National Assembly for Wales

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Y Cyfarfod Llawn

Plenary

08/05/2018

Cynnwys

Contents

1. Cwestiynau i'r Prif Weinidog 1. Questions to the First Minister
2. Datganiad a Chyhoeddiad Busnes 2. Business Statement and Announcement
Pwynt o Drefn Point of Order
3. Datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol: Adroddiad y Gwasanaeth Cynghori ar Iechyd a Gofal Cymdeithasol (HASCAS) i’r gofal a’r driniaeth a ddarparwyd ar ward Tawel Fan 3. Statement by the Cabinet Secretary for Health and Social Services: The Health and Social Care Advisory Service (HASCAS) Report into the care and treatment provided on Tawel Fan
4. Datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol: Adroddiad y Grŵp Gorchwyl a Gorffen ar gyfer Adolygu'r Defnydd o Rwyllau Synthetig Gweiniol 4. Statement by the Cabinet Secretary for Health and Social Services: The Report of the Welsh Task and Finish Group to Review the Use of Vaginal Synthetic Mesh
5. Datganiad gan Ysgrifennydd y Cabinet dros yr Economi a Thrafnidiaeth: Uchelgeisiau ar gyfer Prif Linellau Rheilffordd Great Western a Gogledd Cymru 5. Statement by the Cabinet Secretary for Economy and Transport: Ambitions for Great Western and North Wales Main Lines
6. Datganiad gan Ysgrifennydd y Cabinet dros Ynni, Cynllunio a Materion Gwledig: Dyfodol Rheoli Tir 6. Statement by the Cabinet Secretary for Energy, Planning and Rural Affairs: The Future of Land Management
7. Datganiad gan Weinidog yr Amgylchedd: Cyfrifoldeb Cynhyrchydd Estynedig 7. Statement by the Minister for Environment: Extended Producer Responsibility
8. Dadl Cyfnod 4 y Bil Rheoleiddio Landlordiaid Cymdeithasol Cofrestredig (Cymru) 8. Debate on Stage 4 of the Regulation of Registered Social Landlords (Wales) Bill

Cyfarfu’r Cynulliad am 13:30 gyda’r Llywydd (Elin Jones) yn y Gadair. 

The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

1. Cwestiynau i'r Prif Weinidog
1. Questions to the First Minister

Yr eitem gyntaf ar ein hagenda ni y prynhawn yma yw'r cwestiynau i'r Prif Weinidog, a'r cwestiwn cyntaf, Gareth Bennett.

The first item on our agenda this afternoon is questions to the First Minister, and the first question, Gareth Bennett.

Hygyrchedd Trenau
Accessibility of Trains

1. A wnaiff y Prif Weinidog ddatganiad am hygyrchedd trenau ar gyfer personau â lefel symudedd is ? OAQ52130

1. Will the First Minister make a statement on the accessibility of trains for persons of reduced mobility? OAQ52130

Yes. By 31 December of next year, all trains must include provisions for people of reduced mobility, in line with European Union and United Kingdom Government standards, and the procurement documents for the Wales and borders rail services contract will mandate compliance with people of reduced mobility standards.

Gwnaf. Erbyn 31 Rhagfyr y flwyddyn nesaf, mae'n rhaid i bob trên gynnwys darpariaethau ar gyfer pobl ag anawsterau symud, yn unol â safonau'r Undeb Ewropeaidd a Llywodraeth y Deyrnas Unedig, a bydd y dogfennau caffael ar gyfer contract gwasanaethau rheilffyrdd Cymru a'r gororau yn gorchymyn cydymffurfiad â safonau pobl ag anawsterau symud.

Thanks for that. We know that we are going to have a new train operator in Wales from next year. The problem is that the new operator may not be able to get new rolling stock for perhaps four years, so it could be that, in order to comply with that legislation that you stated, we may have a tactic of the new train operator having to, or believing they have to, leave toilets locked up on the trains, meaning that nobody can use them. Do you see that as a potential problem for the new franchisee?

Diolch am hynna. Rydym ni'n gwybod ein bod ni'n mynd i gael gweithredwr trenau newydd yng Nghymru o'r flwyddyn nesaf ymlaen. Y broblem yw ei bod yn bosib na fydd y gweithredwr newydd yn gallu cael cerbydau newydd am bedair blynedd efallai, felly gallem fod â thacteg, er mwyn cydymffurfio â'r ddeddfwriaeth honno a nodwyd gennych, bod y gweithredwr trenau newydd yn gorfod, neu'n credu bod yn rhaid iddo, adael toiledau wedi eu cloi ar y trenau, sy'n golygu na all neb eu defnyddio. A ydych chi'n gweld hynny fel problem bosibl i'r sawl sy'n ennill y fasnachfraint newydd?

No, under no circumstances will toilets be allowed to be locked.

Nac ydw, ni fydd caniatâd i doiledau gael eu cloi o dan unrhyw amgylchiadau.

First Minister, one of the frustrations for disabled passengers is that many trains only have a single wheelchair space, which is too often taken up by pushchairs or luggage. Now, I've been informed that, in Australia, a whole carriage is dedicated to those passengers with reduced mobility, where there are additional spaces for wheelchair users. Can you outline a bit more detail on how the next rail franchise will cater for the needs of those with reduced mobility?

Prif Weinidog, un o'r rhwystredigaethau i deithwyr anabl yw mai dim ond un lle sydd ar gael ar gyfer cadair olwyn ar lawer o drenau, sy'n rhy aml wedi ei lenwi gan gadeiriau gwthio neu fagiau. Nawr, dywedwyd wrthyf bod, yn Awstralia, cerbyd cyfan yn cael ei neilltuo i'r teithwyr hynny ag anawsterau symud, lle ceir lleoedd ychwanegol ar gyfer defnyddwyr cadair olwyn. A allwch chi amlinellu ychydig mwy o fanylion ar sut y bydd y fasnachfraint rheilffyrdd nesaf yn diwallu anghenion y rhai sydd ag anawsterau symud?

Well, we wouldn't want a situation where those people who are in wheelchairs are effectively segragated—and the Member is not suggesting that, in fairness. It's hugely important that people are able to travel on all sections of the train. Coming back to the point I made earlier on, the technical specification, as I said, will need to be complied with by 31 December next year. I can say that agreements are already in place to modify a significant proportion of the existing rolling stock, and plans are in place to deal with the pacer trains. Some of the existing fleet already meet the compliance requirements, but, by the end of next year, all of them will have to.

Wel, ni fyddem ni eisiau sefyllfa lle mae'r bobl hynny sydd mewn cadeiriau olwyn yn cael eu gwahanu i bob pwrpas—ac nid yw'r Aelod yn awgrymu hynny, er tegwch. Mae'n bwysig dros ben bod pobl yn gallu teithio ar bob rhan o'r trên. I ddychwelyd at y pwynt a wneuthum yn gynharach, bydd angen cydymffurfio â'r fanyleb dechnegol, fel y dywedais, erbyn 31 Rhagfyr y flwyddyn nesaf. Gallaf ddweud bod cytundebau eisoes ar waith i addasu cyfran sylweddol o'r cerbydau presennol, ac mae cynlluniau ar waith i ymdrin â'r trenau pacer. Mae rhywfaint o'r fflyd bresennol yn bodloni'r gofynion cydymffurfio eisoes, ond, erbyn diwedd y flwyddyn nesaf, bydd yn rhaid i bob un ohonyn nhw wneud hynny.

I'd be grateful if the First Minister could just clarify: has the Welsh Government requested in its specification from the bidders that all trains in the metro will have toilet facilities that are compliant with the new rules on board?

Byddwn yn ddiolchgar pe gallai'r Prif Weinidog egluro: a yw Llywodraeth Cymru wedi gofyn yn ei manyleb gan yr ymgeiswyr y bydd cyfleusterau toiled sy'n cydymffurfio â'r rheolau newydd ar yr holl drenau yn y metro?

What I can say is that we're considering a number of options at the moment. If the trains don't have—[Interruption.] Well, if the trains don't have toilets on board, then we would expect the operator to provide very much enhanced services at stations in order to ensure that people feel comfortable when they are travelling. There are, of course, examples of metro services elsewhere, such as in Greater Manchester, where there are no toilets on board, and quite often there are no facilities for passengers who wish to use a toilet. That is not what we want; we want to make sure that people are able to access toilet facilities as easily as possible.

Yr hyn y gallaf ei ddweud yw ein bod ni'n ystyried nifer o ddewisiadau ar hyn o bryd. Os nad oes gan y trenau— [Torri ar draws.] Wel, os nad oes toiledau ar y trenau, yna byddem yn disgwyl i'r gweithredwr ddarparu gwasanaethau llawer iawn gwell mewn gorsafoedd i sicrhau bod pobl yn teimlo'n gyfforddus pan eu bod yn teithio. Wrth gwrs, ceir enghreifftiau o wasanaethau metro mewn mannau eraill, fel Manceinion Fwyaf, lle nad oes toiledau ar y trenau, ac yn aml nid oes unrhyw gyfleusterau i deithwyr sy'n dymuno defnyddio toiled. Nid dyna'r ydym ni ei eisiau; rydym ni eisiau gwneud yn siŵr y gall pobl gael mynediad at gyfleusterau toiled mewn modd mor hawdd â phosibl.

First Minister, Cabinet Secretary Ken Skates has been proactive in setting out the Welsh Government's ambitions for rolling stock fit for a twenty-first century rail network. In July last year, Ken Skates stated, and I quote,

'I've made no secret of the difficulty in adding good quality rolling stock in Wales',

and it's been absolutely clear that the next franchise—the Welsh Government's first—must have the passenger at its heart. First Minister, this commitment of the Welsh Labour Government can be evidenced by Wales being selected by Construcciones y Auxiliar de Ferrocarriles as the new location for its new centre of excellence for the manufacture of UK rolling stock. What opportunities, in the First Minister's opinion, will £30 million of investment, and the creation of 300 high-calibre jobs in a facility that assembles, tests, and commissions new railway vehicles, afford the railway industry to ensure the accessibility of trains for persons of reduced mobility in Wales?

Prif Weinidog, mae Ysgrifennydd y Cabinet Ken Skates wedi bod yn rhagweithiol o ran nodi uchelgeisiau Llywodraeth Cymru ar gyfer cerbydau sy'n addas ar gyfer rhwydwaith rheilffyrdd yn yr unfed ganrif ar hugain. Ym mis Gorffennaf y llynedd, dywedodd Ken Skates, a dyfynnaf,

Rwyf wedi bod yn agored iawn ynghylch yr anhawster sydd ynghlwm ag ychwanegu cerbydau o safon uchel at y stoc sydd ar gael yng Nghymru,

ac mae wedi bod yn gwbl eglur bod yn rhaid i'r teithiwr fod yn ganolog i'r fasnachfraint nesaf—sef masnachfraint gyntaf Llywodraeth Cymru. Prif Weinidog, ceir tystiolaeth o'r ymrwymiad hwn gan Lywodraeth Llafur Cymru drwy'r ffaith fod Cymru wedi cael ei dewis gan Construcciones y Auxiliar de Ferrocarriles fel y lleoliad newydd ar gyfer ei ganolfan ragoriaeth newydd i weithgynhyrchu cerbydau yn y DU. Pa gyfleoedd, ym marn y Prif Weinidog, a fydd buddsoddiad o £30 miliwn, a chreu 300 o swyddi o ansawdd uchel mewn cyfleuster sy'n cydosod, yn profi, ac yn comisiynu cerbydau rheilffordd newydd, yn eu cynnig i'r diwydiant rheilffyrdd i sicrhau hygyrchedd trenau i bobl ag anawsterau symud yng Nghymru?

Very much so. This is one of the biggest public transport projects outside of London. It will utilise, of course, some of the existing lines that are already there. They're all heavy rail at the moment, and we'll need to see which will remain as heavy rail, which will be converted to light rail, which new routes would then be rolled out using light rail, alongside some of the existing routes that have rail tracks on them but haven't been used for many, many years. These are all matters that are being considered as part of the franchise tendering process.

Yn sicr. Dyma un o'r prosiectau trafnidiaeth gyhoeddus mwyaf y tu allan i Lundain. Bydd yn defnyddio, wrth gwrs, rhai o'r rheilffyrdd presennol sydd yno eisoes. Maen nhw i gyd yn rheilffyrdd trwm ar hyn o bryd, a bydd angen i ni weld pa rai fydd yn parhau i fod yn rheilffyrdd trwm, pa rai fydd yn cael eu troi'n rheilffyrdd ysgafn, pa lwybrau newydd fyddai'n cael eu cyflwyno wedyn gan ddefnyddio rheilffyrdd ysgafn, ochr yn ochr â rhai o'r llwybrau presennol sydd â chledrau rheilffordd arnyn nhw ond nad ydyn nhw wedi cael eu defnyddio ers blynyddoedd maith. Mae'r rhain i gyd yn faterion sy'n cael eu hystyried yn rhan o'r broses dendro ar gyfer y fasnachfraint.

Cynllun Datblygu Strategol i Dde-ddwyrain Cymru
Strategic Development Plan for South-east Wales

2. Pa drafodaethau y mae Llywodraeth Cymru wedi'u cael gyda'r cabinet ar gyfer prifddinas-rhanbarth Caerdydd o ran cynllun datblygu strategol i dde-ddwyrain Cymru? OAQ52154

2. What discussions has the Welsh Government had with the cabinet for the Cardiff capital region with regard to a strategic development plan for south-east Wales? OAQ52154

13:35

Ministers and officials have met representatives from the Cardiff capital region cabinet several times since October 2015 to promote the preparation of a strategic development plan for the south-east of Wales. The next step now is that the cabinet must identify a responsible authority so that formal preparation of the plan for the region can begin. 

Mae Gweinidogion a swyddogion wedi cyfarfod â chynrychiolwyr o gabinet prifddinas-ranbarth Caerdydd sawl gwaith ers mis Hydref 2015 i hybu'r gwaith o baratoi cynllun datblygu strategol ar gyfer y de-ddwyrain. Y cam nesaf nawr yw bod yn rhaid i'r cabinet nodi awdurdod cyfrifol fel y gall y gwaith o baratoi'r cynllun ar gyfer y rhanbarth yn ffurfiol ddechrau.

On 27 April, elected representatives of the Cardiff capital region wrote to the Cabinet Secretary for Energy, Planning and Rural Affairs and said they firmly believe that the best opportunity to deliver positive planning outcomes and deliver the transformational change is to prepare a strategic development plan for the region that is genuinely a regional plan, based on regional evidence, rather than a plan that simply knits together existing local development plans. They added that if the Welsh Government continues to force all seven local planning authorities with the 2021 planned expiry date to review their LDPs, there will not be sufficient resource within the region to progress the SDP and this opportunity will be lost for many years. Basically, what they're saying is that we need to move ahead with the strategic development plan, and we can't then review LDPs in the depth that the Government wants with those resources. There's a choice to be made, and I urge the Government to back a strategic development plan for south-east Wales. 

Ar 27 Ebrill, ysgrifennodd cynrychiolwyr etholedig prifddinas-ranbarth Caerdydd at Ysgrifennydd y Cabinet dros Ynni, Cynllunio a Materion Gwledig gan ddweud eu bod yn credu'n gryf mai'r cyfle gorau i gyflawni canlyniadau cynllunio cadarnhaol a darparu'r newid gweddnewidiol yw paratoi cynllun datblygu strategol ar gyfer y rhanbarth sy'n gynllun rhanbarthol gwirioneddol, yn seiliedig ar dystiolaeth ranbarthol, yn hytrach na chynllun sy'n gwneud dim ond cyfuno cynlluniau datblygu lleol presennol. Fe wnaethom ychwanegu os bydd Llywodraeth Cymru yn parhau i orfodi pob un o'r saith awdurdod cynllunio lleol â'r dyddiad terfyn arfaethedig yn 2021 i adolygu eu cynlluniau datblygu lleol, ni fydd digon o adnoddau yn y rhanbarth i fwrw ymlaen â'r CDS a bydd y cyfle hwn yn cael ei golli am flynyddoedd lawer. Yr hyn y maen nhw'n ei ddweud yn y bôn, yw bod angen i ni symud ymlaen â'r cynllun datblygu strategol, ac ni allwn wedyn adolygu'r CDLlau ar sail mor drwyadl ag y mae'r Llywodraeth yn dymuno gyda'r adnoddau hynny. Mae dewis i'w wneud, ac rwy'n annog y Llywodraeth i gefnogi cynllun datblygu strategol ar gyfer y de-ddwyrain.

First of all, we want to see a strategic development plan, but it's hugely important that there are LDPs in place because if LDPs run past their expiry date, if I can put it that way, then, of course, often you can get uncontrolled development because applications will come in in the absence of a development plan. We want to see a strategic development plan, but the ball is in the court of the region. They must identify a responsible authority now, and then, of course, we can commence the process. We want to work with them to develop a strategic development plan. That is, by far, the most sensible approach—he has said it himself in this Chamber—but it is important now that they do identify which authority is going to be responsible for its development. 

Yn gyntaf oll, rydym ni eisiau gweld cynllun datblygu strategol, ond mae'n bwysig dros ben bod cynlluniau datblygu lleol ar waith oherwydd os bydd CDLlau yn mynd heibio eu dyddiad terfyn, os gallaf ei roi felly, yna, wrth gwrs, yn aml gallwch gael datblygu heb reolaeth oherwydd y bydd ceisiadau yn dod yn absenoldeb cynllun datblygu. Rydym ni eisiau gweld cynllun datblygu strategol, ond y rhanbarth sydd i benderfynu. Mae'n rhaid iddyn nhw nodi'r awdurdod cyfrifol yn awr, ac yna, wrth gwrs, gallwn gychwyn y broses. Rydym ni eisiau gweithio gyda hwy i ddatblygu cynllun datblygu strategol. Dyna, o bell ffordd, y dull mwyaf synhwyrol—mae ef ei hun wedi ei ddweud yn y Siambr hon—ond mae'n bwysig nawr eu bod yn nodi pa awdurdod sy'n mynd i fod yn gyfrifol am ei ddatblygu.

First Minister, any plan to secure the maximum economic benefit from the Cardiff capital region must include a relief road for the M4. I have been contacted by a number of business owners who have expressed their dismay that the Cabinet Secretary for Finance, and your potential successor, recently appeared to pour cold water on the proposed black route. As one business owner said,

'This is not a picture of Wales open for business.'

First Minister, in your Government's discussion with the Cardiff capital region cabinet, have you committed, and will you continue to commit, to building a relief road for the M4 in or around Newport please?

Prif Weinidog, mae'n rhaid i unrhyw gynllun i sicrhau'r budd economaidd mwyaf posibl o brifddinas-ranbarth Caerdydd gynnwys ffordd liniaru ar gyfer yr M4. Mae nifer o berchnogion busnes wedi cysylltu â mi yn mynegi eu siom iddi ymddangos yn ddiweddar bod Ysgrifennydd y Cabinet dros Gyllid, a'ch darpar olynydd, wedi taflu dŵr oer ar y llwybr du arfaethedig. Fel y dywedodd un perchennog busnes,

Nid yw hwn yn ddarlun o Gymru sy'n agored ar gyfer busnes.

Prif Weinidog, yn nhrafodaeth eich Llywodraeth gyda chabinet prifddinas-ranbarth Caerdydd, a ydych chi wedi ymrwymo, ac a fyddwch chi'n parhau i ymrwymo, i adeiladu ffordd liniaru ar gyfer yr M4 yng Nghasnewydd neu'r cyffiniau os gwelwch yn dda?

Well, first of all, I think it's only fair to point out the context in which the comments were made by the Cabinet Secretary for Finance. He was saying quite properly that cost is clearly an issue. Of course it is. He would not be acting in his role as Cabinet Secretary for Finance if he didn't point that out. And that is an issue, but not the only issue, of course, that will need to be considered. Now, just to remind Members, what will happen is that when the planning inspector's report is received—we expect in the summer or the early autumn—that will be the time to give consideration to that report, and a decision will then be taken as to which route is the way ahead. What we do know is that the congestion will not improve in the Brynglas tunnels—that much is, to me, obvious. But I have to keep an open mind on which route should be taken forward because I will be the person taking the decision. And so, when the inspector's report arrives on my desk, that and any other relevant considerations will form part of my thinking. 

Wel, yn gyntaf oll, credaf nad yw hi hi ond yn deg tynnu sylw at y cyd-destun y gwnaed y sylwadau ynddo gan Ysgrifennydd y Cabinet dros Gyllid. Roedd yn dweud yn gwbl briodol bod cost yn amlwg yn broblem. Wrth gwrs ei fod. Ni fyddai'n gweithredu yn rhinwedd ei swydd fel Ysgrifennydd y Cabinet dros Gyllid pe na byddai'n tynnu sylw at hynny. Ac mae honno'n broblem, ond nid yr unig broblem, wrth gwrs, y bydd angen ei hystyried. Nawr, dim ond i atgoffa'r Aelodau, yr hyn a fydd yn digwydd yw pan fyddwn ni'n cael adroddiad yr arolygydd cynllunio—yn yr haf neu ddechrau'r hydref rydym ni'n disgwyl—dyna fydd yr adeg i roi ystyriaeth i'r adroddiad hwnnw, a bydd penderfyniad yn cael ei wneud wedyn ynghylch pa lwybr yw'r ffordd orau ymlaen. Yr hyn yr ydym ni yn ei wybod yw na fydd y tagfeydd yn gwella yn nhwneli Brynglas—mae cymaint â hynny, i mi, yn amlwg. Ond mae'n rhaid i mi gadw meddwl agored ar ba lwybr y dylid bwrw ymlaen ag ef oherwydd fi fydd y sawl a fydd yn gwneud y penderfyniad. Ac felly, pan fydd adroddiad yr arolygydd yn cyrraedd ar fy nesg, bydd hynny ac unrhyw ystyriaethau perthnasol eraill yn rhan o'm hystyriaethau.

Cwestiynau Heb Rybudd gan Arweinwyr y Pleidiau
Questions Without Notice from the Party Leaders

Cwestiynau nawr gan arweinwyr y pleidiau. Arweinwydd yr wrthblaid, Andrew R.T. Davies. 

Questions now from party leaders. The leader of the opposition, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, last week, we had the report into Tawel Fan up in north Wales, and many Members have had the weekend to digest the contents of that report. One of the startling conclusions of the report was the mishandling of the creation of Betsi as a health board for north Wales. It talked of lines of accountability that were impossible to track; a rift between the health board and the ward into how to deal with patient safety; clinical policy was seriously flawed; and senior nurse leaders were disrespected and ignored. All that was the language that was in the report, on their thoughts about the creation of Betsi as a health board for north Wales. You were a Minister in the Government that made the reorganisation of the health service in 2009 a possibility, and you've been First Minister for the duration of that health board's existence up in north Wales. Do you now not regret the way that that reorganisation was undertaken in north Wales, which has led to such observations and, indeed, can directly be correlated to some of the findings of the mistreatment on the Tawel Fan ward?

Diolch, Llywydd. Prif Weinidog, yr wythnos diwethaf, cawsom yr adroddiad ar Tawel Fan i fyny yn y gogledd, ac mae llawer o Aelodau wedi cael y penwythnos i ystyried cynnwys yr adroddiad hwnnw. Un o gasgliadau syfrdanol yr adroddiad oedd camdrafod sefydliad Betsi fel bwrdd iechyd ar gyfer y gogledd. Cyfeiriodd at linellau atebolrwydd yr oedd yn amhosibl eu holrhain; anghydfod rhwng y bwrdd iechyd a'r ward ynghylch sut i ymdrin â diogelwch cleifion; roedd polisi clinigol yn ddiffygiol dros ben; ac roedd arweinwyr nyrsio uwch yn cael eu hamharchu a'u hanwybyddu. Roedd hynny i gyd yn iaith a oedd yn yr adroddiad, ar eu safbwyntiau ar greu Betsi fel bwrdd iechyd ar gyfer y gogledd. Roeddech chi'n Weinidog yn y Llywodraeth a wnaeth ad-drefnu'r gwasanaeth iechyd yn 2009 yn bosibilrwydd, ac rydych chi wedi bod yn Brif Weinidog drwy gydol bodolaeth y bwrdd iechyd hwnnw i fyny yn y gogledd. Onid ydych chi'n gresynu erbyn hyn y ffordd y cyflawnwyd yr ad-drefnu hwnnw yn y gogledd, sydd wedi arwain at sylwadau o'r fath ac, yn wir, y gellir ei gysylltu'n uniongyrchol i rai o'r canfyddiadau o'r cam-drin ar ward Tawel Fan?

Well, first of all, it's clear that the report contains findings that will need to be acted on. It's far from a whitewash, as was described by one member of his party. It's a report that does identify many of the difficulties that are rightly there for all to see and will need to be acted upon. I don't believe that, in principle, the reorganisation of the health service at that time was a bad idea. We haven't seen similar situations occurring elsewhere, but it is clear that, as far as Betsi is concerned, they will need to act on the report's findings, and as a Government we will support them in order to deliver what the people of the north of Wales would expect to see in terms of rectifying what has been found to be wanting in this report.  

Wel, yn gyntaf oll, mae'n amlwg bod yr adroddiad yn cynnwys canfyddiadau y bydd angen gweithredu arnynt. Mae'n bell o fod yn wyngalchu, fel y disgrifiwyd gan un aelod o'i blaid. Mae'n adroddiad sy'n nodi llawer o'r anawsterau sydd yn gwbl briodol yno i bawb eu gweld a bydd angen gweithredu arnynt. Nid wyf i'n credu, mewn egwyddor, bod ad-drefnu'r gwasanaeth iechyd bryd hynny yn syniad gwael. Nid ydym wedi gweld sefyllfaoedd tebyg yn digwydd mewn mannau eraill, ond mae'n eglur, cyn belled ag y mae Betsi yn y cwestiwn, y bydd angen iddyn nhw weithredu ar sail canfyddiadau'r adroddiad, ac fel Llywodraeth byddwn yn eu cynorthwyo i wneud yr hyn y byddai pobl y gogledd yn disgwyl ei weld o ran datrys yr hyn a ganfuwyd fel bod yn ddiffygiol yn yr adroddiad hwn.

13:40

First Minister, I appreciate your answer, but, really, these findings in the report point clearly to that reorganisation as being the starting point of many of the problems that accumulated in the events on the Tawel Fan ward. I have asked you whether you have any regrets about that reorganisation and, if you had your time again, would you do that reorganisation differently? When you have such a report that talks about accountability being impossible to track, where you have a rift between the health board and the ward, when you have seriously flawed clinical policy, and when senior nurse leaders were disrespected and ignored, because of the process that you politically, as a Government, put in place at that time, then surely, on reflection, you can reflect on the point that all measures were not taken in the right manner to put a health board in place to deliver a first-class health service in north Wales. And is it not now incumbent on the Government to actually start delivering that first-class health service for north Wales? 

Prif Weinidog, rwy'n gwerthfawrogi eich ateb, ond, mewn gwirionedd, mae'r canfyddiadau hyn yn yr adroddiad yn nodi'n eglur mai'r ad-drefnu hwnnw oedd y man cychwyn ar gyfer llawer o'r problemau a ddatblygodd yn y digwyddiadau ar ward Tawel Fan. Rwyf wedi gofyn i chi a oes gennych chi unrhyw edifeirwch ynghylch yr ad-drefnu hwnnw a, phe byddech chi'n cael eich amser eto, a fyddech chi'n ymgymryd â'r ad-drefnu hwnnw mewn ffordd wahanol? Pan fo gennych chi adroddiad o'r fath sy'n sôn ei bod yn amhosibl olrhain atebolrwydd, lle mae gennych chi anghydfod rhwng y bwrdd iechyd a'r ward, lle mae gennych chi bolisi clinigol hynod ddiffygiol, a phan yr oedd arweinwyr nyrsio uwch yn cael eu hamharchu a'u hanwybyddu, oherwydd y broses a roddwyd ar waith gennych chi yn wleidyddol, fel Llywodraeth, ar yr adeg honno, yna does bosib, o fyfyrio, y gallwch chi fyfyrio ar y pwynt na chymerwyd yr holl fesurau yn y ffordd gywir i sefydlu bwrdd iechyd i ddarparu gwasanaeth iechyd o'r radd flaenaf yn y gogledd. Ac onid yw hi'n ddyletswydd ar y Llywodraeth erbyn hyn i ddechrau darparu'r gwasanaeth iechyd o'r radd flaenaf hwnnw ar gyfer y gogledd?

First of all, I don't accept that reorganisation was a major cause in terms of what happened at Tawel Fan, although it was obviously part of it. If that were the case, then we would see problems with reorganisation across Wales and, indeed, in other wards and other hospitals across north Wales as well. That it is a factor is something to consider. Now, people will want to know what happens next, because the report is there and it needs to be acted upon. Well, the recommendations are clear. The Cabinet Secretary for Health and Social Services will be making a statement later on this afternoon, explaining to Members what the future plans are, but it is important, of course, that the plan is acted upon and that is what we intend to do as a Government. 

