We will now move to the short debate. If Members who are leaving the Chamber could do so quietly before I call on Altaf Hussain to speak to the topic he has chosen. Altaf Hussain.

Thank you very much, Presiding Officer. I have agreed to give a minute of my time to Joel James. My short debate this afternoon will focus on living with cancer. 

We all know the stats: one in two of us will develop cancer at some point in our lifetime. Cancer used to be a certain death sentence, but thankfully more and more people are surviving cancer. Across the UK, over 3 million people are still alive at least five years after receiving a cancer diagnosis. In Wales, 70,000 men and 90,000 women are living with cancer, and the total numbers are expected to rise to 0.25 million by the end of this decade.

It's widely acknowledged that much of our success against cancer is thanks to earlier diagnosis. However, regardless of the advances in screening and treatments, a cancer diagnosis can have life-altering consequences—consequences such as health issues that develop during treatment and can have a lasting impact even five years after finishing treatment.

The Deputy Presiding Officer took the Chair.

Long-term effects impact on both physical and psychological health. Issues include fatigue, mobility problems, pain, breathlessness, malnutrition, depression and anxiety. There are also the late effects to contend with. Late effects are defined as physical or psychological health problems that present six months or later post treatment and could affect whole organ systems as a consequence of cancer treatments. Examples include cardiovascular toxicities, reduced bone density or hypothyroidism. There is a lack of evidence on how many people are affected by these lasting consequences of cancer, although Macmillan Cancer Support estimated in 2013 that approximately half a million people UK-wide had health issues post treatment. This number is expected to have risen sharply over the past decade.

In 2015, Macmillan Cancer Support interviewed people affected by cancer in a UK-wide study into their social and emotional care needs and found that 64 per cent of respondents had practical support needs and a further 78 per cent of respondents needed emotional support following diagnosis. Studies have proven the impact prehabilitation and rehabilitation can have on those living with cancer.

The concept of cancer rehab was developed in the United States during the 1960s, but the world has been slow to adopt it. A Danish study conducted in the early 2000s—the FOCARE research project—found that Danish cancer survivors experienced considerably reduced physical health, possibly as late physical effects of treatment. The problems reported by the cancer survivors suggest that cancer rehabilitation should include these aspects of living after cancer and take account of socioeconomic differences among cancer survivors. The study suggested that these challenges might be addressed optimally in multidimensional rehabilitation programmes.

Cancer rehabilitation involves a wide range of allied health professionals carrying out distinct roles throughout the pathway, such as dietitians, lymphoedema practitioners, occupational therapists, physiotherapists and speech and language therapists. They deliver specialist interventions that complement the skills of other multidisciplinary team members. Different patients will have different rehabilitation needs depending on the type, location and stage of their cancer. It is acknowledged that healthcare professionals, including support workers, may also contribute to the rehabilitation of people affected by cancer. Prehabilitation extends that care to before the treatment pathway.

Physical activity has been described as an underrated 'wonder drug' and more should be done to ensure people living with cancer are aware of its benefits. Macmillan’s Move More service was developed to help people with cancer become more active. Evaluation has shown it has the potential to support people with a range of long-term conditions and lead to behaviour change. This evidence and insight can now be used to ensure physical activity is seen as an integral part of cancer care. Being active before, during and after treatment is safe. It can reduce fatigue, reduce anxiety and depression, help you keep to a healthy weight, strengthen your muscles, improve bone health, improve your flexibility and ability to stretch, improve balance, and increase your confidence. This evidence has been put to great use in my constituency by Dr Rhidian Jones, who, in conjunction with the national exercise referral scheme, set up a prehabilitation programme for cancer patients in Cwm Taf. To quote Rhidian,

'We know that, when a patient is diagnosed with bowel or oesophageal cancer, it is an incredibly daunting time leading up to a major operation. Many of these patients are lacking in physical fitness and are extremely anxious in anticipation of their surgery; both of which can lead to poor outcomes after surgery. The aim of the programme is to improve patients' fitness, mental health and experience leading up to their surgery. As a result of these initial goals, we are seeing fewer postoperative complications and a trend towards shorter stays for our patients in hospital.'

