9. Statement by the Minister for Health and Social Services: Cancer Services Improvement Plan

– in the Senedd at 6:00 pm on 31 January 2023.

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Photo of David Rees David Rees Labour 6:00, 31 January 2023

(Translated)

Item 9 this afternoon is a statement by the Minister for Health and Social Services on the cancer services improvement plan. I call on the Minister to make the statement—Eluned Morgan

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr, Dirprwy Lywydd. Today I would like to announce the publication of the cancer services improvement plan by NHS Wales. The plan sets out how the NHS, collectively, will respond to the quality statement for cancer and our wider commitments to improving diagnostic and end-of-life care for people affected by cancer. It follows on from several important debates we have held over the past year on the matter of improving cancer outcomes and my commitment to bring forward such a plan.

We set out in the national clinical framework that we would describe what good clinical services should look like in quality statements, and that we would expect the NHS to plan against those expectations. Health boards and trusts are doing this through the NHS planning framework, which focuses on cancer services, amongst other ministerial priorities, and they are currently developing these in their integrated medium-term plans, setting out their response. So, I've set out six priority areas—cancer is one of those priority areas. The cancer services improvement plan published today supports that process. It describes how the NHS intends to deliver our policy intentions.

One of the key areas in the quality statement is delivering care in line with the cancer waiting time. This means that 75 per cent of patients requiring cancer treatment should start definitive treatment within 62 days of the point at which cancer is first suspected. This expectation has been really challenging to deliver and there are three main reasons for this. The first is the introduction of the new suspected cancer pathway, which overhauled how we counted people on the cancer pathway—unique in the UK—capturing more people earlier on in their pathway without pausing the waiting time clock. The second is the historic growth in demand for cancer investigation and treatment, caused by our population factors and lowering of the risk threshold for referral, to ensure that we don't miss any potential cancers. And, thirdly, delivery has been restricted by our service capacity to refer, investigate, treat and care for people affected by cancer. In short, demand is growing, our capacity struggles to keep pace, and we’re now much better at accurately counting everybody on a cancer pathway. That translates into the cancer performance we see reported, which has been far below all our expectations since the new suspected cancer pathway was introduced. And it is fair to say that the pandemic has had its impact too. COVID has distorted access and created huge pressures in the wider system that have had implications for cancer investigations and access to theatres and critical care.

I held a summit of cancer service leaders in October to reinforce our planning expectations that we recover the volume on the cancer waiting list, we reduce the number of people waiting over 62 days, and build towards that 62-day target. Things are very, very difficult, with services working flat out to meet the needs of patients. But, I am pleased to report NHS management data shows a fall in the number of people waiting more than 62 days for their treatment to start between October and early December, and shows a fall in the overall number of people waiting on the cancer pathway and a slight improvement in cancer performance in the latest figures published for November. This shows the NHS is giving cancer pathways the focus they deserve, although the disruption of Christmas, industrial action and respiratory illnesses have caused us further challenges in recent weeks.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:04, 31 January 2023

(Translated)

We also asked for a focus on implementing the 21 nationally agreed pathways for Wales. This is at the heart of how we will ensure that patients get the right care wherever they are in Wales. These standardised pathways help us to focus on improving consistency and quality of care, and they include the new non-specific symptom pathway for Wales, which plugs into our rapid diagnostic centres. We will have the whole of the population of Wales covered by these centres in the next few months, which is a wonderful achievement. Many of them already exist, and they will be in place a whole year before England.

The quality statement places a focus on person-centred care, and, earlier this month, I spoke about the findings of the cancer patient experience survey, which showed, even during the pandemic, that 92 per cent of patients rated their care 'good' or 'very good'. The survey also provided important information about access to key workers and benefits advice, and that will now form part of local work on improving patient experience. 

