The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

Item 10 this afternoon is the first Welsh Conservatives debate, on hepatitis C. I call on Russell George to move the motion. 

Motion NDM8064 Darren Millar

To propose that the Senedd:

1. Acknowledges that Wales has made good progress towards eliminating the hepatitis C virus (HCV) by establishing a highly effective national clinical network, as well as having equitable and transparent access to treatment right across the country.

2. Notes the ground-breaking successes in several areas, including achieving the elimination of HCV in the prison population of HMP Swansea (the first remand prison in the UK), as well as successfully transplanting and treating the organs from infected donors with HCV to new recipients - another UK first.

3. Recognises that whilst the Welsh Government is still committed to its strategic elimination goal, increased political prioritisation and resources are required to close the testing and treatment gap that has emerged due to the COVID-19 pandemic and to ensure the 2030 target date is not exceeded.

4. Calls on the Welsh Government to:

a) mandate the re-establishment of frontline blood borne virus and harm reduction services in all health board areas, so that the identification, testing, linkage to care and treatment of HCV patients in Wales can resume;

b) develop a national strategic plan to deliver HCV elimination by 2030 at the latest, which is sustainably resourced, patient centric and focuses on the whole pathway;

c) ensure that health boards are funded and accountable for delivering the national strategic plan, in terms of service delivery, data monitoring and reporting performance.

Motion moved.

Diolch, Deputy Presiding Officer. I'm pleased to lead this first debate of two this afternoon. Our first debate this afternoon is on hepatitis C. I thought it would be useful just to set out some background, perhaps, for Members who might be less informed on this issue. The hepatitis C virus is a blood-borne virus affecting the liver, and if untreated, four fifths of those infected develop chronic hepatitis C, which can cause fatal cirrhosis, scarring of the liver, which can lead to liver failure, and also liver cancer. The virus is spread when the blood of an infected person gets into the bloodstream of another person.

The main way in which HCV is spread in the UK is through drug use by sharing of needles. Body piercing or tattooing using unsterilised needles can also spread the virus, and on rare occasions it can be spread through sexual contact, or from mother to baby before or during birth. Other people at higher risk of acquiring HCV include those who come into contact with blood, such as healthcare workers, prison officers and people who've received a blood transfusion before 1991 in the UK, or in countries that do not screen donated blood for the virus. 

There is no vaccine for HCV. New medications are seen to have revolutionised the treatment so that it is now curable in nine out of 10 people, if treated early. The new tablet treatments are more effective and have far fewer side effects, and treatment takes about eight to 12 weeks. Even if treatment does not clear the virus, it can slow down inflammation or liver damage. The World Health Organization estimates that globally, 71 million people have chronic hepatitis C infection. The UK is a low-prevalence country, and Wales has around 12,000 to 14,000 people with HCV. 

Much of what I have outlined in my opening there has been sourced from the former Health, Social Care and Sport Committee report published in June 2019. In their report, 'Hepatitis C: Progress towards achieving elimination in Wales', the committee set out a number of recommendations, which included recommendations that the Welsh Government produces a comprehensive national elimination strategy for hepatitis C, a targeted awareness campaign, and investment into Welsh prisons to improve testing. The Welsh Government did accept the majority of the recommendations—in fact, it accepted all of the recommendations either in principle or fully.

Unfortunately, Wales is an outlier amongst UK nations in its elimination targets. Wales is at risk of missing the World Health Organization's elimination target of 2030. So, what we in our motion today, Minister, seek to achieve is to build on the recommendations of the Health, Social Care and Sport Committee. We are calling on the Welsh Government to mandate the re-establishment of frontline blood-borne virus and harm reduction services in all health board areas, so that the identification, testing, linkage to care and treatment of HCV patients in Wales can resume. We are calling for a national strategic plan to deliver HCV elimination by 2030 at the latest, which is also sustainably resourced and patient centric. Our third point in our motion calls to ensure that health boards are fully funded and accountable for delivering the national strategic plan.

Whilst the previous health committee called for the Government to write to health boards, we in our motion are asking the Government to go even further and make sure that our local health boards have the ability to meet the elimination target. Without action, Wales is on track to miss its commitment to eliminating hepatitis C by 2030, and with this is the increased risk of further health impacts and health inequalities in our communities. In order to reach the 2030 elimination target in Wales, at least 900 patients must be treated each year, and sadly only 300 were treated between 2020 and 2022. Of course, I accept the pandemic as the reason for this. However, even pre pandemic the treatment rates were around 600 to 700 patients per year, which would now not be good enough, I look forward to Members' contributions and the Minister's comments in our debate this afternoon.

I have selected the amendment to the motion. I call on the Minister for Health and Social Services to move formally amendment 1, tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete point 4 and replace with:

Notes:

a) the Welsh Government’s expectation that frontline blood borne viruses and harm reduction services, including for hepatitis C, will be re-established in all health board areas as soon as possible;

b) that the Welsh Government is working closely with the NHS in Wales to support their planning to ensure that Wales is able to meet the World Health Organisation target of eliminating hepatitis C by 2030;

c) that established systems are in place to ensure that health boards are supported and held accountable for meeting the target in terms of service delivery, data monitoring and reporting performance.