Yn gyntaf oll, nid wyf i'n derbyn bod yr ad-drefnu yn brif achos o ran yr hyn a ddigwyddodd yn Tawel Fan, er ei fod yn amlwg yn rhan ohono. Pe byddai hynny'n wir, yna byddem ni'n gweld problemau o ran ad-drefnu ledled Cymru ac, yn wir, mewn wardiau eraill ac mewn ysbytai eraill ar draws y gogledd hefyd. Mae'r ffaith ei fod yn ffactor yn rhywbeth i'w ystyried. Nawr, bydd pobl eisiau gwybod beth sy'n digwydd nesaf, oherwydd mae'r adroddiad yno ac mae angen gweithredu ar ei sail. Wel, mae'r argymhellion yn eglur. Bydd Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol yn gwneud datganiad yn ddiweddarach y prynhawn yma, yn esbonio i'r Aelodau beth yw'r cynlluniau ar gyfer y dyfodol, ond mae hi'n bwysig, wrth gwrs, y gweithredir ar sail y cynllun a dyna yr ydym ni'n bwriadu ei wneud fel Llywodraeth.

I regret that you couldn't identify the flaws that the report identified as being at the heart of the reorganisation that happened in 2009. The language that I used was directly taken from the report, and, obviously, that is what the investigations have unearthed.

But, moving on, First Minister, the health board has now been in special measures for three years—or nearly three years, should I say. In an interview you gave to the BBC some two weeks ago, you said that there was no unfinished business left now that your term as First Minister was coming to a close. We could debate that across this Chamber and we most probably wouldn't move much further forward, but one thing certainly residents in north Wales would appreciate an understanding of—. Given that you think there's no unfinished business, surely one of the items of business that needs to be addressed is the normalisation of the structures that Betsi operates under, rather than direct Government control. So, do you believe that by the time you step down as First Minister, Betsi will be out of special measures come December of this year? 

Mae'n drueni na allech chi nodi'r diffygion a nodwyd yn yr adroddiad fel bod wrth wraidd yr ad-drefnu a ddigwyddodd yn 2009. Cymerwyd yr iaith a ddefnyddiais yn uniongyrchol o'r adroddiad, ac, yn amlwg, dyna mae'r ymchwiliadau wedi ei ddatguddio.

Ond, i symud ymlaen, Prif Weinidog, mae'r bwrdd iechyd wedi yn destun mesurau arbennig ers tair blynedd bellach—neu bron i dair blynedd, dylwn i ddweud. Mewn cyfweliad a roesoch i'r BBC tua pythefnos yn ôl, dywedasoch nad oedd unrhyw fusnes anorffenedig ar ôl nawr bod eich cyfnod fel Prif Weinidog yn dod i ben. Gallem drafod hynny ar draws y Siambr hon ac mae'n debyg na fyddem ni'n symud lawer ymhellach ymlaen, ond un peth yn sicr y byddai trigolion yn y gogledd yn gwerthfawrogi dealltwriaeth ohono—. O gofio eich bod chi'n credu nad oes unrhyw fusnes anorffenedig, does bosib mai un o'r eitemau busnes y mae angen rhoi sylw iddo yw normaleiddio'r strwythurau y mae Betsi yn gweithredu'n unol â nhw, yn hytrach na rheolaeth uniongyrchol gan y Llywodraeth. Felly, a ydych chi'n credu y bydd Betsi allan o fesurau arbennig erbyn yr amser y byddwch chi'n ymddeol fel Prif Weinidog ym mis Rhagfyr eleni?

Well, I suppose there will always be things that will need to continue to be proceeded with when you leave office. That's inevitable. But, for me, what's important is that people continue to see a continued improvement in the health service across the north of Wales. I have never been prepared to put a time limit on when Betsi should come out of special measures. It will remain in special measures for as long as is necessary to ensure continuous improvement. How long that will be will depend, of course, on us being satisfied that there is sufficient progress to enable us to release Betsi from special measures. That's not the case at the moment, and I don't think it would be wise to put a particular date on that. 

Wel, mae'n debyg y bydd  pethau y bydd angen parhau i fwrw ymlaen â nhw pan fyddwch chi'n gadael swydd bob amser. Mae hynny'n anochel. Ond, i mi, yr hyn sy'n bwysig yw bod pobl yn parhau i weld gwelliant parhaus yn y gwasanaeth iechyd ar draws y gogledd. Nid wyf i erioed wedi bod yn barod i roi cyfyngiad amser o ran pryd y dylai Betsi ddod allan o fesurau arbennig. Bydd yn parhau i fod yn destun mesurau arbennig cyhyd ag sy'n angenrheidiol i sicrhau gwelliant parhaus. Bydd pa mor hir yw hynny yn dibynnu, wrth gwrs, ar ein bodlonrwydd bod cynnydd digonol wedi'i wneud i'n galluogi i ryddhau Betsi o fesurau arbennig. Nid yw hynny'n wir ar hyn o bryd, ac nid wyf yn credu y byddai'n ddoeth rhoi dyddiad penodol ar hynny.

Arweinydd grŵp UKIP, Neil Hamilton. 

The leader of the UKIP group, Neil Hamilton. 

Diolch, Llywydd. The Welsh Government remains committed to the universal adoption of the Welsh baccalaureate, but the elite universities don't seem to be terribly interested in it as a qualification, indeed the top three universities don't require it at all. I've been written to by a school student who says that the Welsh bac is a burden for students and teachers alike and the work is tedious and not useful for more able students, and because these two subjects are compulsory for year nines it will be very difficult to compete with English pupils for jobs and university places as they'll have done two more valuable subjects. So, in the circumstances, does the First Minister not see that this is at best a distraction from more useful use of time in schools?  

Diolch, Llywydd. Mae Llywodraeth Cymru yn parhau'n ymrwymedig i fabwysiadu Bagloriaeth Cymru yn gyffredinol, ond nid yw'n ymddangos bod gan y prifysgolion elît fawr o ddiddordeb ynddo fel cymhwyster, yn wir nid yw'r tair prifysgol orau yn ei wneud yn ofynnol o gwbl. Mae myfyriwr ysgol wedi ysgrifennu ataf gan ddweud bod Bagloriaeth Cymru yn faich i fyfyrwyr ac athrawon a bod y gwaith yn ddiflas ac nad yw'n ddefnyddiol i fyfyrwyr mwy galluog, ac oherwydd bod y ddau bwnc hyn yn orfodol ar gyfer disgyblion blwyddyn naw, bydd yn anodd iawn cystadlu gyda disgyblion o Loegr am swyddi a lleoedd prifysgol gan y byddant wedi astudio dau bwnc mwy gwerthfawr. Felly, o dan yr amgylchiadau, a yw'r Prif Weinidog yn gweld bod hwn, o edrych arno o'r ochr orau, yn tynnu sylw oddi wrth ddefnydd mwy defnyddiol o amser mewn ysgolion?

Well, it's not correct to say that the Welsh bac is not recognised by the top universities, as he put it. People do recognise it for the breadth it gives to the skills that students are able to acquire when they're in school. My son is in school: I've seen the work that he does via the Welsh bac and, I have to say, both he and I found it extremely useful, because it takes him beyond looking at just academic subjects and enables him to develop more as an individual and therefore have a more rounded education. I believe that students, whatever level they leave full-time education, are more employable as a result of the skills that the Welsh bac gives them. 

Wel, nid yw'n gywir i ddweud nad yw Bagloriaeth Cymru yn cael ei gydnabod gan y prifysgolion gorau, fel y dywedodd. Mae pobl yn ei gydnabod am yr ehangder y mae'n ei roi i'r sgiliau y gall myfyrwyr eu caffael pan fyddant yn yr ysgol. Mae fy mab i yn yr ysgol: rwyf i wedi gweld y gwaith y mae'n ei wneud trwy gyfrwng Bagloriaeth Cymru ac, mae'n rhaid i mi ddweud, roedd ef a minnau o'r farn ei fod yn ddefnyddiol iawn, gan ei fod yn mynd ag ef y tu hwnt i edrych ar bynciau academaidd yn unig ac yn ei alluogi i ddatblygu mwy fel unigolyn ac felly cael addysg mwy cytbwys. Credaf fod myfyrwyr, ar ba bynnag lefel y byddan nhw'n gadael addysg llawn amser, yn fwy cyflogadwy o ganlyniad i'r sgiliau y mae Bagloriaeth Cymru yn eu rhoi iddyn nhw.

13:45

Well, that is a debatable point in itself, I believe—it's not one I'm going to pursue at this minute, but, to take the wider point that the First Minister has raised, yes, I do agree that the Welsh baccalaureate course might have some use beyond formal learning in classrooms, making students think about wider issues in the world. That, in itself, could be a good thing. It depends on how the course is structured and how it is taught. One of the things that the Welsh bac contains is a global citizen challenge, which deals with issues such as cultural diversity, fair trade, future energy, inequality and poverty. These are all highly political topics, which need to be taught in a balanced way if education is not to degrade itself into mere propaganda. There are serious debates, for example, about the causes of poverty in other parts of the world: why is a potentially rich country like Venezuela reduced to destitution? We know that's because it has a Corbynite Government. Why is a country like Singapore, which has virtually no natural resources, now the country in the world that has the highest per capita income? None of this features in the Welsh baccalaureate course on poverty. So, does the First Minister not agree with me that we need to be very careful about the way these political subjects are taught in schools to make sure that the course is balanced and it teaches students how to think critically about issues, rather than just to swallow what they're told?

Wel, mae hwnnw'n bwynt dadleuol ynddo'i hun, rwy'n credu—nid yw'n un yr wyf i'n mynd i'w drafod ymhellach ar hyn o bryd, ond, i gymryd y pwynt ehangach a godwyd gan y Prif Weinidog, ydw, rwy'n cytuno y gallai cwrs Bagloriaeth Cymru fod â rhywfaint o ddefnydd y tu hwnt i ddysgu ffurfiol mewn ystafelloedd dosbarth, gan wneud i fyfyrwyr feddwl am faterion ehangach yn y byd. Gallai hynny, ynddo'i hun, fod yn beth da. Mae'n dibynnu sut y mae'r cwrs wedi'i strwythuro a sut y mae'n cael ei addysgu. Un o'r pethau y mae Bagloriaeth Cymru yn ei gynnwys yw her dinesydd byd-eang, sy'n ymdrin â materion fel amrywiaeth ddiwylliannol, masnach deg, ynni yn y dyfodol, anghydraddoldeb a thlodi. Mae'r rhain i gyd yn bynciau hynod wleidyddol, y mae angen eu haddysgu mewn ffordd gytbwys os nad yw addysg am ddiraddio ei hun i ddim ond propaganda. Ceir dadleuon difrifol, er enghraifft, am yr achosion o dlodi mewn rhannau eraill o'r byd: pam mae gwlad a allai fod yn gyfoethog fel Venezuela mewn amddifadedd? Rydym ni'n gwybod bod hynny oherwydd bod ganddi Lywodraeth Corbynaidd. Pam mai gwlad fel Singapôr, nad oes ganddi unrhyw adnoddau naturiol braidd, yw'r wlad yn y byd lle ceir yr incwm uchaf y pen erbyn hyn? Nid oes dim o hyn yn ymddangos yng nghwrs Bagloriaeth Cymru ar dlodi. Felly, onid yw'r Prif Weinidog yn cytuno â mi bod angen i ni fod yn ofalus iawn o ran y ffordd yr addysgir y pynciau gwleidyddol hyn mewn ysgolion i wneud yn siŵr bod y cwrs yn gytbwys a'i fod yn addysgu myfyrwyr sut i feddwl yn feirniadol am faterion, yn hytrach na dim ond llyncu'r hyn a ddywedir wrthynt?

I trust our teachers, bluntly, and I also trust our students to be able to think critically for themselves. There are education systems that, if you look at the Programme for International Student Assessment, perform better on the figures than ours, but I'm not sure they necessarily give students the ability to think critically. They can pass exams, but that's not the same as being prepared for the world of work or to think about the world around them. The issues that he has identified there are surely issues that concern us all. There'll be different views on how to address inequality, different views on how to address poverty, nevertheless, they are hugely important issues that I think every young person needs to think about. But I've seen no examples at all of any kind of bias being introduced into the curriculum, and, from my perspective, I think it's hugely important that our students do have the ability to go beyond academic subjects, because I think it makes them more rounded individuals when they do think more critically and more widely.

Rwy'n ymddiried yn ein hathrawon, i fod yn blwmp ac yn blaen, ac rwyf hefyd yn ymddiried yn ein myfyrwyr i allu meddwl yn feirniadol drostynt eu hunain. Ceir systemau addysg sydd, os edrychwch chi ar y Rhaglen Ryngwladol Asesu Myfyrwyr, yn perfformio'n well o ran y ffigurau na'n rhai ni, ond nid wyf yn siŵr eu bod o reidrwydd yn rhoi'r gallu i fyfyrwyr feddwl yn feirniadol. Maen nhw'n gallu llwyddo mewn arholiadau, ond nid yw hynny yr un fath â bod yn barod ar gyfer y byd gwaith nac i feddwl am y byd o'u cwmpas. Does bosib nad yw'r materion a nodwyd ganddo yn faterion sy'n berthnasol i bob un ohonom ni. Bydd gwahanol safbwyntiau ar sut i fynd i'r afael ag anghydraddoldeb, gwahanol safbwyntiau ar sut i fynd i'r afael â thlodi, serch hynny, maen nhw'n faterion hynod bwysig yr wyf i'n credu y mae angen i bob person ifanc eu hystyried. Ond nid wyf i weld gweld unrhyw enghreifftiau o gwbl o unrhyw fath o ragfarn yn cael ei gyflwyno i'r cwricwlwm, ac, o'm safbwynt i, credaf ei bod hi'n hynod bwysig bod y gallu gan ein myfyrwyr i fynd y tu hwnt i bynciau academaidd, oherwydd rwy'n credu ei fod yn eu gwneud yn unigolion mwy cyflawn pan eu bod yn meddwl yn fwy beirniadol ac yn fwy eang.

Well, all I can say is, having looked at the various materials that are used in teaching these courses, they're all from a centre-left disposition. Now, we can all—[Interruption.] Well, matter of fact—and I think the false indignation coming from the other side proves the point that I'm trying to make here, that, because they control the education system, it is being used as a tool of propaganda. There is nothing, for example, in the topic of wind energy that calls into question the efficacy of this even to deal with the problems of man-made global warming if that is held to be a problem. So, what I'm saying to the First Minister is that parents should be very worried. And, yes, the First Minister has said he trusts teachers, and, of course, I'm not saying that teachers set out in order to propagandise children, but the mindset of a teacher is very important as a background to this, and considering that 72 per cent of secondary school teachers, according to the Times Educational Supplement, vote Labour, 10 per cent vote Liberal, only 8 per cent vote Conservative, there is clearly—[Interruption.] There is—[Interruption.] Well—[Interruption.] That, of course—[Interruption.] That, of course, is a highly unrepresentative sample of the population as a whole. And, therefore, even if bias is subconscious, it must be regarded as a potential danger.

Wel, y cwbl y gallaf i ei ddweud, o edrych ar y gwahanol ddeunyddiau a ddefnyddir wrth addysgu'r cyrsiau hyn, eu bod nhw i gyd o safbwynt chwith-canol. Nawr, gall pob un ohonom—[Torri ar draws.] Wel, mater o ffaith—ac rwy'n meddwl bod y dicter ffug sy'n dod o'r ochr arall yn profi'r pwynt yr wyf i'n ceisio ei wneud yn y fan yma, sef, gan mai nhw sy'n rheoli'r system addysg, mae'n cael ei defnyddio fel arf propaganda. Nid oes dim, er enghraifft, yn y pwnc ynni gwynt sy'n cwestiynu pa mor effeithiol yw hyn hyd yn oed i ymdrin â phroblemau cynhesu byd-eang artiffisial pe ystyrir bod hynny'n broblem. Felly, yr hyn yr wyf i'n ei ddweud wrth y Prif Weinidog yw y dylai rhieni fod yn bryderus iawn. Ac, ydy, mae'r Prif Weinidog wedi dweud ei fod yn ymddiried mewn athrawon, ac, wrth gwrs, nid wyf yn dweud bod athrawon yn mynd ati i gyflwyno propaganda i blant, ond mae meddylfryd athrawon yn bwysig iawn fel cefndir i hyn, ac o ystyried bod 72 y cant o athrawon ysgol uwchradd, yn ôl y Times Educational Supplement, yn pleidleisio dros Lafur, 10 y cant yn pleidleisio dros y Rhyddfrydwyr, dim ond 8 y cant yn pleidleisio dros y Ceidwadwyr, mae'n amlwg—[Torri ar draws.] Mae—[Torri ar draws.] Wel—[Torri ar draws.] Mae hwnnw, wrth gwrs—[Torri ar draws.] Mae hwnnw, wrth gwrs, yn sampl anghynrychioliadol iawn o'r boblogaeth yn ei chyfanrwydd. Ac, felly, hyd yn oed os yw rhagfarn yn isymwybodol, mae'n rhaid ei ystyried fel perygl posibl.

You do wonder. Well, it's quite clear why teachers are reluctant to vote UKIP then, given what they've just heard. I do wonder, listening to the leader of UKIP, whether he regards, from his perspective, George W. Bush as a dangerous communist, because—. Was he somebody, for example, who backed section 28 of the Local Government Act 1988 and the demonising of gay and lesbian people as a result of that? Well, if he did, and I think I'm right in saying that he did do exactly that, then, yes, anything is centre-left from his perspective. From our perspective, we want to make sure that young people get a balanced view of the world and not a view that says, for example, well, man-made, as he put it, global warming, if such a thing exists—the vast weight of evidence supports that. The fact that a few people choose to say it differently doesn't mean that the proper weight should be given to their evidence, because there are so few of them. If he is really saying that the point of teaching young people, through the Welsh bac, information about energy, for example, is to ignore the full weight of science, then that gives us some idea of what he would like to be taught in our schools. We prefer balance; he wants right-wing revisionism.

Mae rhywun yn synnu. Wel, mae'n gwbl eglur pam mae athrawon yn amharod i bleidleisio dros UKIP felly, o ystyried yr hyn y maen nhw newydd ei glywed. Rwy'n meddwl tybed, o wrando ar arweinydd UKIP, pa un a yw'n credu, o'i safbwynt ef, bod George W. Bush yn gomiwnydd peryglus, oherwydd—. A oedd e'n rhywun, er enghraifft, a gefnogodd adran 28 Deddf Llywodraeth Leol 1988 a'r demoneiddio pobl hoyw a lesbiaidd o ganlyniad i hynny? Wel, os gwnaeth, ac rwy'n credu fy mod i'n iawn yn dweud iddo wneud yn union hynny, yna, ydy, mae unrhyw beth yn chwith-canol o'i safbwynt ef. O'n safbwynt ni, rydym ni eisiau gwneud yn siŵr bod pobl ifanc yn cael darlun cytbwys o'r byd ac nid safbwynt sy'n dweud, er enghraifft, wel, cynhesu byd-eang artiffisial, fel y mae'n dweud, os oes y fath beth yn bodoli—mae pwysau enfawr y dystiolaeth yn cefnogi hynny. Nid yw'r ffaith bod rhai pobl yn dewis dweud yn wahanol yn golygu y dylid rhoi'r pwys priodol i'w tystiolaeth, gan fod cyn lleied ohonynt. Os yw wir yn dweud mai diben addysgu pobl ifanc, trwy fagloriaeth Cymru, am wybodaeth am ynni, er enghraifft, yw anwybyddu pwysau llawn maes gwyddoniaeth, yna mae hynny'n rhoi rhyw syniad i ni o'r hyn yr hoffai iddo gael ei addysgu yn ein hysgolion. Mae'n well gennym ni gydbwysedd; mae ef eisiau adolygiadaeth asgell dde.

13:50

Arweinydd Plaid Cymru, Leanne Wood.

Plaid Cymru leader, Leanne Wood.

Diolch, Llywydd. The EU withdrawal Bill, as amended, will still allow the Assembly's competence to be restricted without its consent, and the inter-governmental agreement does not provide water-tight assurance that this will not happen. Does the First Minister agree or disagree with that statement?

Diolch, Llywydd. Bydd Bil ymadael yr EU, fel y'i diwygiwyd, yn dal i ganiatáu i gymhwysedd y Cynulliad gael ei gyfyngu heb ei ganiatâd, ac nid yw'r cytundeb rhynglywodraethol yn rhoi sicrwydd pendant na fydd hyn yn digwydd. A yw'r Prif Weinidog yn cytuno neu'n anghytuno â'r datganiad hwnnw?

I disagree with the way that it's been put, because I think we've come a long way from where the UK Government were; they have given a lot of ground. It's not ideal from our perspective, of course not, but the nature of an agreement is that you come to ground that you believe to be common ground. What the agreement says is that the UK Government will not normally legislate in devolved areas. That simply reflects what's already said in the devolved settlements across the UK. It is something, I think, that will need to be addressed in the future, but I believe we have an agreement that shows that a lot of ground has been given by the UK Government, particularly the introduction, in effect, of the Sewel convention into secondary legislation, something that didn't exist in the same way before, and I believe it gives us the protection that we need. We will, of course, be very vigilant in making sure that the UK Government keeps to the terms of the agreement.

Rwy'n anghytuno â'r ffordd y mae wedi ei roi, gan fy mod i'n credu ein bod ni wedi dod yn bell o ble'r oedd Llywodraeth y DU; maen nhw wedi ildio llawer o dir. Nid yw'n ddelfrydol o'n safbwynt ni, wrth gwrs nad ydyw, ond natur cytundeb yw eich bod chi'n cyrraedd tir yr ydych chi'n credu sy'n dir cyffredin. Yr hyn y mae'r cytundeb yn ei ddweud yw na fydd Llywodraeth y DU yn deddfu mewn meysydd datganoledig fel rheol. Y cwbl y mae hynny'n ei wneud yw adlewyrchu'r hyn a ddywedwyd eisoes yn y setliadau datganoledig ledled y DU. Mae'n rhywbeth, rwy'n credu, y bydd angen rhoi sylw iddo yn y dyfodol, ond rwy'n credu bod gennym ni gytundeb sy'n dangos bod llawer o dir wedi ei ildio gan Lywodraeth y DU, yn enwedig, mewn gwirionedd, cyflwyno confensiwn Sewel i is-ddeddfwriaeth, rhywbeth nad oedd yn bodoli yn yr un ffordd o'r blaen, ac rwy'n credu ei fod yn rhoi'r amddiffyniad i ni sydd ei angen arnom. Byddwn, wrth gwrs, yn wyliadwrus iawn o ran gwneud yn siŵr bod Llywodraeth y DU yn cadw at delerau'r cytundeb.

The words in that statement, First Minister, were not my words. They were taken from an analysis by the National Assembly for Wales's legal team that confirms the damning repercussions of the dodgy deal between the Tories in Westminster and your Labour Government. Last week, Labour frontbench Members claimed that Plaid Cymru didn't understand the outcome of this deal when it came to the powers of this Assembly and its ability to withhold consent. First Minister, the legal advice shows the opposite to be true. The advice says any indication that this Assembly will be able to block Westminster by withholding consent is, and I quote, 'misleading'. It goes on to say, and I quote again, 'the Assembly's competence can be restricted without its consent'. Does the First Minister agree with the Assembly's lawyers that Westminster can now meddle in our Assembly and there is absolutely nothing we can do about it?

Nid fy ngeiriau i oedd y geiriau yn y datganiad yna, Prif Weinidog. Fe'u cymerwyd o ddadansoddiad gan dîm cyfreithiol Cynulliad Cenedlaethol Cymru sy'n cadarnhau sgil-effeithiau damniol y fargen amheus rhwng y Torïaid yn San Steffan a'ch Llywodraeth Lafur chi. Yr wythnos diwethaf, honnodd Aelodau Llafur ar y meinciau blaen nad oedd Plaid Cymru yn deall canlyniad y cytundeb hwn o ran pwerau'r Cynulliad hwn a'i allu i wrthod rhoi cydsyniad. Prif Weinidog, mae'r cyngor cyfreithiol yn dangos bod y gwrthwyneb yn wir. Mae'r cyngor yn dweud bod unrhyw awgrym y bydd y Cynulliad hwn yn gallu rhwystro San Steffan trwy beidio â chydsynio yn, a dyfynnaf, 'gamarweiniol'. Aiff ymlaen i ddweud, a dyfynnaf eto, 'gellir cyfyngu ar gymhwysedd y Cynulliad heb ei gydsyniad'. A yw'r Prif Weinidog yn cytuno â chyfreithwyr y Cynulliad y gall San Steffan fusnesa yn ein Cynulliad erbyn hyn, ac nad oes dim gwbl y gallwn ni ei wneud am hynny?

The way she presents—. This has been the case since 1999; it's not new. The reality is that it's always been the case, both in Scotland and in Wales, that the UK Parliament—the expression is 'would not normally legislate' in devolved areas, but it's always been able to do it because of the doctrine of parliamentary sovereignty. The agreement's not going to change that. Now, in the future, I agree that there needs to be a debate about whether parliamentary sovereignty is appropriate—and I've said it before—publicly, for the future. I think we do need to move to a constitutional settlement that recognises that there are different centres of democratic legitimacy within the UK itself. But, as far as the current devolution settlement is concerned, we now have a situation where, in effect, there will be a very high political cost for any UK Government to pay if it wished just to ram through whatever it wanted to. Can I say as well, if it was the case that the UK Government wanted to ignore completely the Assembly or Scottish Parliament, it would've done so already? It hasn't done so—not for me to defend it, and I don't do it often—but, in reality, the UK Government has come to an agreement where they have conceded, I recognise, a great deal of ground. And we are in a position where—whilst we would have preferred to get rid of clause 11 completely, we are in a position where safeguards, sufficient safeguards, have been put into clause 11. A level playing field has been created in terms of the making of legislation that we were nowhere close to a year ago. I certainly pay tribute to my colleague, Mark Drakeford, for the work that he did on a week-to-week basis in coming to the agreement that we did.

Y ffordd y mae hi'n ei gyflwyno—. Mae hyn wedi bod yn wir ers 1999; nid yw'n newydd. Y gwir amdani yw y bu hynny'n wir erioed, yn yr Alban ac yng Nghymru, na fyddai Senedd y DU—na fyddai'n deddfu mewn meysydd datganoledig fel rheol yw'r ymadrodd, ond mae wedi gallu gwneud hynny erioed, oherwydd yr athrawiaeth o sofraniaeth seneddol. Nid yw'r cytundeb yn mynd i newid hynny. Nawr, yn y dyfodol, rwy'n cytuno bod angen dadl ynghylch pa un a yw sofraniaeth seneddol yn briodol—ac rwyf i wedi ei ddweud o'r blaen—yn gyhoeddus, ar gyfer y dyfodol. Rwy'n credu bod angen i ni symud i setliad cyfansoddiadol sy'n cydnabod bod gwahanol ganolfannau o gyfreithlondeb democrataidd o fewn y DU ei hun. Ond, o ran y setliad datganoli presennol, mae gennym ni sefyllfa lle, i bob pwrpas, y bydd cost wleidyddol uchel iawn i unrhyw Lywodraeth y DU ei thalu pe byddai'n dymuno hyrddio beth bynnag yr oedd ei eisiau drwodd. A gaf i ddweud hefyd, pe byddai'n wir bod Llywodraeth y DU eisiau anwybyddu'r Cynulliad neu Senedd yr Alban yn llwyr, oni fyddai wedi gwneud hynny eisoes? Nid yw wedi gwneud hynny—nid fy lle i yw ei hamddiffyn, ac nid wyf yn gwneud hynny'n aml—ond, mewn gwirionedd, mae Llywodraeth y DU wedi dod i gytundeb lle maen nhw wedi ildio, rwy'n cydnabod, llawer iawn o dir. Ac rydym ni mewn sefyllfa lle—er y byddai wedi bod yn well gennym ni gael gwared ar gymal 11 yn llwyr, rydym ni mewn sefyllfa lle mae mesurau diogelu, mesurau diogelu digonol, wedi eu rhoi yng nghymal 11. Sicrhawyd chwarae teg o ran gwneud deddfwriaeth nad oeddem yn agos ati flwyddyn yn ôl. Rwy'n sicr yn talu teyrnged i'm cyd-Aelod, Mark Drakeford, am y gwaith a wnaeth o wythnos i wythnos i ddod i'r cytundeb a wnaethom.

First Minister, this is a dodgy deal, and it's one that you have signed up to. And it's not simply created constitutional chaos. Your decision to give this Bill consent will have ramifications for our economy as well. Whilst your party is all over the place on this question, your Ministers and Labour Members continue to campaign for membership of a customs union. By advising that we consent to the withdrawal Bill, however, you are serving up a hard Brexit to the Tories on a plate. Will the First Minister confirm that he understands that by consenting to the withdrawal Bill he is ensuring that it is Westminster that will decide whether Wales leaves the customs union and the single market?