Rhidian’s programme is having a dramatic impact on patients’ long-term chances. Coupled with an extensive cancer rehabilitation programme, we can ensure that patients in Wales do not just survive cancer, not just live with cancer, but live well with cancer. That has to be our priority. That is why I want to see programmes like Rhidian’s available to all cancer patients in Wales, and why we have to have extensive cancer rehabilitation programmes tailored to individual patient needs.

I do have to congratulate the Welsh Government. They have taken a positive stance on prehab and rehab services. In Wales, pre-treatment health optimisation and prehabilitation are explicitly mentioned in the cancer delivery plan for Wales 2016-20. This puts Wales ahead of other UK nations. I am informed by Macmillan that discussions are ongoing with Welsh Government about long-term sustainable prehabilitation delivery and funding. Macmillan have produced their primary care for cancer framework. This framework spans from initial consultation, referral and through to diagnosis and treatment and beyond. Pre-treatment health optimisation in primary care at the point of referral for cancer investigation is a key aspect of this framework.

I hope that the Welsh Government will adopt this framework when it launches their cancer services implementation plan, which is due imminently. However, whilst the quality statement for cancer states that prehabilitation and rehabilitation are key parts of the cancer pathway, this does not fill me with hope that services will be delivered on the ground. Despite commitments in the former cancer delivery plan to prehab and rehab services, the patient experience on the ground did not reflect the plans. Access to rehab has remained a postcode lottery with over a third of patients reporting that they received no post-treatment support at all.

A 2020 study, the 'Qualitative exploration of cancer rehabilitation in South Wales’, found that rehabilitation is not routine in the cancer pathway. Healthcare professionals reported numerous barriers to care provision. One of the main barriers is that cancer rehabilitation is not provided routinely within the cancer pathway. Given the importance of prehab and rehab services to cancer patients, I urge the Minister to commit this afternoon to ensuring that such services are available to and tailored to every single cancer patient in Wales. Thank you.

Can I thank Altaf for giving me a minute of his time? As chair of the cross-party group on liver disease and liver cancer, I want to highlight some of the challenges facing liver cancer patients navigating treatment pathways in Wales. Liver cancer is one of the least survivable, but fastest growing forms of cancer in the UK, and outcomes are shockingly poor. Only 13 per cent of people diagnosed with liver cancer will survive for more than five years after being diagnosed. It has been found that patients with low fitness, as assessed by the cardiopulmonary exercise testing, CPET, have higher mortality and morbidity after surgery. Therefore, prehabilitation has potential as a method to improve CPET values and thus improve outcomes after liver resection for colorectal or liver metastatic. It has also been found to better prepare patients for the often toxic and disabling effects of cancer treatment.

Recent findings from the British Liver Trust's helpline, support groups and surveys show that fewer than 10 per cent of liver cancer patients feel adequately signposted to information about their condition, and many are left confused and unsure of where to go for credible advice on treatment options. There are also disparities in liver cancer care and outcomes across health boards. Therefore, improving access to rehabilitation, personalised information and ensuring equitable access to physical, psychological and nutritional support for liver cancer patients at every stage of the treatment pathway will not only improve patient experience, but, ultimately, could improve outcomes and survival rates for liver cancer patients. With this in mind, I'm keen to know if the Minister will commit to specific targets for prehabilitation and rehabilitation to help improve outcomes for less survivable cancers, such as liver cancer, in the forthcoming NHS cancer services action plan. Thank you.

I call on the Minister for Health and Social Services to reply to the debate—Eluned Morgan.

Diolch yn fawr. Thank you to Altaf Hussain, who is my secret special adviser in the NHS, for bringing forward this short debate and for his recent invitation to Cwm Taf Morgannwg to meet with clinicians delivering those prehabilitation services. I very much look forward to our joint visit next month.