I’ve also recently issued a written statement on the cancer information solution. This is our £11 million investment in replacing the digital cancer patient record. We achieved the first major milestone of the overall programme in November, when Velindre Cancer Centre moved onto the Welsh patient administration system to manage its clinics, and started using the new digital patient record for cancer care. This has resolved a major service continuity risk that the public accounts committee has previously highlighted.

We all know how critical the development of the workforce is, and that's why we have committed to planning the workforce to meet future need for cancer care. So, I was very pleased to announce, on 18 January, the  education and training plan of Health Education and Improvement Wales. That included uplifts, for the the third successive year, in the number of higher training posts for clinical and medical oncology, as well as further uplifts in training for clinical radiology and palliative care, which are vital roles in cancer pathways.

There are numerous other areas to mark or celebrate, including the all-Wales robotic surgery programme, the new breast cancer centres of excellence coming into place, the reduction in the bowel screening age range, and improvements in participation. But, I would like to end by focusing on our announcement last week of more than £86 million for new radiotherapy treatment equipment and facilities, including a new radiotherapy satellite centre in Abergavenny. Collectively, these developments, described in the cancer services improvement plan, speak to our commitment to support improved cancer services and outcomes. I hope that they will make a significant difference to the people delivering and, of course, those receiving cancer care in Wales.

Photo of Russell George Russell George Conservative 6:08, 31 January 2023

Thank you, Minister, for the statement today. It's very much welcome, and the cancer plan is very much welcome indeed also. It was, until this morning, that Wales was the only area of Britain that didn't have a cancer plan, and the cancer plan is well overdue. But, on a positive note, we've got the cancer plan today, and it's very much welcome. 

What I did particularly like, as I looked through the cancer action plan, was that there are a whole lot of timescales and goals, with dates attached to the goals and targets as well. That's very much appreciated. I suppose the obvious question there is: do you think that the timelines in there, and the dates that are published alongside the goals, Minister, are reasonable? And do you think that they're reasonable to be achieved, I suppose, is the obvious question to ask?

Funnily enough, I was just looking back, Minister, and it was a year ago next Wednesday that I led a Senedd debate on cancer services in Wales. At the time, we talked about—I certainly talked about—the negative side effects for many patients and the focus that was needed on recovery, and many people worrying about additional costs as well. And, at the time, I asked for some measures, such as free dental care for cancer patients, and suggested that that could be offered as part of their recovery, especially now in terms of the cost-of-living pressures that we're all aware of. I couldn't see anything in the plan in regard to that, and I wonder if that's something that could be examined, Minister. 

At the time, I also mentioned the number of people entering hospital in Wales for cancer treatment had fallen by over 40,000 in the first year of the pandemic. So, I would be interested if you could speak to that point, really, about how the plan specifically helps those who have missed out, potentially, on diagnosis as well.

Prior to the pandemic, the Welsh cancer intelligence unit showed that Wales had the lowest survival rates for six cancers, and the second lowest for three in the UK. We were already behind England, Scotland and Northern Ireland when it came to female, breast, lung, colon, rectal and stomach cancers. So, I would ask you, Minister, in that regard, if you are confident that Wales is going to be in a much better position when this plan expires. I suppose I should just ask you about the time frame of the plan. The plan is for three years. I would ask why three years. I'm not suggesting it's wrong; I'm just asking why, particularly, a three-year timeline, I suppose. But, also, I can see some stakeholders, whilst they welcomed the plan, and they welcomed the three-year plan, are also suggesting that there should be a longer term plan. So, I can see you looking at that, Minister, and thinking 'Oh, no he's asking for another plan now', but, no, just to get an understanding on what your response would be to stakeholders who say that something more longer term is needed also.

Also, I'd like to ask about the involvement of health boards in the development of the plan. Are you satisfied that local health boards will be able to deliver the goals set out in the plan, and particularly, I suppose, I'm asking that question in the context of the workforce issues that we're all aware of as well.