Prif Weinidog, mae hon yn fargen amheus, ac mae'n un yr ydych chi wedi cytuno iddi. Ac nid creu anhrefn cyfansoddiadol yw'r unig beth y mae wedi ei wneud. Bydd eich penderfyniad i roi cydsyniad i'r Bil hwn yn arwain at oblygiadau i'n heconomi hefyd. Er bod eich plaid mewn llanastr ar y cwestiwn hwn, mae eich Gweinidogion ac Aelodau Llafur yn parhau i ymgyrchu dros aelodaeth o undeb tollau. Trwy hysbysu ein bod yn cydsynio i'r Bil ymadael, fodd bynnag, rydych chi'n rhoi Brexit caled i'r Torïaid ar blât. A wnaiff y Prif Weinidog gadarnhau ei fod yn deall ei fod yn sicrhau, trwy gydsynio i'r Bil ymadael, mai San Steffan fydd yn penderfynu pa un a yw Cymru'n gadael yr undeb tollau a'r farchnad sengl?

13:55

Well, it was always the case that, in law, it's Westminster that decides whether we leave the customs union. In reality, as she has heard me say many, many times, that would be madness as far as the UK is concerned. It is hugely important that the UK remains within the customs union. Trade policy is not devolved—that is reality. But we have ensured that we have a voice to make sure that the voice of Wales is heard.

I have to say, last week—I listened to Plaid Cymru last week; it was almost as if there were two different debates. I listened to Rhun ap Iorwerth and what he said—a measured, detailed response. It was a measured, detailed response compared to what we had before from the leader of Plaid Cymru, where she used words like 'capitulation', 'betrayal', 'dodgy deal'. She sounds like Jacob Rees-Mogg when talking about Brexit. I don't mind criticism, but at least—[Interruption.] Let's look at the detail. Let's look at the detail. [Interruption.] Let's look at the detail. If there are disagreements on the detail, fine, but, in the answers that I gave, not once did she come back to me and say, 'Well, look, what about this? What about this? How does that provide us with reassurance?' I have to say that I thought the answer that was given by, or the speech that was given by, Rhun ap Iorwerth, certainly, last week, was measured and something, I thought, on which we could have a proper debate.

Wel, roedd hi'n wir erioed, yn ôl y gyfraith, mai San Steffan sy'n penderfynu pa un a fyddwn ni'n gadael yr undeb tollau. Mewn gwirionedd, fel y mae hi wedi fy nghlywed i'n dweud lawer, lawer gwaith, byddai hynny'n wallgofrwydd cyn belled ag y mae'r DU yn y cwestiwn. Mae'n bwysig dros ben bod y DU yn aros yn yr undeb tollau. Nid yw polisi masnach wedi'i ddatganoli—dyna'r gwirionedd. Ond rydym ni wedi sicrhau bod gennym ni lais i wneud yn siŵr bod llais Cymru yn cael ei glywed.

Mae'n rhaid i mi ddweud, yr wythnos diwethaf—gwrandewais ar Blaid Cymru yr wythnos diwethaf; roedd hi bron fel pe byddai dwy wahanol ddadl. Gwrandewais ar Rhun ap Iorwerth a'r hyn a ddywedodd ef—ymateb pwyllog a manwl. Roedd yn ymateb pwyllog a manwl o'i gymharu â'r hyn a gawsom yn gynharach gan arweinydd Plaid Cymru, pan ddefnyddiodd eiriau fel 'ildio', 'bradychu', 'bargen amheus'. Mae hi'n swnio fel Jacob Rees-Mogg wrth sôn am Brexit. Nid wyf i'n gwrthwynebu beirniadaeth, ond o leiaf—[Torri ar draws.] Gadewch i ni edrych ar y manylion. Gadewch i ni edrych ar y manylion. [Torri ar draws.] Gadewch i ni edrych ar y manylion. Os oes anghytuno ynghylch y manylion, iawn, ond, yn yr atebion a roddais, ni wnaeth hi ddod yn ôl ataf unwaith a dweud, 'Wel, edrychwch, beth am hyn? Beth am hyn? Sut mae hynny'n rhoi tawelwch meddwl i ni?' Mae'n rhaid imi ddweud fy mod i'n credu bod yr ateb a roddwyd gan Rhun ap Iorwerth, neu'r araith a wnaed ganddo, yn sicr, yr wythnos diwethaf, yn bwyllog ac yn rhywbeth, yn fy marn i, y gallem ni fod wedi cael dadl wirioneddol yn ei gylch.

Argaeledd Meddygon y Tu Allan i Oriau
The Availability of Out-of-hours Doctors

3. A wnaiff y Prif Weinidog ddatganiad am argaeledd meddygon y tu allan i oriau yn ardal Bwrdd Iechyd Prifysgol Hywel Dda? OAQ52153

3. Will the First Minister make a statement on the availability of out-of-hours doctors in the Hywel Dda University Health Board area? OAQ52153

Rwy’n disgwyl i Fwrdd Iechyd Lleol Hywel Dda ddarparu ystod o wasanaethau diogel ac effeithiol y tu allan i oriau er mwyn ymateb i anghenion gofal iechyd brys eu poblogaeth pan fydd meddygfeydd ar gau.

I expect Hywel Dda Local Health Board to provide a range of safe and effective services out of hours to respond to the urgent healthcare needs of their population when GP surgeries are closed.

Efallai bod Llywodraeth Cymru yn disgwyl iddyn nhw ei wneud e, ond, wrth gwrs, ar nifer o achlysuron eleni, mae cleifion yn Hywel Dda wedi cael eu gadael heb ofal meddygon tu allan i oriau ar benwythnosau, oherwydd beth mae'r bwrdd iechyd ei hunain yn disgrifio fel prinder meddygon teulu dybryd. Nawr, mae'n effeithio ar y tair sir o fewn eu hardal nhw ac mae’n benodol yn effeithio ar sir Gaerfyrddin, oherwydd problemau arbennig yn ysbytai Glangwili a Thywysog Philip. Mae’r bwrdd iechyd ei hunain wedi ymddiheuro sawl gwaith i gleifion. A ydy Llywodraeth Cymru’n mynd i ymddiheuro? Oherwydd roeddech chi wedi penderfynu peidio â chynnwys sir Gaerfyrddin, er enghraifft, yn y cynllun 'Hyfforddi. Gweithio. Byw.' i ddenu meddygon teulu i sir Gaerfyrddin. Onid yw peth o’r cyfrifoldeb yn syrthio arnoch chi?

Well, perhaps the Welsh Government expect them to do that, but, on a number of occasions this year, patients within Hywel Dda have been left without out-of-hours cover on weekends, because of what the health board itself describes as a dire shortage of GPs. It affects the three counties within their area, but it is specifically having an impact on Carmarthenshire, because of particular problems at Glangwili and Prince Philip hospitals. Now, the health board itself has apologised to patients on a number of occasions. Is the Welsh Government going to apologise too? You decided not to include Carmarthenshire in the 'Train. Work. Live.' programme to attract GPs to Carmarthenshire. Doesn't some of the responsibility fall on your shoulders?

Wel, rŷm ni'n moyn sicrhau, wrth gwrs, bod pobl yn dod i Gymru i weithio. Rŷm ni'n gweld y niferoedd yn codi o achos hynny. Rŷm ni'n gweld, er enghraifft, y niferoedd yn codi yng Ngheredigion a sir Benfro. Hefyd, yn sir Benfro, er enghraifft, yn 2016, roedd y ganran o ddoctoriaid yn mynd i mewn i lefydd hyfforddi ar y pryd yn sero y cant; mae wedi mynd lan i 100 y cant o fewn blwyddyn, 2017. Nawr, a ydy e'n wir bod yna bwysau? Ydy. A ydy e'n wir i ddweud nad yw rhai gwasanaethau wedi gallu cael eu cynnal? Ydy, mae hynny'n iawn. Beth, felly, sy'n digwydd nesaf? Wel, mae Hywel Dda yn cyflogi advanced paramedic practitioners, yn Saesneg—pobl sy'n mynd i allu gweithredu a gweithio yn yr ardaloedd lleol. Mae yna hysbysebion yn mynd mas gan y bwrdd iechyd sydd yn edrych i dynnu pobl i mewn i Hywel Dda. Mae yna drafodaethau yn cymryd lle ar hyn o bryd ynglŷn â'r potensial i ddatblygu gweithio rhanbarthol, yn enwedig yn y cyfnod dros nos, ac mae'r trafodaethau hynny'n cynnwys ABMU, Hywel Dda a hefyd Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru. Hefyd, wrth gwrs, rŷm ni'n edrych ar ffyrdd lle mae meddygon teulu, er enghraifft, yn gallu gweithio o gartref. Mae hynny'n rhywbeth sy'n cael ei ystyried ar hyn o bryd ac, wrth gwrs, bydd hynny'n gorfod cael ei ystyried i weld pa mor effeithiol yw hynny. So, ydy, mae'n wir i ddweud nad yw'r gwasanaeth wedi bod o'r safon y byddwn i'n ei erfyn o'r bwrdd iechyd, ond dyna beth mae'r bwrdd iechyd yn ei wneud er mwyn datrys y sefyllfa.

Well, what we wish to ensure, of course, is that people do come to work in Wales. We have seen the numbers increasing because of that. We've seen, for example, the numbers increase in Ceredigion and in Pembrokeshire. Also, in Pembrokeshire, for example, in 2016, in terms of doctors coming into the training places, the percentage was zero, and then it's increased to 100 per cent within a year, in 2017. Now, is it true that there are pressures? Yes. Is it true to say that some services have not been sustained? Yes, that's correct. So, what's next? Well, Hywel Dda is employing advanced paramedic practitioners—people who can work within the local area. Adverts have been placed by the health board seeking to attract people into the Hywel Dda area. There is discussion ongoing at present on the potential to develop regional working, particularly during the night hours, and those are discussions with ABMU and Hywel Dda and also the Welsh Ambulance Services NHS Trust. We are also looking at GPs working from home. That is being considered at present, and that, of course, will need to be considered to see how effective it is. So, yes, it’s true to say that the service has not been of the quality that we would expect, but the health board is working on resolving the situation.

Prif Weinidog, mae'n amlwg bod yna broblem enfawr ynglŷn â doctoriaid tu allan i oriau yn ardal bwrdd iechyd Hywel Dda, ac un o'r sgil effeithiau yw bod hyn yn rhoi pwysau difrifol ar wasanaethau A&E, er enghraifft. Mae opsiynau ymgynghoriad presennol y bwrdd iechyd yn golygu y bydd ysbyty Llwynhelyg yn cael ei israddio i ysbyty gymunedol heb wasanaethau A&E, sydd yn hollol annerbyniol. A ydych chi'n cytuno â fi, felly, ei bod hi'n bwysicach fyth bod gwasanaethau A&E ar gael i bobl yn sir Benfro o ystyried bod yna broblem enfawr gyda doctoriaid tu allan i oriau, ac y dylai bwrdd iechyd Hywel Dda o leiaf gydnabod hyn yn ei ymgynghoriad ar ad-drefnu gwasanaethau iechyd yng ngorllewin Cymru?

First Minister, there is clearly a huge problem in terms of out-of-hours doctors in the Hywel Dda health board area, and one of the impacts of this is to place significant pressures on A&E services, for example. Now, the options for the health board's current consultation mean that Withybush hospital will be downgraded to a community hospital without A&E services, which is entirely unacceptable. Would you agree with me, therefore, that it is even more important that A&E services should be available to people in Pembrokeshire, given that there is a huge problem with out-of-hours doctors, and that the Hywel Dda health board should at least recognise this in its consultation on reconfiguring health services in west Wales?

14:00

Wel, ni allaf i ddim mynegi barn, wrth gwrs, ynglŷn â'r ymgynghoriad. Mae'n bwysig bod yr ymgynghoriad yn cymryd lle. Mae'n bwysig ei fod e'n agored ac mae'n bwysig bod pobl yn cael y cyfle, wrth gwrs, i fynegi barn yn y broses ei hunan er mwyn eu bod nhw'n gallu dweud pa mor gryf maen nhw'n teimlo ynglŷn ag unrhyw issue. Ynglŷn â sir Benfro, mae yna chwe meddyg teulu sydd yn cael eu hyfforddi yn ychwanegol yn sir Benfro, ac mae hynny'n rhywbeth, wrth gwrs, sydd o help i'r ardal. Hefyd, mae yna chwe doctor ychwanegol ar rotas yr ysbytai yn yr ardal leol, achos y ffaith bod y doctoriaid hyn yn chwarae rhan yn yr ysbyty ei hunan. Felly, rydym ni wedi bod yn llwyddiannus yn denu doctoriaid i mewn i ardaloedd Ceredigion a gogledd Penfro, a byddwn i'n erfyn y bydd Hywel Dda yn sicrhau eu bod nhw'n dal i barhau i dynnu doctoriaid i mewn er mwyn sicrhau bod yna ddigon o ddoctoriaid ar gael dros nos.

Well, I cannot express a view on the consultation, of course. It's important that this takes place and that it is an open consultation where people have the opportunity to express their view on the process itself, and to say how strongly they feel about any issue. As regards Pembrokeshire, there are an additional six GPs that are being trained in Pembrokeshire, and that, of course, will be of assistance to the area. Also, there are an additional six doctors on the hospital rota in the local area, because those doctors will have a role to play in the hospital itself. So, we have succeeded in attracting doctors to the Ceredigion and northern Pembrokeshire area, and we would expect Hywel Dda to continue to attract more doctors in order to ensure that there is a sufficient number of doctors available out of hours.

Cymorth i'r Rhai sy'n Gadael Gofal
Support for Care Leavers

4. A wnaiff y Prif Weinidog ddatganiad am gymorth i'r rhai sy'n gadael gofal? OAQ52156

4. Will the First Minister make a statement on support for care leavers? OAQ52156

Supporting care leavers into independent adulthood and successful futures is a key commitment in 'Prosperity for All'. Through the ministerial advisory group and investment in key initiatives, a strong collaborative approach will improve outcomes for those involved, and we're beginning to see the beneficial effects of what has already been announced.

Mae cynorthwyo’r rhai sy'n gadael gofal i annibyniaeth fel oedolyn a dyfodol llwyddiannus yn ymrwymiad allweddol yn 'Ffyniant i Bawb'. Drwy'r grŵp cynghori gweinidogol a buddsoddiad mewn mentrau allweddol, bydd dull cydweithredol cryf yn gwella canlyniadau i'r rhai dan sylw, ac rydym ni'n dechrau gweld effeithiau llesol yr hyn a gyhoeddwyd eisoes.

Thank you, First Minister. I'm very proud that, despite the challenges of austerity, Torfaen council became the first local authority in Wales to exempt care leavers from paying council tax until 21, or 25 in some circumstances. As you'll be aware, that decision was followed by six other local authorities. This exemption will provide care leavers with a vital opportunity to transition and adapt to independent living, and this peace of mind should be available to all care leavers in Wales, not just in the seven local authorities who have introduced the policy. First Minister, what can you do to assist the remaining local authorities in Wales to provide this exemption to care leavers to ensure that care leavers in Wales can access the support wherever they live?

Diolch, Prif Weinidog. Rwy'n falch iawn, er gwaethaf heriau cyni cyllidol, mai cyngor Torfaen oedd yr awdurdod lleol cyntaf yng Nghymru i eithrio pobl sy'n gadael gofal rhag talu'r dreth gyngor tan neu bod yn 21 oed, neu'n 25 oed o dan rai amgylchiadau. Fel y byddwch yn gwybod, dilynwyd y penderfyniad hwnnw gan chwe awdurdod lleol arall. Bydd yr eithriad hwn yn cynnig cyfle hollbwysig i'r rhai sy'n gadael gofal bontio ac addasu i fyw'n annibynnol, a dylai'r tawelwch meddwl hwn fod ar gael i bawb sy'n gadael gofal yng Nghymru, nid yn unig yn y saith awdurdod lleol sydd wedi cyflwyno'r polisi. Prif Weinidog, beth allwch chi ei wneud i gynorthwyo'r awdurdodau lleol eraill yng Nghymru i ddarparu'r eithriad hwn i'r rhai sy'n gadael gofal i sicrhau y gall y rhai sy'n gadael gofal yng Nghymru gael gafael ar y cymorth lle bynnag y maen nhw'n byw?

'Learn from the good example of others' is what I would say. We've already asked local authorities to use their powers to exempt care leavers from paying council tax. I would not think it's a massive financial hit on the budgets of local authorities. I very much welcome what Torfaen has done, and the other local authorities. I would very much urge the others to follow suit.

'Dysgu o esiampl da pobl eraill' yw'r hyn y byddwn i'n ei ddweud. Rydym ni eisoes wedi gofyn i awdurdodau lleol ddefnyddio eu pwerau i eithrio'r rhai sy'n gadael gofal rhag talu'r dreth gyngor. Ni fyddwn yn meddwl ei fod yn ergyd ariannol enfawr i gyllidebau awdurdodau lleol. Rwy'n croesawu'n fawr yr hyn y mae Torfaen wedi ei wneud, a'r awdurdodau lleol eraill. Byddwn yn sicr yn annog eraill i'w dilyn.

It's a really good question that's been asked here today. Because of the seven local authorities that have already introduced this—the actual cost across Wales would be £2 million. Sixty local authorities in England have implemented this, and in October it was announced for all care leavers in Scotland. So, First Minister, what commitment will you make to provide funding to local authorities here in Wales to provide a 100 per cent council tax exemption for young care leavers?

Mae'n gwestiwn da iawn a ofynnwyd yma heddiw. Oherwydd o'r saith awdurdod lleol sydd eisoes wedi cyflwyno hyn—£2 filiwn fyddai'r gost wirioneddol ledled Cymru. Mae trigain o awdurdodau lleol yn Lloegr wedi cyflwyno hyn, ac fe'i cyhoeddwyd ym mis Hydref ar gyfer pawb sy'n gadael gofal yn yr Alban. Felly, Prif Weinidog, pa ymrwymiad fyddwch chi'n ei wneud i ddarparu cyllid i awdurdodau lleol yma yng Nghymru i ddarparu eithriad treth gyngor 100 y cant i bobl ifanc sy'n gadael gofal?

Some local authorities have done it already. Because they've done it already, I can't see why others cannot follow suit. I believe, actually, that it's now eight, rather than seven, across Wales that have exempted care leavers from paying council tax until at least the age of 21. Two local authorities have exempted all care leavers up to the age of 25, and three have exempted up to the age of 25 in certain cases. Now, I understand that a further 10 local authorities have plans to move ahead with this, subject to the necessary approvals. We haven't had information back from four local authorities, but we will continue to press. If one local authority can do it, the others can do it, and so I would very much urge the other local authorities to follow the good example of those who have already committed to this policy.

Mae rhai awdurdodau lleol wedi ei wneud eisoes. Gan eu bod nhw wedi ei wneud eisoes, ni allaf weld pam na all eraill ddilyn eu hesiampl. Rwy'n credu, a dweud y gwir, mai wyth, yn hytrach na saith, ledled Cymru sydd wedi eithrio'r rhai sy'n gadael gofal rhag talu'r dreth gyngor tan eu bod yn 21 oed o leiaf, erbyn hyn. Mae dau awdurdod lleol wedi eithrio pawb sy'n gadael gofal tan eu bod yn 25 oed, ac mae tri wedi eithrio hyd at 25 oed mewn achosion penodol. Nawr, rwy'n deall bod gan 10 awdurdod lleol gynlluniau i fwrw ymlaen â hyn, yn amodol ar y cymeradwyaethau angenrheidiol. Nid ydym wedi cael gwybodaeth yn ôl gan bedwar awdurdod lleol, ond byddwn yn parhau i bwyso. Os gall un awdurdod lleol ei wneud, gall eraill ei wneud, ac felly byddwn yn sicr yn annog yr awdurdodau lleol eraill i ddilyn esiampl dda y rhai sydd eisoes wedi ymrwymo i'r polisi hwn.

First Minister, the best support we can give to care leavers is ensuring that they have the knowledge and skills needed to prepare them for an independent adult life, the skills most of us are taught by our parents. What is the Welsh Government doing to ensure that corporate parents equip those in care with the skills needed in later life and will you learn from the Roots Foundation in my region who focus on helping those in care to transition to independent living?

Prif Weinidog, y cymorth gorau y gallwn ni ei roi i'r rhai sy'n gadael gofal yw sicrhau eu bod yn meddu ar y wybodaeth a'r sgiliau sydd eu hangen i'w paratoi ar gyfer bywyd annibynnol fel oedolyn, sgiliau a addysgir i'r rhain fwyaf ohonom ni gan ein rhieni. Beth mae Llywodraeth Cymru yn ei wneud i sicrhau bod rhieni corfforaethol yn rhoi'r sgiliau sydd eu hangen yn ddiweddarach mewn bywyd i'r rhai sy'n derbyn gofal ac a wnewch chi ddysgu gan y Roots Foundation yn fy rhanbarth i sy'n canolbwyntio ar helpu'r rhai sy'n derbyn gofal i bontio i fyw'n annibynnol?

I think our carers, and our foster carers particularly, do an incredible job. I've met people who have fostered many, many children and they've fostered children who have come to them in the most difficult of circumstances, sometimes more than once. I've seen foster carers who foster children at a very young age who then, of course, see them go for adoption when they're 18 months or two years old. It's very, very emotionally difficult for people, and I really take my hat off to them.

She asked what we have done as a Government. Well, we have established the £1 million St David's Day fund. That supports care leavers to access opportunities in education, training and employment. There's £625,000 for the local authorities to develop apprenticeship and traineeship opportunities within the local authority, acting as good corporate parents, and £1 million has been provided to local authorities so that personal adviser support can be provided for all care leavers up to the age of 25. Those are just some examples of what we have done as a Government in order to provide the sorts of funds that are required to give our care leavers a better start in life.

Rwy'n credu bod ein gofalwyr, a'n gofalwyr maeth yn arbennig, yn gwneud gwaith anhygoel. Rwyf i wedi cyfarfod pobl sydd wedi maethu llawer iawn o blant ac maen nhw wedi maethu plant sydd wedi dod atyn nhw o dan yr amgylchiadau anoddaf, weithiau fwy nag unwaith. Rwyf i wedi gweld gofalwyr maeth sy'n maethu plant yn ifanc iawn sydd wedyn, wrth gwrs, yn eu gweld yn cael eu mabwysiadu pan eu bod yn 18 mis neu'n ddwyflwydd oed. Mae'n anodd dros ben yn emosiynol i bobl, ac rwyf i'n llawn edmygedd ohonynt.

Gofynnodd beth yr ydym ni wedi ei wneud fel Llywodraeth. Wel, rydym ni wedi sefydlu cronfa Dydd Gwŷl Dewi gwerth £1 filiwn. Mae honno'n cynorthwyo'r rhai sy'n gadael gofal i fanteisio ar gyfleoedd ym meysydd addysg, hyfforddiant a chyflogaeth. Mae £625,000 i'r awdurdodau lleol ddatblygu cyfleoedd prentisiaeth a hyfforddeiaeth yn yr awdurdod lleol, gan weithredu fel rhieni corfforaethol da, a darparwyd £1 filiwn i awdurdodau lleol fel y gellir darparu cymorth cynghorydd personol i bob un o'r rhai sy'n gadael gofal tan y byddant yn 25 oed. Dim ond rhai enghreifftiau yw'r rhain o'r hyn yr ydym ni wedi ei wneud fel Llywodraeth i ddarparu'r math o gyllid sydd ei angen i roi dechrau gwell mewn bywyd i'n pobl ifanc sy'n gadael gofal.

14:05
Cymorth i Brynu—Cymru
Help to Buy—Wales

5. A wnaiff y Prif Weinidog roi'r wybodaeth ddiweddaraf am effaith cynllun Cymorth i Brynu—Cymru? OAQ52155

5. Will the First Minister provide an update on the impact of the Help to Buy—Wales scheme? OAQ52155

Since its launch in 2014, Help to Buy—Wales has helped nearly 6,900 households to buy their new home, with around 75 per cent being first-time buyers. In addition, of course, the scheme is attracting development funding into Wales and providing jobs and opportunities for the Welsh supply chain.

Ers ei lansio yn 2014, mae Cymorth i Brynu—Cymru wedi helpu bron i 6,900 o aelwydydd i brynu eu cartref newydd, gan gynnwys oddeutu 75 y cant o brynwyr tro cyntaf. Hefyd, wrth gwrs, mae'r cynllun yn denu cyllid datblygu i Gymru ac yn darparu swyddi a chyfleoedd i gadwyn gyflenwi Cymru.

Thank you, First Minister. The value of homes in Newport has grown by 4.7 per cent in the last year, with the average house price now in Newport over £185,000. The Welsh Government's Help to Buy scheme has helped over 1,200 first-time buyers to purchase their homes in Newport, and that's one fifth of all Help to Buy homes purchased in Wales. With the removal of the Severn bridge tolls fast approaching, and people moving from Bristol and Cardiff to Newport, increasing rents and house prices continue to put a real strain on young people and families. Consequently, there's a real risk of young first-time buyers being priced out of the market. What more can the Welsh Government do, with the local authority and social landlords and developers, to ensure property hotspots like Newport are attainable for those who want to get on the housing ladder for the first time?

Diolch, Prif Weinidog. Mae gwerth cartrefi yng Nghasnewydd wedi cynyddu 4.7 y cant yn y flwyddyn ddiwethaf, ac mae pris cyfartalog tŷ yng Nghasnewydd yn fwy na £185,000 erbyn hyn. Mae cynllun Cymorth i Brynu Llywodraeth Cymru wedi helpu dros 1,200 o brynwyr tro cyntaf i brynu eu cartrefi yng Nghasnewydd, ac mae hynny'n un rhan o bump o'r holl gartrefi Cymorth i Brynu a brynwyd yng Nghymru.O gofio bod diddymiad tollau pont Hafren yn prysur agosáu, a phobl yn symud o Fryste a Chaerdydd i Gasnewydd, mae rhenti a phrisiau tai sy'n codi yn parhau i roi straen gwirioneddol ar bobl ifanc a theuluoedd. O ganlyniad, ceir perygl gwirioneddol y bydd prynwyr tro cyntaf ifanc yn cael eu prisio allan o'r farchnad. Beth arall all Llywodraeth Cymru ei wneud, gyda'r awdurdod lleol a landlordiaid cymdeithasol a datblygwyr, i sicrhau bod mannau poblogaidd ar gyfer prynu tai, fel Casnewydd, yn gyraeddadwy i'r rhai hynny sydd eisiau dringo ar yr ysgol dai am y tro cyntaf?

Help to Buy—Wales is part of that, but other schemes such as Rent to Own are hugely important, and also making sure, of course, that there's sufficient supply of housing in the area. That's not just about building more and more homes—although we have our target of 20,000 homes that we will reach by the end of this Assembly term—but also, of course, bringing more empty homes into use, and Newport, of course, has a good record of doing that. And, of course, it's looking at alternative ways such as shared equity schemes, such as community land trusts, in order to make housing more affordable, and particularly to make sure that the price of housing doesn't go up so fast and so far that the housing then becomes unaffordable. One way of doing that is through shared equity. One way of doing that is through community land trusts, where the land is owned by a landlord and the people who own houses on the land are leaseholders. It helps to control the price of houses. I think all these things can be looked at by house builders, in order to make sure that more and more houses become available.

Mae Cymorth i Brynu—Cymru yn rhan o hynny, ond mae cynlluniau eraill fel Rhentu i Brynu yn hynod bwysig, a gwneud yn siŵr hefyd, wrth gwrs, bod cyflenwad digonol o dai yn yr ardal. Nid yw hynny'n golygu adeiladu mwy a mwy o gartrefi yn unig—er bod gennym ni ein targed o 20,000 o gartrefi a fydd yn cael ei fodloni erbyn diwedd y tymor Cynulliad hwn—ond hefyd, wrth gwrs, dod â mwy o gartrefi gwag i ddefnydd, ac mae gan Gasnewydd, wrth gwrs, hanes da o wneud hynny. Ac, wrth gwrs, mae'n golygu ystyried ffyrdd amgen fel cynlluniau ecwiti a rennir, fel ymddiriedolaethau tir cymunedol, er mwyn gwneud tai yn fwy fforddiadwy, ac yn enwedig i wneud yn siŵr nad yw prisiau tai yn cynyddu mor gyflym a mor bell fel nad yw'r tai yn fforddiadwy wedyn. Un ffordd o wneud hynny yw drwy ecwiti a rennir. Un ffordd o wneud hynny yw drwy ymddiriedolaethau tir cymunedol, lle mae'r tir yn eiddo i landlord ac mae'r bobl sy'n berchen ar dai ar y tir yn lesddeiliaid. Mae'n helpu i reoli prisiau tai. Rwy'n credu y gall adeiladwyr tai ystyried yr holl bethau hyn, er mwyn gwneud yn siŵr bod mwy a mwy o gartrefi yn dod ar gael.

First Minister, I certainly agree that the Help to Buy scheme has been successful, as it has been in England, and the other demand-side measures that you mentioned—most of them are also in England—have also been helpful, but they're not as powerful as supply-side measures. Can I tell you, now, the latest figures? Since March 2018, just gone, the average house price in Wales is now over £181,000. That's between six and seven times the average income. That's why we have a housing crisis. It's not your fault in particular; it's all of us who have been active in politics for the last 25 to 30 years. We've got to have a complete change, starting on the supply side.

