We will move on to the short debate. Today's short debate is from Delyth Jewell and I call on Delyth Jewell to speak on the topic she has chosen for the short debate.

And if Members who are leaving could do so quietly. 

Diolch, Llywydd. My debate this evening is about the inequalities relating to cancer diagnoses, treatment and outcomes in Wales. And I'm pleased to be giving John Griffiths, Joel James, Heledd Fychan, Mark Isherwood, Rhun ap Iorwerth and Jack Sargeant a minute each of my time.

I'm indebted to Cancer Research UK and the cross-party group on cancer, and their 'All Things Being Equal?' report.

The Deputy Presiding Officer took the Chair.

Poverty is a driving force in determining whether you get cancer, how quickly you'll receive treatment, and your chances around survival. I wanted to bring this debate to the Senedd because of the brutal inequalities that so many of the areas I represent in the Valleys have always had to grapple with. These are inequalities visited on people, which are the legacy of a lack of investment in our communities over decades, which have complex, often unpredictable effects. When the mines closed, they left behind a trail of injustice, which can be traced right through to the increased prevalence of respiratory disease affecting people today, the mental health burdens and lack of faith in public systems that can deter people from seeking help, and an absence of investment in jobs and support services, which leave residents more likely to fall through the gaps. So, let's start with the incidence of cancer in these areas.

As the CPG report makes clear, if you live in an area that is more deprived of economic and social resources, you are more likely to get cancer. Some of the reasons for this are social, including higher rates of smoking and obesity. Then there are barriers that stand in between residents and support services. Research suggests that people who live in the areas I've mentioned will be less likely to get time off to go to medical appointments. They will be less likely to have private transport, leaving them at the mercy of often unreliable bus services. Where someone is from shouldn't limit their life in such a literal way as this. I am so proud, Dirprwy Lywydd, to be from the Valleys, and it makes me deeply angry that so many unfairnesses are faced by the communities I'm from through no fault of their own.

Data gleaned by Cancer Research UK from 2020-21 shows a deprivation gap in the uptake for cancer screening, a 19 percentage point gap for breast screening, a 15 percentage point gap for bowel screening, a 12 percentage point gap for cervical screening—and again, that is the gap between the most and least deprived groups in Wales. Now, that word 'deprived', I know that it has a very specific socio-scientific meaning. It has connotations I don't like very much, but I'm using it because it's the word that the data relates to, and I would remind anyone who has a similar discomfort about those connotations to reflect with me on the fact that 'deprivation' means taking something away from a person. People living in our areas have been prevented from living safer lives, and I find that monstrously unfair.

I know from Cancer Research UK about the variation in performance between health boards, and I want to make clear here that my remarks are not meant as a criticism of members of staff, who I know care deeply and work incredibly hard to look after people when they're at their most vulnerable. But for all the reasons that we will be discussing in this debate, people living in some communities in Wales face these increased risks. For Cwm Taf, the incidence rate for all cancers combined is 8 per cent higher than the rest of Wales. Lung cancer rates are 20 per cent higher than the Wales average. So many factors will feed into why this picture is so stark. Again, this isn't a question of laying blame at anyone's door. It's about understanding why the different pieces come together to make up that picture.

Barriers to services, like whether people can get to appointments, can be affected by travel and work issues, as I've already talked about. And some cancer treatment regimes are demanding. The Welsh cancer patient experience survey found that people living in some areas are more concerned about the distance they need to travel to get to a hospital. And what about when you've had the diagnosis? Waiting times for treatment can also be worse if you happen to live in one of these areas. In March 2023, NHS cancer waiting times showed that only 55.3 per cent of patients started their first treatment within 62 days of first being suspected of having cancer. That is the highest performance since the beginning of 2023. It is still far below the performance target for suspected cancer pathways, which aims for 75 per cent. It's a target that hasn't been met.

NHS diagnostic and therapy service waiting times show that, again in March this year, roughly 91,400 patients were waiting for one of seven key diagnostic tests in Wales. Nearly 40 per cent of those patients had been waiting for more than eight weeks. With cancer, possibly more than almost any other diagnosis, I think it's important for us to remember what those waiting times will mean. We're brought up to dread that diagnosis—a lot of the time because we don't understand enough about survival rates, and things are improving with research all the time. But the shorthand we have is that cancer is something that will get you, which is why so many people are too scared to ask for help. And if people, after making that leap and asking for help, which is so important—and people, please, should always ask for help if they've got any symptoms that they're not sure about; it's always best to ask for help—but, if after making that leap, if they have to wait for eight weeks to get an answer, then, they're in this kind of hellish limbo where they'll be expecting the worst, because that's human nature, before they can get any answers, before they can start on the journey to start to get better. Now, these waiting times prolong people's pain. The human cost of waiting times is, I think, incalculable, because you can't quantify the hurt that's made.