I also wanted to just touch upon the experience of cancer patients in Wales. In your statement, you maintain that 92 per cent of patients rated their care 'good' or 'very good'. Yet, results published from a charity survey highlight that cancer services are still massively failing patients. Getting information out to patients was an area that was shown to be largely inadequate, with 30 per cent of respondents stating they did not have possible side effects fully explained to them, or they weren't fully explained to them. And 52 per cent stated that they did not receive all the necessary information about how to manage their health and well-being following their treatment. So, Minister, I want to understand from you how confident you are that everyone will receive their personalised needs assessment promised in the cancer improvement care plan, when 70 per cent of respondents said they did not even receive a written care plan after their diagnosis in 2021-22? Thanks.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:13, 31 January 2023

Diolch yn fawr, Russell. I'm pleased that you agree it's a good thing that we've got dates and goals and targets, and I think it is important to hold people to account; you hold me to account, I hold the health boards to account. So, it is important to have those in, and I am sure you will note the workforce implementation plan that's been published today also has very clear targets against the time frame. 

This is a plan that has been developed and is owned by the NHS. It's not a Welsh Government plan; it is owned by the NHS. And, so, if they have developed this plan, I fully expect them to be able to deliver the plan. So, they think it's achievable. I think a huge amount of work has gone into this, and I would like to pay tribute to all of the people who have worked over a long period of time to get this into the right place, because it's not just about writing a plan; you've got to get buy-in from across the whole of Wales when you're talking about needing consistent quality standards. You can't just make a statement about that; you've got to get buy-in to make sure that everybody is signed up to that. 

On the free dental care, look, at the moment, you know how pressurised our budgets are, so anything that involves any additional money is really, really difficult. Much as we'd love to go down that route, that would be very challenging at the moment. But, obviously, we can point, as I said in my statement, to the kind of support networks and funding streams that are available, particularly to people who are struggling. 

COVID of course did throw things out for a while. We're getting back on track now in terms of screening. It has taken a while, particularly in relation to breast cancer, because we needed to get areas where people wouldn't come into contact with each other. So, we've had to adapt quite a lot, and we're still only just getting back on track with some of those. But, it is a concern, of course, that we do have low survival rates in Wales, but, I think, it's really important for us to understand that, actually, things have improved over the past few years. We are in a situation where the outcomes for people are much better than they have been in the past. So, the one-year survival rate has gone from 66 per cent to 73 per cent in the past two decades, so, I think, we're going in the right direction. We've almost doubled the amount of money that's gone into cancer support, so I think it's important that we recognise that.

We have lower survival rates. Some of this is about making sure that we understand the preventative agenda. We've got to get in the right place. We keep on talking about the importance of the preventative agenda, Apparently, between 30 and 50 per cent of cancers are preventable, so we all have a responsibility to play our part if we want to try—. Now, that's not true for everybody; it's really important to state that, but, actually, there are things that we can do to help ourselves. I am confident that we will be in a better position at the end of this programme. 

Just in terms of the longer term, well, our cancer quality statement is our plan for the longer term. That's the statement that, again, has been developed by and with the NHS. And the health boards, as I say, were key in developing these plans, in particular, the Velindre cancer trust. I think that's really important to note there—the massive, massive amount of investment and work that's gone into this. 

And, of course, when it comes to the workforce, it is the health boards and the trusts that indicate to HEIW where the gaps are, and, then, they commission that work. And, just in terms of your personalised needs assessment, by 2024, every cancer patient will have a caseworker, so I hope that will give some comfort to people. 

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 6:17, 31 January 2023

(Translated)

I suppose the first thing I should say is that I'm pleased that we do have a cancer plan, and I look forward to seeing it hopefully make a difference. We know that our survival rates aren't good enough. We know that there are people—I was speaking to one person who found out too late over this weekend that he had cancer—there are too many people not being able to access the treatment that they could have had. There are too many members of staff who want to do more who can't do more, and that's heartbreaking for them. 

