1. How is the Welsh Government monitoring the management of health inequalities across Wales? OQ59758

In collaboration with Public Health Wales and the World Health Organization's regional office for Europe, Welsh Government launched the Welsh health equity solutions platform on 22 June, to monitor the management of health inequalities across Wales, and it's leading the way with its complex interdisciplinary technique.

Diolch am yr ateb, Gweinidog. The cross-party group on cancer's inquiry into cancer inequalities in Wales really brings to life the brutal realities of getting a cancer diagnosis in Wales and living with the fall-out. Cancer death rates are 55 per cent higher among the most deprived Welsh populations. Swansea bay health board in my region contains the joint highest proportion of areas in the most deprived quintile. Today, Minister, I'd like to ask what the Welsh Government is doing to help people who directly suffer from these inequalities whilst navigating a difficult stage 4 cancer diagnosis.

I have been told by those managing stage 4 cancers that short staffing has meant being placed on waiting lists for treatment, while only some health boards have a key worker or a point of contact to support people with stage 4 cancer. How does the Welsh Government plan to measure progress in the treatment and support of stage 4 patients, as they deal with the inequalities outlined in the cross-party group's report?

Thanks very much. I've looked at that report and I think there are a lot of things for us to consider and to act upon. Before we get to stage 4, I think we've got to get to the prevention bit of it, and you heard the announcement yesterday by my colleague. The obesity crisis in Wales—and I'm going to call it a crisis—when you've got 60 per cent of your population who are overweight or obese, you're heading for a very difficult place, and what we know is that that issue is more prevalent in poorer communities, which is why we do have to intervene in order to avoid the kind of situation that you're talking about, in which, then, you see very clearly the disparities between those richer areas and poorer areas in terms of numbers suffering from cancer.

When it comes to the diagnosis, what is clear is that there are parts of Wales that are performing much better than others. It was quite interesting—. If you look at Betsi, Betsi is consistently actually quite good in terms of cancer treatment compared to others. I'm very concerned at the moment, for example, with the performance in Cwm Taf Morgannwg. That's probably one of my biggest headaches at the moment. And we're putting a lot of support into that. We've put them into a special Intervention framework to make sure that we're monitoring what they should do, and we're working with communities to see if we can chase down people who perhaps might not have been taking part in screenings, for example. I know that in relation to colon cancer and things, for example, it's trying to get people to take up that screening facility and working with communities, engaging with them, learning the lessons that we know, and we've learnt a lot of lessons during the pandemic: how do you communicate with people? How do you get into those hard-to-reach places? And I think some of that learning, we've got to now take into all those other areas.

But cancer is absolutely—. I've got six priorities, but now, with the very difficult financial pressures we're under, I have asked the health boards very much to focus on the top three, which are to avoid people going into hospital in the first place, shifting resources into the community, and working with local authorities to avoid delayed transfers of care; secondly, to bring those waiting lists down; and, thirdly, to focus on cancer.

Minister, sadly the simple fact is that our black and minority ethnic communities are not getting the same healthcare as the rest of the Welsh population, whether that is in cancer care, as recently highlighted by the CPG report; or in maternity care, as shown by the shocking report into maternity care at the University Hospital of Wales; or the whole host of other ways that BAME patients are being let down by the system. Population-level assumptions do not work. Treatment has to be tailored to the individual, taking account of their sex and ethnicity, as well as the usual things such as lifestyle and genetic make-up.

Minister, when I raised this issue with the First Minister yesterday, he said that the 'Anti-racist Wales Action Plan' would improve the situation. Can you expand on what specific actions within the plan will improve health outcomes for our BAME communities?

Thanks very much, Altaf. Part of what will happen next is that we have this new constituted organisation, this group, the NHS health inequalities group, and what they're going to do is to focus on a small number of areas, which aim to maximise the contribution of the NHS and make sure that the NHS now becomes and exemplar when it comes to tackling inequalities. The thing you've got to start with is data, data, data. So, let's find out what's actually going on, let's make sure that we've got that analysis, and then you can target and you can respond to the gaps. So, that's what we're doing in relation to that.

We do, of course, have the 'Anti-racist Wales Action Plan'. There's a very specific—. I had a meeting with my colleague who's responsible for this, the other day. She's really holding us all to account, making sure that we're delivering on our responsibilities within the 'Anti-racist Wales Action Plan'. I'm really pleased I was able to report to her that the actions that we have as an NHS are being taken very, very seriously in relation to the 'Anti-racist Wales Action Plan' and, obviously, all of that will feed into the planned-care challenges that we're facing.

Minister, building on your statement yesterday regarding the national immunisation programme for Wales, Public Health Wales published data last year on the take-up of childhood immunisation vaccinations, and that data showed that clear inequality gaps had increased in the Majority of age groups and in the majority of health boards, with children from the most deprived quintile being less likely to be up to date with routine immunisations than those from the least developed quintile. So, Minister, what is Welsh Government doing to monitor this clear inequality, and how is it working with health boards and other partners to put this right and eliminate the gap?

Well, thanks very much, and you're quite right to highlight the fact that, actually, in terms of childhood vaccinations, we don't have a bad level, but, actually, the pandemic pushed things back a bit. So, we do have about 20 per cent of the child population who are perhaps not taking up that opportunity.

So, what are we going to do about it? Well, we're taking that national immunisation framework and making sure that we take those lessons that we learned during the pandemic, making sure that we look at the evidence. What worked during that roll-out? What was best practice? And how do we avoid that unnecessary variation across Wales? What we're trying to do is to make sure that this is being led by local teams, who are engaging and empowering their own communities to understand the advantages of taking up the offer of vaccination. I think it's really important that we make this easy to understand, that we communicate well, that people understand the risks of not having vaccinations. So, each health board now is being asked to develop a vaccine equity strategy and a programme of work with dedicated public health input. So, that's how we're going to address the issue that you put forward.