None of what I'm saying is meant as a criticism of either front-line staff or Government; it's meant as a plea, because I've lost people I love through cancer; everyone who sits in this Chamber will have done. This is a subject that nobody will look on coldly—I know that. 

Some of the questions I'd like to ask the Minister, please, to consider are whether the Government can commit to an annual report to the Senedd on the Welsh Government's efforts to tackle cancer inequalities in Wales. I'd ask whether, in implementing the cancer improvement plan, the Wales Cancer Network can set out how new initiatives can either help reduce these inequalities, or set out what needs to happen to make sure that these inequalities certainly don't get worse. I'd ask whether the Government and Public Health Wales will commit to awareness-raising campaigns, perhaps particularly targeted at these groups that need that exposure most of all, which would seek to tackle the risk factors that make people more exposed to risk of cancer, and campaigns that also address the barriers that prevent so many people from making that leap, either to go into a screening or go into an appointment. 

When it comes to the transport issues I've raised, I'd be grateful to know if an urgent review into patient transport options for cancer tests and treatment could be conducted. There are wonderful initiatives already like that, run by Cancer Aid Merthyr Tydfil Ltd, that provide a free, door-to-door transport service to attend cancer appointments. It's a long way from Merthyr Tydfil to Velindre, for example, and they provide this service, which is a godsend. Could a review look into how initiatives like that could be enhanced or supported, please, and would you commit to expanding existing targets for cancer screening, so that they include targets for improving uptake in the groups that are less likely to take part?

I'm grateful to the Minister, I'm grateful to everyone who's going to be speaking, and indeed, everyone who's going to be part of this debate. And, in my remaining few minutes, before I wait to hear what everyone else says in this debate, I would just emphasise again that I know that this is an issue that affects—. Each one of us will have at least one story that will have affected us deeply. Some of us will have had personal experience of this. I know that it is something that everyone wants to get right. So, this is, really, a plea, in a very cross-party way, and I welcome hearing more in the debate. Diolch yn fawr iawn. 

I'd like to thank Delyth Jewell very much for allowing me to contribute to this very important short debate today, and to congratulate Delyth on the way that she presented the case so effectively and powerfully. I'd like, as Chair of the cross-party group on smoking and health, Dirprwy Lywydd, to concentrate on smoking, which Delyth mentioned, because we know it's a very significant factor in terms of more deprived communities smoking at a greater rate. In fact, I think the last statistics show that smoking rates are four times higher in the most deprived communities compared to the least deprived. And over 2,000 cancer cases annually in Wales are attributed to deprivation, with almost half of them being linked to lung cancer. So, it's pretty clear just how important smoking, lung cancer and other diseases from smoking are to health inequalities. 

And what we need to do, I think, as well as addressing the multidimensional factors that Delyth mentioned, which are very complex—and, obviously, anything that is done across Welsh Government to tackle deprivation will help tackle these health inequalities, including lung cancer—we also need to improve services and target them more effectively at our more deprived communities. Anything that drives down smoking rates, generally, will help, but anything that particularly targets our more deprived communities and smoking rates will be particularly helpful. And I think we all know about that inverse law that means that, in general—as Delyth again touched upon—those communities with the greatest health needs tend to receive lesser services, and that's something that we must tackle, if we're going to make the sort of progress that we must in tackling these matters.

I'd like to start by thanking my colleague Delyth Jewell for giving me a minute of her time to talk about such a vital topic. In the few moments that I have, I would like to address one specific recommendation of the CPG report, and that is the increasing need for Welsh Government to work with Public Health Wales and the Wales Cancer Network, to commit to the collection and publication of data on cancer inequalities, including ethnicity, age, gender, sexual orientation and disability.

The CPG's report was limited to socioeconomic deprivation, because this was the only data available. This is not good enough. We need more thorough data collection, because it is the only way we can really improve the understanding of the needs of cancer sufferers and the impact it has on their lives. Moreover, we need to improve our understanding of the factors that influence cancer outcomes. I truly believe that relatively small interventions can be made at key points on a cancer sufferer's journey that will have significant improvements in their outcomes and welfare. But these will remain out of reach until we properly understand all aspects of cancer sufferers' lives. As such, for the Welsh Government, the NHS Wales Executive, Wales Cancer Network and health boards to continue tackling cancer inequalities, I ask that the Welsh Government takes seriously this recommendation and commits to working with Public Health Wales and the Wales Cancer Network on better collection of data on cancer inequalities in Wales. It is only with more comprehensive data that we'll be able to properly address cancer inequalities and ensure that the experiences of the most marginalised groups are equal. Thank you.

