5. Statement by the Minister for Health and Social Services: The National Diagnostic Strategy

– in the Senedd at 3:43 pm on 25 April 2023.

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Photo of David Rees David Rees Labour 3:43, 25 April 2023

(Translated)

We'll move now to item 5, a statement by the Minister for Health and Social Services on the national diagnostic strategy, and I call on the Minister, Eluned Morgan. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 3:44, 25 April 2023

Diolch yn fawr, Dirprwy Lywydd. Diagnostics are tests or procedures that are used to identify a patient’s disease or condition. Finding out what is wrong with a patient is vital to treating them. Prompt diagnosis can save lives, saves time and money, and can improve patient outcomes. Diagnostics also have an important part to play in preventative health by detecting disease and illness before major symptoms develop. Diagnostics are often subdivided into broad categories that reflect their commonalities. Examples include imaging, such as x-rays, CT, MRI and PET scans; pathology, such as analysis of blood, urine or tissue biopsies; and endoscopy. 

Of approximately 660,000 people on waiting lists in the Welsh NHS, it's anticipated that some 85 per cent will require at least one diagnostic test to help inform their clinical management, with around 30,000 waiting for identified tests. As such, prioritising diagnostics as a key component of our health system is imperative to providing our population with appropriate care.

We know that diagnostics play an important role in identifying medical conditions in Wales, which is why, unlike England, we include diagnostic waits in our waiting list figures, and these account for around 6 per cent of our overall waiting list numbers.

It’s important to note that, although today we are publishing a strategy for diagnostics, we already have a number of well-developed plans that are already delivering for certain types of diagnostic specialisms. We have national programmes for imaging, pathology, endoscopy, healthcare science and genomics that collectively cover most diagnostic techniques. These have been providing leadership and resource to the development of these key areas, such as maintaining up-to-date equipment and training of the professional workforce required to conduct these tests.

Over the past four years, we have invested over £55 million for equipment and to provide updates and replacement, and since 2016, we've increased the number of histopathologists by 14 per cent, clinical radiology staff by 16 per cent, and diagnostic radiographer training places have increased by 34 per cent. But we're acutely aware of the impact caused by the pandemic and the need to go further to help recover these essential services and ensure any new intervention sets the foundation for our vision of what we will require in the years to come.

I must make it clear that the complexity and scale of this issue is not trivial. To deliver safe and effective services will require a careful balance between investment in equipment, infrastructure and facilities, adequate numbers of appropriately qualified personnel, and maximising the use of our resources through clinical pathway redesign. It is with this in mind that we are today committing to a strategy that pulls together our historical ambitions under a single governance structure to develop rapid and impactful progress.

In April 2022, I launched the transforming and modernising planned care and reducing NHS waiting lists plan for the NHS in Wales. This plan outlines recovery and transformation objectives for planned care in Wales, to reduce waiting times and move towards sustainable elective and diagnostic services by 2026. I am today announcing the new diagnostics recovery and transformation strategy, which was a key objective of the plan launched last year. It aims to improve access to diagnostic tests, improve patient outcomes, and support the development of our diagnostic workforce across NHS Wales. This strategy sets out how we will create additional capacity, move to a combined approach for diagnostic tests, and provides leadership through a national diagnostics programme.

The recent purchase of the former British Airways buildings in Llantrisant, close to the Royal Glamorgan Hospital, will enable the Cwm Taf Morgannwg health board to develop a regional service for the south-east to deliver diagnostics away from traditional hospital settings, increasing access for patients, bringing down waiting lists, and ensuring that our hospitals have the capacity to help those who require urgent care. We are also exploring using the site to accommodate a regional endoscopy unit, with two theatres that can be utilised as a clinical skills training academy.

The strategy outlines a combined approach to align immediate interventions with future demand predictions to facilitate long-term sustainable transformation.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 3:49, 25 April 2023

(Translated)

To deliver transformation, the strategy has a keen focus on the multi-professional diagnostic workforce in NHS Wales—for example, the 7,080 healthcare scientists who are skilled at developing, trialling and evaluating new techniques and ways of working. Health Education and Improvement Wales, HEIW, are developing a diagnostics workforce plan to inform the training pipeline. This will include advanced practice roles such as reporting biomedical scientists and radiographers, and support for new roles, such as consultant clinical scientists, that will be integral to service redesign.