Prif Weinidog, rwy'n sicr yn cytuno bod y cynllun Cymorth i Brynu wedi bod yn llwyddiannus, fel y mae wedi bod yn Lloegr, ac mae'r mesurau eraill o ran galw a grybwyllwyd gennych—mae'r rhan fwyaf ohonynt yn Lloegr hefyd—wedi bod o gymorth hefyd, ond nid ydynt mor rymus â mesurau'r ochr gyflenwi. A gaf i ddweud wrthych chi, nawr, y ffigurau diweddaraf? Ers mis Mawrth 2018, sydd newydd fynd heibio, mae pris cyfartalog tŷ yng Nghymru dros £181,000 erbyn hyn. Mae hynny rhwng chwech a saith gwaith yr incwm cyfartalog. Dyna pam mae gennym ni argyfwng tai. Nid eich bai chi yw hynny'n arbennig; mae'n fai ar bob un ohonom ni sydd wedi bod yn weithredol ym myd gwleidyddiaeth dros y 25 i 30 mlynedd diwethaf. Mae'n rhaid i ni gael newid llwyr, gan ddechrau ar yr ochr gyflenwi.

I agree, but I think it's about more than that. The most difficult part of the housing market in the UK is that people have become used, over many, many years, to seeing a house as an asset—as something that potentially could be something where they could see an increase in their financial investment, or something for their children. It doesn't happen everywhere else, in other countries. Quite often, in some countries, renting is seen as the norm and property isn't seen as something you invest in. But it is, in reality, the case that people do invest in houses with the expectation that prices will go up. The question is getting the balance right: prices will go up, but it's making sure they don't go up at an astronomical rate, and that means increasing the supply. He's quite right about that. But it's about making sure that the supply properly matches the demand that's there. There's no point increasing the supply of high-end housing if the market isn't going to help those people who are at the lowest end of the income scale, which is why I've always emphasised the fact that, yes, we need social housing, yes, we need to make sure that there is more good private rented accommodation, yes, we need more houses for purchase, but we also need to look at other ways in which people can get a stake in property without having to buy a house outright, which would be beyond them financially.

Rwy'n cytuno, ond mae'n ymwneud â mwy na hynny. Rhan anoddaf y farchnad dai yn y DU yw bod pobl wedi dod i arfer, dros flynyddoedd lawer iawn, â gweld tŷ fel asedl—fel rhywbeth a allai o bosibl fod yn rhywbeth lle gallent weld cynnydd i'w buddsoddiad ariannol, neu'n rhywbeth i'w plant. Nid yw'n digwydd ym mhobman arall, mewn gwledydd eraill. Yn aml iawn, mewn rhai gwledydd, ystyrir mai rhentu yw'r norm ac ni ystyrir eiddo fel rhywbeth yr ydych chi'n buddsoddi ynddo. Ond mewn gwirionedd, mae'n wir bod pobl yn buddsoddi mewn tai gyda'r disgwyliad y bydd prisiau yn codi. Y cwestiwn yw cael y cydbwysedd cywir: bydd prisiau yn codi, ond mae'n fater o wneud yn siŵr nad ydynt yn codi'n aruthrol, ac mae hynny'n golygu cynyddu'r cyflenwad. Mae yn llygad ei le am hynny. Ond mae'n golygu gwneud yn siŵr bod y cyflenwad yn cyfateb yn briodol i'r galw sydd yno. Nid oes unrhyw bwynt mewn cynyddu'r cyflenwad o dai uwchraddol os nad yw'r farchnad yn mynd i helpu'r bobl hynny sydd ar ben isaf y raddfa incwm, a dyna pam yr wyf i wedi pwysleisio'r ffaith honno erioed, oes, mae angen tai cymdeithasol arnom, oes, mae angen i ni wneud yn siŵr bod mwy o lety rhent preifat da, oes, mae angen mwy o dai arnom i'w prynu, ond mae angen i ni hefyd ystyried ffyrdd eraill y gall pobl gael cyfran mewn eiddo heb orfod prynu tŷ yn llwyr, a fyddai y tu hwnt iddyn nhw yn ariannol.

14:10
Twf Economaidd yng Nghwm Cynon
Economic Growth in Cynon Valley

6. Pa gamau y mae Llywodraeth Cymru'n eu cymryd i gefnogi twf economaidd yng Nghwm Cynon? OAQ52157

6. What action is the Welsh Government taking to support economic growth in Cynon Valley? OAQ52157

The 'Prosperity for All' national strategy and the economic action plan sets out the actions we're taking to support economic growth in the Cynon valley and across Wales. Just some examples, of course: our Vibrant and Viable Places town centre loans fund is helping to support town-centre regeneration across Wales. Aberdare, in particular, is seeing the benefit of that. If we look, for example, at the Cynon valley, the Cynon valley has attracted four investments from foreign-owned companies and two investments from elsewhere in the UK over the past five years. And, of course, there are examples of home-grown businesses in the valley that are doing well, such as Ashwood Designs.

Mae'r strategaeth genedlaethol 'Ffyniant i Bawb' a'r cynllun gweithredu economaidd yn nodi'r camau yr ydym yn eu cymryd i gefnogi twf economaidd yng nghwm Cynon a ledled Cymru. Dim ond rhai enghreifftiau, wrth gwrs: mae ein cronfa benthyciadau canol tref Lleoedd Llewyrchus Llawn Addewid yn helpu i gefnogi gwaith adfywio canol trefi ledled Cymru. Mae Aberdâr, yn arbennig, yn gweld budd hynny. Os edrychwn ni, er enghraifft, ar gwm Cynon, mae cwm Cynon wedi denu pedwar buddsoddiad gan gwmnïau â pherchnogion tramor a dau fuddsoddiad o rannau eraill o'r DU dros y pum mlynedd diwethaf. Ac, wrth gwrs, ceir enghreifftiau o fusnesau cynhenid yn y cwm sy'n gwneud yn dda, fel Ashwood Designs.

Thank you, First Minister, and I agree with everything you said there. I recently visited Pontus Research, which is an award-winning aquaculture research and development business in my constituency, with a global client list. The company has done incredibly well, but they've now reached capacity and they need to grow. They've applied for funding from the European maritime and fisheries fund, but have been told that their application could take at least 120 days—that's 120 working days—just to process. This is preventing them from developing, from possibly securing match funding, from taking on new staff and thereby contributing to economic growth even further in my constituency. First Minister, will you look at how the EMFF is working in Wales to see whether improvements can be made to timescales so that other businesses like Pontus don't lose out?

Diolch, Prif Weinidog, ac rwy'n cytuno â phopeth a ddywedasoch yn y fan yna. Ymwelais yn ddiweddar â Pontus Research, sy'n fusnes ymchwil a datblygu dyframaethu arobryn yn fy etholaeth i, â chanddo restr o gleientiaid byd-eang. Mae'r cwmni wedi gwneud yn anhygoel o dda, ond maen nhw wedi cyrraedd capasiti erbyn hyn ac maen nhw angen tyfu. Maen nhw wedi gwneud cais am gyllid o gronfa'r môr a physgodfeydd Ewrop, ond fe'u hysbyswyd y gallai eu cais gymryd o leiaf 120 diwrnod—120 o ddiwrnodau gwaith yw hynny—dim ond i'w brosesu. Mae hyn yn eu hatal rhag datblygu, rhag sicrhau arian cyfatebol o bosibl, rhag cyflogi staff newydd a thrwy hynny cyfrannu at dwf economaidd hyd yn oed ymhellach yn fy etholaeth i. Prif Weinidog, a wnewch chi edrych ar sut y mae cronfa'r môr a physgodfeydd Ewrop yn gweithio yng Nghymru i weld a ellir gwneud gwelliannau i amserlenni fel nad yw busnesau eraill fel Pontus yn dioddef?

Well, first of all, the appraisal process should take up to 120 working days, not at least 120 working days. What I can say, though, in relation to Pontus is that the application is currently being appraised. The company has received a letter confirming that it can start work, at their own risk, from the point the application is submitted, and that was in January 2018, in order for that work to begin. I can also say that the company has been able to benefit as well from funding made available by the Welsh Government through the fisheries business development advisors scheme to help to pay a consultant to develop the business idea. If your constituent has been told that it's at least 120 days, let me give the assurance that it is 'up to', with the objective, of course, that the appraisal process is finished long before that.

Wel, yn gyntaf oll, dylai'r broses werthuso gymryd hyd at 120 o ddiwrnodau gwaith, nid o leiaf 120 o ddiwrnodau gwaith. Yr hyn y gallaf ei ddweud, fodd bynnag, o ran Pontus yw bod y cais wrthi'n cael ei werthuso ar hyn o bryd. Mae'r cwmni wedi derbyn llythyr yn cadarnhau y gall ddechrau gwaith, ar eu risg ei hun, o'r adeg y cyflwynir y cais, ac roedd hynny ym mis Ionawr 2018, fel y gall y gwaith hwnnw ddechrau. Gallaf hefyd ddweud bod y cwmni wedi gallu elwa hefyd ar gyllid a roddwyd ar gael gan Lywodraeth Cymru drwy'r cynllun cynghorwyr datblygu busnes pysgodfeydd er mwyn helpu i dalu i ymgynghorydd ddatblygu'r syniad busnes. Os yw eich etholwr wedi cael ei hysbysu ei fod yn 120 diwrnod o leiaf, gadewch i mi roi'r sicrwydd mai 'hyd at' yw'r achos, gyda'r nod, wrth gwrs, y bydd y broses werthuso yn cael ei gorffen ymhell cyn hynny.

Diolch yn fawr, Llywydd. I'm obviously in your good books this afternoon, and long may it continue. [Laughter.] First Minister, Cynon Valley is the third least economically active constituency in Wales, and we know the association between economic activity and prosperity. The main reason that people remain economically inactive, when they could, actually, for health reasons, be fit enough for work, is that they don't have the basic skills to enter the job market, as it changes rapidly. Therefore, investment in basic skills is as important as driving towards the great knowledge-based economy, which, of course, we also want to see in Wales. These programmes are what we really need in areas like Cynon Valley.

Diolch yn fawr, Llywydd. Rydych chi'n amlwg yn fy ffafrio i y prynhawn yma, a hir y parhaed hynny. [Chwerthin.] Prif Weinidog, Cwm Cynon yw'r drydedd etholaeth leiaf gweithgar yn economaidd yng Nghymru, a gwyddom am y cysylltiad rhwng gweithgarwch economaidd a ffyniant. Y prif reswm y mae pobl yn parhau i fod yn economaidd anweithgar, pan y gallent, mewn gwirionedd, am resymau iechyd, fod yn ddigon ffit i weithio, yw nad ydynt yn meddu ar y sgiliau sylfaenol i ymuno â'r farchnad swyddi, wrth iddi newid yn gyflym. Felly, mae buddsoddi mewn sgiliau sylfaenol mor bwysig â bwrw ymlaen tuag at yr economi seiliedig ar wybodaeth fawr, yr ydym, wrth gwrs, hefyd eisiau ei gweld yng Nghymru. Y rhaglenni hyn yw'r hyn yr ydym ni wir ei angen mewn ardaloedd fel Cwm Cynon.

I agree. The reason why, of course, productivity is historically low, not just in Wales but in the rest of the UK, is that over many years, there was a lack of investment in skills development. We know that the more skilled people are, the more productive they are and the more they can earn. I've said this before in the Chamber: why is it that, if we give a German worker a particular machine, we get far more out of it than a worker in the UK? Why? Training. That's the reason for it, and that's the lesson we must learn. How are we doing it? Working with higher education bodies, who are working hard in their communities. Further education colleges—we have new colleges that have been built across Wales, offering fantastic facilities for local people. The Valleys taskforce has, at its very heart, the desire to ensure that people can have better jobs closer to home, and that means, of course, making sure that they have access to the skills that they need. But it is hugely important as well to make sure that jobs don't leave Valleys communities, and that's why I was so disappointed to see that the Department for Work and Pensions have decided to centralise lots of jobs that have come from other valleys in Treforest. They're not new jobs; they're jobs that have simply been moved around. Unfortunately, for many people, that will mean that they will now find they have to travel further in order to keep the jobs that they have. That is the wrong direction.

Rwy'n cytuno. Y rheswm pam, wrth gwrs, mae cynhyrchiant ar ei isaf erioed, nid yn unig yng Nghymru ond yng ngweddill y DU, yw y bu diffyg buddsoddiad dros flynyddoedd lawer mewn datblygu sgiliau. Rydym ni'n gwybod mai'r mwyaf medrus yw pobl, y mwyaf cynhyrchiol ydyn nhw a'r mwyaf y gallan nhw ei ennill. Rwyf i wedi dweud hyn o'r blaen yn y Siambr: pam, os rhoddwn beiriant penodol i weithiwr o'r Almaen, yr ydym ni'n cael llawer mwy ohono na gweithiwr yn y DU? Pam? Hyfforddiant. Dyna'r rheswm am hyn, a dyna'r wers y mae'n rhaid i ni ei dysgu. Sut ydym ni'n gwneud hynny? Gweithio gyda chyrff addysg uwch, sy'n gweithio'n galed yn eu cymunedau. Colegau addysg bellach—mae gennym ni golegau newydd sydd wedi eu hadeiladu ledled Cymru, gan gynnig cyfleusterau gwych i bobl leol. Mae gan tasglu'r Cymoedd, yn gwbl greiddiol, y dymuniad i sicrhau y gall pobl gael swyddi gwell yn nes at eu cartrefi, ac mae hynny'n golygu, wrth gwrs, gwneud yn siŵr bod ganddyn nhw fynediad at y sgiliau sydd eu hangen arnynt. Ond mae'n hynod bwysig hefyd gwneud yn siŵr nad yw swyddi yn gadael cymunedau yn y Cymoedd, a dyna pam yr oeddwn i mor siomedig o weld bod yr Adran Gwaith a Phensiynau wedi penderfynu canoli llawer o swyddi sydd wedi dod o gymoedd eraill yn Nhrefforest. Nid ydynt yn swyddi newydd; swyddi ydyn nhw sydd ddim ond wedi eu symud o gwmpas. Yn anffodus, i lawer o bobl, bydd hynny'n golygu y byddan nhw'n canfod bellach bod yn rhaid iddyn nhw deithio ymhellach i gadw'r swyddi sydd ganddyn nhw. Mae hwnnw'n gyfeiriad anghywir.

Canser yr Ofari
Ovarian Cancer

7. A wnaiff y Prif Weinidog ymateb i'r galwad gan Ovarian Cancer Action am archwiliad clinigol cenedlaethol o ganser yr ofari yng Nghymru? OAQ52133

7. Will the First Minister respond to the call from Ovarian Cancer Action for a national clinical audit of ovarian cancer in Wales? OAQ52133

Tthe clinical audit and outcome review programme for the NHS doesn't include provision—that's true—for a national clinical audit of ovarian cancer services. We do, however, encourage ovarian cancer charities in Wales to approach the Wales Cancer Network to consider alternative approaches for reviewing services.

Nid yw'r rhaglen archwilio clinigol ac adolygu canlyniadau ar gyfer y GIG yn cynnwys darpariaeth—mae hynny'n wir—ar gyfer archwiliad clinigol cenedlaethol o wasanaethau canser yr ofari. Rydym ni, fodd bynnag, yn annog elusennau canser yr ofari yng Nghymru i gysylltu â Rhwydwaith Canser Cymru i ystyried dulliau amgen ar gyfer adolygu gwasanaethau.

Thank you, First Minister. You'll be aware that today, in fact, is World Ovarian Cancer Day. On Mother's Day, I joined hundreds of others on a walk in memory of Lesley Woolcock from Barry, who was a tireless campaigner on ovarian cancer who sadly passed away in 2016.

According to Ovarian Cancer Action, ovarian cancer is the UK's deadliest gynaecological cancer, and the UK has one of the lowest survival rates in western Europe. So, an ovarian cancer audit could provide the data to help find out why this is and where the challenges lie. And, of course, recognising the importance of national clinical audits—and they have improved survival rates for lung, bowel and head and neck cancers—I understand that Scotland has just completed an ovarian cancer audit, and the chief medical officer in England has called for an audit. So, I hope, indeed, there will be consideration for an audit for women in Wales.

Diolch, Prif Weinidog. Byddwch yn ymwybodol mai heddiw, mewn gwirionedd, yw Diwrnod Canser yr Ofari y Byd. Ar Sul y Mamau, ymunais â channoedd o bobl eraill ar daith gerdded er cof am Lesley Woolcock o'r Barri, a oedd yn ymgyrchydd ddiflino ar ganser yr ofari a fu farw yn 2016, yn anffodus.

Yn ôl Ovarian Cancer Action, canser yr ofari yw canser gynaecolegol mwyaf marwol y DU, ac mae gan y DU un o'r cyfraddau goroesi isaf yng ngorllewin Ewrop. Felly, gallai archwiliad canser yr ofari ddarparu'r data i helpu i ddarganfod y rheswm am hyn a ble mae'r heriau. Ac, wrth gwrs, gan gydnabod pwysigrwydd archwiliadau clinigol cenedlaethol—ac maen nhw wedi gwella cyfraddau goroesi ar gyfer canser yr ysgyfaint, y coluddyn a'r pen a'r gwddf—rwy'n deall bod yr Alban newydd gwblhau archwiliad canser yr ofari, ac mae'r prif swyddog meddygol yn Lloegr wedi galw am archwiliad. Felly, gobeithiaf, yn wir, y rhoddir ystyriaeth i archwiliad ar gyfer menywod yng Nghymru.

14:15

Well, there already exist clinical audits for a number of other cancers, as the Member clearly pointed out. We keep an open mind on whether clinical audits are appropriate for all cancers, but what I can say is that there is already a system in place in order to examine the way in which ovarian cancer is detected and, indeed, treated—that's part of the approach set out in the cancer delivery plan for Wales. We do have a significant amount of data on ovarian cancer that is provided by the Wales cancer registry, and we do learn from that in terms of what impacts cancer survival through our participation, for example, in international studies. 

I can also assure Members that ovarian cancer services are subject to a peer review programme. That has taken place this year, and that is intended, of course, to support quality improvements in services.

Wel, mae archwiliadau clinigol ar gyfer nifer o fathau eraill o ganser eisoes yn bodoli , fel y soniodd yr Aelod yn eglur. Rydym yn cadw meddwl agored ynghylch a yw archwiliadau clinigol yn briodol ar gyfer pob math o ganser. Ond yr hyn y gallaf ei ddweud yw bod system eisoes ar waith sy'n edrych ar sut y mae canser yr ofari yn cael ei ganfod ac, yn wir, yn cael eu drin—mae hynny'n rhan o'r dull a nodwyd yng nghynllun cyflawni Cymru ar gyfer canser. Mae gennym lawer iawn o ddata ar ganser yr ofari a ddarperir gan gofrestrfa canser Cymru, ac rydym yn dysgu o hynny beth sy'n effeithio ar gyfraddau goroesi canser drwy ein cyfranogiad, er enghraifft, mewn astudiaethau rhyngwladol.

Gallaf hefyd roi sicrwydd i'r Aelodau bod gwasanaethau canser yr ofari yn destun rhaglen adolygiad gan gymheiriaid. Mae hynny wedi digwydd eleni, ac mae hynny, wrth gwrs, er mwyn cefnogi gwelliannau ansawdd i wasanaethau.

Ac yn olaf, cwestiwn 8, Llyr Gruffydd. 

And finally, question 8, Llyr Gruffydd. 

Caffael Gwasanaethau Iechyd yn Ngogledd Cymru
The Procurement of Health Services in North Wales

8. A wnaiff y Prif Weinidog ddatganiad am gaffael gwasanaethau iechyd yn Ngogledd Cymru? OAQ52117

8. Will the First Minister make a statement on the procurement of health services in North Wales? OAQ52117

Dylai pob proses gaffael gan unrhyw fwrdd iechyd gael ei chynnal yn unol â chyfarwyddiadau ariannol sefydlog y bwrdd, yr egwyddorion rheolaeth ariannol sydd wedi’u nodi yn 'Rheoli Arian Cyhoeddus Cymru', a gyda chyngor a chymorth arbenigol gwasanaethau caffael Partneriaeth Cydwasanaethau GIG Cymru, er mwyn sicrhau cydymffurfiaeth a gwerth am arian.

All procurement by any health board should be undertaken in accordance with its standing financial instructions, the principles of financial management set out in 'Managing Welsh Public Money', and with the specialist advice and support of NHS Wales Shared Services Partnership procurement services to assure compliance and value for money.

Mewn ymateb i gwestiynau gan Blaid Cymru ynglŷn â chynigion i breifateiddio gwasanaethau dialysis yng ngogledd Cymru, mi ddywedoch chi, ar 31 Ionawr, eich bod chi yn gwbl yn erbyn preifateiddio.

'We are completely against privatisation',

meddech chi. Nawr rŷm ni'n ffeindio mas, wrth gwrs, fod Betsi Cadwaladr yn gwthio ymlaen gyda chynlluniau i breifateiddio'r gwasanaethau dialysis yna ar draws y gogledd. Mae'r staff yn dweud wrthyf i nad ydyn nhw eisiau trosglwyddo o'r NHS i'r sector preifat, ac maen nhw hefyd yn dweud nad ydyn nhw'n teimlo bod yna ddigon o ymgynghori wedi bod â nhw, ac yn sicr, nid oes dim ymgynghori wedi bod â chleifion nag â'r cyhoedd yn ehangach. Ac mae gen i lythyr gan y bwrdd iechyd yn cadarnhau bod ganddyn nhw gefnogaeth eich Llywodraeth chi i'r cynnig yma. Llywodraeth Lafur yn gadael i wasanaethau cyhoeddus drosglwyddo o'r NHS i'r sector preifat—rhywbeth rŷch chi'n ei geryddu pan mae'r Ceidwadwyr yn ei wneud yn Lloegr. 

Felly, pan oeddech chi'n dweud wrthym ni ar 30 Ionawr eich bod chi yn llwyr yn erbyn preifateiddio, a oedd hynny'n awgrymu efallai nad ydych chi'n gwybod beth sy'n digwydd yn y gwasanaeth iechyd yng ngogledd Cymru neu, yn wir, a oeddech chi'n trial ein camarwain ni?

In response to questions from Plaid Cymru on proposals to privatise dialysis services in north Wales, you said, on 30 January, that you were entirely opposed to privatisation:

'We are completely against privatisation'.

Those were your words. We now hear that Betsi Cadwaladr is proceeding with plans to privatise those dialysis services across north Wales. The staff tell me that they don't want to transfer from the NHS into the private sector, and they also tell me that they don't feel that there has been sufficient consultation with them. There certainly hasn't been consultation with patients or the public more generally. And I have a letter from the health board confirming that they have your Government's support for this proposal. A Labour Government allowing public services to transfer from the NHS into the private sector—it's something that you are very critical of when the Conservatives do it in England.

So, when you told us on 30 January that you were entirely opposed to privatisation, did that suggest that you didn't know what was happening within the health service in north Wales, or, indeed, were you trying to mislead us?

Na, dim o gwbl, a hoffwn i weld y llythyr y mae'r Aelod yn sôn amdano i weld beth yn gymwys sydd yn y llythyr hynny, a chaf i aros, felly, i weld beth ddigwyddith ynglŷn â hynny.

Mae hon yn broses y mae Betsi Cadwaladr wedi dechrau ac mae'n mynd i orffen erbyn mis Gorffennaf. Beth maen nhw'n trial ei wneud yw sicrhau bod y gwasanaeth gorau ar gael i'w cleifion nhw, ac mae yna ddyletswydd arnyn nhw i sicrhau eu bod hynny'n digwydd. 

No, not at all, and I would like to see the letter that the Member alludes to, to see exactly the content of that letter. So, I will wait, therefore, to see what will happen on that.

This is a process that Betsi Cadwaladr trust has begun, and it will be complete by July. What they are trying to do is ensure that the best possible service is available for their patients, and they are duty-bound to ensure that that happens.

2. Datganiad a Chyhoeddiad Busnes
2. Business Statement and Announcement

Yr eitem nesaf, felly, yw'r datganiad a chyhoeddiad busnes, ac rydw i wedi cael gwybod y bydd Ysgrifennydd y Cabinet dros Ynni, Cynllunio a Materion Gwledig yn gwneud y datganiad heddiw ar ran arweinydd y tŷ, ac rydw i'n galw, felly, ar Lesley Griffiths. 

The next item, therefore, is the business statement and announcement, and I have been informed that the Cabinet Secretary for Energy, Planning and Rural Affairs will make the statement today on behalf of the leader of the house. Therefore, I call on Lesley Griffiths.

Member
Lesley Griffiths AM 14:19:01
Cabinet Secretary for Energy, Planning and Rural Affairs

Diolch, Llywydd. Two statements by the Cabinet Secretary for Health and Social Services have been added to today's agenda on the recently published reports on Tawel Fan and the use of the vaginal synthetic mesh. Business for the next three weeks is shown on the business statement and announcement found among the meeting papers that are available to Members electronically.

Diolch, Llywydd. Ychwanegwyd dau ddatganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol at yr agenda heddiw ar yr adroddiadau a gyhoeddwyd yn ddiweddar ar Tawel Fan a'r defnydd o rwyll synthetig y wain. Dangosir busnes y tair wythnos nesaf ar y datganiad a chyhoeddiad busnes ymhlith papurau'r cyfarfod sydd ar gael i'r Aelodau yn electronig.

Could I seek two statements, Cabinet Secretary, please, today, if possible? One is on the proposals to build a new road from junction 34 in the Vale of Glamorgan to Sycamore Cross. I do declare an interest in that, potentially, some of my land could be affected by it. There was a large public meeting that I was unable to attend on Thursday night, but I know that the Member for the Vale of Glamorgan was there. This has caused considerable concern in the locality of Pendoylan, and whilst the consultations have been welcomed, there is still much vagary around the dates and timelines of possible delivery, or not, as the case may be, and exactly who is driving these proposals? Is it the local authority, is it the Welsh Government, is it a combination of the two? A statement from the relevant Cabinet Secretary would benefit informing the community around the issues around this proposal.

Secondly, could we have a statement from the health Secretary around the news over the weekend from the Royal College of Physicians that there has been potentially a computer glitch that has affected 1,500 job offers to junior doctors and their placements in other parts of the United Kingdom and, indeed, I dare say, in Wales as well—how that might or might not have affected positions to be filled here in Wales? We're all aware of recruitment issues in the health service in whatever part of the United Kingdom, but to hear of this glitch from the royal college, which has potentially affected at least 1,500 job offers, is of concern. In particular, could we understand how that might or might not have affected health services here in Wales?

A gaf i ofyn am ddau ddatganiad, Ysgrifennydd y Cabinet, os gwelwch yn dda, heddiw, os yw'n bosibl? Un yw ar y cynigion i adeiladu ffordd newydd o Gyffordd 34 ym Mro Morgannwg i Sycamore Cross. Rwy'n datgan buddiant gan y gallai hyn, o bosibl, effeithio ar ryw ran o fy nhir i. Cynhaliwyd cyfarfod cyhoeddus mawr na lwyddais i fynd iddo nos Iau, ond rwy'n gwybod bod yr Aelod dros Fro Morgannwg wedi bod yno. Mae hyn wedi achosi cryn bryder yng nghyffiniau'r Pendeulwyn, ac er bod croeso wedi bod i'r ymgynghoriadau, mae llawer o amwysedd o hyd o amgylch y dyddiadau a'r amserlenni cyflwyno posibl, neu beidio, fel y bo'n berthnasol, ac o ran pwy yn union sy'n cefnogi'r cynigion hyn? Ai'r awdurdod lleol neu Lywodraeth Cymru , neu a yw'n gyfuniad o'r ddau? Byddai datganiad gan yr Ysgrifennydd Cabinet perthnasol o fudd i roi gwybod i'r gymuned am y materion ynghylch y cynnig hwn.

Yn ail, a gawn ni ddatganiad gan yr Ysgrifennydd dros Iechyd ynghylch y newyddion dros y penwythnos gan Goleg Brenhinol y Meddygon fod problem gyfrifiadurol wedi bod o bosibl, sydd wedi effeithio ar 1,500 o gynigion am swyddi i feddygon iau a'u lleoliadau mewn rhannau eraill o'r Deyrnas Unedig ac, yn wir, mentraf ddweud, yng Nghymru hefyd—sut y gallai hyn fod wedi effeithio neu beidio ag effeithio ar swyddi sydd i'w llenwi yma yng Nghymru? Rydym i gyd yn ymwybodol o'r problemau recriwtio yn y gwasanaeth iechyd ym mhob rhan o'r Deyrnas Unedig. Ond mae'n destun pryder clywed am y broblem hon gan y Coleg Brenhinol, sydd wedi effeithio ar o leiaf 1,500 o gynigion swyddi o bosibl. Yn benodol, a gawn i wybod sut y gallai hynny fod wedi effeithio neu beidio ag effeithio ar wasanaethau iechyd yma yng Nghymru?