May I sincerely thank Delyth Jewell? As Delyth mentioned, we have all known people who were too late in getting their diagnosis, unfortunately. The inequality—there are so many people who don't want to be a nuisance, they ignore the symptoms. And it can be very difficult, as you outlined, if you don't have access to public transport— you're reliant on a family member to take you just because something doesn't feel quite right. Or, many of those people in our communities who live alone, they don't have money to pay for a taxi where there is no public transport available. This is an equalities issue—that equality of access to medical services, if you can get through to the surgery, and then that you do get that necessary diagnosis. In the area that I represent—you mentioned Cwm Taf Morgannwg—there are so many inequalities in that area; people dying needlessly at the moment. The science continues to improve, but we must send a clear message: people aren't being a nuisance if they go to their GP; don't ignore the symptoms; and everyone has a right to go to their GP. Hopefully, we can make it clear that you do need to go to your GP, if you have symptoms.

I also thank Delyth Jewell for allowing me to contribute to this short debate. It was concerning to learn further about the barriers that those from deprived communities may face during their cancer journey, most importantly, when identifying the signs and symptoms of cancer. Recognising these is critical to seeking help from a GP, getting an early diagnosis and starting treatment, where any delays can have a detrimental impact on health outcomes. In light of this, I urge the health Minister to consider the report's recommendation to expand existing cancer awareness campaigns, specifically target the most deprived communities in Wales. Can Welsh Government commit to investing in regular cancer awareness campaigns to address the barriers to diagnosis that those from most deprived communities face? And will Welsh Government work with Public Health Wales to ensure a roll-out of targeted symptom awareness campaigns, to ensure that those from the most deprived communities in Wales are not left behind?

May I thank Delyth for giving a little of her time in this short debate? I'll take just a few seconds, and I want to thank the cross-party group on cancer for their report on the inequalities within diagnosis and cancer treatment. 

Reading the report brings the scandal alive, doesn't it—that profound inequality that exists between life chances and the chances of survival of people from privileged communities and backgrounds as opposed to those from deprived backgrounds. The mortality rate in deprived areas is 55 per cent higher than in wealthier areas—55 per cent higher. We need to talk about this. We need to shout about this. We need to implement a policy that ensures that that awful truth becomes part of our history, rather than our present in Wales in the twenty-first century.

I'm extremely grateful to Delyth for allowing me to do this. I just wanted to take the time to raise the gynaecological cancers inquiry the Health and Social Care Committee are currently undertaking, in particular, the evidence we heard from cancer patient Claire O'Shea—so brave, so powerful, so inspirational. And I keep coming back—and Rhun will be aware of this—to this word of 'medical gaslighting', and it's an issue that we have to address. I would urge Members to go and look at Claire's Instagram—she's documenting her journey. And we as a committee must listen to those patients' experiences, make recommendations on the back of them, and I do hope—. I know the Minister can't answer this now, but, when we do report our committee report, and lay that down to the Government, I hope they listen and implement those actions and experiences, because the experience of Claire O'Shea and patients like her is simply incredible, and it's so brave of her to come forward like that.

I now call on the Health and Social Services Minister to respond to the debate—Eluned Morgan.

Diolch yn fawr. I'd like to thank Delyth Jewell for tabling this short debate on cancer and inequality, and, in particular, thanks to the cross-party group for its work on the 'All Things Being Equal?' report. I know that the deputy chief medical officer attended the launch of the report on 8 June, and we're really giving careful considerations to its recommendations.

I think it's really important that we focus on the issue, and it doesn't sit comfortably with me that where people live, their circumstances, their age, their race, their gender, that that can all have a significant impact on their chances of getting cancer and surviving cancer. Now, in 2015, the chief medical officer wrote extensively in his annual report, 'Rebalancing Healthcare', about how we must work in partnership to reduce social inequality and, in particular, its effect on health outcomes. I've spent a lot of time talking to Sir Michael Marmot about his views on health inequalities. I think we also recognise the importance of this in our policy that already has been developed, in terms of the quality statement for cancer, which includes as its first domain the issue of equity in cancer care and, importantly, outcome.

So, we expect NHS services to be planned and delivered in a way that mitigates these inequalities. The NHS response to the quality statement, the cancer improvement plan, is framed throughout by a focus on inequality. Now, a newly established NHS health inequalities group will focus on a small number of areas that aim to maximise the contribution of the NHS and seek to make the NHS an exemplar. The group is tasked to oversee, co-ordinate and drive work at the national level to tackle health inequalities. It will include identifying and scaling up best practice to maximise impact. Priority areas include reviewing data sets and taking action to respond to gaps, along with mainstreaming. So, the point that was brought up by Joel James about data, I absolutely concur with—data, data, data. We need to know what's going on, and I'm very much of the view that data is absolutely crucial in this space.

