Item 7 this afternoon is the Welsh Conservatives debate—gynaecological cancer. I call on Russell George to move the motion.

Motion NDM8082 Darren Millar

To propose that the Senedd:

1. Notes that September is gynaecological cancer awareness month.

2. Expresses its concern that the lowest single cancer pathway performance by tumour site is gynaecological, with less than a third of patients being seen within 62 days.

3. Regrets that one-year and five-year survival rates for cancer of the uterus have dropped significantly over the last decade.

4. Further notes research carried out by Jo’s Cervical Cancer Trust which highlights that 80 per cent of women who work full time cannot get a convenient cervical screening appointment.

5. Calls on the Welsh Government to:

a) urgently conduct a review into gynaecological cancer waiting times;

b) ensure that workforce plans for cancer specialists have a focus on gynaecological health; and

c) immediately introduce its cancer action plan.

Motion moved.

Thank you, Deputy Presiding Officer. I move the motion in the name of my colleague, Darren Millar. In this motion today, we, as Welsh Conservatives, are urging the Welsh Government to ensure that its cancer action plan is published urgently, alongside focusing its cancer workforce plan on gynaecological health, with clear and measurable aims that can be achieved within the next five to 10 years.

Now more than ever, gynaecological cancer services must be given the priority that they deserve. There is little doubt that the pandemic, of course, has accelerated inequalities in healthcare, no more so than in female cancers. Latest cancer survival rates between 2015 and 2019 show that the five-year survival rates had dropped for cancer of the uterus by 4 per cent over the last decade, the only cancer to dip in survival rates over a 10-year period.

The pausing of vital screening services for four months in 2020, alongside restrictions over the past two years, has caused a drop in attendance for cervical screening to its lowest in over a decade. Furthermore, many women who were invited for appointments are finding it difficult to arrange suitable time with their employers, some often taking annual leave in order to attend medical procedures.

Sadly, long waits for cancer treatments are not new. Cancer waiting times have not been met since 2008. Fifty-six per cent received treatment within 62 days in February 2020; that was, of course, prior to the pandemic. Although gynaecological cancers typically have a high survival rate at both one and five years, performance of treatment for gynaecological tumour sites against the single cancer pathway has dropped significantly, leading to concerns about whether survival rates will drop further because of the pandemic. So, I think it is time, and it is imperative, that patients are seen quickly, to receive the treatment that they need, and I believe that, by having a robust plan in place, we can start to make progress on this.

As part of this, a specialist cancer workforce that is able to cope with demand and increasing backlogs I really think should be a priority for the Government, in order to prevent gynaecological cancer survival rates from slipping further. Wales already has the highest shortfall of cancer specialists in the UK. Ninety per cent of clinical directors in Wales told the Royal College of Radiologists in 2021 that they were concerned about patient safety. And none of this, of course, that I’ve mentioned is a party political issue. These are not party political points that are being made. Many organisations have expressed deep concern surrounding workforce. For example, Macmillan Cancer Support also found that one in five of those diagnosed with cancer in Wales over the past five years said that they lacked specialist cancer nursing during diagnosis or treatment, and Cancer Research UK has also outlined that gaps in the NHS workforce are a fundamental barrier to transforming cancer services and improving cancer survival rates in Wales. And shockingly, despite these grave concerns, the last 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 Wales strategy from October 2020 fails to mention cancer at all. And while there are laudable aims, of course—I accept that—in the Welsh Government’s cancer quality statement, the lack of detail within the 10-year NHS workforce plan for cancer specialists is sadly reflected in this document.

In response to Mabon ap Gwynfor’s debate on cancer treatment and diagnosis in December, while of course the Minister mentioned the cancer quality statement, again, little detail was provided to ensure how increases in cancer workforce could be carried out. Welsh Conservatives have been concerned over the past two years about the lack of progress the Welsh Government has made over both supporting cancer services to recover from the pandemic and the lack of forward planning to ensure that cancer services are fit for the future.

Thank you, Minister, for listening attentively to my contribution today. For me, I think it’s all very well me repeating the same arguments that we’ve been experiencing for years, but this is a specific area that I really think we should be leading on by example. Jo’s Cervical Cancer Trust has expressly outlined the barriers for women to obtain a simple test that would prevent them from often going through complicated procedures or even risking death, so I don’t think we can delay any further. We must ensure that women are tested, diagnosed earlier, and tested within target times, for gynaecological cancer especially.