14:20

Thank you, Andrew R.T. Davies, for those questions. In relation to the first one, around the proposed road at junction 34, I understand the Cabinet Secretary for Economy and Transport has already written to the constituency Member, and so he will now update all Assembly Members in relation to that.

The second part of your question: the Cabinet Secretary for Health and Social Services is aware of, I think, this very unfortunate situation, and of course it does raise concerns. His officials are now in contact with the Wales Deanery to ensure that they will be very clear about any developments and to understand what impact it will have here in Wales. We need to ensure that the situation is, obviously, rectified as soon as possible.

Diolch, Andrew R.T. Davies, am y cwestiynau hynny. O ran y cwestiwn cyntaf, y ffordd arfaethedig ar Gyffordd 34, rwy'n deall bod Ysgrifennydd y Cabinet dros yr Economi a Thrafnidiaeth eisoes wedi ysgrifennu at yr Aelod yn yr etholaeth, ac felly bydd ef nawr yn diweddaru holl Aelodau'r Cynulliad ar hynny.

Ail ran eich cwestiwn: mae Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol yn ymwybodol o'r sefyllfa anffodus iawn hon, rwy'n credu, ac wrth gwrs mae'n codi pryderon. Mae ei swyddogion nawr mewn cysylltiad â Deoniaeth Cymru i sicrhau y byddant yn glir iawn ynghylch unrhyw ddatblygiadau ac i ddeall pa effaith a gaiff hyn yma yng Nghymru. Mae angen inni sicrhau bod y sefyllfa, yn amlwg, yn cael ei chywiro cyn gynted â phosibl.

Today, new leader of the house, for the time being, pro tem, the House of Lords is, of course, on its last realistic opportunity on Report Stage of amending the European Union (Withdrawal) Bill, and before them is a very important amendment in the name of a Labour lord, Lord Alli, supporting remaining in the European Economic Area as a negotiating objective of the UK Government. Now, that's precisely the aim, the stated aim, of the Welsh Government—leaving the EU but remaining in the single market and customs union—and is one of the negotiating objectives in the White Paper published by the Welsh Government. The fudge of a customs partnership—for once, I think Boris Johnson's probably got it right—is not going to suit anyone, and is a ridiculous way forward, and won't work. You're either in or you're out of a customs union. So, can we have a statement from the Welsh Government on what work it is doing now to support this vital amendment, which would in turn allow the House of Commons to make a decision, because it is the stated policy of the Welsh Government? In particular, has the Government instructed the two lords who are members of the Welsh Government to attend the House of Lords today and vote in line with Welsh Government policy? [Interruption.] My question is to the leader of the house, if I may.

Secondly, can we have a debate led by the Cabinet Secretary for Economy and Transport on cycle safety? I enjoyed a glorious cycle ride myself on Sunday, from Aberystwyth to Pontarfynach and around the back lanes of Ceredigion. Much of it was on a Sustrans route, so I was disappointed to read that our own First Minister doesn't feel safe to cycle in Cardiff. What does it say to how we prioritise cars over safe routes, and how we design our cities, if our own First Minister doesn't feel safe to cycle in his own capital city? Now, I've raised cycle safety before with the First Minister directly, and perhaps now we will all take it seriously, and take action so we see a genuine change in the way we travel and live our lives. We need to get past the welcome, yes, additional resources for safe routes to debate—and that's why I'm asking for a debate—what the alternative is for car journeys in our cities, and how we make our cities more accessible for all of us, including the First Minister when he wants to cycle. If he ever does want to cycle, when he's retired from his current role, up the Rheidol valley, I would be delighted to accompany him.

Heddiw, arweinydd newydd y tŷ, am y tro, pro tem, mae Tŷ'r Arglwyddi, wrth gwrs, ar ei gyfle realistig olaf ar Gyfnod Adrodd i ddiwygio Bil yr Undeb Ewropeaidd (Ymadael), a ger eu bron mae gwelliant pwysig iawn yn enw arglwydd Llafur, yr Arglwydd Alli, sy'n cefnogi aros yn yr Ardal Economaidd Ewropeaidd fel un o amcanion negodi Llywodraeth y DU. Nawr, dyna union nod, nod ddatganedig, Llywodraeth Cymru—gadael yr UE ond aros yn y farchnad sengl a'r Undeb Tollau—ac mae'n un o amcanion negodi y Papur Gwyn a gyhoeddwyd gan Lywodraeth Cymru. Ni fydd y llanast o bartneriaeth tollau—am unwaith, rwy'n credu bod Boris Johnson fwy na thebyg wedi'i gael yn iawn—yn mynd i fod yn addas i unrhyw un, ac mae'n ffordd ymlaen chwerthinllyd, ac ni fydd yn gweithio. Rydych chi naill ai y tu mewn neu'r tu allan i'r undeb tollau. Felly, a gawn ni ddatganiad gan y Llywodraeth ar ba waith y mae'n ei wneud nawr i gefnogi'r gwelliant hollbwysig hwn, a fydd yn ei dro yn caniatáu i Dŷ'r Cyffredin wneud penderfyniad, oherwydd mai hwn yw polisi datganedig Llywodraeth Cymru? Yn benodol, a yw'r Llywodraeth wedi rhoi cyfarwyddyd i'r ddau Arglwydd sy'n aelodau o Lywodraeth Cymru fynd i Dŷ'r Arglwyddi heddiw a phleidleisio yn unol â pholisi Llywodraeth Cymru? [Torri ar draws.] Mae fy nghwestiwn i arweinydd y tŷ, os caf i.

Yn ail, a gawn ni ddadl a arweinir gan Ysgrifennydd y Cabinet dros yr Economi a Thrafnidiaeth ar ddiogelwch beicio? Mwynheais daith feic ogoneddus fy hun ddydd Sul, o Aberystwyth i Bontarfynach ac o gwmpas lonydd cefn Ceredigion. Roedd llawer ohono ar lwybr Sustrans, felly roeddwn i'n siomedig o ddarllen nad yw ein Prif Weinidog yn teimlo'n ddiogel i feicio yng Nghaerdydd. Beth mae hyn yn ei ddweud o ran sut yr ydym ni'n blaenoriaethu ceir dros lwybrau diogel, a sut rydym ni'n dylunio ein dinasoedd, os nad yw ein Prif Weinidog yn teimlo'n ddiogel i feicio yn y brifddinas ei hun? Nawr, rwyf wedi codi mater ddiogelwch beicio o'r blaen gyda'r Prif Weinidog yn uniongyrchol, ac efallai y bydd pob un ohonom ni nawr yn ei gymryd o ddifrif, ac yn cymryd camau fel y gallwn weld newid gwirioneddol yn y ffordd yr ydym ni'n teithio ac yn byw ein bywydau. Mae angen inni symud ymlaen o'r adnoddau ychwanegol ar gyfer llwybrau diogel, y mae croeso iddyn nhw, oes, i gael dadl—a dyna pam rwyf yn gofyn am ddadl—ar beth yw'r dewis amgen i deithio mewn car yn ein dinasoedd, a sut rydym ni'n gwneud ein dinasoedd yn fwy hygyrch i bob un ohonom, gan gynnwys y Prif Weinidog pan mae eisiau beicio. Os bydd eisiau mynd ar ei feic unrhyw bryd, pan fydd wedi ymddeol o'i swydd bresennol, i fyny ar hyd Dyffryn Rheidol, byddwn i wrth fy modd yn mynd gydag ef.

Thank you, Simon Thomas. In relation to your first point, it has always been the Welsh Government's position that we should remain in the single market. We believe that's absolutely right for the economy of Wales, and I'm sure the Cabinet Secretary will update us at the appropriate time.

I'm not quite sure that's what the First Minister said. I only read the article very briefly, but I thought the reference was more to his age than to the fact that he didn't feel safe, but I'm sure he'll be very pleased to take you up on your offer.

Obviously, the Cabinet Secretary for Economy and Transport has made £60 million available to local authorities. It's now for local authorities to make sure that they have the cycle paths that are required by their local population.

Diolch, Simon Thomas. Mewn cysylltiad â'ch pwynt cyntaf, mae Llywodraeth Cymru bob amser wedi bod o'r farn y dylem ni barhau i fod yn y farchnad sengl. Credwn mai hynny yw'r peth iawn ar gyfer economi Cymru heb os nac oni bai, ac rwy'n siŵr y bydd Ysgrifennydd y Cabinet yn rhoi'r wybodaeth ddiweddaraf i ni ar yr adeg briodol.

Nid wyf yn hollol siŵr mai hynny a ddywedodd y Prif Weinidog. Dim ond darllen yr erthygl yn fyr iawn a wnes i, ond cefais yr argraff fod y cyfeiriad yn ymwneud yn fwy â'i oedran na'r ffaith nad oedd yn teimlo'n ddiogel, ond rwy'n siŵr y bydd ef yn falch iawn o dderbyn eich cynnig.

Yn amlwg, mae Ysgrifennydd y Cabinet dros yr Economi a Thrafnidiaeth wedi sicrhau bod £60 miliwn ar gael i awdurdodau lleol. Bellach mae angen i'r awdurdodau lleol wneud yn siŵr bod ganddyn nhw'r llwybrau beicio sy'n angenrheidiol ar gyfer eu poblogaeth leol.

Can I just ask two questions, Cabinet Secretary? Last week, I attended the real living wage leadership group and I met the directors of the Living Wage Foundation and Cynnal Cymru, which undertakes the accreditation of real living wage employers in Wales. It's reported that there are now 143 accredited real living wage employers in Wales, drawn from the public, private and third sector, as part of 4,000 real living wage accreditations UK-wide. Can you update on whether the real living wage will be acknowledged as part of the economic action plan and the gender review?

And, secondly, can I add to the question, following Andrew R.T. Davies, regarding the proposals affecting the people living in the Pendoylan area? I did attend a PACT meeting last week regarding the Welsh transport appraisal guidance road proposals to link the M4 to the A48.FootnoteLink Ten years ago there was a consultation over similar proposals and the Welsh Government decided not to proceed, but undertook to invest in improvements to Five Mile Lane, which are taking place, and improved frequency of bus and rail services on the Vale line to half-hourly. Can the Cabinet Secretary give a statement as to why those half-hourly rail services have not been implemented? I believe those would be the best way to improve access to Cardiff Airport and the St Athan enterprise zone in the Vale of Glamorgan.

A gaf i ofyn dim ond dau gwestiwn, Ysgrifennydd y Cabinet? Yr wythnos diwethaf, ymwelais i â'r grŵp arweinyddiaeth dros gyflog byw gwirioneddol a chwrdd â Chyfarwyddwyr y Sefydliad Cyflog Byw a Cynnal Cymru, sy'n ymgymryd ag achrediad cyflogwyr cyflog byw gwirioneddol yng Nghymru. Adroddir bod 143 o gyflogwyr cyflog byw achrededig gwirioneddol yng Nghymru nawr, yn y sector cyhoeddus, preifat a'r trydydd sector, sy'n rhan o'r 4,000 o achrediadau cyflog byw gwirioneddol ledled y DU. A wnewch chi roi'r wybodaeth ddiweddaraf ynghylch a fydd y cyflog byw gwirioneddol yn cael ei gydnabod yn rhan o'r cynllun gweithredu economaidd a'r adolygiad rhywedd?

Ac, yn ail, a gaf i ychwanegu at y cwestiwn, yn dilyn Andrew R.T. Davies, ynghylch y cynigion sy'n effeithio ar y bobl sy'n byw yn ardal Pendeulwyn? Es i gyfarfod o'r Bartneriaeth ar gyfer Gweithredu Cymunedol yr wythnos diwethaf ynghylch cynigion ffyrdd canllawiau arfarnu trafnidiaeth Cymru, i gysylltu'r M4 â'r A48.FootnoteLink Ddeng mlynedd yn ôl, cafwyd ymgynghoriad dros gynigion tebyg a phenderfynodd Llywodraeth Cymru beidio â bwrw ymlaen, ond addawodd y byddai'n buddsoddi mewn gwelliannau i Five Mile Lane, sydd yn mynd rhagddynt, ac yn gwella amlder y gwasanaethau bws a rheilffordd ar linell y Fro i bob hanner awr. A wnaiff Ysgrifennydd y Cabinet roi datganiad ynghylch pam na weithredwyd y gwasanaethau rheilffyrdd hynny bob hanner awr? Credaf mai'r gwasanaethau hynny fyddai'r ffordd orau o wella mynediad i Faes Awyr Caerdydd ac ardal fenter Sain Tathan ym Mro Morgannwg.

14:25

Thank you, Jane Hutt, for those two questions. In relation to the real living wage being acknowledged as part of the economic action plan and the gender review, you'll be aware that when the economic action plan was launched in December 2017, that really set out Welsh Government's vision for inclusive growth to boost our wealth and well-being and the narrowing of inequalities that we have across Wales. So, absolutely at the heart of that plan is a commitment to developing a new and very dynamic relationship between Government and businesses, based on the principle of public investment with a social purpose. I think, in particular, the focus on fair work as a key element of our new economic contract really will provide an opportunity to promote and raise awareness of the business benefits of the real living wage. And what we want to see is that increasingly adopted across Wales.

In relation to your second point, around the meeting you attended and whether the half-hourly rail services—why they haven't been implemented. As you know, we will take over the full responsibility for the Wales and borders rail service later this year and that will then enable us to introduce our own improved contract, service and systems for rail users across Wales and the borders. Obviously, specific services will be for the new operator and development partner, but our minimum requirement for the bidders tendering for the contract is that services will at least be equivalent to those currently provided. Obviously, the procurement process is still ongoing, so it's not appropriate for me to comment further on the outcome. 

Diolch, Jane Hutt, am y ddau gwestiwn hynny. O ran cydnabyddiaeth o'r cyflog byw gwirioneddol yn rhan o'r cynllun gweithredu economaidd a'r adolygiad rhywedd, byddwch yn ymwybodol o lansiad y cynllun gweithredu economaidd ym mis Rhagfyr 2017, sydd mewn gwirionedd yn nodi gweledigaeth Llywodraeth Cymru ar gyfer twf cynhwysol i hybu ein cyfoeth a'n lles a lleihau'r anghydraddoldebau sydd gennym ledled Cymru. Felly, yn hollol wrth wraidd y cynllun hwnnw mae ymrwymiad i ddatblygu perthynas newydd a deinamig iawn rhwng y Llywodraeth a busnesau, yn seiliedig ar yr egwyddor o fuddsoddi cyhoeddus gyda diben cymdeithasol. Credaf, yn benodol, y bydd canolbwyntio ar waith teg fel elfen allweddol o'n contract economaidd newydd yn gyfle i hyrwyddo a chodi ymwybyddiaeth o fanteision busnes y cyflog byw gwirioneddol. A'r hyn yr ydym eisiau ei weld yw hynny'n cael ei fabwysiadu fwyfwy ledled Cymru.

O ran eich ail bwynt, ynghylch y cyfarfod yr aethoch chi iddo a'r gwasanaethau rheilffyrdd bob hanner awr—pam nad ydyn nhw wedi'u gweithredu. Fel y gwyddoch, byddwn yn cymryd y cyfrifoldeb llawn am wasanaeth rheilffordd Cymru a'r Gororau yn ddiweddarach eleni a bydd hyn wedyn yn ein galluogi ni i gyflwyno ein contract, ein gwasanaeth a'n systemau gwell ni ein hunain ar gyfer defnyddwyr rheilffyrdd ledled Cymru a'r Gororau. Yn amlwg, bydd gwasanaethau penodol ar gyfer y gweithredwr newydd a'r partner datblygu, ond ein gofyniad sylfaenol ar gyfer cynigwyr sy'n tendro am y contract yw y bydd y gwasanaethau o leiaf yn cyfateb i'r rhai a ddarperir ar hyn o bryd. Yn amlwg, mae'r broses gaffael yn parhau o hyd, felly nid yw'n briodol imi wneud sylwadau pellach ar y canlyniad.

Cabinet Secretary, may I ask for a statement on respite services for people affected by dementia in Wales? The older people's commissioner has produced a report claiming that traditional respite care that does not meet people's needs is detrimental to their health and well-being. The report further claims that traditional respite services often lacked flexibility and did not always deliver positive outcomes. Cabinet Secretary, could we have a statement from your colleague, another Cabinet Secretary, the Cabinet Secretary for health, providing us with a full response to the concern raised in the older people's commissioner's report, please?

Ysgrifennydd y Cabinet, a gaf i ofyn am ddatganiad ar wasanaethau gofal seibiant ar gyfer pobl yr effeithir arnynt gan ddementia yng Nghymru? Mae'r comisiynydd pobl hŷn wedi cynhyrchu adroddiad sy'n honni bod gofal seibiant traddodiadol, nad yw'n diwallu anghenion pobl, yn andwyol i'w hiechyd a'u lles. Mae adroddiad pellach yn honni nad yw gwasanaethau seibiant traddodiadol yn aml yn ddigon hyblyg ac nid oedd bob amser yn cyflawni canlyniadau cadarnhaol. Ysgrifennydd y Cabinet, a gawn ni ddatganiad gan eich cyd-Aelod, Ysgrifennydd Cabinet arall, Ysgrifennydd y Cabinet dros Iechyd, yn rhoi ymateb llawn i'r pryder a godwyd yn adroddiad y comisiynydd pobl hŷn, os gwelwch yn dda?

Thank you. Once the Cabinet Secretary for Health and Social Services has had time to consider the report from the older people's commissioner, I'm sure he will then update Members, as he sees fit.

Diolch. Ar ôl i Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol gael amser i ystyried adroddiad y comisiynydd pobl hŷn, rwy'n siŵr y bydd ef wedyn yn diweddaru'r Aelodau, fel y gwêl yn dda.

Thank you, Cabinet Secretary. I've got two issues. The first one: it was clearly a desperately disappointing day last Thursday as we learnt of the news that nearly 800 jobs are to go at the Virgin Media call centre in Llansamlet in Swansea. The loss of hundreds of jobs is clearly going to have an impact locally. It means a huge uncertain and distressing time for staff and their families. Now, I realise that written statements have been produced, but I would hope that the Welsh Government will now provide as much support as possible to those affected. But the announcement also raises questions about the level of communication between the Welsh Government and major companies such as this, because last year we had a similar announcement with a Tesco call centre moving over 1,000 jobs from Cardiff, with the Welsh Government again seemingly being made aware only when the announcement was made public. Now, given that the call centre sector is a key employer in Swansea, as in other parts of Wales, I would expect the Welsh Government to be fully aware of any difficulties faced by employers or of any planned changes before such public announcements are made. The Virgin Media announcement therefore raises questions about the type of relationship that the Welsh Government has with business and the mechanisms that you have in place to gather intelligence and to formally discuss and resolve any business pressures or planned changes. So, with all of that in mind, I'd be grateful if the Cabinet Secretary would bring forward a statement that we can debate here on the Virgin Media call-centre decision.

And my second issue is on the costs of medical indemnity for GPs. That's the cost of medical insurance that we—all GPs, all doctors—have to have. Before you can practise as a doctor, you have to have insurance to cover any possible costs of litigation, which runs into several thousands of pounds, and for GPs this is paid personally. Full-time GPs pay as much as £6,000 to £8,000 a year, and even as part-time GPs, that cost can be £3,500 or more. And that is paid personally by GPs. Hospital doctors have those costs paid for them. The situation as regards GPs increasingly going part-time, or doing locum work later in their careers, is that they are now weighing up the costs of still paying that medical indemnity insurance with the costs going up, with wanting to do one or two days' work, and finding that doing one or two days' work does not pay for the costs of the medical indemnity. So, I'd be grateful if that situation could be looked at in some detail by the Cabinet Secretary, because we are losing a valuable and experienced sector of the GP workforce through inaction on this point. Diolch yn fawr.

Diolch, Ysgrifennydd y Cabinet. Mae gennyf i ddau fater. Yr un cyntaf: roedd dydd Iau diwethaf yn amlwg yn ddiwrnod eithaf siomedig wrth inni glywed y newyddion y bydd bron i 800 o swyddi yn cael eu colli yng nghanolfan alw Virgin Media yn Llansamlet yn Abertawe. Mae colli cannoedd o swyddi yn amlwg yn mynd i gael effaith yn lleol. Mae'n golygu amser ansicr a thrallodus iawn i'r staff a'u teuluoedd. Nawr, rwy'n sylweddoli y cynhyrchwyd datganiadau ysgrifenedig, ond byddwn yn gobeithio y bydd Llywodraeth Cymru yn darparu cymaint o gymorth â phosibl i'r rheini yr effeithir arnynt. Ond mae'r cyhoeddiad hefyd yn codi cwestiynau ynglŷn â lefel y cyfathrebu rhwng Llywodraeth Cymru a chwmnïau mawr fel hyn. Oherwydd y llynedd bu cyhoeddiad tebyg pan symudwyd dros 1,000 o swyddi yng nghanolfan alwadau Tesco o Gaerdydd, gyda Llywodraeth Cymru eto yn amlwg yn cael gwybod dim ond pan wnaed y cyhoeddiad cyhoeddus. Nawr, gan fod y sector canolfannau galw yn gyflogwr allweddol yn Abertawe, fel mewn rhannau eraill o Gymru, byddai disgwyl i Lywodraeth Cymru fod yn gwbl ymwybodol o unrhyw anawsterau a wynebir gan gyflogwyr neu o unrhyw newidiadau arfaethedig cyn i ddatganiadau cyhoeddus o'r fath gael eu gwneud. Mae cyhoeddiad Virgin Media felly yn codi cwestiynau am y math o berthynas sydd rhwng Llywodraeth Cymru a busnesau, a'r mecanweithiau a sefydlwyd i gasglu gwybodaeth ac i drafod yn ffurfiol a datrys unrhyw bwysau busnes neu newidiadau arfaethedig. Felly, gyda hynny i gyd mewn golwg, byddwn yn ddiolchgar pe bai Ysgrifennydd y Cabinet yn cyflwyno datganiad y gallwn ni ei drafod yma ar benderfyniad canolfan alwadau Virgin Media.

A'r ail fater yw'r costau indemniad meddygol ar gyfer meddygon teulu. Dyna'r gost yswiriant meddygol y mae'n rhaid i ni—pob meddyg teulu, pob meddyg—ei chael. Cyn y cewch ymarfer fel meddyg, mae'n rhaid  chi gael yswiriant i dalu am unrhyw gostau posibl o ymgyfreitha, sy'n filoedd o bunnoedd, ac ar gyfer meddygon teulu telir hwn yn bersonol. Mae meddygon teulu llawn amser yn talu cymaint â £6,000 i £8,000 y flwyddyn, a hyd yn oed i feddygon teulu rhan-amser, gall y costau fod yn £3,500 neu fwy. A thelir hyn yn bersonol gan feddygon teulu. Telir y costau hynny ar ran meddygon ysbyty. Y sefyllfa o ran meddygon teulu sy'n mynd yn fwyfwy rhan-amser, neu'n gwneud gwaith locwm nes ymlaen yn eu gyrfaoedd, yw eu bod yn pwyso'r costau o barhau i dalu'r yswiriant indemniad meddygol hwnnw a'r costau cynyddol, gyda'r awydd i wneud un neu ddau ddiwrnod o waith, a chanfod nad yw gwneud un neu ddau ddiwrnod gwaith yn talu am gostau indemniad meddygol. Felly, byddem yn ddiolchgar pe gellid edrych yn fanwl ar y sefyllfa honno gan Ysgrifennydd y Cabinet, oherwydd ei bod yn colli sector gwerthfawr a phrofiadol o weithlu meddygon teulu drwy beidio â gweithredu ar y pwynt hwn. Diolch yn fawr.

14:30

Diolch, Dai Lloyd, for those two questions. In relation to Virgin Media, obviously we're extremely disappointed by their plans to close their customer engagement centre in Swansea, and Welsh Government was not informed of this prior to the announcement. Obviously, we can only act if we're told, but the Cabinet Secretary for Economy and Transport has set up a task and finish group, on the same model as the one that he set up in relation to Tesco, which you mentioned earlier. And, also, alongside that, the Welsh Contact Centre Forum will work, where it can, with Virgin Media and the affected employees to help them secure, obviously, employment again. One of the reasons that we provide financial support to that forum is to enable them to do that. Employment opportunities are being created at other regulated customer service centres across south Wales, so I know the Cabinet Secretary is confident, as with Tesco, that alternative employment can be found.

The Cabinet Secretary for Health and Social Services will have heard your request for a statement around medical indemnity fees for general practitioners, which I think is a very pertinent point.

Diolch, Dai Lloyd, am y ddau gwestiwn hynny. O ran Virgin Media, yn amlwg rydym ni'n siomedig iawn ynghylch eu cynlluniau i gau eu canolfan gwsmeriaid yn Abertawe, ac ni chafodd Llywodraeth Cymru wybod am hyn cyn y cyhoeddiad. Yn amlwg, ni allwn ni weithredu os nad ydym ni'n ymwybodol o'r sefyllfa, ond mae Ysgrifennydd y Cabinet dros yr Economi a Thrafnidiaeth wedi sefydlu grŵp gorchwyl a gorffen, ar yr un model â'r un a sefydlodd mewn perthynas â Tesco, a grybwyllwyd gennych chi yn gynharach. A, hefyd, ochr yn ochr â hynny, bydd Fforwm Canolfannau Cyswllt Cymru yn gweithio, lle y gall, gyda Virgin Media a gweithwyr a gaiff eu heffeithio gan hyn i'w helpu i sicrhau cyflogaeth eto, yn amlwg. Un o'r rhesymau pam yr ydym ni'n darparu cymorth ariannol i'r fforwm hwnnw yw er mwyn ei alluogi i wneud hynny. Mae cyfleoedd cyflogaeth yn cael eu creu mewn canolfannau gwasanaethau i gwsmeriaid rheoledig eraill ar draws De Cymru, felly rwy'n gwybod fod Ysgrifennydd y Cabinet yn ffyddiog, fel gyda Tesco, y gellir dod o hyd i waith arall.

Bydd Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol wedi clywed eich cais am ddatganiad ynghylch ffioedd indemniad meddygol ar gyfer meddygon teulu, ac rwy'n credu bod hynny'n bwynt perthnasol iawn. 

Can we have a debate on the announcement that the First Minister mentioned in his questions today, that the Department for Work and Pensions plans to close five offices across south Wales and centralise those jobs in one new build, in Treforest? The plans will affect jobs in Newport, Cwmbran, Caerphilly and Merthyr, as well as 714 staff working at the Gabalfa office, in my constituency of Cardiff North—1,700 jobs altogether. Does she agree that this will take public sector jobs away from many needy communities, and will impact unfairly on staff, in increasing travel time and costs, and it will particularly affect those with caring responsibilities? And, above all, it is not supporting the Valleys taskforce, as Fiona Jones from the DWP says in her letter to Assembly Members, because these are not new jobs, and they are being moved from many needy communities. So, could we have a debate on this very important issue?

A allwn ni gael dadl ar y cyhoeddiad y soniodd y Prif Weinidog amdano yn ei gwestiynau heddiw, fod yr Adran Gwaith a Phensiynau yn bwriadu cau pum swyddfa yn y de a chanoli'r swyddi hynny mewn un adeilad newydd, yn Nhrefforest? Bydd y cynlluniau yn effeithio ar swyddi yng Nghasnewydd, Cwmbrân, Caerffili a Merthyr, yn ogystal ag ar 714 o aelodau staff sy'n gweithio yn swyddfa Gabalfa, yn fy etholaeth i, Gogledd Caerdydd—cyfanswm o 1,700 o swyddi i gyd A yw hi'n cytuno y bydd hyn yn amddifadu cymunedau anghenus o swyddi sector cyhoeddus, ac yn cael effaith annheg ar y staff, o ran cynyddu amser a chostau teithio, ac y bydd yn enwedig yn effeithio ar y rhai sydd â chyfrifoldebau gofalu? Ac, yn anad dim, nid yw'n cefnogi Tasglu'r Cymoedd, fel y dywed Fiona Jones o'r Adran Gwaith a Phensiynau yn ei llythyr at Aelodau'r Cynulliad, oherwydd nid swyddi newydd mo'r rhain, ac maen nhw'n cael eu symud o lawer o gymunedau anghenus. Felly, a gawn ni ddadl ar y mater pwysig iawn hwn?

Thank you, Julie Morgan. And you will have heard the First Minister's concern around this decision. Obviously, it's a non-devolved matter; it's been taken by the UK Government. We understand that approximately 1,400 DWP staff will be affected by the relocation proposals, which were announced by the DWP last week. As the First Minister said, these are not new jobs. We know that staff are currently based in benefit offices in Merthyr, Caerphilly, Cwmbran, Newport and Gabalfa, Cardiff, in your own constituency, and the prospect is of moving to a new building in Treforest in 2021. We do understand the DWP are working to ensure that there are no job losses for staff resulting from the relocation, and that staff will be offered alternative roles, if relocation is not an option. But, clearly, as a Government, we are very concerned about this decision by the UK Government.