Health boards have also got a responsibility for their populations, and, under the Well-being of Future Generations (Wales) Act 2015, have duties to address the determinants of health over the long term. So, lots of people talked about smoking. Obesity, actually, is also a real issue when it comes to increasing the risks of cancer. Health boards work with local authorities through regional partnership boards to tackle these cross-sectoral issues. Now, the socioeconomic duty also requires specified public bodies to consider how their decisions might help to reduce the inequalities associated with socioeconomic disadvantage when making strategic decisions, such as deciding priorities and setting objectives. The Well-being of Future Generations (Wales) Act 2015 also embeds health in all policy approach across Welsh Government, and there is work already under way to develop regulations under the Public Health (Wales) Act 2017, which will require specified public bodies to carry out a health impact assessment in certain circumstances. This is truly innovative. It's something I know that the World Health Organization is really interested in, in seeing how that changes things in Wales, how that focus that we're anxious to see across Government and outside of Government actually works in practice. 

We are taking a number of steps at a national level to cover the factors that have an influence on people's health: for example, Flying Start; the steps to tackle poor housing and air pollution; our employability programme; and our plans to tackle tobacco use and obesity. We've published an anti-racism and an LGBTQ+ action plan, which aim to tackle the inequalities faced by these groups. This is a comprehensive set of programmes across our public services and health services, and that is over the long term, to give attention to the factors that can cause disease and illness such as cancer. It's important that we do everything we can to prevent cancer among our most deprived communities, and that is what will have the greatest impact in tackling the inequalities within health. 

Smoking and obesity, as many have mentioned, are the main factors that cause cancer and are preventable. So, clearly, many people develop cancer and they don't smoke and they're not obese, so there are a range of reasons as to why people are affected by cancer, but we know that rates increase where those are factors. 

Part of the reason that we're seeing more cases of cancer and fewer people surviving in some of our deprived communities is the link between being deprived and harmful behaviour, such as smoking. So, smoking cessation is the most positive step that people can take to improve their health, and we have seen significant progress in reducing smoking rates across Wales. But we know that more needs to be done if we are to deliver our ambitions here in Wales. We have taken steps to make being smoke-free the norm in all parts of society, and we are focused on reducing smoking among mothers, because we do want to see more children and young people enjoying a smoke-free childhood. We're also targeting groups where the highest numbers of people are smokers in order to encourage them to take advantage of the NHS services that are there to support and help them. 

There will also be a need for us to support people to reach a healthy weight. Tackling inequalities in health will continue to be a crucial focus for us. And just to touch upon some of the points that people have raised during the debate—

Delyth, thank you for being so passionate and so powerful in your presentation. I think this report is something that we're going to have to take very seriously, and I'm very aware that it is important to have awareness-raising campaigns. Very interesting, the work that organisations like the Moondance Cancer Initiative is doing, targeting those deprived areas. I hear what you're saying in terms of transport. So, what we're going to see is a concentration. Because of the issues around things like workforce and the fact that kit is expensive, we're going to see a concentration in particular areas, and people will have to travel to those areas. But what I do recognise is that we have to make sure, in particular for those people from poorer areas, that they've got a means of getting there. As you say, there are some really good initiatives; we just need to make sure that those initiatives are available across the country.

John, I know you're very passionate about the issue of smoking, and thank you for your points that you've put forward in relation to that. Lung cancer—interestingly, we've started on this project targeting lung cancer, because lung cancer, the problem with it is that very often you don't see it until quite late, and, when you see it, it's very difficult to tackle. Now we've got this liquid biopsy approach that we're trying to look at, and I'm just really interested to see what that pilot is going to come up with, to see if there's more we can do in that space.

Heledd, you talked also about the trafnidiaeth gyhoeddus. I just think we've got to be absolutely aware that this is something, as I tried to set out, that is very much on our agenda. And Jack, thank you very much for your reference, again, to Claire O'Shea. I recognise that it's really important for us to really focus on this area. There is a real issue with women's cancer. I've asked my officials to really focus on that. I'm aware you're doing a report on it, I'm looking forward to seeing the recommendations of that report, but I'm not waiting for the report, because, for every day that people wait, that is a problem for somebody who's suffering. So, we're on it, we're trying to work with it. We are challenged at the moment; there's no question that the NHS in Wales is massively challenged, but there is a particular problem with women's cancer, and I'm very, very keen to make sure that we do something to address that. Diolch.

I thank the Minister. And, as the chair of the cross-party group on cancer, I'd like to thank you, Delyth, for sharing this very important report and debate.

And that brings today's proceedings to a close. 

The meeting ended at 18:56.