I recognise how important it is to help people get ready for their cancer treatment and for them to be in the best place possible in terms of condition for a good recovery. So, being referred with suspected cancer and then waiting, often in fear, as you've suggested, with a huge degree of uncertainty until the tests and the treatment come around is a really difficult experience for many people.

So, rather than wasting this time and leaving people to cope, we have an opportunity here to get them ready and to empower them to take some control. This is always something they can do, even if it's over a few weeks, to get themselves ready. Actions can include addressing the psychological impact of a diagnosis and developing some coping techniques and strategies. And as you've suggested, people can work on their nutrition and their fitness and their strength so that they are ready to face their treatment and have, as you both suggested, a better chance of recovery afterwards. So, if we can be alongside people, giving them that emotional support, encouraging and supporting people with appropriate changes to their lifestyle, then they'll have a better experience and a better chance of a good outcome.

Prehabilitation enables people with cancer to prepare for cancer treatment, maximising their ability to withstand the side effects. Evidence suggests that prehabilitation delivers better outcomes with fewer complications. If the impact of prehabilitation was achieved by a drug, we'd no doubt be prescribing it, so we need to work together to put this support in place, and that's why we've set a very clear expectation in the quality statement for cancer: prehabilitation and rehabilitation are key parts of that cancer pathway. Included within the quality statement, we've introduced 21 nationally agreed cancer pathways, and these set out how the various cancer-type pathways should function and what should be involved. They all involve prehabilitation at key points in the pathway.

I expect it to become a more common and standardised part of the cancer pathway over the next few years, as health boards develop new ways of working and the evidence base grows. But it's not easy, it's not just as simple as saying, 'Just do it.' The cancer clinical teams and the allied health professionals in particular are already under immense pressure, given the large increase in the number of people being referred for cancer. There's no extra money to throw at this, as we've already been providing every last bit of resource to supporting recovery in services.

That's why it's important that we look at whether we can scale access to prehabilitation through digital through digital services. The Wales Cancer Network has funded pilots, and we have those pilots under way in our health boards, in collaboration with the Bevan Commission, to see if digital solutions can help. The Wales Cancer Network has also appointed a lead medical clinician and a lead cancer allied health professional to help work on this over the next two years. The post will help co-ordinate and guide the health boards' efforts, so that we can put these services in place for more cancer pathways in more health boards in a way that's sustainable. This work will be overseen by an all-Wales cancer prehabilitation group, reporting to the Wales Cancer Network board, as part of the NHS executive.

In last week's cancer conference, health boards were eager to accept the offer of the Wales Cancer Alliance for resources and support for patients waiting on cancer pathways.

More generally, our programme for transforming and modernising care was planned and published in April of this year, and it notes that we will develop and establish a prehabilitation programme to improve outcomes. So, prehabilitation and rehabilitation should be seen as core elements of all care in all pathways. And when one needs any treatment, we must go about it as soon as possible to prepare them for that treatment and to prepare them for what will happen afterwards. We are not delivering the full value of health interventions unless we support people to recover as much as possible, and this means intervening pre and post treatment to secure the best outcomes.

Health and social care organisations are already working on this. We've also launched an amended national rehabilitation framework. It sets out strong and clear principles for prehabilitation and rehabilitation of high quality. Specifically, it seeks to ensure that our health and social care services establish a prehabilitation service that focuses on the ability of the individual to live as independently as possible for as long as possible. The national lead allied health professionals for patient-focused rehabilitation will lead the way on implementing the new framework.

All staff in health and care will be expected to focus positively on rehabilitation and supporting patients. Our allied health professions framework ensures that allied health professionals are available more generally in primary and community care. It also ensures that plenty of prehabilitation and rehabilitation services are provided, and in particular rehabilitation in the community. To make the best use possible of resources and to provide convenient services to patients, I expect services to be integrated and located within the community, and to be focused on the individual rather than the disease.

So, I agree on the need to develop these services, and I do hope that I have conveyed the breadth of the work that is already in the pipeline. Thank you.

Thank you, Minister. That brings today's proceedings to a close.

The meeting ended at 18:48.