Diolch i chi, Julie Morgan. A byddwch wedi clywed pryder y Prif Weinidog ynghylch y penderfyniad hwn. Yn amlwg, mae'n fater sydd heb ei ddatganoli; mae'n benderfyniad a wnaed gan Lywodraeth y DU. Rydym ni'n deall y bydd y cynigion adleoli, a gyhoeddwyd gan yr adran Gwaith a Phensiynau yr wythnos diwethaf, yn effeithio ar oddeutu 1,400 o staff yr adran. Fel y dywedodd y Prif Weinidog, nid swyddi newydd mo'r rhain. Rydym ni'n gwybod bod staff wedi'u lleoli ar hyn o bryd mewn swyddfeydd budd-daliadau ym Merthyr, Caerffili, Cwmbrân, Casnewydd a Gabalfa, Caerdydd, yn eich etholaeth chi eich hun, ac mai'r posibilrwydd yw symud i adeilad newydd yn Nhrefforest yn 2021. Rydym ni yn deall bod yr Adran Gwaith a Phensiynau yn gweithio i sicrhau nad oes unrhyw golledion swyddi ar gyfer staff o ganlyniad i adleoli, ac y bydd swyddi amgen yn cael eu cynnig i staff, os nad yw adleoli yn ddewis posibl. Ond, yn amlwg, fel Llywodraeth, rydym ni'n bryderus iawn am y penderfyniad hwn gan Lywodraeth y DU.

A gaf fi ofyn am ddatganiad buan ar ddyfodol ariannu'r cynllun SchoolBeat? Mae'n fater rwyf fi, ac eraill, wedi ei godi'n gyson dros y misoedd diwethaf. Mae yna ansicrwydd—nid yw'r gwasanaeth yn gwybod a fydd yn gallu parhau tan i'r Llywodraeth benderfynu beth sy'n digwydd. Mae yn wasanaeth pwysig, wrth gwrs, gyda heddluoedd yn mynd i mewn i ysgolion i weithio gyda disgyblion a staff ar ddatblygu adnoddau a darparu dosbarthiadau ar ddiogelwch ar y we, camddefnydd sylweddau ac yn y blaen. Ond rydym ni nawr yn y sefyllfa yng ngogledd Cymru lle mae yna swyddi gwag o fewn y rhaglen, lle nad oes posib recriwtio staff oherwydd yr ansicrwydd sy'n deillio o benderfyniad eich Llywodraeth chi. Felly, a gaf bwyso plîs am ddatganiad buan, oherwydd mae hwn yn wasanaeth sy'n cael ei werthfawrogi gan y disgyblion, gan y staff, gan yr athrawon, ac mae'n ddyletswydd ar y Llywodraeth i roi'r eglurder yna?

May I ask for an early statement on SchoolBeat and its funding? It's a matter that I and others have raised regularly over the past few months. There is some uncertainty. The service doesn't know whether it will be able to persist until the Government makes a decision on its funding. It's an important service, with police forces going into schools to work with pupils and staff on developing resources and providing classes on online security, the misuse of substances and so on and so forth. But we're now in a situation in north Wales where there are vacant posts within the programme where it isn't possible to recruit staff because of the uncertainty emerging from your Government's decision. So, can I ask you for an early statement on this because this is a service that is appreciated by pupils, by staff, by teachers, and it's the Government's duty to provide that clarity?

14:35

I am very well aware of the service and I will ask the Cabinet Secretary for Health and Social Services, whose remit it comes under, to write to the Member around that issue.FootnoteLink

Rwy'n ymwybodol iawn o'r gwasanaeth a byddaf yn gofyn i Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol, sy'n gyfrifol am hyn, i ysgrifennu at yr Aelod ynghylch y mater hwnnw.FootnoteLink

Pwynt o Drefn
Point of Order

Diolch i'r Ysgrifennydd Cabinet. Pwynt o drefn—point of order—Joyce Watson. 

Thank you, Cabinet Secretary. Point of order, Joyce Watson. 

Llywydd, following the point of order that I made last Wednesday in this Chamber, I wish to correct the record and confirm that I did in fact use the words quoted by the leader of the UKIP group during a previous debate. 

Llywydd, yn sgil y pwynt o drefn a wneuthum ddydd Mercher diwethaf yn y Siambr hon, hoffwn gywiro'r cofnod a chadarnhau y gwnes i mewn gwirionedd ddefnyddio'r geiriau a ddyfynwyd gan arweinydd y grŵp UKIP yn ystod dadl flaenorol.

Further to that point of order, Llywydd—

Ymhellach i'r pwynt hwnnw o drefn, Llywydd —

No. The point of order has been clarified and corrected, and I am satisfied with that and there is nothing further to this point of order to be made at this time. [Interruption.] 

Na. Mae'r pwynt o drefn wedi'i egluro a'i gywiro, ac rwy'n fodlon ar hynny ac nid oes dim rhagor ynglŷn â'r pwynt o drefn hwn i'w wneud ar hyn o bryd. [Torri ar draws.]

Rŷm ni'n symud ymlaen, felly, i'r datganiad—

We move on, therefore, to the statement—

Your microphone is not on. The people of Wales cannot hear you, and if the people of Wales cannot hear you, then the Assembly Members in this Chamber are not to hear you. [Interruption.] Yes, thank you very much for writing to me in advance, and as I have already told you this afternoon, I met with Joyce Watson, and she has agreed and corrected and clarified the matter that was raised last week, and this matter has no place else to go. And I am moving on to next business. [Interruption.] Neil Hamilton, you will sit down at this point because you are not being asked to speak or to make any further contribution to this point [Interruption.] Nothing you have said during this point has been on the record or on microphone.

Nid yw eich microffon arnodd. Ni all pobl Cymru eich clywed, ac os na all pobl Cymru eich clywed, yna ni all yr Aelodau Cynulliad yn y Siambr hon eich clywed. [Torri ar draws.] Ie, diolch yn fawr iawn am ysgrifennu ataf ymlaen llaw, ac fel yr wyf eisoes wedi dweud wrthych chi y prynhawn yma, fe wnes i gyfarfod â Joyce Watson, ac mae hi wedi cytuno a chywiro ac egluro'r mater a grybwyllwyd yr wythnos diwethaf, a does dim byd arall i'w ddweud ynghylch y mater hwn. Rwy'n symud ymlaen i'r eitem nesaf. [Torri ar draws.] Neil Hamilton, fe wnewch chi eistedd nawr oherwydd ni ofynnir ichi siarad neu i wneud unrhyw gyfraniad pellach i'r pwynt hwn [torri ar draws.] Nid oes dim yr ydych chi wedi ei ddweud yn ystod y pwynt hwn wedi'i roi ar y cofnod nac ar y meicroffon.

3. Datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol: Adroddiad y Gwasanaeth Cynghori ar Iechyd a Gofal Cymdeithasol (HASCAS) i’r gofal a’r driniaeth a ddarparwyd ar ward Tawel Fan
3. Statement by the Cabinet Secretary for Health and Social Services: The Health and Social Care Advisory Service (HASCAS) Report into the care and treatment provided on Tawel Fan

I am moving on to the next point of business and that is item 3, which is the statement by the Cabinet Secretary for Health and Social Services on the report into—. I have this in Welsh in front of me, so I'm going to change to Welsh at this point. 

Rwy'n symud ymlaen at yr eitem nesaf o fusnes i'w drafod, ac eitem 3 yw hwnnw, sef y datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol ar yr adroddiad ynghylch—. Mae hwn gennyf yn Gymraeg o'm mlaen i, felly rwy'n mynd i droi i'r Gymraeg nawr. 

Adroddiad y Gwasanaeth Cynghori ar Iechyd a Gofal Cymdeithasol, HASCAS, i'r gofal a'r driniaeth a ddarparwyd ar ward Tawel Fan, ac rwy'n galw ar yr Ysgrifennydd Cabinet i wneud ei ddatganiad. Vaughan Gething.

The Health and Social Care Advisory Service Report, HASCAS, into the care and treatment provided on Tawel Fan, and I call on the Cabinet Secretary to make his statement. Vaughan Gething. 

Diolch, Llywydd. On 3 May, the Health and Social Care Advisory Service published the outcome of its investigation into the care and treatment provided on the Tawel Fan ward. I am acutely aware that this has been a very difficult period for all individuals, families and staff directly affected by the concerns over care and treatment at Tawel Fan. I acknowledge the additional strain caused by the length of this investigation. It was, however, essential that the investigation remained focused on a thorough and fair process that was not compromised to achieve restrictive timescales.The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry that this happened and I apologise for it without hesitation.

The scope of the investigation was significant and broader than the original commission. It ultimately involved reviewing 700,000 pages of documentation, 148 interviews and 108 case reviews. It also considered material provided as part of previous investigations. This was a broad remit, and unlike previous reports, it was able to have access to a comprehensive set of documentation, including clinical records, and draw in specific mental health expertise. HASCAS maintained an independent and evidence-based stance throughout, with the aim of providing as accurate an account of events as the evidence available allows. This has been done with the support of an expert panel of 16 individuals of national standing.

I do need though to address the accusation made that there was a direct link between the Welsh Government and HASCAS that affects the independence of the report. The inference of a conspiracy directing the report to protect the Government or a political party is a direct attack on the integrity of HASCAS and the individuals on the investigation panel. None of the investigation panel were practitioners in Wales. The legal advice to the HASCAS investigation was independent of the Welsh Government, and HASCAS, as an organisation, has undertaken a range of reviews, for example, into the English health and care system without fear or favour, and there is no reasonable basis to attack their integrity in this matter. 

Diolch, Llywydd. Ar 3 Mai, cyhoeddodd y Gwasanaeth Cynghori ar Iechyd a Gofal Cymdeithasol ganlyniad ei ymchwiliad i'r gofal a'r driniaeth a ddarparwyd ar ward Tawel Fan. Rwy'n ymwybodol iawn y bu hyn yn gyfnod anodd iawn i'r holl unigolion, teuluoedd a staff sydd wedi eu heffeithio'n uniongyrchol gan y pryderon ynghylch gofal a thriniaeth yn Tawel Fan. Rwy'n cydnabod y pwysau ychwanegol a achoswyd gan hyd yr ymchwiliad hwn. Fodd bynnag, roedd hi'n hanfodol bod yr ymchwiliad yn parhau i ganolbwyntio ar broses deg a thrwyadl, ac na thanseiliwyd hynny er mwyn ymlynu ag amserlenni caeth. Roedd yr adroddiad yn nodi amrywiaeth o fethiannau a oedd yn siom i gleifion ac a arweiniodd at achosi niwed gwirioneddol. Mae'n ddrwg iawn gennyf fod hyn wedi digwydd ac rwy'n ymddiheuro yn ei gylch heb unrhyw betruso.

Roedd cwmpas yr ymchwiliad yn sylweddol ac yn ehangach na'r comisiwn gwreiddiol. Yn y pen draw, fe olygodd adolygu 700,000 o dudalennau o ddogfennaeth, 148 o gyfweliadau a 108 o adolygiadau achos. Roedd yr ymchwiliad yn ystyried hefyd ddeunydd a ddarparwyd yn rhan o ymchwiliadau blaenorol. Roedd hwn yn gylch gwaith eang, ac yn wahanol i adroddiadau blaenorol, roedd modd gweld set gynhwysfawr o ddogfennau, gan gynnwys cofnodion clinigol, a manteisio ar arbenigedd iechyd meddwl penodol. Seiliodd HASCAS ei safbwynt ar annibyniaeth a thystiolaeth drwy gydol y broses, â'r nod o ddarparu darlun mor gywir o ddigwyddiadau ag y caniatâ'r dystiolaeth sydd ar gael. Gwnaed hyn gyda chymorth panel arbenigol o 16 o unigolion sy'n uchel iawn eu parch yn genedlaethol.

Mae angen imi roi sylw i'r cyhuddiad a wnaed fod cysylltiad uniongyrchol rhwng Llywodraeth Cymru a'r Gwasanaeth Cynghori sy'n effeithio ar annibyniaeth yr adroddiad. Mae'r awgrym bod yna gynllwyn i lywio'r adroddiad er mwyn amddiffyn y Llywodraeth neu blaid wleidyddol yn ymosodiad uniongyrchol ar ddidwylledd HASCAS a'r unigolion ar y panel ymchwilio. Nid oedd unrhyw un ar y panel ymchwilio yn ymarferwyr yng Nghymru. Roedd y cyngor cyfreithiol a roddwyd i ymchwiliad HASCAS yn annibynnol ar y Llywodraeth, ac mae HASCAS, fel sefydliad, wedi cynnal amrywiaeth o adolygiadau, er enghraifft, yn y system iechyd a gofal yn Lloegr heb ofn na ffafriaeth, ac nid oes unrhyw sail resymol i ymosod ar eu didwylledd yn y mater hwn.

Daeth y Dirprwy Lywydd (Ann Jones) i’r Gadair.

The Deputy Presiding Officer (Ann Jones) took the Chair.

14:40

I do understand that many will have been surprised by the findings of their report. However, anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached. In relation to the care on Tawel Fan the independent findings are that the levels of care and treatment provided on Tawel Fan ward were of good overall general standards and that good nursing was provided.

Whilst assurance can be taken from some of the findings, the report is a difficult read. It is far from a clean bill of health. I do not shy away from the significant issues it highlights across a number of areas, including governance and clinical leadership; service design and care pathways; and safeguarding. Many of the issues go beyond mental health services at the Tawel Fan ward.

HASCAS will be meeting individually with each family to discuss individual patient reports, which are crucial in providing the detail of the care provided. I hope that, alongside the thematic report, the individual reports will provide assurance to families about the integrity of the investigation. A similar process will also take place for staff who have been affected. I have already sought assurance that the health board is providing appropriate levels of support to both staff and families during this process.

As I have already stated, it is very clear that further, sustained improvement is still required by the health board. This will require further focused oversight under the special measures arrangements. 

The report does though acknowledge the considerable journey that the health board has embarked upon, recognising that it hasn’t stood still since the period being investigated. The report states the health board has made significant progress in key areas detailed in the dementia strategy, for instance, having a designated consultant nurse in dementia care. It also recognises the steady progress that Betsi Cadwaladr has made in relation to patient and carer support, and working proactively to support the care home sector.

The report also references many areas where they saw good practice. I am keen that, despite the criticism in the report, we recognise the excellent care provided by so many staff across the health board, both then and every day since the events that this report examined. For example, the nursing team on the Bryn Hesketh mental health in-patient unit have been shortlisted for an award that recognises those who have achieved excellence in their field of nursing. 

However, despite some positives, I continue to be very clear with the health board about the need to increase the pace of improvements and to deal with issues that are again highlighted in this report, and I will set out my expectations for that improvement. I will today publish a special measures improvement framework that sets out the milestones and expectations for the health bard for the next 18 months in leadership and governance, strategic and service planning, mental health and primary care, including out-of-hours services.

This improvement clearly references the work required by the organisation as a result of the recommendations from HASCAS. It may require a further update after Donna Ockenden’s governance review, which is expected shortly. This will take the form of a detailed quality and governance improvement plan to be prepared by the health board and to be available by the board’s July meeting this summer. I will continue to provide ministerial oversight with monthly accountability meetings with the chair and the chief executive. I expect Betsi Calwaladr to provide detailed progress reports against the new improvement framework and the first report will be provided in October this year.

Key to improvements is strong leadership for the organisation. I previously reported that a new chair will lead the next critical phase of the health board’s improvement journey. I am pleased to announce today that Mark Polin has been appointed to the role. He will bring a wealth of public sector leadership and governance experience, commitment to and knowledge of the communities of north Wales from his current role as the chief constable of North Wales Police. I will provide a further update on his appointment and the special measures arrangements in an oral statement in early June.

I expect strong leadership, and especially clinical leadership, from all parts of the organisation to address once and for all the issues that this report identifies. There must be a significant culture change to move from the current underlying resistance to clinical policy and consistency in practice. The board will need to give this rapid and serious consideration to determine what steps need to be taken to change ways of working. I expect, at the least, to see this demonstrated in clinical leadership and engagement to support the design and delivery of a care pathway for older people with dementia, together with the significant improvement in mental health provision that is still required.

I expect both the health board and local authority partners to carefully consider the findings in relation to the operation of safeguarding arrangements. Protecting people at risk from all forms of abuse and neglect is one of the key priorities of the Welsh Government. This is clearly reflected in the legislation and policy that we have introduced in this term and the previous one.

I expect the findings in this report to be used to hold a mirror up to all NHS organisations in Wales. I am therefore writing to all chairs and chief executives of NHS organisations in Wales, asking their boards to consider the report's recommendations and to confirm how they will use the findings to improve their organisation. I will also expect the chief medical officer and the chief nursing officer to engage with professional executive leads to ensure that lessons drawn from this report are embedded in the future planning and delivery of healthcare in Wales. These are immediate actions being taken in response to the findings of the HASCAS report. I will of course continue to update Members on the progress being made on the wider required improvement.

Rwy'n deall y bydd llawer wedi'u synnu gan ganfyddiadau eu hadroddiad. Fodd bynnag, dylai unrhyw un sydd wedi rhoi o'u hamser i ddarllen yr adroddiad yn ofalus sylweddoli pa mor drylwyr oedd yr ymchwiliad a deall sut y daethpwyd i'r casgliadau. O ran y gofal yn Tawel Fan, y canfyddiadau annibynnol yw bod graddau'r gofal a'r driniaeth a ddarparwyd ar ward Tawel Fan o safon gyffredinol da ar y cyfan ac y darparwyd gofal nyrsio da.

Er bod rhai o'r canfyddiadau yn rhoi sicrwydd inni, mae'r adroddiad yn boenus i'w ddarllen. Mae ymhell o fod yn berffaith. Nid wyf yn gwadu'r materion sylweddol y mae'n eu hamlygu mewn nifer o feysydd, gan gynnwys llywodraethu ac arweinyddiaeth glinigol; dyluniad y gwasanaethau a'r llwybrau gofal; a diogelu. Mae llawer o'r materion yn mynd y tu hwnt i wasanaethau iechyd meddwl ar ward Tawel Fan.

Bydd HASCAS yn cwrdd yn unigol â phob teulu i drafod adroddiadau cleifion unigol, sydd yn hollbwysig wrth ddarparu manylion ynglŷn â'r gofal a ddarparwyd. Rwy'n gobeithio, ochr yn ochr â'r adroddiad thematig, y bydd adroddiadau unigol yn rhoi sicrwydd i deuluoedd ynghylch didwylledd yr ymchwiliad. Cynhelir proses debyg ar gyfer staff sydd wedi cael eu heffeithio hefyd. Rwyf eisoes wedi ceisio sicrwydd bod y Bwrdd Iechyd yn darparu'r graddau priodol o gymorth i staff a theuluoedd yn ystod y broses hon.

Fel yr wyf i wedi'i ddweud eisoes, mae'n glir iawn bod angen i'r Bwrdd Iechyd ddal ati i wella'n barhaus. Bydd angen goruchwyliaeth benodol bellach o dan y trefniadau mesurau arbennig er mwyn gwneud hyn.  

Mae'r adroddiad er hynny yn cydnabod y daith sylweddol y mae'r Bwrdd Iechyd wedi dechrau arni, gan gydnabod nad yw wedi sefyll yn ei unfan ers y cyfnod sy'n cael ei ymchwilio. Mae'r adroddiad yn dweud bod y Bwrdd Iechyd wedi gwneud cynnydd sylweddol mewn meysydd allweddol y manylir arnyn nhw yn y strategaeth dementia, er enghraifft, bod â nyrs ymgynghorol dynodedig ym maes gofal dementia erbyn hyn. Mae hefyd yn cydnabod y cynnydd cyson y mae Betsi Cadwaladr yn ei wneud o ran cymorth i gleifion a gofalwyr, a gweithio mewn modd rhagweithiol i gynorthwyo'r sector cartrefi gofal.

Mae'r adroddiad hefyd yn cyfeirio at nifer o feysydd lle gwelsant arfer da. Rwy'n awyddus, er gwaethaf y feirniadaeth yn yr adroddiad, ein bod yn cydnabod y gofal rhagorol a ddarperir gan gynifer o staff ar draws y Bwrdd Iechyd, bryd hynny a phob dydd ers y digwyddiadau y mae'r adroddiad hwn yn eu harchwilio. Er enghraifft, mae'r tîm nyrsio yn uned iechyd meddwl cleifion mewnol Bryn Hesketh wedi cyrraedd rhestr fer ar gyfer gwobr sy'n cydnabod y rhai sydd wedi cyflawni rhagoriaeth yn eu maes nyrsio.

Fodd bynnag, er gwaethaf rhai pethau cadarnhaol, rwy'n parhau i fod yn glir iawn gyda'r Bwrdd Iechyd ynglŷn â'r angen i gyflymu'r gwelliannau ac i ymdrin â materion a amlygwyd yn yr adroddiad hwn eto, a byddaf yn egluro fy nisgwyliadau ar gyfer y gwelliant hwnnw. Byddaf heddiw yn cyhoeddi fframwaith gwelliant mesurau arbennig sy'n nodi cerrig milltir a disgwyliadau ar gyfer y bwrdd iechyd ar gyfer y 18 mis nesaf o ran arweinyddiaeth a rheolaeth, cynllunio strategol a chynllunio gwasanaethau, iechyd meddwl a gofal sylfaenol, gan gynnwys gwasanaethau y tu allan i oriau.

Mae'r gwelliant hwn yn amlwg yn cyfeirio at y gwaith sy'n ofynnol i'r sefydliad ei wneud o ganlyniad i argymhellion HASCAS. Efallai y bydd angen diweddariad pellach ar ôl adolygiad llywodraethu Donna Ockenden, a ddisgwylir cyn bo hir. Bydd hyn ar ffurf cynllun gwella ansawdd a llywodraethu manwl a gaiff ei baratoi gan y Bwrdd Iechyd ac sydd i fod ar gael erbyn cyfarfod y Bwrdd ym mis Gorffennaf yr haf hwn. Byddaf yn parhau i ddarparu goruchwyliaeth weinidogol gyda chyfarfodydd atebolrwydd bob mis gyda'r Cadeirydd a'r Prif Weithredwr. Rwy'n disgwyl i Betsi Cadwaladr ddarparu adroddiadau cynnydd manwl o'i gymharu â'r fframwaith gwella newydd ac fe gaiff yr adroddiad cyntaf ei ddarparu ym mis Hydref eleni.

Mae arweinyddiaeth gref ar gyfer y sefydliad yn allweddol i'r gwelliannau hyn. Rwyf wedi sôn o'r blaen y bydd cadeirydd newydd yn arwain cam tyngedfennol nesaf taith y Bwrdd Iechyd tuag at welliant. Rwy'n falch o gyhoeddi heddiw fod Mark Polin wedi'i benodi i'r swyddog. Bydd yn dod â chyfoeth o brofiad o arweinyddiaeth a llywodraethu yn y sector cyhoeddus, ynghyd ag ymrwymiad a gwybodaeth am gymunedau'r gogledd o'i swydd bresennol yn Brif Gwnstabl Heddlu Gogledd Cymru. Byddaf yn rhoi diweddariad pellach ar ei benodiad a'r trefniadau mesurau arbennig mewn datganiad llafar ddechrau mis Mehefin. 

Rwy'n disgwyl arweiniad cryf, ac arweinyddiaeth glinigol yn enwedig, gan bob rhan o'r sefydliad i fynd i'r afael unwaith ac am byth â materion y mae'r adroddiad hwn yn eu nodi. Mae'n rhaid cael newid diwylliant sylweddol er mwyn cefnu ar y gwrthwynebiad sylfaenol presennol i'r polisi clinigol a chysondeb o ran arferion. Bydd angen i'r Bwrdd ystyried hyn yn ddwys ac ar fyrder er mwyn penderfynu beth sydd angen ei wneud i newid ffyrdd o weithio. Rwy'n disgwyl, o leiaf, gweld arwyddion o hyn mewn arweinyddiaeth ac ymgysylltu clinigol i gefnogi'r gwaith o ddylunio a darparu llwybr gofal ar gyfer pobl hŷn sydd â dementia, ynghyd â'r gwelliant sylweddol yn y ddarpariaeth iechyd meddwl sy'n dal yn angenrheidiol.

Rwy'n disgwyl i'r Bwrdd Iechyd a phartneriaid o blith yr awdurdodau lleol ystyried y canfyddiadau yn ofalus o ran gweithrediad y trefniadau diogelu. Mae amddiffyn pobl mewn perygl rhag pob math o gam-drin ac esgeulustod yn un o flaenoriaethau allweddol Llywodraeth Cymru. Adlewyrchir hyn yn glir yn y ddeddfwriaeth a'r polisïau yr ydym ni wedi'u cyflwyno yn y tymor hwn a'r un flaenorol.

Rwy'n disgwyl y caiff y canfyddiadau yn yr adroddiad hwn eu defnyddio fel maen prawf gan holl sefydliadau'r GIG yng Nghymru. Byddaf felly yn ysgrifennu at holl gadeiryddion a Phrif Weithredwyr sefydliadau'r GIG yng Nghymru, yn gofyn i'w byrddau ystyried argymhellion yr adroddiad ac i gadarnhau sut y byddant yn defnyddio'r canfyddiadau i wella eu sefydliad. Byddaf hefyd yn disgwyl i'r Prif Swyddog Meddygol a'r Prif Swyddog Nyrsio drafod ag arweinwyr gweithredol proffesiynol i sicrhau y caiff y gwersi a geir yn yr adroddiad hwn eu hymgorffori i'r gwaith o gynllunio a darparu gofal iechyd yng Nghymru yn y dyfodol. Mae'r rhain yn gamau brys sy'n cael eu gweithredu mewn ymateb i ganfyddiadau adroddiad HASCAS. Byddaf wrth gwrs yn parhau i ddiweddaru'r Aelodau ynglŷn â'r cynnydd a wneir o ran y gwelliant ehangach angenrheidiol. 

14:45

In your statement to us, you state,

'anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached.'

We have to disagree. But, of course, we're not alone. The chief officer in the north Wales community health council has said that dismissing the testimony of Tawel Fan families is akin to not believing survivors of sexual abuse. He insisted the evidence given by relatives of dementia patients at the Ablett unit was absolutely credible. The older person's commissioner for Wales, Sarah Rochira, said the headline findings of the report will be of little comfort to the families of the patients on the Tawel Fan ward, who had been clear that their relatives suffered standards of care that were quite simply unacceptable.

Was not your use of the word 'reassuring' in initial press reports following the publication of the report at the very best insensitive to the relatives and families, who themselves were reported as stating they found this report devastating? They were angry and in uproar over the abuse report. They again talked about how their loved ones were seen being dragged by the scruff of the neck, barricaded and left in their own mess. One spoke about how his mother was bullied and forced to sleep in an ant-infested bed. There was more than one occasion when she'd be in the same clothes for at least two days, lying in her own mess. He described the report as a huge cover-up, as reported in the press.

The Tawel Fan mental health board, in the Ablett unit report in 2013—in that report, the health board said it was alerted to serious concerns regarding patient care in December 2013. Of course, reports go back a lot, lot further. In 2009, I represented a constituent who alleged the treatment received by her husband in the unit nearly killed him and that three other patients admitted around the same time as her husband had similar experiences and that she was now worried about the treatment others may receive in this unit. Her husband suffered from Alzheimer's and terminal cancer. I was also copied in on a complaint in respect of another patient at the time who had vascular dementia, which included distressing before-and-after photographs. These were shared with both the health board and its predecessor and your predecessor. No action appears to have been taken. 

Thankfully, in 2015, Welsh Government, the health board and Healthcare Inspectorate Wales all accepted the findings of Donna Ockenden's 2015 report. So, why now, when many serious allegations are peppered throughout the HASCAS report, has it come to the bizarre conclusion that care was good and that institutional abuse didn't happen? Why do the conclusions not stack up with the findings? The HASCAS report doesn't chime with concerns raised in other reports. Why doesn't it chime with the Healthcare Inspectorate Wales report in July 2013, which found a patient locked in a room sitting in a bucket chair, incontinent in their own faeces and urine. It found no activities for patients. It found the garden unkempt and inaccessible. It found insufficient staffing, and much more—HIW, July 2013.

There was internal work on dementia care mapping in October 2013, which revealed that patients were desperately trying to engage with staff, and it reported an elderly patient found to be smearing herself with her own faeces resulting from that lack of engagement. The HASCAS report on page 115 talks about this dementia care mapping, but then on page 116 says no serious concerns were raised and no poor practice was observed. Why does that not agree with the October 2013 report, which found precisely the opposite? If this was your own grandmother, your mother or your sister, would you not consider this a serious concern? Any other rational human being would consider this to be a matter of the most utter and utmost seriousness.

Page 64 of the HASCAS report says that 29 families described significant concerns with communication and dementia diagnosis, and 18 families alleged unexplained bruising and injuries. This isn't an election; it's not a poll. It's not a question of how many people had one experience or another to decide on the outcome. These are the experiences reported by dozens and dozens of families regarding the people that mattered most to them. Page 66 says that 10 families described relatives as being dirty and the ward smelling of urine. Why is this not a breach of care to these patients and, by association, to their families?