I very much hope that this motion today will gain cross-party support. It’s not a party political issue; it’s something that I think we can all get behind. I look forward to Members’ contributions to the debate today.

I very much thank the Conservatives for tabling this motion, because women’s health gets much less attention from the NHS, from medical research and the pharmaceutical industry, so anything that shines a light on women’s health is really welcome. And we should all be concerned that less than a third of gynaecological referrals are seen within 62 days, but having talked to some of the gynaecologists and obstetricians working in England, I appreciate that this is not something that is facing Wales alone; it’s also a major concern across the NHS.

I think one of the things we need to do when we look at why gynaecological referrals—. Obviously, waiting lists are much longer than we currently have capacity to see. Are they appropriate, these gynaecological referrals, or are people in primary care not dealing with issues themselves, when they ought to be? Now, we need to start, of course, with prevention, and I think that the mandatory relationships and sexuality education helps all citizens be aware of how their body works and what is normal and what is not normal, and when they should be seeking advice. That's a really important issue. We need to operate prudent healthcare in primary care, and I recall, for example, that the UK Government had to be dragged kicking and screaming into making telemedical abortions a permanent feature of sexual health provision, which was something that Wales took a bold decision about. That's clearly the right thing, particularly for people who've got caring responsibilities or live in rural areas, where getting to a clinic is going to be way more difficult than if you live in an urban constituency like mine.

Equally, we need to ensure that people have access to contraception so that they are not needing abortions in the first place. That's all part of prudent healthcare. I know we have C-Cards for under-25-year-olds, so they can get condoms, and that obviously helps prevent unwanted pregnancies and also sexually transmitted infections, both of which are seriously important in preventing gynaecological problems later on.

This week, I heard from a consultant in women's health in the women's hospital in Liverpool that long-acting—LARCs—long-acting reproductive—. I can't remember what they're called, but they're basically an injection to enable you to not get pregnant, with a long-acting release to do that. They were the most effective public health intervention. I wrote it down because I thought it was a really bold statement. But she said that in England, anyway, it's made very difficult to get hold of, and we know from earlier work done by the Welsh Government that this is a really effective prevention for vulnerable groups—teenagers who have become pregnant, and then who obviously want to ensure that they don't get pregnant again.

So, we need to ensure that all people who are sexually active have access to the appropriate consultation for their needs, and also to protect themselves from sexually transmitted infection. Chlamydia is one of the major sources of infertility, which then causes huge referrals to gynaecologists, and a very complicated and lengthy journey to try and reverse the problems that may have been created by sexually transmitted diseases that haven't been dealt with effectively and early enough.

Now, we also know that, more recently, there have been major advances in how we support people with the menopause, as a result of campaigns by people like Fair Treatment for the Women of Wales, the Wales TUC's 'The menopause in the workplace', and the training for employers offered by people like Jayne Woodman, which includes support from the Welsh Government through Academi Wales. I was really interested to see that Hywel Dda University Health Board has been piloting a questionnaire to everybody who turns up for cervical screening over 40, to alert them to the menopause symptoms they may or may not be experiencing. This helps build women's own knowledge of their bodies, and allows them to visit their GP with a starter for 10, so they've got a little list of things that are relevant to the issue, which reduces the length of the consultation and increases the effectiveness of that consultation.

The Member needs to conclude now, please.

This could be a really important tool for ensuring that all women know about it.

The elephant in the room, in my view, is endometriosis, and I appreciate that we're doing lots of work to improve the understanding of both GPs and gynaecologists on this issue. But, it really is a serious issue, and very difficult to disentangle from gynaecological cancer, because if you've got such problems—

Jenny, can you conclude now, please?

—then it can be really problematic, and we clearly need to do way more work on this. 

It's a pleasure to take part in this debate this afternoon on what is such an important topic in the lives of many women in Wales. And while it may raise eyebrows that a bloke is talking about women's health, I believe it's important that we all work together to enhance the lives of women in Wales to tackle the barriers to cervical screening, and avoid unnecessary deaths due to gynaecological cancer.