The development of a new state-of-the-art genomics facility at Cardiff Edge life sciences park will physically bring together partner organisations that deliver services and research, as well as the supporting infrastructure, to create an environment that promotes innovation and provides opportunities for collaboration with industry.

In imaging, the expansion of digital fixed positron emission tomography, or PET, scanning capacity will allow us to perform more scans with higher accuracy and reliability than the existing analogue and mobile scanners.

In north Wales, we have rolled out digital cellular pathology, enabling faster reporting times and reducing the time taken for lymphoma diagnosis. The flexibility that comes with working digitally has supported the recruitment of consultant pathologists, with an additional nine working across Betsi Cadwaladr.

The diagnostics transformation programme will develop an implementation plan that builds on these initiatives to design better services, which will be improving patient health outcomes while reducing inequalities across Wales. By bringing together all of the national diagnostic programmes under one clear strategic vision, and with leadership from a clinically led national diagnostics board in partnership with health boards, we will maximise the use of available resources and provide joint focus on key priorities, addressing previously described ambitions. This includes pursuing the creation of national and regional models for fragile services, such as pathology, to drive throughput and achieve full accreditation of services to enhance patient safety.

Finally, we are expediting transformation in diagnostic service models to improve and innovate in the way that we treat patients, supporting and encouraging collaboration between NHS bodies, Government, academia, the third sector and industry. Today sees the launch of a new trial evaluating the benefits of using liquid biopsy diagnostic technology for people with suspected lung cancer. The study, involving over 1,200 patients, will look at how the use of a less-invasive blood test can reduce the time between diagnosis and treatment.

In conclusion, I recognise that timely access to diagnostic testing is crucial for patient outcomes, and that is why we are launching this strategy today. This strategy will create modern and sustainable diagnostic services in NHS Wales and will improve the health and well-being of people in Wales. Thank you very much.

Photo of Russell George Russell George Conservative 3:53, 25 April 2023

Can I thank the Minister for the statement today and the advance copy, of course, as well? Anything that can help improve diagnostic services and, ultimately, bring down waiting times will certainly be supported by me and the Welsh Conservatives. I think, in terms of bringing down waiting times, this has to be, of course, the top priority for the Government. Sometimes, I think the Government, over the last couple of years, has focused on other areas that I don't believe should have been prioritised as they have been. This should be the top priority for the Government, so, in that sense, I would have liked this to have come a little bit sooner, of course.

So, thank you for your plan, announced this week, Minister. A couple of the things I picked up on: in regard to data—so important. In the health committee, we're constantly hearing from witnesses about the lack of data—the lack of data available—and data is so important in order to inform decisions and Government policy. I see it mentioned a number of times in the document, and I suppose the question is: are you suggesting, perhaps, that data, and having that data, hasn't been available previously as it should be? Is that why it's forming a priority in your plan?

There's a lot I can agree on in the plan. There are some things on which I just think, 'Okay.' There's one point here, this is in the nine themes of focus:

'Use research to ask important questions and improve outcomes.'

So, there's an aspect here about there being some very simple, very obvious statements in the plan, which I just question: why are they in there if they're so straightforward and simple? Is it because Government isn't doing these things at the moment? There's a point here about, 'have more trusted partnerships'. Of course, that's great, to have more trusted partnerships. Has the Welsh Government not had enough trusted partnerships previously?

This is the transformation plan for the next two years, so I wonder if we can expect anything more detailed, a more detailed plan coming forward as a result, or, just to clarify, is this the overarching plan that will sit ahead of us and we're not to expect any further detail ahead?

What, of course, was a big concern to us all is that drop of 40,000 in cancer hospital admissions during the course of the pandemic. Indeed, 1.3 million appointments and over 50,000 operations were cancelled between April 2020 and September 2021. We understand why, of course, and we understand why a lot of diagnostic services were paused and stopped. We understand why. That was happening across the UK and across the world, but I wonder, Minister, if there is any sense that you have of what lessons could be learned in terms of future pandemics, perhaps. A big question, I know, but some early  thoughts and considerations that you might have in that regard.