Amendment 1 moved.

Formally.

I'm pleased to see this motion before us here today. I'm going to be referring to a couple of points that have been made already. At least 8,000 people in Wales have a chronic HCV infection. Untreated, of course, it can cause very serious illness—cirrhosis of the liver, liver cancer, and other health problems. I know, having spoken to constituents, about the impact that it can have on people's everyday lives. In the words of one constituent, who had HCV through infected blood in the 1970s, 'I never have a good day, just bad days or some very bad days.' 

By now, of course, it's possible to treat hepatitis C, get better and prevent it in the first place, and, vitally, we can eliminate hepatitis C entirely. But even though eliminating it is possible, and Wales in the past has taken great strides towards elimination by 2030, the truth is that we are backsliding and we are not on the right path at present to hit the target. Wales is the only country in the UK not to have a target of eliminating HCV before that 2030 target that has been set by the WHO. England and Northern Ireland have set an ambitious target for elimination by 2025, the SNP Government in Scotland set an even more ambitious target of 2020.

You'll hear the Government here in Wales saying that COVID has had a great impact, and of course I don't doubt that, but even before the pandemic, the health committee stated concerns that we were not on the right path to hit even the 2030 target. There is very good work being done. I am very grateful to those within the health system and charities for the great strides they have ensured are happening already, but we need further action, broader action by the Welsh Government.

First of all, the Government should allocate specific budgets—a specific budget for hepatitis C. That would give the certainty that's needed to health boards to be able to invest in accordance with the process of eradicating the illness by that date. Secondly, we need to ensure that savings—which we've seen recently in the cost of treatment, because of changes to procurement systems and centralised systems—are reinvested to detect hepatitis C patients who are undiagnosed. Third, with very high rates of HCV among drug users who inject, we need specific financial support in that area to offer more testing, for example. I'd like to hear the response of the Government and the Minister to those three points.

I have a couple of other comments, and two questions. Some of the strategies that will help us to eradicate HIV and the work that's been done in that area, which is something that's had attention recently, can be very useful as we try to hit the eradication target for hepatitis C. Is the Government ensuring that those two campaigns are working hand in hand to avoid any duplication?

And finally, shifting focus a little bit, as the chair of the CPG on infected blood, this week the inquiry into infected blood heard evidence from Sir Robert Francis about the compensation scheme for victims and families of victims. I'd like to hear about any discussions that the Governments has had with the UK Government on that.

To reiterate, our motion calls on the Welsh Government to develop a national strategic plan to deliver HCV elimination by 2030 at the latest, which is sustainably resourced, patient centric, and focuses on the whole pathway. At least 8,000 people in Wales are estimated to be chronically infected with hepatitis C, about half of whom are unaware they have the virus. Hepatitis C is a preventable and treatable blood-borne virus primarily affecting the liver. It can be fatal without treatment. During a debate here on hepatitis C five years ago, which called on the Welsh Government to confirm their commitment to the World Health Organization eradication date of 2030, I stated that the elimination of hepatitis C as a serious public health concern in Wales is a wholly achievable goal. Noting that in the 1970s and 1980s, a large proportion of blood products supplied to patients by the NHS was contaminated with HIV or hepatitis C, I concluded that to achieve the elimination of hepatitis C, we must find the 50 per cent of people currently undiagnosed, by widening access to testing and further investigating which groups could be cost-effectively screened, and that with effective and accessible new treatments now available to all who need them, it is easier than ever to treat and cure patients, presenting a great opportunity to achieve the elimination of hepatitis C in Wales. That was five years ago. Five years later, action is needed to get the hepatitis C elimination journey in Wales back on track and stop Wales being left behind.

Questioning the health Minister here in February, I noted that in England and Northern Ireland, the target to eliminate hepatitis C is 2025, and in Scotland 2024, and asked the Minister to confirm that the Welsh Government will review its target date to eliminate hepatitis in Wales by 2030 at the latest, and in so doing, how she will address calls for best practice developed in Wales and other UK nations to be harnessed. Although the Minister agreed to look at whether there was any possibility of moving the target date in Wales, she subsequently wrote to me, stating:

'While I do not rule out bringing forward the elimination target in the future, realistically, our current target of elimination by 2030 is already very stretching...I will continue to update the Senedd on our progress.'

And then that 'health boards are working on recovery plans, and my officials are in the process of reviewing opposition in order to prioritise next steps.' Yet, despite the impact of the pandemic on the health services and populations of the other UK nations, they have not altered their elimination target dates and have put in place national strategic plans and programmes and additional resources. Why should Wales have to lag behind yet again?