I worked in the NHS for 11 years, if you didn't know already, and while I didn't work directly in the field of women's health, I did work in community mental health teams and would support women's mental health, which deteriorated as a result of their physical health. And the point I'd like to make is, sometimes, we focus on the core issue, which is quite right, but what we also have to consider and care for is the knock-on effects such illnesses have on women's self-esteem and mental health, of course.

Deputy Llywydd, Jo's Cervical Cancer Trust has outlined the problems women already face towards cervical screening, including embarrassment, pain, fear, fear of results and inconvenience. These existing barriers, on top of COVID-19 creating restrictions in backlogs and in seeing GPs, has led to cervical screening coverage falling to 69.5 per cent in October last year, the lowest in over 13 years, and below the minimum service standard for coverage of 70 per cent—[Interruption.] Yes, sure.

Thank you for taking an intervention. I wonder if you can just tell us if those are UK figures or Welsh figures, because Jo's Cervical Cancer Trust is a UK-wide charity.

Yes, these are Wales-only figures, because I'm just going to mention now that, in Merthyr Tydfil, less than two thirds of women took their screening test, which I think is shocking but not surprising, to say the least, when many women have said that the main barrier was working their tests around employment and, as Russell George mentioned in opening the debate, it's women in a situation of having to take annual leave in order to make cervical screening appointments. Jo's Cervical Cancer Trust also noted that just one in four women were able to get a convenient cancer screening appointment in 2021, and one in five women reported that they had used annual leave more than once to attend cervical screening appointments. And a staggering 80 per cent of women who work full time cannot get a convenient cervical screening appointment, and 15 per cent have delayed screening because they felt unable to take time off work.

But it's not for me to tell the Chamber today how hard it is for women to get cancer screening appointments. I will, however, use the words of one of my constituents, who had difficulties in arranging their test. They said, 'In August, I received a letter from my GP about my three-year cervical cancer screening appointment. I know this is an important procedure and I was lucky that my GP surgery had an e-mail address, so I didn't have to feel uncomfortable about phoning in. But even though the surgery picked up on my e-mail that same day, I was unable to arrange a convenient appointment until October. My work means that I have to be in the office on certain days and at certain times, so while I was anxious about the appointment, I was unable to book it in for an earlier time. So, I'll be waiting two months from the date I received my letter to actually getting a test. While my boss has been understanding, I dread to think of women who are put in the position that they have to book annual leave for a medical appointment.'

Now, that's just one person, but her story is being repeated right across Wales. My constituent left her cervical screening to one side. The consequences could be disastrous by having possible cancerous cells diagnosed at a later stage, her survival rate would drop from 95 per cent for five or more years at stage 1 to just 15 per cent at stage 4. And we will have heard previously, even when gynaecological cancers have been diagnosed, just over a third will be treated within 62 days on the single cancer pathway, and I think that's an unacceptable position to put the women and girls of Wales in.

And, Deputy Llywydd, to close, it should be our duty to remove those barriers and to set an example to half of Wales's population. Employers and even ourselves as politicians must ensure that vital cancer tests are taken, so that women are diagnosed and are being treated earlier, and we can't delay this any further. So, it's time we focused our efforts on gynaecological cancers, alongside boosting our cancer workforce, and, above all, it's time to test, so support our motion this afternoon. Thank you.

I welcome this motion before us today, as we note Gynaecological Cancer Awareness Month. Every woman in Wales and every woman across the world faces the risk of gynaecological cancer. It increases with age, but it is something that is a risk for everyone. But, of course, as with all cancers, the way to increase the chances of survival, if the cancer has an opportunity to take hold, is to identify and treat that cancer early. But, the reality is a very depressing one in Wales: fewer than one in three cancer patients is seen within the 62-day target. One-year and five-year survival rates for cancer of the uterus have dropped significantly over the last decade. We should be seeing survival rates increasing in the twenty-first century. Tragically, more than half of the kinds of cancer with the lowest survival rates in Wales are found late, which makes the work of treating the cancer more difficult.

In May, I called on the Welsh Government to develop a bespoke women's health strategy for Wales. Such a strategy should focus on closing the gender gaps in healthcare, providing consistent investment, support and treatment into women's health. But, today's debate again exemplifies that there's so much work to be done still. Even before the COVID pandemic, which at times can feel is being blamed for everything, Wales was experiencing significant gaps in the diagnostic and cancer workforce, in imaging, in endoscopy, pathology, non-surgical oncology. The NHS has relied, has it not, on the goodwill of its workforce to keep services running.