And we do now have a plan, and looking forward is important. But it is important to bear in mind the delays that there have been before getting to this point today. The last two cancer plans—2012 to 2016, then 2016 to 2020—and we're almost three years on from there getting this plan. It is not good enough, and before the Minister says 'Well, COVID was the great problem from 2020 onwards' the plan for 2020 onwards should have been ready before COVID struck. What we had, of course, was the quality statement for cancer, but it was quite clear that that wasn't considered to be adequate by all bodies involved with the fight against cancer in Wales. Yes, it's taken three years to bring us to this point. 

Many of the questions that I have now reflect some of those questions raised by organisations that have been involved in drawing this up but still see some gaps in the key information. Tenovus, for example, asked for more information around performance and accountability monitoring. How will we be able to identify as to whether we are on the right track? Does the plan deliver what it's supposed to deliver? I wonder if the Minister could tell us more about that issue.

Then, the workforce. The nature of the questions has changed slightly during the day, because, in less than the last two hours, we've had the workforce plan that we were promised by the end of January. Some five hours and 40 minutes of January remain. This isn’t the way we should be working. We should be in a position where we would have a statement to the Senedd on the workforce plan. I will take this opportunity to ask questions on the workforce because this statement’s been given, but I am not, and I’m sure those involved in the fight against cancer aren’t happy that things have been done in this way.

I’ve had a brief opportunity to take a look at the new workforce plan. I was concerned this morning with the BBC reporting comments from the Minister in the context of the fact that the cancer workforce was tired, and there are too many vacancies, and what the BBC said was that the Minister was saying that the health boards had the money and it was up to them to prioritise. Well, that doesn’t represent a workforce plan, I’m afraid. But we now do have a workforce plan, and it does state that responding to challenges set out in the cancer plan is one of the priorities for the new workforce plan—but I can’t see what the plan is for strengthening the cancer workforce. There is mention of timetables for different elements of strengthening the workforce. I can’t see a specific reference to the cancer workforce in that timetable. Perhaps the Minister could elucidate how exactly the plan published today will help in implementing the cancer plan, because without the workforce we have no means of improving survival rates, we have no means of taking pressure off our existing workforce. So I will look forward to a response on that.

And I’ll ask, if I may, one question on a major part of our cancer landscape, namely Velindre. I’ve been aware over recent weeks that more and more people, as I have done in the past, have suggested strongly that the co-location of cancer services with other emergency services is what makes sense, rather than developing them as discrete cancer centres. Has the Minister had an opportunity to consider the most recent comments by those who are very prominent in the cancer field and who are still suggesting that the wrong decision has been made? We want the best possible cancer services, but we don’t want decisions being made that we may regret in years to come.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:23, 31 January 2023

(Translated)

Thank you very much. I think a lot of people, unfortunately, find out that they have cancer as they go to emergency departments—the symptoms don’t show up until the last minute, and obviously that’s very difficult for them, and part of what we’re talking about in this plan is ensuring that there are acute oncology services available in our emergency departments.

This is an NHS plan, as I said, and it responds to the quality system that we have. In terms of accountability, the health boards are accountable to me, of course, through the chairs, but the NHS executive will have a specific role in ensuring that this is delivered, so I do hope—. And of course, through the integrated medium-term plans process, as you know, cancer is one of the six priorities that I have. So, monitoring those and making sure that they get the attention that they need will mean that it is one of the priorities.

In terms of the workforce, it is difficult, isn’t it? Because there’s so much going on, so much on our plate at the moment. If I hadn’t published the HEIW report, you would have complained about that, so I preferred to do what I said I was going to do. I can’t fit more things into the agenda—we only have one day this week. I’ve been on my feet already twice today, so it’s just a lack of space on the agenda—that’s the problem. We have done it. I did promise that we’d have it by the end of the month, and we’ve delivered.  