The HASCAS findings are based, quite properly, on clinical notes. You refer to the clinical notes in your statement, but they acknowledge that they understand that when they came to start their review, the clinical records they needed had not been secured. Why therefore, in breach of standard NHS practice to stop clinical notes being got at, were these notes not secured? And how, even if they weren't got at, can we have any confidence regarding their content in these circumstances, especially given the different findings of different reports I've referred to previously? 

Is it not therefore the case that our colleague, Darren Millar, who can't be with us today, is right to have written to the Public Accounts Committee asking them to examine this matter, reflecting both the inconsistent evidence and the huge concerns caused to north Wales in general, but particularly to the families of these dozens of victims, I will call them, where the evidence is so strong that we have to accept that they were clearly telling the truth? I hope, Cabinet Secretary, you're going to change your tune on this, that you're going to listen, that you're not going to shoot the messenger, and that you're going to reconsider your approach, because, if not, you will have failed in your duty to these people, you will have failed in your duty to the patients and staff, and you will have failed in your duty to Wales. I look forward to your response.   

Yn eich datganiad i ni, rydych chi'n dweud

y dylai unrhyw un sydd wedi rhoi o'u hamser i ddarllen yr adroddiad yn ofalus sylweddoli pa mor drylwyr oedd yr ymchwiliad a deall sut y daethpwyd i'r casgliadau.

Mae'n rhaid inni anghytuno. Ond, wrth gwrs, nid ni yw'r unig rai. Mae'r prif swyddog yng Nghyngor Iechyd Cymuned Gogledd Cymru wedi dweud bod diystyru tystiolaeth teuluoedd Tawel Fan yn gyfystyr â pheidio â chredu pobl sydd wedi goroesi cam-drin rhywiol. Mynnodd ef fod y dystiolaeth a roddwyd gan berthnasau cleifion sydd â dementia yn Uned Ablett yn gwbl gredadwy. Dywedodd Comisiynydd Pobl Hŷn Cymru, Sarah Rochira, na fydd prif ganfyddiadau'r adroddiad yn fawr o gysur i deuluoedd cleifion ar ward Tawel Fan, a oedd wedi bod yn glir bod eu perthnasau wedi dioddef safonau gofal a oedd yn gwbl annerbyniol.

Onid oedd eich defnydd o'r gair 'cysuro' mewn adroddiadau cychwynnol yn y wasg yn sgil cyhoeddi'r adroddiad ar y gorau yn ansensitif i berthnasau a theuluoedd, yr adroddwyd eu bod hwy eu hunain  wedi dweud eu bod cynnwys yr adroddiad hwn yn dorcalonnus? Roedden nhw'n ddig ac yn gandryll ynglŷn â'r adroddiad ar y cam-drin. Dywedasant eto ynglŷn â sut y gwelwyd eu hanwyliaid yn cael eu llusgo gerfydd eu gwar, yn cael eu carcharu a'u gadael yn eu baw eu hunain. Dywedodd un sut y cafodd ei fam ei bwlio a'i gorfodi i gysgu mewn gwely a oedd yn bla o forgrug. Roedd mwy nag un achlysur pan gadawyd hi yn yr un dillad am o leiaf dau ddiwrnod, yn gorwedd yn ei baw ei hun. Disgrifiodd yr adroddiad fel ymgais enfawr i gelu'r gwir, fel yr adroddwyd yn y wasg.

Dywedodd bwrdd iechyd meddwl Tawel Fan, yn adroddiad Uned Ablett yn 2013—yn yr adroddiad hwnnw, dywedodd y Bwrdd Iechyd y tynnwyd ei sylw at bryderon difrifol ynghylch gofal cleifion ym mis Rhagfyr 2013. Wrth gwrs, mae'r adroddiadau yn mynd yn ôl llawer, llawer pellach. Yn 2009, cynrychiolais etholwr a honnodd y gwnaeth y driniaeth a gafodd ei gŵr yn yr uned bron ei ladd a bod tri chlaf arall a dderbyniwyd tua'r un amser â'i gŵr wedi cael profiadau tebyg a'i bod hi nawr yn poeni am y driniaeth y caiff eraill o bosib yn yr uned hon. Roedd ei gŵr yn dioddef o glefyd Alzheimer a chanser angheuol. Anfonwyd ataf hefyd gŵyn ar ran claf arall ar y pryd a oedd â dementia fasgwlaidd, a oedd yn cynnwys lluniau torcalonus o'r claf cyn ac ar ôl bod yno. Rhannwyd y rhain â'r Bwrdd Iechyd a'i ragflaenydd a'ch rhagflaenydd chi. Ymddengys na wnaed unrhyw beth. 

Diolch byth, yn 2015, derbyniodd Llywodraeth Cymru, y Bwrdd Iechyd ac Arolygiaeth Gofal Iechyd Cymru ganfyddiadau adroddiad Donna Ockenden a gyhoeddwyd y flwyddyn honno. Felly, pam yn awr, pan fo adroddiad HASCAS yn frith o honiadau difrifol, ei fod wedi dod i'r casgliad rhyfeddol y bu'r gofal yn dda ac na ddigwyddodd cam-drin sefydliadol? Pam nad yw'r casgliadau yn cyfateb i'r canfyddiadau? Nid yw adroddiad HASCAS yn cyd-fynd â'r pryderon a nodwyd mewn adroddiadau eraill. Pam nad yw yn cyd-fynd ag adroddiad Arolygiaeth Gofal Iechyd Cymru ym mis Gorffennaf 2013, a ganfu claf dan glo mewn ystafell yn eistedd mewn cadair bwced, yn ei faw a'i ddŵr ei hun. Canfu nad oedd unrhyw weithgareddau ar gyfer cleifion. Canfu fod yr ardd yn flêr ac yn anhygyrch. Canfu staffio annigonol, a llawer mwy—Arolygiaeth Gofal Iechyd Cymru, Gorffennaf 2013.

Gwnaed gwaith mewnol yn mapio gofal dementia ym mis Hydref 2013, a oedd yn dangos bod cleifion yn ymdrechu'n daer i gael sylw staff, ac adroddwyd am glaf oedrannus y canfuwyd ei bod yn taenu ei hun â'i baw ei hun oherwydd y diffyg sylw hwnnw. Mae adroddiad HASCAS ar dudalen 115 yn sôn am y gwaith hwn o fapio gofal dementia, ond wedyn ar dudalen 116 yn dweud na fynegwyd unrhyw bryderon difrifol ac na welwyd unrhyw arferion gwael. Pam nad yw hynny yn cytuno ag adroddiad mis Hydref 2013, a ganfu'r gwrthwyneb yn llwyr? Os mai eich mam-gu chi, eich mam chi neu eich chwaer chi fyddai hon, oni fyddech chi'n ystyried bod hyn yn bryder difrifol? Byddai unrhyw fod dynol rhesymol arall yn ystyried bod hwn yn fater o'r difrifoldeb mwyaf a dwysaf. 

Dywed tudalen 64 o adroddiad HASCAS fod 29 o deuluoedd wedi disgrifio pryderon sylweddol ynghylch cyfathrebu a rhoi diagnosis o ddementia, a honnodd 18 o deuluoedd fod cleifion wedi dioddef cleisiau ac anafiadau anesboniadwy. Nid etholiad mo hwn; nid pleidlais mohono. Nid yw'n gwestiwn o faint o bobl gafodd rhyw brofiad neu'i gilydd i benderfynu ar y canlyniad. Dyma'r profiadau a nodwyd gan ddwsinau a dwsinau o deuluoedd, a hynny o ran y bobl a oedd o'r pwys mwyaf iddynt. Dywed tudalen 66 bod 10 o deuluoedd wedi disgrifio perthnasau yn fudr a'r ward yn drewi o wrin. Pam nad yw hyn yn dor-ddyletswydd i'r cleifion hyn o'r gofal yr oeddent i fod i'w gael, ac yn hynny o beth, i'w teuluoedd?

Seilir canfyddiadau HASCAS, yn briodol iawn, ar nodiadau clinigol. Rydych yn cyfeirio at y nodiadau clinigol yn eich datganiad, ond maen nhw'n cydnabod eu bod yn deall pan ddaeth hi'n bryd iddyn nhw ddechrau eu hadolygiad, nad oedd y cofnodion clinigol a oedd eu hangen wedi'u cadw'n ddiogel dan glo. Pam felly, yn groes i safonau safonol y GIG i rwystro nodiadau clinigol rhag cael eu gweld, nad oedd y nodiadau hyn yn cael eu cadw'n ddiogel? A sut, hyd yn oed os nad oedd neb wedi cael gafael arnynt, y gallwn ni fod ag unrhyw hyder ynghylch eu cynnwys yn yr amgylchiadau hyn, yn enwedig o ystyried canfyddiadau gwahanol yr adroddiadau gwahanol yr wyf wedi cyfeirio atyn nhw?

Onid y gwir yw bod ein cyd-Aelod, Darren Millar, nad oes modd iddo fod yma gyda ni heddiw, yn gywir i fod wedi ysgrifennu at y Pwyllgor Cyfrifon Cyhoeddus yn gofyn iddyn nhw edrych ar y mater hwn, o ystyried y dystiolaeth anghyson a'r pryderon mawr a achoswyd yn y gogledd yn gyffredinol, ond yn enwedig i deuluoedd y dwsinau o ddioddefwyr hyn, ac felly y byddaf yn cyfeirio atynt, bod y dystiolaeth mor gryf fel bod yn rhaid inni dderbyn yr oeddent yn amlwg yn dweud y gwir? Rwy'n gobeithio, Ysgrifennydd y Cabinet, y byddwch yn newid eich cân ynghylch hyn, eich bod yn mynd i wrando, nad ydych chi'n mynd i geryddu'r cennad, ac y byddwch chi'n ailystyried eich ymagwedd, oherwydd, os nad ydych chi'n gwneud hynny, fe fyddwch chi wedi methu yn eich dyletswydd i'r bobl hyn, byddwch chi wedi methu yn eich dyletswydd i gleifion a staff, a byddwch chi wedi methu yn eich dyletswydd i Gymru. Rwy'n edrych ymlaen at eich ymateb.

14:50

I recognise that there'll be a range of people who won't accept the findings produced in the independent HASCAS investigation report. I recognise that there'll be a range of families who will simply not be able to accept the conclusions they have reached, and I think it's easy to understand why that might be, where people have witnessed challenges that they have reported on. But, as the report set out, it certainly does not provide a clean bill of health for the health board—far from it—and it does recount failings in the care that some people were provided with, but it says that, overall, it does not support the previous finding of institutional abuse and neglect. 

And it's fair again to reflect that, whilst some families are angry and hurt, and you understand why in the conclusions reached, there are a range of families who did not wish to engage because they had no complaints about the care provided. Other families did engage and confirmed they had no concerns or complaints about the care provided. It's also true to reflect on the fact that there were disagreements within families about the care provided as well. So, in that contested environment, where people have different versions of the same events, where there's an acceptance that, on occasion, the care was not as it should have been and that people were let down when that happened, it is not surprising that there are different views on the overall conclusions of the report. But, as I say, that does not affect the integrity of this report. 

It's worth again reminding you and others that, of course, this report had access to a much wider range of information. It interviewed 168 witnesses that were not available to the initial report. It considered 190 witness statements in the police report that were not available to the first report as well. There were real problems highlighted.

In terms of the response from HASCAS, we should remember what they themselves have said. They say that their report does not cast doubts on the validity of families' concerns. Indeed, it actually upholds very many of their concerns. It is important that this is a highly critical report. And that is the approach that I will take to seeking further improvement. I wish to see families that are affected, even including those who do not accept the report, being supported in the continued life that they will have. I wish to see support provided to staff directly affected, and I wish to see, for the future, real and sustained improvement that will take forward the real concerns and criticisms in what is a highly critical report.

It is for the Assembly, though, to determine whether it wishes to review the 300 pages of the HASCAS report and the 700,000 pages of documentation and witness evidence that underpin it. That is a matter for the Assembly, not the Government, to determine. For my part, I will do what I can and should to provide the reassurance that all of us, I'm sure, will wish to seek, and that is that people have their concerns listened to and that we take seriously the requirement for improvement that does exist within north Wales healthcare.

Rwy'n cydnabod y bydd amrywiaeth o bobl na fyddant yn derbyn canfyddiadau adroddiad ymchwiliad annibynnol HASCAS. Rwy'n cydnabod y bydd amrywiaeth o deuluoedd na fyddant yn gallu derbyn eu casgliadau, ac mae'n hawdd deall pam y gallai hynny fod, pan fo pobl wedi gweld heriau a chwyno amdanynt. Ond, fel y mae'r adroddiad yn nodi, yn sicr nid yw'n dweud bod y Bwrdd Iechyd yn berffaith—ddim o bell ffordd—ac mae yn sôn am fethiannau yn y gofal a gafodd rhai pobl, ond mae'n dweud, yn gyffredinol, nad yw'n cefnogi'r canfyddiad blaenorol o gam-drin ac esgeulustod sefydliadol.

Ac eto mae'n deg dweud, er bod rhai teuluoedd yn ddig ac wedi cael eu brifo, ac rydych chi'n deall pam yn y casgliadau y daethpwyd iddynt, mae yna amrywiaeth o deuluoedd nad oedd yn dymuno lleisio barn oherwydd nad oedd ganddyn nhw unrhyw gŵynion ynghylch y gofal a ddarparwyd. Mynegodd teuluoedd eraill eu barn a chadarnhau nad oedd ganddyn nhw unrhyw bryderon neu gŵynion ynghylch y gofal a ddarparwyd. Mae hefyd yn wir y dylid ystyried y ffaith y bu anghytuno mewn teuluoedd ynghylch y gofal a ddarparwyd hefyd. Felly, yn y sefyllfa gynhennus honno, lle mae gan bobl wahanol fersiynau o'r un digwyddiadau, lle derbynnir nad oedd y gofal, ar adegau, fel y dylasai fod ac y siomwyd pobl pan ddigwyddodd hynny, nid yw'n syndod bod safbwyntiau gwahanol ynglŷn â chasgliadau cyffredinol yr adroddiad. Ond, fel y dywedaf, nid yw hynny'n effeithio ar ddidwylledd yr adroddiad hwn.

Mae'n werth eto eich atgoffa chi ac eraill, wrth gwrs, fod ystod ehangach o lawer o wybodaeth ar gael wrth lunio'r adroddiad hwn. Cynhaliwyd cyfweliadau â 168 o dystion nad oeddent ar gael ar gyfer yr adroddiad cychwynnol. Ystyriwyd 190 o ddatganiadau gan dystion yn yr adroddiad i'r heddlu nad oedd ar gael ar gyfer yr adroddiad cyntaf hefyd. Amlygwyd problemau gwirioneddol.

O ran yr ymateb gan HASCAS, dylem gofio beth y maen nhw eu hunain wedi ei ddweud. Maen nhw'n dweud nad yw eu hadroddiad yn amau dilysrwydd pryderon teuluoedd. Yn wir, mewn gwirionedd mae'n cadarnhau llawer iawn o'u pryderon. Mae'n bwysig bod hwn yn adroddiad hynod feirniadol. A dyna'r ymagwedd y byddaf i yn ei harddel i geisio gwelliannau pellach. Hoffwn weld teuluoedd yr effeithiwyd arnyn nhw, gan gynnwys hyd yn oed y rhai hynny nad ydynt yn derbyn yr adroddiad, yn cael eu cefnogi weddill eu bywydau. Rwyf eisiau gweld staff yr effeithiwyd arnyn nhw yn uniongyrchol yn cael cymorth, ac rwyf eisiau gweld gwelliant gwirioneddol a pharhaus a fydd yn ystyried pryderon a beirniadaethau gwirioneddol yr adroddiad beirniadol iawn hwn.

Lle'r Cynulliad, fodd bynnag, yw penderfynu a yw eisiau adolygu'r 300 o dudalennau o adroddiad HASCAS a'r 700,000 o dudalennau o ddogfennau a thystiolaeth tystion sy'n ategu hynny. Mae hynny'n fater i'r Cynulliad, nid i'r Llywodraeth, benderfynu arno. O'm rhan i, byddaf yn gwneud popeth y gallaf ac y dylaf ei wneud i roi'r sicrwydd yr wyf yn siŵr y mae pob un ohonom ni yn chwilio amdano, a hynny yw y gwrandewir ar bryderon pobl, a'n bod o ddifrif ynglŷn â'r angen am welliannau yn y maes gofal iechyd yn y gogledd. 

14:55

Thank you for your statement today, Cabinet Secretary, but you've read, I'm sure, the statement issued by the Tawel Fan families group in response to the HASCAS report's publication:

'we cannot and will not accept the findings',

they say. They say that what they've read in this report doesn't stack up compared with all else that has gone before it—the experiences of the families themselves, the public emergence of those experiences that led five years ago to the closure of the Tawel Fan ward, the previously critical reports, the apologies from the health board itself for, and I quote:

'the appalling treatment and subsequent harm...experienced'.

Of course, as you say, it still is a very damning report. We heard you say this afternoon that 

'The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry',

you say,

'that this happened and I apologise for it without hesitation.'

So, the report highlights serious failings, but, somehow, it not only concludes that this didn't amount to institutional abuse and neglect, in direct conflict with the Ockenden report, but also that some of the light that ought to be shed on what happened should be reflected back onto the families themselves. Cabinet Secretary, how do you account for the difference in conclusion between this and previous reports? How do you account for the difference between the clear description of multiple and serious failings in the way that Tawel Fan was run and the conclusion that (a) this didn't in effect mean poor care for patients and (b) that, really, the patients and their families were somehow themselves to blame, at least partly for having unrealistic expectations or for not understanding dementia or for changing their recollection of their experiences in response to media coverage.

Looking forward, I wish Mark Polin well taking over as chair of the health board. I note your planned publication today of a special measures improvement framework, but, of course, Betsi Cadwaladr has been in special measures for nearly three years and people must have confidence that lessons have been learnt about the past before they can have confidence in what the health board can provide for them in future.

Many have already concluded that this is a cover-up. Families don't find this to be a credible report. And bearing in mind what we've heard from you today—that you wish for this report, which the families don't consider to be credible, to be the basis for moving forward to better healthcare—how do you now regain those people's trust?

Diolch i chi am eich datganiad heddiw, Ysgrifennydd y Cabinet, ond rydych chi wedi darllen, rwy'n siŵr, y datganiad a gyhoeddwyd gan grŵp teuluoedd Tawel Fan mewn ymateb i gyhoeddi adroddiad HASCAS: maen nhw'n dweud

'ni allwn ni ac ni wnawn ni dderbyn y canfyddiadau',

Maen nhw'n dweud nad yw'r hyn y maen nhw wedi ei ddarllen yn yr adroddiad hwn yn gwneud synnwyr o'i gymharu â phopeth arall a ddigwyddodd cyn hynny—profiadau y teuluoedd eu hunain, rhoi cyhoeddusrwydd i'r profiadau hynny, a arweiniodd bum mlynedd yn ôl at gau ward Tawel Fan, yr adroddiadau beirniadol blaenorol, yr ymddiheuriadau gan y Bwrdd Iechyd ei hun

am y driniaeth ofnadwy a'r niwed a brofwyd yn sgil hynny.

Wrth gwrs, fel y dywedwch chi, mae'n dal i fod yn adroddiad damniol iawn. Fe glywsom ni chi'n dweud y prynhawn yma fod

yr adroddiad yn nodi amrywiaeth o fethiannau oedd yn siom i gleifion ac a arweiniodd at achosi niwed gwirioneddol,

ac rydych chi'n dweud

ei bod hi'n ddrwg iawn gennych chi y digwyddodd hynny a'ch bod yn ymddiheuro yn ei gylch heb unrhyw betruso.

Felly, mae'r adroddiad yn amlygu methiannau difrifol, ond, rhywsut, daw nid yn unig i'r casgliad nad oedd hyn yn gyfystyr â cham-drin ac esgeulustod sefydliadol, yn hollol groes i adroddiad Ockenden, ond hefyd y dylai peth o'r goleuni a ddylai gael ei daflu ar yr hyn a ddigwyddodd gael ei adlewyrchu ar y teuluoedd eu hunain. Ysgrifennydd y Cabinet, sut ydych chi'n egluro'r gwahaniaeth yng nghasgliadau'r adroddiad hwn â chasgliadau'r adroddiadau blaenorol? Sut ydych chi'n egluro'r gwahaniaeth rhwng y disgrifiad clir o ddiffygion difrifol a lluosog yn y ffordd y rheolwyd Tawel Fan a'r casgliad (a), nad yw hyn i bob diben yn golygu gofal gwael i gleifion a (b), mewn gwirionedd, fod y cleifion a'r teuluoedd rywsut eu hunain ar fai, yn rhannol o leiaf am fod â disgwyliadau afrealistig neu am beidio â deall dementia neu am newid eu barn am eu profiadau mewn ymateb i sylw yn y cyfryngau.

Gan edrych i'r dyfodol, hoffwn ddymuno'n dda i Mark Polin wrth iddo gamu i swydd Cadeirydd y Bwrdd Iechyd. Rwy'n nodi eich cyhoeddiad arfaethedig heddiw o fframwaith gwella mesurau arbennig, ond, wrth gwrs, mae Betsi Cadwaladr wedi bod mewn mesurau arbennig ers bron i dair blynedd ac mae'n rhaid i bobl gael hyder bod gwersi wedi eu dysgu am y gorffennol cyn y gallan nhw fod yn ffyddiog yn yr hyn y gall y Bwrdd Iechyd ei ddarparu ar eu cyfer yn y dyfodol.

Mae llawer eisoes wedi dod i'r casgliad mai ymgais yw hon i gelu'r gwir. Nid yw'r teuluoedd yn ystyried bod hwn yn adroddiad credadwy. Ac o gofio'r hyn yr ydym ni wedi'i glywed gennych chi heddiw—eich bod yn dymuno i'r adroddiad hwn, nad yw teuluoedd yn ei ystyried yn gredadwy, fod yn sail ar gyfer symud ymlaen at ofal iechyd gwell—sut ydych chi yn awr yn adennill ymddiriedaeth y bobl hynny?

15:00

I, again, refer back to the reality, the factual, undeniable reality, that this report by HASCAS, an independent group, an independent organisation, considered a much wider range of evidence than previous reports. And it should not be surprising that, when more evidence is available, including the 108 clinical records that were reviewed, it is possible to reach a different conclusion. That does not cast doubt on the integrity of people who previously gave evidence—far from it. And, in fact, HASCAS themselves say, 'Our report does not accuse any families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.' 

And I think that's quite easy to understand. The challenge is how all of us in our different roles, including me, with my role within the Government, actually take forward the very difficult messages from this report and understand the real hurt that has already been caused to a range of families and how those people are supported through that. And that is not easy; it goes into your final point about regaining trust. Well, I think part of that is to be honest, and that is sometimes to say things that are not automatically easy to say or to hear. So, when I accept the report and its findings, and we have to work through our recommendations, that will please a range of families who will be reassured. It will also mean there are a number of families who are angry and upset and will not agree that is the right thing to do. There is no way to please everybody in this position, and you start from accepting there have been failings in the care provided and that is what we need to resolve.

I think that it also comes back to the point about the suggestion that there has been a cover-up. The more that that suggestion is made and the ferocity with which that suggestion is made will make it more difficult to regain trust. I accept there are questions people will want to ask, but the pre-emptive strike on the integrity of HASCAS and their individuals is something that I really do regret. HASCAS is an organisation that has undertaken reports like this into a range of health and care establishments and failings right across these islands. They have never yet had the same level of attack upon their integrity provided. If you look at the CV of the dozen people who are on the panel and the four different lawyers, including a Queen's Counsel who was engaged around this to provide reassurance about legal advice, to say that they are part of a cover-up is an extreme accusation to make, and I do not think any of the evidence available really honestly supports that accusation. And, in that, I think it is different to seeing how families are upset and will lash out—you understand that. How could you not have real, human sympathy for those families involved? But I think that we have to hold ourselves to a higher standard, to be more objective about what has happened. That may make us sound cold and unsympathetic, but we have to be able to do our job in understanding how people feel and then recognising what we think is right for the whole service.

And your point about the Tawel Fan families—I have seen their statement, of course I have. And the Tawel Fan families, a group of about nine or 10 families that have been the most engaged in the process—. But the challenge in this—I think all of us should be able to understand—is that some families do not wish to be engaged in that collective process. They have not themselves thought that that was an environment where they could themselves put their individual concerns. So, we've had different ways for families to engage in this report. Thirty-five families gave direct witness evidence to this investigation. A further 25 families were engaged but chose not to give direct evidence, and they made it clear that they were broadly content with the care that their loved ones had received. So, there are inherent contradictions between the events recounted by families over the same period of time, and this report is an honest attempt to understand those and to report on the evidence provided. I restate my commitment to trying to regain the trust of families across north Wales and beyond by actually making sure that we take seriously the criticisms in this report and take seriously the requirement to see further and sustained improvement in healthcare services in north Wales, especially as they refer to the older adult patients suffering with dementia, because that is the real challenge that this report sets out.

Hoffwn, unwaith eto, gyfeirio'n ôl at y realiti, y realiti ffeithiol diymwad, sef bod yr adroddiad hwn gan HASCAS, grŵp annibynnol, sefydliad annibynnol, wedi ystyried ystod lawer ehangach o dystiolaeth na'r adroddiadau blaenorol. Ac ni ddylai fod yn syndod, pan fydd mwy o dystiolaeth ar gael, gan gynnwys y 108 o gofnodion clinigol a adolygwyd, ei bod hi'n bosibl dod i gasgliad gwahanol. Nid yw hynny'n bwrw amheuaeth ar ddidwylledd y bobl a roddodd dystiolaeth yn flaenorol—ddim o gwbl. Ac, yn wir, mae HASCAS eu hunain yn dweud nad yw eu hadroddiad yn cyhuddo unrhyw deuluoedd o newid neu ymhelaethu ar eu straeon. Mae'r adroddiad, fodd bynnag, yn ei gwneud hi'n glir bod llawer o deuluoedd nad oedd ganddynt bryderon hyd nes y cafwyd y cyhoeddusrwydd yn ymwneud ag adroddiad cynharach. Yna, roedd arnyn nhw eisiau gwybod a oedd eu hanwyliaid wedi cael eu cam-drin, a cheisio sicrwydd yn hyn o beth.  

Ac rwy'n credu bod hynny'n eithaf hawdd i'w deall. Yr her yw sut y mae pob un ohonom ni yn ein swyddogaethau gwahanol, gan gynnwys fi, â'm swyddogaeth i yn y Llywodraeth, mewn gwirionedd yn ymateb i'r negeseuon anodd iawn o'r adroddiad hwn ac yn deall y loes wirioneddol a achoswyd eisoes i amryw o deuluoedd a sut y mae cynorthwyo'r bobl hyn drwy hynny. Ac nid yw hynny'n hawdd; mae a wnelo hynny â'ch sylw olaf ynghylch adennill ymddiriedaeth. Wel, rwy'n credu mai rhan o hynny yw bod yn onest, ac mae hynny weithiau'n golygu dweud pethau nad ydyn nhw yn awtomatig yn hawdd i'w dweud neu i'w glywed. Felly, pan wyf i'n derbyn yr adroddiad a'i ganfyddiadau ac y mae'n rhaid inni weithio drwy ein hargymhellion, bydd hynny yn plesio ystod o deuluoedd, a fydd wedi eu calonogi gan hynny. Bydd hefyd yn golygu bod yna nifer o deuluoedd sy'n ddig ac yn ofidus ac nad ydyn nhw'n cytuno mai dyna'r peth iawn i'w wneud. Does dim modd plesio pawb yn y sefyllfa hon, ac rydych chi'n dechrau drwy dderbyn y bu methiannau yn y gofal a ddarparwyd, a dyna beth y mae angen inni ei ddatrys.

Rwy'n credu hefyd fod a wnelo hyn â'r pwynt ynghlŷn â'r awgrym y cafodd pethau eu celu. Po fwyaf y gwneir yr awgrym hwnnw a po fwyaf ffyrnig y gwneir yr awgrym hwnnw, yr anoddach i gyd y bydd hi i adennill ymddiriedaeth. Rwy'n derbyn y bydd pobl yn dymuno gofyn cwestiynau, ond mae'r ymosodiad rhag blaen ar ddidwylledd HASCAS a'u hunigolion yn rhywbeth yr wyf yn siomedig iawn yn ei gylch, yn wir. Mae HASCAS yn sefydliad sydd wedi llunio adroddiadau fel hyn i amrywiaeth o sefydliadau iechyd a gofal a methiannau ledled yr ynysoedd hyn. Ni chawsant erioed o'r blaen y fath ymosodiad ar eu didwylledd. Os edrychwch chi ar CV y dwsin o bobl sydd ar y panel a'r pedwar cyfreithiwr gwahanol, gan gynnwys Cwnsler y Frenhines a oedd yn gweithio ar hyn er mwyn rhoi sicrwydd ynghylch cyngor cyfreithiol, mae dweud eu bod yn rhan o gynllwyn i gelu gwybodaeth yn gyhuddiad eithafol i'w wneud, ac nid wyf yn credu bod unrhyw dystiolaeth ar gael sydd o ddifrif calon yn cefnogi'r cyhuddiad hwnnw. Ac, yn hynny o beth, rwy'n credu bod hynny'n wahanol i weld bod teuluoedd yn ofidus ac y byddant yn gwylltio—rydych chi'n deall hynny. Sut allech chi beidio â chael cydymdeimlad dynol, gwirioneddol â'r  teuluoedd hynny sy'n rhan o hyn? Ond rwy'n credu bod yn rhaid i ni ymgyrraedd at safon uwch, i fod yn fwy gwrthrychol ynglŷn â'r hyn sydd wedi digwydd. Efallai y bydd hynny'n gwneud inni ymddangos yn  oer a digydymdeimlad, ond mae'n rhaid inni allu gwneud ein gwaith er mwyn deall sut y mae pobl yn teimlo, a chydnabod wedyn beth yn ein barn ni sy'n briodol ar gyfer y gwasanaeth cyfan.