In July this year, figures told us that just 34 per cent of gynaecological cancers met the suspected cancer pathway target of starting treatment within 62 days from the point of suspected cancer in Wales. This falls far behind the target of 75 per cent of people starting treatment within 62 days.

In 2017, the then Assembly's Petitions Committee produced a report calling for a public-facing ovarian cancer awareness campaign in Wales. To date, there has been no specific awareness campaign on ovarian cancer, despite low levels of awareness of the symptoms of ovarian cancer in Wales. Nearly 400 women in Wales are diagnosed with ovarian cancer each year. Well over half of them will die of ovarian cancer in Wales each year. If there's no public awareness campaign, if there's no general awareness of ovarian cancer, including the common symptoms, when people should seek medical advice, then those who have the cancer go undetected and untreated, and early detection, as I say, is critical.

Target Ovarian Cancer wants to shorten the diagnostic pathway. Now, currently, individual tests are carried out separately, leaving women waiting longer for a diagnosis. We want to see the relevant tests carried out at the same time, allowing women to be diagnosed faster.

Screening is vital when it comes to women's health. Many lives have been saved by an early diagnosis stemming from the screening programme. The movement towards five-year screening rather than three-year screening undertaken previously was based on evidence. It was the right decision, but it was dealt with in an unacceptable way, with poor communication, a lack of information, and that happens too often when it comes to women's health conditions across Wales. But, of course, Jo's Cervical Cancer Trust emphasises that preventing cervical cancer doesn't begin and end with screening, and there's a lot of work to be done in terms of the patient pathway following diagnosis.

To close, according to Cancer UK, rates of cancer of the uterus in Wales are significantly higher than in the rest of the United Kingdom. Vulval cancer affects around 80 women in Wales every year, requiring specialist and complex treatment. We have no screening procedures for that at all. 

Wales was performing poorly in terms of cancer diagnosis, treatment and survival rates, as I say, long before the COVID pandemic. That is why we on these benches and others have been asking for a cancer plan for many years. Let us today, in the context of women specifically and gynaecological cancer, make that call again. We can't act soon enough when it comes to cancer and the threat to women's lives in Wales.

The adverse effects of the pandemic on the delivery of health services in Wales are still being felt, and it's particularly concerning when it comes to cancer services. I'd like to reiterate what my colleague Russell George said earlier, in that vital cancer screening services had to be paused for four months in 2020, and the imposition of restrictions on movement and face-to-face meetings have resulted in attendance for cervical screening falling to their lowest levels in over a decade, which is a real shame, but we also understand why. Each year, around 1,200 people are diagnosed with gynaecological cancer here in Wales. The incidence rate for gynaecological cancer is significantly higher in Wales, with 72 cases per 100,000 women, compared to the UK average of 68 cases. Sadly, the mortality rate is also significantly higher here, with 26 deaths per 100,000, compared to 24 in the UK—some 470 deaths in Wales each year.

The suspected cancer pathway sets a target of 62 days for people to start treatment from a point of suspicion. In Wales, in July this year, only 34 per cent of gynaecological cancer patients met this target. It is clear that urgent action needs to be taken, not just to recover cancer services to pre-pandemic levels, but also to improve cancer outcomes and survival in the future. Without this action aimed at delivering timely diagnosis and effective treatment, outcomes for cancer patients in Wales will not improve.

The Welsh Government cancer quality statement remains vague. It does not specify a target and lacks detail on how it will reduce waiting times and how it plans to increase the NHS cancer workforce. Even before the pandemic, Wales was experiencing significant gaps in the diagnostic and cancer workforce, such as imaging, endoscopy, pathology and non-surgical oncology. These gaps have severely affected the ability of the Welsh NHS to diagnose cancers early, provide the most effective cancer treatment and improve cancer survival rates.