Just how many more appointments are being missed right now? How many appointments are being missed now? I've heard so many people—. One of the biggest issues in my postbag, as it will be for most Members, is people struggling to access a GP in a timely manner. Now, given the majority of first out-patient appointments are triggered in response to a request from a GP or other health professional in primary and community care to help with diagnostics, is it fair to say this inability to see a doctor is building in a significant delay into the diagnostic pathway? I notice in your plan you talk about increased diagnostic specialists. That's good, but that's not going to help, of course, if people can't be referred to them by their GP. So, how is the Welsh Government ensuring we've got more GPs to see more patients in a more timely manner in order to resolve the issue I've just outlined? I would suggest taking a look, of course, at the Welsh Conservatives' GP access plan.

I'm pleased to see a lot of mention about diagnostic hubs in your plan, Minister. We've heard a lot of quite positive outcomes in terms of the diagnostic hubs. They make a lot of sense, I'm pleased to see them in the plan and perhaps the Minister could outline where we're at with that. I think we have five in the seven health board areas, but how many more can we expect to see and when is it we can expect them by? But I notice them in the plan, which is good to see.

Finally, just to raise the NHS app, we've had some information, I think, in a written statement last week on that. We called for that, as Welsh Conservatives, as part of our NHS tech bundle. I think this is really important as well, but, in regards to your statement today and diagnostic services, can you give us a sense of whether the diagnostic systems will tap into the app and allow patients to have access to records and updates through it in terms of their diagnostics journey, as well? Thanks, Deputy Presiding Officer.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 3:59, 25 April 2023

Diolch yn fawr, Russell. Thank you. I'd like to make it absolutely clear that we haven't been sitting around twiddling our thumbs for the past couple of years since the pandemic started. This is a strategy that's bringing together a whole load of national programmes that are and were already under way, including imaging, genomics, pathology, healthcare in science and endoscopy. So, what we're trying to do, by pulling all of these together—and you asked about data. If we integrate the data relevant to all of those different pathways onto one platform, then you're getting better economies of scale, you're getting different diagnoses being able to be compared with each other, making sure that those are sent down the appropriate pathway. So, data is important, but putting that data onto a single pathway despite having all of these national plans in place is going to be a key change in future.

This is the overarching plan, but the detailed work in terms of making sure that this is delivered—. I don’t intend to bring that back to the Senedd time and again, because I’ve appointed a national diagnostic board, which is going to be led by the deputy chief executive officer of the NHS in Wales, bringing in those experts from the different specialist areas, to make sure that we stick and we deliver on this plan, because it is, as you say, crucial to the delivery of those reductions in the waiting times.

You mentioned that there were good reasons for cancelling so many operations during the COVID pandemic; we’re still on a period of catch-up. One of the things that we’re trying to do here is not just to reconfigure services, through, for example, streamlining the pathways, making sure that, when appropriate, people go straight to test, making sure that we have regional centres. And yes, you talk a lot about your hubs, and there’s a hub here coming in Llantrisant. The whole point of this is that we can keep them away from the urgent centres, so the urgent work will carry on and won’t knock out the diagnostics that happens. It’s not easy to do that. If you don’t have a huge population base in big cities, like they do in parts of England—. We’ve kind of got two big population centres in Cardiff and Swansea, where you have more than one hospital in a particular area, where you can separate work from urgent work. But that’s why these new stand-alone diagnostic centres, I think, will be helpful.

In terms of getting access, of course, you’ve been hearing, I’m sure, about the issues in relation to getting GP access in England. We’ve changed the contracts here in Wales. Those have been voluntary, for example, up until April, in terms of the 8 a.m. bottleneck. That’s now a part and an expectation of the new contract that started in April, so obviously, we’ll want to be policing that to make sure that people are implementing that in full and respecting those contracts. There are rapid diagnostic centres in, I think, every health board—maybe not Powys—already, so what we’re talking about here is a different proposal, but of course, all of that will be fed into this overarching strategy.

When it comes to the apps—and you’ll see that we’re moving ahead with that—what’s likely to happen with the apps is that we will just keep building on the app, so that things will be switched on as we move ahead with the app. There is a platform where we can keep adding things. There will be an expectation for patients to be able to see their records. Certainly they’ll be able to see, hopefully, the GP records. To what extent they’ll be able to see secondary care records, we’ll have to work all that out. Obviously, there’s a lot of information and privacy issues that we have to also make sure that we’ve ironed out as well.