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

Diolch yn fawr, Dirprwy Llywydd. Thank you for allowing me the opportunity to provide an update on what we’re doing in Wales to help reach the World Health Organization's target to eliminate hepatitis C as a significant public health threat by 2030. The World Health Organization target is a 90 per cent reduction in incidence, and a 65 per cent reduction in mortality due to hepatitis C by 2030. We in Wales are pleased to have signed up to this target; obviously, if we can go faster, we will. You might have noticed that there’s quite a lot going on in the NHS at a moment, but we are not weakening the target that we’ve already set out. Thanks to medical advances, new directly acting antiviral medications have revolutionised the treatment of hepatitis C, so that the disease is now, to all intents and purposes, curable in the early stages. Treatments are well tolerated and of relatively short duration. This paradigm shift in treatment provides an opportunity to significantly reduce the incidence and prevalence of hepatitis C in all communities in Wales.

Of course, during the COVID-19 pandemic, difficult decisions have had to be taken to prioritise our health protection expertise and resources. As a result, work on important areas, including hepatitis C testing, were paused temporarily. But we remain committed to working towards the World Health Organization target and to improving lives in Wales. Our focus for the elimination of hepatitis C is on ensuring that health boards have robust, cohesive plans in place to be able to find and treat people with hepatitis C through existing harm-reduction services. And to do this, we will need to focus on individuals who may be unaware that they have the disease, as has been pointed out, or, until now, have been unwilling to engage with traditional health services. We've previously worked with health boards to set out the route-map to elimination of hepatitis C, and we have nationally funded posts to support this.

Despite the challenges of recent years, we have several stories of success here in Wales, and these will work as catalysts to achieve our target. We've already mentioned about the opt-out tests for blood-borne viruses that were introduced in Swansea prison in 2016. By doing this, we succeeded in having micro-elimination in the prison—the first in the UK to do that. And this was featured in the report that you wrote as a committee. By now, there is a strategy in place in Berwyn prison as well, and Public Health Wales has ensured funding to be introduced in Cardiff prison. The aim is to eliminate the virus in all of the prisons in Wales in the longer term.

On top of that, there is a Follow Me support programme and it's aimed at raising awareness. And under that plan, staff from the voluntary sector, from the Hepatitis C Trust, will be working within the clinical pathway, with people who they see as challenging, to try and seek help from health services, and will be encouraging them to have IgG tests. The project is being trialled at present in Cardiff and Vale University Health Board, with awareness-raising work in homeless shelters happening in Cardiff, and further training for staff to be introduced in terms of service users.

We're fortunate that the hepatitis C clinical network is very effective and dedicated here in Wales. This leads to the saving of more than £40 million in drug treatments since anti-viral agents, which operate directly, were introduced in 2014. It's a flexible way of funding drugs and providing them to patients, and improves the patient experience, improves outcomes and helps to save costs as well. Even though we're all aware of the great work that's been done already, and that we still have to do, to meet the target of eradicating the virus by 2030, we're continuing to work with the health service here in Wales to deliver our aim jointly, and our aim is to give you a further update in the autumn. Thank you.

I call on Russell George to reply to the debate.

Thank you, Deputy Presiding Officer. Can I thank Rhun ap Iorwerth and Mark Isherwood for their contributions? I can't disagree with anything that they added to the debate this afternoon. I thank the Minister for her update—much I can, of course, welcome and support. There are, of course, some elements that I was disappointed about—I'll focus on those areas. We did ask in our motion for the re-establishment of front-line blood-borne virus and harm reduction services. The Minister was not prepared to accept that in our motion, simply saying that the services will resume as soon as possible, but it's disappointing that we couldn't at least have a date when services could have resumed.

The other part to our debate this afternoon was, of course, asking for a strategic plan to deliver on HCV. And the Government really is an outlier on this. There are so many Governments around the world that have those plans in place, and we also are aware that Public Health Wales has also previously called for a plan as well. So, it's not just in our motion today, it's Members across this Chamber, and, in fact, two Ministers actually signed up to the previous committee's report. The Deputy Minister, Lynne Neagle, was on the committee that signed up to that report at the time, and it was her recommendation that called for a plan to tackle and deliver HCV elimination. So, I hope that the Deputy Minister could perhaps persuade you in that regard as well. Dawn Bowden was also on the committee, actually, that made that recommendation. So, I hope that Government colleagues can perhaps persuade you of the need for the plan. And the Deputy Presiding Officer was actually on the committee that made that same recommendation as well. I think I've gone through everyone now—and my colleague Darren Millar was on there as well. And that's everyone who is currently here.

But, thank you, Minister, for your update, but we would've preferred that you had gone, of course, further in that plan. I think the current situation isn't good enough. There have been valid solutions that have been put forward. I appreciate what's happened during the pandemic, but as I pointed out, even pre pandemic, we weren't treating enough people even at that point to meet the World Health Organization targets, which you currently say that you're still going to meet. So, I do think, also, that putting responsibility on health boards is simply not good enough. I think we need a strategy that is not designed to fail, one that creates an in-depth strategic plan. We need to fund our health boards correctly and show ambition in the fight to eliminate this virus. I move our motion this afternoon, Deputy Presiding Officer.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there are objections and I will therefore defer voting under this item until voting time.

Voting deferred until voting time.