The clinical oncology consultant workforce in England and Wales has only grown by an average of 3 per cent a year over the past five years, compared with 5 per cent in Northern Ireland and 6 per cent in Scotland. Spending on agency staff for NHS Wales has increased from £50 million in 2011 to £143 million in 2019. This equates to more than half of Health Education and Improvement Wales’s annual spend on healthcare education training. This significant resource is spent on outsourcing rather than investment in the long-term growth of the NHS workforce here in Wales. Without this investment, we will not have the front-line staff and specialists we need to address the cancer backlog. Minister, the time has come for a detailed cancer action plan. This plan must include robust reporting mechanisms to report on progress regularly and transparently.

The cancer quality statement is totally inadequate, as you said, and needs to be replaced as soon as possible. The Welsh Government needs to develop a laser-like focus on cancers in general in Wales and produce a strategy to tackle them. All this will inform and guide not just doctors and other clinical staff, but also the managers who need to understand what the priorities will be going forward.

In relation to the cancer action plan, the plan should have, as its central aim, the principle that everyone should have equitable access to timely diagnosis and the most effective evidence base, treatment and support. Consideration should be given to how adequate capacity and expertise can be brought together to enable timely access and transformation, and how to bring cancer services closer to communities and patients at large. However, lasting transformation that will deliver improvement in outcomes will be impossible without adequate investment, growing the cancer workforce as well as improving infrastructure. We need to see innovative approaches to service delivery in areas such as early detection and diagnosis, digital pathology and developing integrated IT systems.

Minister, your Government and all parties in this Senedd are committed to promoting the rights of women, I have no doubt in my mind. On Monday, I took part in the first meeting of the women's caucus steering group, organised by our esteemed colleague Joyce Watson. Based on the Senedd's desire to support women in all areas, nothing would demonstrate more clearly your commitment to promoting the rights of women than by giving your support to the motion today. Thank you.

I thank the Conservatives for bringing this debate today. In recent years, there have been huge strides in the prevention of cervical cancer through the introduction of the human papillomavirus vaccine programme. That vaccine was first rolled out in schools in the UK for teenage girls in 2008 and has been available for boys since 2019. It has had a hugely positive impact on cervical cancer rates since its introduction. A recent study including decades of research showed that cervical cancer rates were reduced by 90 per cent in women in their twenties who had that vaccine at the age of 12 or 13. HPV is a name given to a common group of viruses, many of which do not cause any harm, but some HPVs are known as high risk because they are linked to the development of some cancers like cervical cancer. In fact, HPV is linked to 99 per cent of cervical cancers.

It's important to note that this has not eradicated the need for smear tests—that’s been mentioned here today—and that they are still as important as ever, because no vaccine is 100 per cent effective, and it's still possible for the virus to be transmitted despite that vaccination. But it has been a huge breakthrough in women's health, and it's been found to be effective in protecting women against other gynaecological cancers—that is cancer of the vulva and the vagina. Uptake of this vaccine in Wales has generally been high since its introduction—roughly around 80 per cent. There was a dip, as we all know, between 2019 and 2021, as routine vaccinations were paused. An 80 per cent uptake seems a really good uptake, and it is, but if you compare it to MMR, that has an uptake of 90 to 95 per cent. So, I'd be keen to know what actions the Welsh Government are taking to increase the uptake of the HPV vaccine in 12 to 13-year-olds.

I know that Jenny was trying to mention endometriosis, so I shall pick up that—the link to undiagnosed endometriosis within women and the fact that the longer that women are living with it undiagnosed, the potential for the spread and the likelihood of that becoming a cancerous spread happens. Therefore, I will call on you, Minister—I’m sure I’m pushing at an open door—to look at that.

The other thing is that ovarian cancer is known—and Rhun mentioned it—as the silent killer. We have to do more to educate those people working in the field, but also those people suffering symptoms, to know what it is that they're dealing with. It shouldn't be a silent killer—we should be bringing it to the fore and making sure that women and girls, and also their partners and the people around them, are informed about the signs and symptoms from a very young age, and also the risk factors associated with cancers and the steps that they can take to help reduce that risk, like vaccination, diet and lifestyle. I’d certainly like to see a real drive in helping to raise awareness of these issues. I ask you, Minister: is that something that you might be including in your women's health plan for Wales?

