raise the profile of the six less survivable cancers, and to highlight the critical importance of early diagnosis in improving survival.

In opening today's debate, Russell George stated that the current cancer treatment times are not catching up, that Welsh cancer survival rates have been stalling for many years, and the system was broken even before the pandemic. He referred to the years of chronic understaffing and shortage of cancer specialists, and he urged the Welsh Government to publish a full workforce recruitment and retention plan for cancer specialists and a full cancer strategy.

Rhun ap Iorwerth moved the Plaid Cymru amendment urging the Welsh Government to complete the roll-out of multidisciplinary diagnostic centres across Wales as a matter of priority, which we, of course, fully support, alongside Plaid Cymru. He referred to the clear absence of a national cancer strategy and pointed out that cancer survival rates in Wales were below those in our fellow British nations and other nations across Europe. They're voting against the Labour Government amendment—of course, so will we. And he's asked the Welsh Government to instead listen to the over 20 charities forming Wales Cancer Alliance, as did Russell George in response to the Minister at the end. These aren't just happy volunteers or, sadly, bereaved families, these are experts. These are people who have the technical knowledge, expertise and front-line knowledge to be able to help Government do things the right way, and must be listened to.

Laura Anne Jones referred to the 19,600 people in Wales tragically diagnosed with cancer each year. She said survival rates in Wales have improved, but they're still well below the UK average, and that we need decisive and determined action to improve cancer survival in Wales in the future, with a comprehensive cancer strategy alongside a preventative agenda. Gareth Davies referred to early diagnosis being key to survival, but the specialist cancer workforce is actually forecast to fall. He talked about the need to address historical staffing shortages, both in diagnostics and clinical oncology, and he said it's time for an ambitious cancer strategy and workforce plan to eradicate needless, avoidable deaths. Janet Finch-Saunders stated that under the Labour Welsh Government, thousands are being let down and that this is not something that's just cropped up on them. She called for the gap in provision for the dental health needs of cancer patients to be filled also.

Well, even before COVID, Wales was already behind other UK nations in terms of cancer survival rates. As we heard from many speakers, from Plaid and, of course, Welsh Conservatives, it's not just the UK; we're behind many of our international partners also. Now, Welsh cancer services are struggling to cope with the tsunami—and we've heard that word many times—of missed cancer diagnoses and the appearance of later-stage cancers. When this is added to years of chronic understaffing, it's easy to understand why cancer charities say that the cancer quality statement lacks both detail and ambition. It is not a national strategy. I urge Members to support our motion accordingly. Diolch.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There is objection, therefore I will defer voting on the motion until voting time. 

Voting deferred until voting time.