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 4:03, 25 April 2023

(Translated)

Thank you to the Minister for her statement. Without doubt, the Minister is right in emphasising the need for early diagnosis. The earlier the diagnosis, the greater the hope of having successful treatment. It saves lives; it improves quality of life, too. As the Minister said, some half a million people are on waiting lists already, and they will need some sort of diagnostic test, and there are more and more people being added to that list every day. We must also bear in mind that, if we look at the latest waiting figures, the numbers waiting for therapeutics and diagnostics have increased. So, it's clear that there is work to be done in order to increase capacity, to provide early diagnosis to more people. I'm pleased that there is a new strategy that has been developed; I welcome that announcement. We of course need to ask why didn't we have a strategy before now, but we will look forward. The objectives set are ones that we can all welcome—the need to increase capacity and to provide clear leadership at a national level in delivering diagnostic testing, and so on. 

I have some three questions. Given that we're not adding to the momentum of bringing these figures down—the figures have been increasing—how is the Minister going to work with the health boards in order to plan capacity growth in a way that will lead to early outcomes for patients? Secondly, I'd like to hear more from the Minister on the work that will be done to develop the sustainable workforce that will be needed to deliver a strategy of this kind. Without a workforce, there is no diagnostics plan or any other plan within the NHS. So, I would appreciate more detail on that. And finally, I'm eager to have a slightly clearer picture from the Minister than we've had to date on how diagnostic services will be developed in a way that makes them accessible to people wherever they are in Wales. I am aware of concerns in north Ceredigion, for example, and more broadly across mid Wales, that the emergency diagnostic centre in Hywel Dda is down in Llanelli, which is quite a distance from them. We do need to think carefully about the geographical distribution of the provision that's going to be developed under this strategy. I would welcome some comments from the Minister that can give hope to those people who are in areas where they feel that services are being developed a long way from them that the Minister is at least aware of those concerns. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:07, 25 April 2023

(Translated)

Thank you very much. We are very aware that there are a great many people who are waiting for treatment in the NHS, and it is true that more people are joining the waiting lists, but of course there are more of them leaving the waiting lists at present. So, at least that is a move in the right direction. 

Why haven't we done this before now? Well, because we've been focusing on those individual programmes—endoscopy, pathology and so forth. So it's not as if no work has been done. A lot of that has already been done. But what we're doing now is bringing everything together. As you said, the important thing is that we plan growth together so that things aren't seen in isolation in the future but that they can feed off each other. And to ensure that that growth and that progress is done in the right way, there will be representatives on the board who will be involved in this strategy. There will be representation from the different categories, in terms of the specialisations, but also from the health boards. And there will be an expectation for them to collaborate, because obviously we're in a period of great shortages, and we're in a period where it will be difficult for us to have more than three of these organisations. So, we will need to recognise that we will need help for people to find their ways to these centres, because it won't be possible to have a centre in every part of Wales. But, with these specialist centres, I think we're in a position now where people are willing to travel a little bit further if it will accelerate the time that it takes for them to get their medical intervention

In terms of the workforce plan, HEIW is already working on that, and so that's an integral part of the strategy, and we would expect to see that in due course. 

Photo of Jenny Rathbone Jenny Rathbone Labour 4:09, 25 April 2023

Thank you very much for your statement, Minister. I strongly welcome this good use of scarce resources. These are very expensive bits of kit, and therefore making them available on a regional basis seems to me an entirely rational way of doing things. I wonder if you could just confirm if this regional service will be for Cwm Taf Morgannwg, Aneurin Bevan and Cardiff and Vale, or does it include Swansea Bay as well? What is your proposal around that? 

It seems to me that it's really, really important for patients to know whether they've got a serious problem or not, because if they haven't then they can stop worrying, and if they have, then we can quickly find out what we can do to sort it out. Could you just explain the timescale on when you think Cwm Taf Morgannwg, the regional service in Llantrisant, will be able to go live, because I appreciate you've got to change the building that you've just acquired, and also when you think you might know whether you can get the money together for a regional endoscopy unit on the same site?

Lastly, just in line with the question from Rhun ap Iorwerth, will transport be available for my constituents who have no access to a car?