One of the downsides of going later on in these debates is that a lot of people have already said a lot of what I wanted to raise. I'm not going to reiterate a lot of the comments that other people have made, but one thing I did want to say, and something about the key statistics that has really stood out for me, is that 1,200 people each year are diagnosed with gynaecological cancer, and out of that, 470 die. That's 470 sisters, grandmothers, wives and mothers. It's just not good enough that those people are dying. The Government must do more. The Minister has heard, across the Chamber today, ideas of how we can address this, from Members from across the political divide. These people suffered in pain and then they died, and I'm sure the Government want to get on top of this. That is what our motion is clear to do. This isn't political, this is about actually getting on top of an issue, to address gynaecological cancer so people don't have to die unnecessarily, because I'm sure, as I said earlier, those sisters, wives, mothers and grandmothers still want to be here, and if the Government can do more to put a cancer action plan in place, no-one will have to die unnecessarily to this absolutely hateful disease. Thank you, Deputy Llywydd.

One in two of us will develop some form of cancer in our lifetime. This inevitably means that we'll all feel the effects of cancer, but much like many other diseases and illnesses, thanks to groundbreaking research funding, not all cancer diagnoses are a death sentence. We have made leaps and bounds over the decades, with survival rates doubling over the last 40 years, but inequalities still remain, so there is work still to be done. Reading today's motion makes me feel a great amount of sadness. The lowest single cancer pathway performance by tumour site is gynaecological, and one-year and five-year survival rates for cancer of the uterus have dropped significantly. This inequality is unfair, and it's only right that we discuss this on the Chamber floor together during Gynaecological Cancer Awareness Month.

If we're to save more lives, and if we're to reach the ambitions of today's motion, we must remove the barriers that women face at each and every milestone on their journey with cancer. It's absolutely shocking that 80 per cent of working women who work full time can't get a convenient cervical screening appointment. If we are to save more lives, we need to be diagnosing early. We'll only make sure this happens if women are able to arrange appointments when needed. This, to me, has to be the most important aspect of the cancer action plan. After receiving a diagnosis, too often we hear stories from women who are waiting unacceptable durations from one appointment to the next. The uncertainty this causes leads to an even further decline in their health and mental health. Conducting an urgent review into gynaecological waiting times is a must if we are to bring this to an end.

I think, during these debates, the language that we use and the points that we make can make NHS staff feel as if they're the ones to blame. So, let me make one thing absolutely clear: NHS staff aren't the problem. We need more dedicated NHS staff, so that doctors and nurses aren't working more than their contracted hours out of goodwill. We need more dedicated NHS staff to plug the gaps in endoscopy, imaging, pathology and non-surgical oncology. They aren't the problem; they are the solution, and I can't thank them enough for their work. We need to unashamedly support the new Velindre Cancer Centre, not shy away from it or treat it as some sort of profanity. We need to unashamedly support the plans for the centre of true world-class standard in the treatment of all types of cancer care—no ifs, no buts.

I'd like to finish my contribution today with a thank you to Wayne Griffiths, who some of you met earlier this year at the Senedd. As many of you will know, I am a proud support of the Forget Me Not fund, which is a tribute fund in loving memory of Rhian Griffiths, who sadly passed away at the age of 25 in June 2012 from cervical cancer. Rhian's story and her legacy, thanks to her parents, changes lives every day. Let's take inspiration from Rhian, from her parents, from the Forget Me Not fund that celebrates its 10-year anniversary this year, to ensure that we can change the outcomes for women diagnosed with gynaecological cancer in Wales. 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 another important debate on cancer services. I'd like to thank others, also, for their really powerful and thoughtful contributions to this debate. 

As we emerge from the impact of the pandemic, we must continue to focus on recovery in cancer services and look to minimise any impact on outcomes. We've set out in a number of plans the work we are doing to support cancer services, and we are giving this significant and ongoing focus in our discussions with health boards. Frankly, we're not doing well enough yet, and I'm very well aware that we've got a long way to go on this. Much of what's been discussed today applies across many types of cancers, but I think it's right, during Gynaecological Cancer Awareness Month, that we focus on cancers of the ovary, uterus, cervix and some of the rarer types, such as vulval and vaginal.

I know that survival rates for cancer of the uterus have dropped in recent figures, although we have seen improvements for ovarian and for cervical cancer. It's really important that people with concerns about cancer come forward early to see their GP, and we must not be embarrassed to talk about these conditions and to seek help. I also encourage people eligible to take part in cervical screening or the HPV vaccination programme, as prevention is the very best approach.