In terms of co-location, the decision on Velindre has been made. We've heard all sides of that debate, and there are questions in terms of timing and the best location, and so forth. The decision has been made, we won't be changing that decision, and the work will start before long. But I was very pleased to see the £86 million that we announced on Friday for new radiotherapy equipment. That's 10 new machines, and two of them are going to go to Abergavenny, which will mean that people won't have to travel quite so far on that side of Wales. So, I'm very pleased that we are going to push forward and that we do have the right equipment in place. 

Photo of Jenny Rathbone Jenny Rathbone Labour 6:25, 31 January 2023

Thank you, Minister, for your honest statement and also for your achievements, despite everything that you're having to do in the health field.

I just wanted to share with Members the discussion that took place in the women's health cross-party group in December, where we discussed the five gynae cancers. One of the speakers was a completely excellent patient campaigner who you may have heard of called Jim Sweet, whose wife died of ovarian cancer, and he's since made himself into a real expert in ovarian cancer, because she died two weeks after correct diagnosis, having been misdiagnosed as having irritable bowel syndrome and being sent to the gastroenterology clinic. I believe that this is not unusual.

He also was a great expert in comparing the way in which the healthcare system treats men versus women, and I know that this is something that you are very worried about. He compared the Rolls-Royce service that he got for prostate cancer versus the really fragmented service that his wife got. How do we improve that, because there clearly is a bias against women who complain about particular symptoms, who are not heard clearly enough? And how do we improve awareness of symptoms across all clinical specialisms so that, for example, gastroenterology is working really closely with cancer services, because this is not infrequently the case that these sorts of concerns are misdiagnosed by people who probably ought to know a lot more about ovarian cancer, and also some of the preventative measures around breastfeeding, multiple pregnancies, contraceptive pill, which, obviously, can massively decrease your likelihood of getting cancer, as well as the fact that eight out of 10 cases occur in women over 50?  

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:28, 31 January 2023

Thanks very much. I think we've got to be aware that one in two people are likely to get cancer, and so we're all touched by cancer in some way or another. And so, it is important that we do our very best to get a better understanding. Every day, we're getting new developments, new technologies and new genetic improvements. So, all of these things I hope will make sure that we just keep on improving the performance in this area. 

Early diagnosis is absolutely key. That is true, of course, for gynae cancers, and I'm particularly concerned about the rates in relation to gynae cancers. I know that this will be something that the team across Wales will be looking at and be focusing on. Screening, of course, is absolutely key when it comes to making sure that people take up that opportunity of screening, and that we chase down—in the same way that we've chased down people who haven't had their vaccinations, we need to think about doing that in relation to screening as well. 

You're absolutely right—I am very concerned that the healthcare system needs to make sure that they treat women, fairly, correctly, and in a way that is respectful to women as well as men. That's why we've already produced the women's health quality statement, and you're quite right, I think there's a lot more that we could all do in terms of learning what to look out for when it comes to symptom awareness. Some of the charities that have certainly been talking to me as we've been developing this plan, they are really good at raising awareness, but I think all of us have a responsibility to try and learn a bit more about what we should be looking out for. But the point is that, actually, we know our own bodies; if there is a change, we just need to be sensitive to that change and make sure that we go and get some support.

Photo of Laura Anne Jones Laura Anne Jones Conservative 6:30, 31 January 2023

Thank you for your statement, Minister. I'm pleased to finally see a statement and a plan today, as my constituents have been waiting an awfully long time for this to come to fruition. The Welsh Conservatives, and my colleague here, Russell George, have been calling for a cancer plan for a long time now, and Wales was the only country in the UK not to have a Government publish a cancer plan for far too long. So, I welcome that today.