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:10, 25 April 2023

Thanks very much, Jenny. I think one of the most exciting things about this programme is actually the ability for us to look to the future, where things may change pretty rapidly in this area. One of the things I've been really concerned about—. As you mentioned, this kit is really expensive, so the last thing I want to do is to invest in a whole lot of capital equipment that we find will become a stranded asset in a few years' time. Last Thursday, I went on a visit to Cardiff university hospital, where there are some genius women working on liquid biopsy tests. What happens is they take a sample of your blood and they can analyse that genomically and tell whether you've got cancer and tell what type of cancer, and then they can adjust what kind of medicine they give you in response to the precise cancer that you have. So, we're getting into real precision technology here. Obviously, that's far less intervention than using huge equipment where you have to go into machines and all kinds of things. I'm really keen to make sure that, whatever we do, we're keeping one eye on the future and what is going to be best clinically for the public.

In terms of the regional services, we expect that the Cwm Taf one will cover the south-east Wales footprint, so that will include Cardiff and Cwm Taf and Aneurin Bevan. We're proposing another one, then, for west Wales, and obviously there will be another one in north Wales. That's the kind of configuration. I think it is essential that we understand that you have to do a hell of a lot of tests to find the 5 per cent of people who may suffer. In order to find the 5 per cent of people who may have cancer, you have to test the other 95 per cent of people. This is a lot of tests, and obviously while you're waiting that is a really, really concerning and troubling time. If we can reduce the demand on the service, through, for example, using blood tests instead of expensive tests, then obviously that would be a good way to go. But the science is still developing in that area. So, we've just got to be aware that we may need to shift direction quickly as the science develops.

On Cwm Taf Morgannwg, I'm hoping that we're going to be getting somewhere by the end of this year, which is very, very ambitious. That's where I'd like to be. The endoscopy part of it, I think, will come later, but certainly, on the broader diagnostics, I'm pushing them very hard to see how quickly we can get that in place, ideally by the end of this year. There will be a challenge in relation to transport. You know how strapped not just public transport at the moment is, but also the health service, so I'm afraid I won't be able to make a commitment in relation to that.

Photo of Altaf Hussain Altaf Hussain Conservative

Diolch, Dirprwy Lywydd. Minister, new innovations like the liquid biopsies you highlighted are welcome news. Anything we can do to reduce pain and suffering while at the same time cutting down diagnostic waits is to be applauded. Are you concerned that we will once again see pockets of excellence but that the reality in most health boards will be continuing long waits for diagnostics? We have discussed in the past innovations such as FibroScan, which is hailed as transformational in liver care, yet availability is not universal. What steps are you taking to ensure that all these innovative diagnostic techniques are available to every Welsh patient who needs them? For example, dynamic contrast-enhanced magnetic resonance imaging has revolutionised prostate cancer diagnoses, but is not universally available. Finally, Minister, last week, Swansea Bay health board told me of their plans to expand blood tests from a three-day week service to a four-day week one. Their average waiting time for results across all sites is 13 working days. Do you think this is acceptable, and what steps can you take to speed up the process? Diolch yn fawr.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:15, 25 April 2023

Thanks very much. You're quite right; there are always going to be pockets of excellence, and that's not necessarily a bad thing, because if you have pockets of excellence you can attract key and expert workers to those places. So, I'm not going to apologise for developing three regional diagnostic centres that I hope will attract some excellent workers to those facilities. What we've got to do, though, is to make sure that the board that will be monitoring this understand their responsibility to monitor, to make sure that there's no geographical hindrance for those people, and that it's not effectively discriminatory on the basis of geography. But some boards perform better than others, and I think part of my role is to keep their feet to the fire. 

Just in terms of the blood service, three days a week is not good enough, frankly. I want seven days a week in this area. I want seven days a week. If we're spending money on expensive kit, I want it to be used for 24 hours a day. And the limitation, I'm expecting, in terms of people and the numbers of people—so that's why we have to get this training aspect of the strategy absolutely right. But, actually, I think we can be a little bit creative as well. So, for example, as we digitise some of these results, there's no reason why we can't send the results, as is already being done, to be monitored and analysed overnight to Australia, who are awake, and they can send it back. So, that's already being done. What I'd like to see is a lot more of that, so creativity being used so that we don't do things in the way that we always have done. So, three days a week is not nearly good enough for me, no.