I've heard loud and clear what some of you have said about the need to make sure that those screenings are available to women at convenient times. I understand that it can be challenging for working-age women to make appointments around their work commitments, so we're going to look and we're going to learn from England about the potential to introduce self-sampling. I agree that NHS Wales's performance in relation to gynaecological cancers in particular is not what it should be and it's certainly not what I expect to see. The service is working hard to address this, putting in additional clinics, streamlining pathways and looking for new ways to deliver services. In July alone, 1,561 people entered this particular cancer pathway, and during the same month—the same month—1,256 people on this cancer pathway were given the all clear. So, work is going on and people are getting through the system, but it's not enough. Seventy-six people started their definitive first cancer treatment for these conditions in July. 

Now, we're still in a pandemic situation and, even though the direct impact on services is receding, we still have the indirect consequences of earlier waves of the pandemic with us—people who perhaps delayed presenting with concerns are now seeking help on top of those who would ordinarily be coming forward at this time. And what's happening is that that's resulting in significantly larger numbers of people requiring investigation—roughly around 11 per cent more for gynaecological cancers since January. 

Now, our NHS teams at the diagnostic and treatment stages are struggling to get through the number of referrals that we're now seeing and have been seeing for many, many months. And, as we all know, we can't just magic up additional trained specialist nurses, radiologists, gynaecologists, surgeons and oncologists. We have the workforce that we entered the pandemic with. Although we are training more specialists in areas like oncology and radiology, it's going to take several years to see the benefit of this extra staffing capacity. In the meantime, we're training people in advanced practice roles to alleviate some of these pressures. And, of course, as cancer referrals go through generic diagnostic and out-patient services, we're prioritising cancer care over other conditions due to the clinical urgency involved. 

But, there is a reality to all of this. It's going to take time to recover, time to grow our workforce and to reach where we need to be. Now, I'm aware in terms of cancer services that time is not always available to people, and I'm not asking people to be patient, but I am seeking to explain what's causing the problem and how we're going to restore the situation.

I can assure you that there is no need for a review of gynaecological waiting times. We look at the data on a monthly basis, on an all-Wales basis, and with individual health boards. We discuss cancer performance with health boards regularly in every one of the relevant fora, and the health boards understand the focus that I expect to see on this issue. There are some signs that performance is improving, and it's important to note, too, that around 94 per cent of the people on a cancer pathway are informed that they don't have cancer. If we consider everyone on a gynaecological cancer pathway, those who are informed that they don't have cancer and those who need treatment, the median waiting time for the pathway to discover whether they have been diagnosed with cancer or not is 36 days.

I will hold a summit of senior managers and cancer clinicians from all parts of Wales on 12 October in order to ensure that we are doing everything within our power to restore our services. 

So, I am holding a summit, a cancer summit, on 12 October, and I can assure you that I am now going to make sure that I put on that agenda gender-related cancer breakdowns just to make sure that we're not seeing a difference in the way that different cancers are being considered. 

I am more than willing to give particular attention to improving the work on workforce development for cancer and whether our provision for the workforce is sufficient. I intend to introduce a cancer service action plan for the NHS over the next few weeks. 

So, the plan for the cancer services will be published in the next few weeks. 

And in this plan, I will set out in more detail how we will deliver against the expectation set out in the quality statement for cancer and the care transformation programme that is planned. We will also introduce an action plan on women's health in order to ensure that we meet the particular health and care needs of women in Wales.

So, just in answer, specifically in terms of how this is going to be built into the women's plan, this is a bottom-up approach. There's a consultation that's going on asking women to contribute: what is it that we should be putting in in that women's healthcare plan for the future? And so, that is a bottom-up approach, so if people want this to be on the agenda as well, to make sure that people are feeding into that, but I will certainly be making sure that it's something that we consider. 

There is so much to be done, and I know that our committed managers and clinicians are doing everything within their power to meet people's needs. Raising these concerns in terms of systems is no criticism at all of their efforts or their commitment, and I can assure you that I'm doing everything within my power to place a deserved focus on this.

Russell said that this is not a party political issue. I can assure you that I don't think it's a party political issue, and that's why we, like you, want to see an improvement in the system and that's why we in the Government and on the Labour benches will be supporting this motion.