But, Minister, I wanted to touch on less survivable cancers. It's mentioned in the plan, which is welcome, but I'm conscious that, in the past, Welsh Government communication campaigns have been poor. So, in terms of symptom awareness, will you be embarking on a cancer symptom awareness campaign to help members of the public and GPs? And regarding one of the most life-threatening cancers, lung cancer, will you be ramping up and implementing targeted lung health checks, which could save over 100 lives a year once it's rolled out in Wales? And will the Welsh Government be implementing the recommendations of the UK National Screening Committee? Thank you.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:31, 31 January 2023

Thanks very much. Well, there are of course lots of campaigns that are already under way in relation to less survivable cancers by some of those organisations. What I'm not going to do is—. I've just published a plan; we're not going to start bolting new things onto the plan. This has been developed by people, it's been worked on by organisations across Wales, by the NHS. So, what's there is what we're going to deliver on, and we're not going to bolt anything new onto it, because actually it's been very carefully worked out. But there are things in relation, for example, to lung screening, and there is a pilot that we're undertaking there, and obviously we'll just see how that pilot goes. And that's about targeting people who've been smokers and whatever, in a particular area. So, we're going to see how that goes, and, obviously, we'll build on that if that works.

Photo of Vikki Howells Vikki Howells Labour 6:32, 31 January 2023

Thank you, Minister, for your statement. I've got a real interest in NHS informatics and how they can be used to drive service improvements. So, I note your comments around digital systems and Velindre Cancer Centre moving on to the Welsh patient administration system, and I was interested to read your written statement yesterday on the cancer informatics programme. So, I've got a few questions on that, and, in particular, on the next phase of the roll-out. Would you be able to update Members on the next significant milestone that's being aimed for on this journey of improvement, and when do you estimate that we might reach that next milestone? I was also interested to see your comments about capturing additional data through this system. So, what particular information would Welsh Government be looking to collect during these next phases of the roll-out?

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:33, 31 January 2023

Thanks very much. Well, I'm really keen on making sure that we use the most up-to-date technology to try and improve our systems. That is why, already, we've spent £86 million on these new radiotherapy machines; that's why we've spent £3 million on an electronic records system; and we've also got new robotic surgery technology that is already in place and working and getting lots of surgeons very excited across Wales. So, making sure that we use the most up-to-date machines and therapies is absolutely critical. We've also spent £4 million on the Wales cancer network, and I was being asked earlier about how we monitor this. Well, actually, the cancer network is going to be key to making sure that, actually, this plan is delivered. When it comes to informatics and collecting data, well, the detail and the timetables are set out in the plan of what is expected when. But, in terms of collecting information, the key thing for me is that we just keep on learning from people and their experiences, and that we feed back in a loop that will improve our services constantly, when it comes to cancer care.

Photo of Altaf Hussain Altaf Hussain Conservative

Thank you very much, Deputy Presiding Officer. Great achievement, Minister. Now, people from deprived areas of Wales face worse outcomes when it comes to lung cancer, ovarian cancer or other cancers, and my concern is, which was raised by Laura as well, about the screening—targeted screening—between the age of 55 to 74, as we do with bowel cancer. And it is vital to understand and address the cause of health inequalities, and how are you going to tackle that?

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:35, 31 January 2023

Thanks very much. Well, you're right, and I think we just have to constantly be trying to learn from what works. So, for example, we are now targeting screening when it comes to bowel cancer, and people are sent a faecal immunochemical test, and it's been really interesting to see that people seem to be more willing to use the FIT test that they can do at home, rather than coming into a surgery and whatever. So, we've got to use more of what works and make sure we target, as you say, some of those deprived areas. And there's some great work being done, for example, I think, in Dawn Bowden's constituency in relation to trying to encourage men in particular to take up the opportunity of bowel cancer screening, and the Moondance Foundation have been pushing this and just trying to make sure that, actually, we engage people, get people to take up the opportunities when they're given them. And so I think we've learnt quite a lot through the vaccination programme of leaving nobody behind, and we've just got to keep on using those techniques now when it comes to chasing down people who are not taking up those opportunities when it comes to screening.