I call on Janet Finch-Saunders to reply to the debate.

Diolch, Dirprwy Lywydd. I would like to thank my colleague, Russ George MS, for introducing this important debate, and those across the Chamber for their really important contributions in what is a hugely important issue for women. Cancer of any type is an awful affliction that already takes far too many lives, with Public Health Wales noting that cancer has become the main cause of mortality since 2016, even including the shocking times that we went through with the COVID-19 pandemic.

As other colleagues have already noted, approximately 12,000 women are diagnosed with gynaecological cancer every year in Wales, resulting in the tragic deaths of 470 people annually. And that's why it was an important point that you made, James, that these are people's mothers, sisters, daughters or other relatives—470 families a year whose lives are irreparably damaged by this awful, awful disease. Gynaecological cancer, of course, is a massive problem right across the UK, but I'm afraid that it is worse here in Wales. Russ George highlighted the concerns—[Interruption.]

Will you take an intervention?

Yes.

I just think that one of the issues that nobody's mentioned that needs mentioning and putting on the record is the link between obesity and cancer. And we do have higher rates of obesity in Wales than in England, and that has to be one of the factors that we need to bear in mind when we're endeavouring to reduce cancer rates.

Yes. You make a really valid point. I know that when we've done inquiries into obesity in children, we have some of the most shockingly worrying statistics. So, yes, you make a valid point.

Russ George highlighted concerns that we as a group have had these concerns over the past two years and the need that has arisen, and that it's obvious that more tests are part of the solution. According to Cancer Research UK, the incidence rate for gynaecological cancer is significantly higher in Wales, with 72 cases per 100,000 women, compared to the UK average of 68. If that wasn't bad enough, it's been pointed out today that the mortality rate for this cancer is significantly much higher with 26 deaths per 100,000 women, compared to the UK average of 24. And, Jenny, the fact that you recognise that women-related cancers are a major concern, and there is a need for greater prevention, and recognising themselves—we should all, as women, know what to look for, what is normal, what is not normal.

But it isn’t just incidence and deaths in Wales that we're worried about; it's also the waiting times. We understand the impact that the pandemic has had on the provision of services in the NHS, but we know—Rhun made a very valid point that we had some of these problems in our health system prior to the pandemic. In July of this year, only 34 per cent of these cancers met the suspected cancer pathway target of 62 days from suspicion to treatment, compared to 40 per cent in February. So, it’s really worrying that, as we speak, we're seeing a downward spiral. Joyce Watson raised very valid concerns about HPV, and whilst there's been a breakthrough in the vaccines, there are still concerns, going forward. The Welsh Government's own target of 75 per cent and the responsibility for very long waiting times for cancer treatment does lie with the Welsh Government, and I've been really heartened, actually, Minister, to see that you've really listened and taken on board all the comments that the Welsh Conservatives have made, in particular about the immediate introduction of a cancer action plan. And how heartening, again, it is to hear that you are going to be implementing that and quite soon.

We need to ensure that workforce plans for cancer specialists have a focus on gynaecological health, as it does appear that these gynaecological cancers are slipping through the net when it comes to treatment. Other colleagues have stated that the Welsh Government's cancer quality statement really does need to be more clear, with Wales having the largest cancer specialist gap in the UK. I actually echo calls from colleagues for the Welsh Government and Healthcare Inspectorate Wales to work towards a substantial increase in training places, with rapid diagnostic cancer centres rolled out nationwide so that we can ensure that these cancers are detected much earlier. Natasha Asghar, my colleague, pleaded that we need these services more locally and the need to bring forward true equality for women in terms of healthcare. Unfortunately, cancer may always be a scourge on our existence, but it doesn't have to be as bad as it currently is. I believe, after this debate today, that you are taking these concerns forward. It's heartening to hear that you are supporting our motion today—thank you for that, and I say that on behalf of all the group. Buffy Williams, your contribution and mention of the Forget Me Not fund was very relevant indeed. Buffy's not here, but wherever you are.

Anyway, thank you, Minister. Thank you, Deputy Presiding Officer. Thank you for all your contributions, and thank you to my group for introducing this debate. Thank you.

The proposal is to agree the motion. Does any Member object? No. The motion is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.