A'ch sylw ynglŷn â theuluoedd Tawel Fan—rwyf wedi gweld eu datganiad, wrth gwrs fy mod i. Ac mae  Teuluoedd Tawel Fan, grŵp o ryw naw neu 10 o deuluoedd sydd wedi bod fwyaf blaenllaw yn y broses—. Ond yr her yn hyn i gyd—rwy'n credu y dylai pob un ohonom ni allu deall—yw bod yna rhai teuluoedd nad ydynt eisiau bod yn rhan o'r broses ar y cyd honno. Nid oedden nhw eu hunain yn credu fod hwnnw'n amgylchedd lle y gallent leisio eu pryderon unigol eu hunain. Felly, roedd gennym ni ffyrdd gwahanol i deuluoedd ymgysylltu a bod yn rhan o'r adroddiad hwn. Rhoddodd tri deg pump o deuluoedd dystiolaeth uniongyrchol i'r ymchwiliad hwn. Roedd 25 o deuluoedd eraill yn rhan o'r ymchwiliad ond dewisasant beidio â rhoi tystiolaeth uniongyrchol, ac roedden nhw'n glir eu bod yn fodlon ar y cyfan â'r gofal a gafodd eu hanwyliaid. Felly, ceir gwrthdaro cynhenid rhwng y digwyddiadau y mae teuluoedd yn sôn amdanynt yn ystod yr un cyfnod o amser, ac mae'r adroddiad hwn yn ymgais onest i ddeall hynny ac i adrodd ar y dystiolaeth a ddarparwyd. Rwy'n ailddatgan fy ymrwymiad i geisio adennill ymddiriedaeth teuluoedd ar draws y gogledd a thu hwnt drwy wneud yn siŵr mewn gwirionedd ein bod yn cymryd o ddifrif y feirniadaeth yn yr adroddiad hwn ac yn ystyried o ddifrif y gofyniad i weld gwelliannau pellach a pharhaus  mewn gwasanaethau gofal iechyd yn y gogledd, yn enwedig o ran oedolion hŷn sy'n dioddef o ddementia, oherwydd dyna yw'r her wirioneddol y mae'r adroddiad hwn yn ei gosod. 

Thank you for your statement, Cabinet Secretary, as well as your earlier written statement. Although I was not a Member of this Assembly when the Ockenden report was published, I remember the shock and outrage I felt when I learnt of what these poor people endured on the Tawel Fan ward. Listening, even last week, on the radio to families reliving their experiences and how they feel when they even have to pass the area concerned—which was more reminiscent of how people in mental ill health were treated in the eighteenth and nineteenth century, not the twenty-first. 

Three years later, we now have the findings of the Health and Social Care Advisory Service investigation. No-one can dispute the independence or expertise of HASCAS, with Dr Johnstone and her team carrying out the investigation and publishing the report. HASCAS found chaotic and poor governance and problems across all mental health services in north Wales. They found nine key factors that compromised patient care. However, there is a disconnect between the HASCAS findings and the earlier investigation conducted by Donna Ockenden, and it is this disconnect that has led families to reject the findings of the HASCAS report, branding it a whitewash and a cover-up. 

I agree with you, Cabinet Secretary, that we should avoid jumping to conclusions, but until we can fully address the concerns of the families involved in the Tawel Fan scandal, or those treated in the Ablett Unit at Ysbyty Glan Clwyd, we cannot move on from this. Cabinet Secretary, have you considered asking Donna Ockenden to work with HASCAS in order to address the concerns of the families? While I am pleased that Dr Johnstone and her team found no evidence of systemic abuse, they did find institutional failings in both the governance and care pathways at Betsi Cadwaladr. Cabinet Secretary, this is not the first report to highlight failings in clinical governance, not just in north Wales but across the NHS. Do you believe that the current governance model is fit for purpose in a modern healthcare system? 

I welcome the announcement that you will publish a special measures improvement framework for Betsi, and I look forward to seeing the first progress report in October. Cabinet Secretary, as Betsi are already in special measures, what recourse is open to you should they fail to make progress against the improvement framework?

Finally, Cabinet Secretary, you have indicated that there are lessons for the wider NHS and that you expect NHS organisations to consider the report. With regard to social care implications, what discussions have you had with Social Care Wales, and do you expect local government to also consider the recommendations of the HASCAS report?

I look forward to working with you to ensure that the events that occurred in the Ablett Unit can never happen again. Diolch yn fawr. Thank you.

Diolch i chi am eich datganiad, Ysgrifennydd y Cabinet, yn ogystal â'ch datganiad ysgrifenedig yn gynharach. Er nad oeddwn yn aelod o'r Cynulliad hwn pan gyhoeddwyd adroddiad Ockenden, rwy'n cofio'r sioc a'r dicter a deimlais pan ddysgais am yr hyn yr oedd y bobl hyn wedi ei ddioddef ar ward Tawel Fan. Wrth wrando, hyd yn oed yr wythnos diwethaf, ar y radio ar deuluoedd yn ail-fyw'r profiadau a chlywed sut y maen nhw'n teimlo pan mae hyd yn oed yn rhaid iddyn nhw fynd heibio'r ardal dan sylw—roedd yn debycach i sut y cai pobl ag afiechyd meddwl eu trin yn y ddeunawfed ganrif a'r bedwaredd ganrif ar bymtheg, nid yr unfed ganrif ar hugain.

Dair blynedd yn ddiweddarach, mae gennym ni bellach ganfyddiadau ymchwiliad y Gwasanaeth Cynghori ar Iechyd a Gofal Cymdeithasol. Ni all unrhyw un anghytuno ag annibyniaeth neu arbenigedd HASCAS, gyda Dr Johnstone a'i thîm yn cynnal yr ymchwiliad ac yn cyhoeddi'r adroddiad. Canfu HASCAS lywodraethu anhrefnus a gwael a phroblemau â holl wasanaethau iechyd meddwl y gogledd. Canfuwyd naw ffactor allweddol a oedd yn peryglu gofal cleifion. Fodd bynnag, mae diffyg cysylltiad rhwng canfyddiadau HASCAS a'r ymchwiliad cynharach a gynhaliwyd gan Donna Ockenden, ac mae'r datgysylltiad hwn wedi achosi i deuluoedd wrthod canfyddiadau adroddiad HASCAS, a dweud ei fod yn ymgais i wyngalchu ac i gelu pethau.

Rwy'n cytuno â chi, Ysgrifennydd y Cabinet, y dylem ni osgoi dod i gasgliadau byrbwyll, ond hyd nes y gallwn ni roi sylw llwyr i bryderon y teuluoedd sy'n rhan o sgandal Tawel Fan, neu'r rhai a gawsant eu trin yn Uned Ablett yn Ysbyty Glan Clwyd, ni allwn ni osod hyn o'r neilltu. Ysgrifennydd y Cabinet, a ydych chi wedi ystyried gofyn i Donna Ockenden weithio gyda HASCAS er mwyn mynd i'r afael â phryderon y teuluoedd? Er fy mod yn falch na wnaeth Dr Johnstone a'i thîm ganfod unrhyw dystiolaeth o gam-drin systematig, fe wnaethon nhw ganfod methiannau sefydliadol yn nhrefniadau llywodraethu a gofal Betsi Cadwaladr. Ysgrifennydd y Cabinet, nid dyma'r adroddiad cyntaf i dynnu sylw at fethiannau mewn llywodraethu clinigol, nid yn unig yn y gogledd ond ledled y GIG. A ydych chi'n credu bod y model llywodraethu presennol yn addas at y diben mewn system gofal iechyd modern?

Rwy'n croesawu'r cyhoeddiad y byddwch yn cyhoeddi fframwaith gwella mesurau arbennig ar gyfer Bwrdd Iechyd Betsi Cadwaladr, ac rwy'n edrych ymlaen at weld yr adroddiad cynnydd cyntaf ym mis Hydref. Ysgrifennydd y Cabinet, oherwydd bod Bwrdd Iechyd Betsi Cadwaladr eisoes mewn mesurau arbennig, pa ddewisiadau sydd ar gael i chi os byddant yn methu â gwneud cynnydd yn unol â'r fframwaith gwella?

Yn olaf, Ysgrifennydd y Cabinet, rydych chi wedi nodi bod gwersi ar gyfer y GIG ehangach a'ch bod yn disgwyl i sefydliadau'r GIG ystyried yr adroddiad. O ran y goblygiadau gofal cymdeithasol, pa drafodaethau ydych chi wedi'u cael gyda Gofal Cymdeithasol Cymru, ac a ydych chi'n disgwyl i lywodraeth leol hefyd ystyried argymhellion adroddiad HASCAS?

Edrychaf ymlaen at weithio gyda chi i sicrhau na all yr hyn a ddigwyddodd yn Uned Ablett fyth ddigwydd eto. Diolch yn fawr. 

15:05

I want to start again by reiterating that this report is certainly not a whitewash or a cover-up. If the report, on the basis of the evidence available, had come to a different conclusion, then, again, I would have been in a position where, of course, I would have been duty bound to accept that. There is precious little point in having an exhaustive independent investigation process, taking nearly three years, if the first response of a Government Minister is to say, 'I don't like the conclusion. Get me a different one.' This was deliberately undertaken as an independent exercise away from the health board with people who are not practitioners in Wales but with real independent expertise and integrity to get at the truth to allow us to understand what happened, but also to help set a path for the necessary improvement.

The Ockenden report, the second report, is about the governance structure of the health board, and, as I said in my statement, I expect that to be provided within the coming weeks. It will be published, it will be made available through the board, and, indeed, the response to it. That may require me to look again at the special measures improvement framework. As I've indicated in my oral statement, I will be happy to do so to make sure that all the required measures are in place and I will then transparently report back on progress made. It's an important part of the special measures framework that the health board didn't go into special measures at the convenance of a politician; there was independent and objective advice that it was the right thing to do. And in all of the progress—or lack or it—that has been made under special measures, again we have had independent assurance, both from the Wales Audit Office, from Healthcare Inspectorate Wales, and, indeed, the chief executive of NHS Wales. So, this is no one person providing advice, no one politician making decisions to benefit themselves individually. Frankly, it would have been to my own selfish interests to have seen them taken out of special measures and this report provide an entirely different conclusion. These are independent, objective and robust conclusions that have been reached both in the report, but also in the continued requirement to keep the health board in special measures, and that will continue to be the case as we report on progress or otherwise. I've indicated I'll report back on the wider improvement work that the rest of the NHS family is undertaking as a result of this report and we will have more to say on the safeguarding work to be undertaken both in north Wales and what that may mean for the rest of the country, too, involving health, local government and others working together.

Rwyf eisiau dechrau eto drwy ailadrodd nad yw'r adroddiad hwn yn sicr yn ymgais i wyngalchu neu gelu'r gwir. Pe bai'r adroddiad, ar sail y dystiolaeth oedd ar gael, wedi dod i gasgliad gwahanol, yna, unwaith eto, byddwn wedi bod mewn sefyllfa lle, wrth gwrs, y byddai'n ddyletswydd arnaf i dderbyn hynny. Nid oes unrhyw ddiben o gwbl cael proses ymchwiliad annibynnol gyflawn, a barodd bron i dair blynedd, os mai ymateb cyntaf Gweinidog Llywodraeth yw dweud, 'Nid wyf yn hoffi'r casgliad. Rhowch un arall imi.' Roedd hwn yn fwriadol yn ymarfer annibynnol heb unrhyw gyswllt â'r Bwrdd Iechyd, yn cynnwys pobl nad ydynt yn ymarferwyr yng Nghymru ond sydd ag arbenigedd gwirioneddol annibynnol a didwylledd i ganfod y gwir, i'n galluogi ni i ddeall beth ddigwyddodd, ond hefyd i helpu i osod llwybr ar gyfer y gwelliant angenrheidiol.

Mae adroddiad Ockenden, yr ail adroddiad, yn ymwneud â strwythur llywodraethu y Bwrdd Iechyd, ac, fel y dywedais yn fy natganiad, rwy'n disgwyl hwnnw o fewn yr wythnosau nesaf. Bydd yn cael ei gyhoeddi, bydd ar gael drwy'r Bwrdd, ac, yn wir, yr ymateb iddo. Efallai y bydd hynny'n golygu y bydd angen imi edrych eto ar y fframwaith gwella mesurau arbennig. Fel y dywedais yn fy natganiad llafar, rwy'n hapus i wneud hynny er mwyn gwneud yn siŵr bod yr holl fesurau gofynnol ar waith a byddaf wedyn adrodd yn ôl ar y cynnydd a wnaed, a hynny mewn modd cwbl tryloyw. Mae'n rhan bwysig o'r fframwaith mesurau arbennig hynny nad oedd y Bwrdd Iechyd yn mynd i fesurau arbennig yn ôl mympwy gwleidydd; cafwyd cyngor annibynnol a gwrthrychol yn nodi mai dyna oedd y peth cywir i'w wneud. Ac ym mhob agwedd ar y cynnydd—neu ddiffyg hynny—a wnaed o dan fesurau arbennig, unwaith eto rydym ni wedi cael sicrwydd annibynnol, gan Swyddfa Archwilio Cymru, gan Arolygiaeth Gofal Iechyd Cymru, ac, yn wir, Prif Weithredwr GIG Cymru. Felly, nid unigolyn yn rhoi cyngor mo hwn, nid dim ond un gwleidydd yn gwneud penderfyniadau er mantais unigol iddo'i hun. A dweud y gwir, byddai wedi bod er fy mudd hunanol fy hun i'w gweld nhw'n dod allan o fesurau arbennig ac i weld yr adroddiad hwn yn dod i gasgliad hollol wahanol. Mae'r casgliadau y daethpwyd iddyn nhw yn rhai annibynnol, gwrthrychol a chadarn, ac maent wedi'u nodi yn yr adroddiad ac yn yn y gofyniad parhaus i gadw'r Bwrdd Iechyd mewn mesurau arbennig, a dyna fydd y sefyllfa o hyd wrth inni adrodd ar gynnydd neu fel arall. Rwyf wedi dweud y byddaf yn adrodd yn ôl ar y gwaith gwella ehangach y mae gweddill teulu'r GIG yn ei wneud o ganlyniad i'r adroddiad hwn, a bydd gennym ni fwy i'w ddweud ynglŷn â'r gwaith diogelu sy'n cael ei wneud yn y gogledd a beth y gallai hynny ei olygu i weddill y wlad, hefyd, sy'n cynnwys iechyd, llywodraeth leol ac eraill yn gweithio gyda'i gilydd.

15:10

Can I thank you for your statement, Cabinet Secretary? I also welcome your recognition that the report does set out a range of failings that led to real harm being caused. I had a few specific points that I wanted to ask about in relation to the report. The first relates to the concerns that are raised about the treatment people get, with dementia, in A&E and in other medical settings in hospitals. I'm sure you'll be aware that Dr Katie Featherstone at Cardiff University has recently published a new report into the hospital care of people with dementia, and we know that 25 per cent to 50 per cent of hospital beds in Wales are going to have someone with dementia in them. So, it is absolutely critical that everybody in our NHS has the skills and awareness needed to provide person-centred care to people with dementia. So, I wanted to ask you what further lessons you feel what's been found in this report can bring for the wider NHS in Wales.

The report refers to the financial pressures, which, it says, have led to things like occupational therapists and the multi-disciplinary team not being available. I know that you are well aware that I've said to you previously that I believe that patients on older people's mental health wards in Wales are some of the most voiceless citizens in our country. They're often on locked wards; they're not wards that people go back and fore to very often. Some of them don't even have relatives to visit them. So, can I ask whether you think there are any further steps that can be taken to strengthen the profile of these patients at health board level, such as by having dementia champions on the board, et cetera, so that they are not out of sight, out of mind?

I very much welcome the reference in the report to the need for clarity on legal frameworks in relation to the Mental Health Act and the Mental Capacity Act 2005. I have to say that I think there are definitely wider lessons there for the NHS in Wales, as I genuinely don't believe that those Acts are being fully complied with across Wales. There are recommendations that there is new guidance issued, that these are kept under review and even audited on a patient-by-patient basis, which I really welcome. Can you say a bit more about how you intend to take that forward?

The report talks about the need for advocacy. A recent written answer I had off you confirmed that all health boards are currently meeting the all-age target on the provision of independent advocacy, but what I would flag is that we are well aware of the concept of an active offer of advocacy for children and young people in Wales. The current target under the Mental Health (Wales) Measure 2010 refers to people who have requested advocacy receiving it within five days, and I wonder whether you might want to say something about what more we can do to ensure that there is an active offer for older people as well, because there are real challenges in offering advocacy and ensuring advocacy take-up for older people with dementia, and I do think that particular measures need to be put into place.

Finally, I know that you are well aware of my view that we should move, at the earliest opportunity, to extend the safe staffing levels legislation to older people's mental health wards in Wales. I think that this report and the issues arising from it confirm the need for that, because many of the issues highlighted would be addressed by staff having the necessary time to do their job properly and to provide person-centred care. So, can you update us on your plans to extend the legislation? Thank you.

A gaf i ddiolch ichi am eich datganiad, Ysgrifennydd y Cabinet? Rwy'n croesawu hefyd eich bod yn cydnabod bod yr adroddiad yn amlinellu'r amrywiaeth o ddiffygion a arweiniodd at achosi niwed gwirioneddol. Mae gennyf ambell bwynt penodol yr hoffwn i holi yn eu cylch mewn cysylltiad â'r adroddiad. Mae'r cyntaf yn ymwneud â'r pryderon a grybwyllwyd ynglŷn â'r driniaeth y mae pobl yn ei chael, gyda dementia, mewn unedau damweiniau ac achosion brys ac mewn lleoliadau meddygol eraill mewn ysbytai. Rwy'n siŵr y byddwch yn ymwybodol bod Dr Katie Featherstone ym Mhrifysgol Caerdydd wedi cyhoeddi adroddiad newydd yn ddiweddar ynglŷn â'r gofal a roddir mewn ysbytai i bobl â dementia, ac rydym ni'n gwybod bod rhwng 25 y cant a 50 y cant o welyau mewn ysbytai yng Nghymru yn cynnwys rhywun â dementia. Felly, mae'n gwbl hanfodol bod gan bawb yn ein GIG y sgiliau a'r ymwybyddiaeth sydd eu hangen i ddarparu gofal sy'n canolbwyntio ar y person i bobl â dementia. Felly, roeddwn i eisiau gofyn ichi, yn eich barn chi, pa wersi pellach all yr hyn a ganfuwyd yn yr adroddiad hwn ei ddysgu i'r GIG ehangach yng Nghymru.

Mae'r adroddiad yn cyfeirio at y pwysau ariannol, sydd, mae'n dweud, wedi arwain at sefyllfaoedd lle nad yw therapyddion galwedigaethol a'r tîm aml-ddisgyblaethol ar gael. Rwy'n gwybod eich bod yn ymwybodol iawn fy mod i wedi dweud wrthych chi o'r blaen fy mod i'n credu bod cleifion ar wardiau iechyd meddwl pobl hŷn yng Nghymru ymhlith y dinasyddion sydd â'r lleiaf o lais yn ein gwlad. Maen nhw yn aml ar wardiau dan glo; dydy'r rhain ddim yn wardiau lle mae pobl yn mynd a dod yn aml iawn. Does gan rai ohonyn nhw hyd yn oed ddim perthnasau i ymweld â nhw. Felly, a gaf i ofyn a ydych chi'n credu a oes unrhyw beth arall y gellir ei wneud i roi mwy o statws i'r cleifion hyn yn y Bwrdd Iechyd, er enghraifft drwy gael hyrwyddwyr dementia ar y Bwrdd, ac ati, fel nad ydyn nhw'n angof anweledig. 

Rwy'n croesawu'n fawr y cyfeiriad yn yr adroddiad at yr angen am eglurder ynglŷn â fframweithiau cyfreithiol o ran y Ddeddf Iechyd Meddwl a Deddf Galluedd Meddyliol 2005. Mae'n rhaid imi ddweud fy mod i'n credu yn bendant bod gwersi ehangach i'w dysgu ar gyfer y GIG yng Nghymru, oherwydd rwy'n credu o ddifri nad oes cydymffurfiad llwyr â'r deddfau hynny ledled Cymru. Mae argymhellion i gyhoeddi canllawiau newydd, ac y caiff y rhain eu hadolygu a hyd yn oed eu harchwilio fesul claf, ac rwy'n croesawu hynny'n fawr. A allwch chi ddweud ychydig mwy wrthym ni ynglŷn â sut yr ydych chi'n  bwriadu datblygu hynny?

Mae'r adroddiad yn sôn am yr angen am eiriolaeth. Roedd ateb ysgrifenedig diweddar a gefais gennych chi yn cadarnhau bod yr holl fyrddau iechyd ar hyn o bryd yn cyrraedd y targed pob oedran o ran darparu eiriolaeth annibynnol, ond yr hyn y byddwn yn tynnu sylw ato yw ein bod ni'n ymwybodol iawn o'r cysyniad o gynnig gweithredol am eiriolaeth ar gyfer plant a phobl ifanc yng Nghymru. Mae'r targed presennol o dan Fesur Iechyd Meddwl (Cymru) 2010 yn cyfeirio at bobl sydd wedi gofyn am eiriolaeth yn cael hynny o fewn pum niwrnod, ac rwy'n meddwl tybed a hoffech chi ddweud rhywbeth ynglŷn â beth mwy y gallwn ni ei wneud i sicrhau bod cynnig rhagweithiol ar gyfer pobl hŷn yn ogystal, oherwydd bod heriau gwirioneddol o ran cynnig eiriolaeth a sicrhau bod pobl hŷn â dementia yn defnyddio gwasanaethau eiriolaeth, ac rwy'n credu bod angen gweithredu mesurau penodol.

Yn olaf, rwy'n gwybod eich bod yn ymwybodol iawn o fy marn y dylem ni geisio, ar y cyfle cynharaf, ymestyn y ddeddfwriaeth ynglŷn â lefelau staffio diogel i gynnwys wardiau iechyd meddwl pobl hŷn yng Nghymru. Rwy'n credu bod yr adroddiad hwn a'r materion sy'n deillio o hynny yn cadarnhau'r angen am hynny, oherwydd gellid datrys llawer o'r materion y rhoddwyd sylw iddyn nhw pe bai gan staff yr amser angenrheidiol i wneud eu gwaith yn iawn ac i ddarparu gofal sy'n canolbwyntio ar y person. Felly, a allwch chi roi diweddariad i ni ar eich cynlluniau i ymestyn y ddeddfwriaeth? Diolch.

Thank you for the range of questions. Forgive me if I don't answer all of them now in the time available, but I'm happy to take them up with you directly after today's proceedings as well. I think, actually, the point you raise about accident and emergency shows the scale of the challenge we face in dementia care, because people with dementia are a regular feature already of care within the hospital sector, and will become more so in future. We expect more people to be diagnosed, we expect undiagnosed people to arrive in our hospitals requiring care and treatment, whether in accident and emergency or in elective care, and it will be a bigger feature of health and care delivery here in Wales. Actually, the fact that the accident and emergency issue was raised shows that the HASCAS report did listen to what the families were saying, because it wasn't part of the earlier remit, but it was raised by families during the course of the investigation, and so the remit of its investigation was broadened to allow that view of the wider care and treatment pathway, to get a broader view on what was going well, as well as what wasn't going well, in providing health and care within north Wales.

I recognise your points about the range of activities that are provided to people, the range of recovery and rehabilitation that is still possible from a physical point of view, but also the fact that these are people who are, by their nature, vulnerable and often don't have a voice. So, your point about advocacy is well made, about there being a genuinely active offer, and that is work that we are seeking to undertake to make sure that—. The focus that we often have on children's advocacy is not often there when it comes to the older adult, which is surprising, and I think that it's largely because people assume that there is a family waiting to look after that person or advocate for them, and often there isn't, either because they don't have a family or because their family is no longer around, and that is a very sad reality that many of our older citizens face.

I also recognise your point about capacity and the work we're doing on the mental health Act and the review that is taking place across England and Wales with the mental capacity Act, and in particular the deprivation of liberty safeguards. So, there is work that we recognise needs to be done right across our system, not just in Wales, and we're working with partners across the four nations to understand what our approach will need to be in the future, because that can be difficult for the individual, for their family and the health and care system itself as well. We have already provided interim annual investment of more than £300,000 to support health boards and local authorities to deal with the challenge that that has provided.

On the nurse staffing Act, I will come back to you, and I'll happily provide a statement to Members, on the work that we're doing to deliver on the commitment of the Government to extend the nurse staffing Act. There are a range of different options and potential priorities that I've previously reported on, and it probably is time for me to provide an update, whether that looks at in-patient paediatric care, whether it's community nursing or, indeed, around care for older adults as well. So, I will provide a fuller update on that, and it's a useful reminder that it is about time to provide Members with that factual written update.

Diolch i chi am yr ystod o gwestiynau. Maddeuwch imi os nad wyf yn llwyddo i ateb pob un ohonyn nhw nawr yn yr amser sydd ar gael, ond rwy'n fodlon eu trafod nhw gyda chi yn uniongyrchol ar ôl trafodion heddiw hefyd. Rwy'n credu, mewn gwirionedd, fod y sylw a wnaethoch chi am unedau damweiniau ac achosion brys yn dangos maint yr her yr ydym yn ei hwynebu o ran gofal dementia, gan fod pobl â dementia yn nodwedd reolaidd eisoes o ofal yn y sector ysbytai, a byddant yn dod yn fwy felly yn y dyfodol. Rydym ni'n disgwyl i fwy o bobl gael diagnosis, rydym ni'n disgwyl i bobl sydd heb gael diagnosis gyrraedd ein hysbytai gydag angen am ofal a thriniaeth, boed mewn adrannau damweiniau ac achosion brys neu mewn unedau gofal dewisol, a bydd yn nodwedd gynyddol o ddarparu gwasanaethau iechyd a gofal yma yng Nghymru. Mewn gwirionedd, mae'r ffaith y cyfeiriwyd at unedau damweiniau ac achosion brys yn dangos bod adroddiad HASCAS wedi gwrando ar yr hyn yr oedd y teuluoedd yn ei ddweud, oherwydd nid oedd yn rhan o'r cylch gwaith cynharach, ond yn hytrach yn fater y cyfeiriodd teuluoedd ato yn ystod yr ymchwiliad, ac felly ehangwyd cylch gorchwyl yr ymchwiliad i ganiatáu bwrw golwg ar y dilyniant gofal a thriniaeth ehangach, i gael safbwynt ehangach ynglŷn â'r hyn a oedd yn gweithio'n dda, yn ogystal â'r hyn nad oedd yn gweithio'n dda, wrth ddarparu gwasanaethau iechyd a gofal yn y gogledd.

Rwy'n cydnabod eich sylwadau am yr ystod o weithgareddau sy'n cael eu darparu i bobl, yr amrywiaeth o driniaethau adfer ac adsefydlu sy'n dal yn bosibl o safbwynt corfforol, ond hefyd y ffaith bod y rhain yn bobl sydd, o ran eu natur, yn agored i niwed ac yn aml heb lais. Felly, mae eich sylw am eiriolaeth yn un priodol iawn, o ran bod â chynnig gweithredol gwirioneddol, ac mae hynny'n waith yr ydym ni'n ceisio ei wneud er mwyn sicrhau bod—. Nid yw'r pwyslais sydd gennym ni yn aml ar eiriolaeth i blant yn aml yn bodoli gydag oedolion hŷn, sy'n syndod, ac rwy'n credu bod hynny'n bennaf oherwydd bod pobl yn tybio bod aelod o'r teulu yn aros i ofalu am yr unigolyn hwnnw neu i eiriol drostyn nhw, ac yn aml does neb, naill ai oherwydd nad oes ganddyn nhw deulu neu oherwydd nad yw eu teulu yn byw yn y cyffiniau bellach, a dyna'r realiti trist iawn y mae llawer o'n dinasyddion hŷn yn ei wynebu.

Rwyf hefyd yn cydnabod eich sylw ynglŷn â chapasiti a'r gwaith yr ydym ni'n ei wneud ar y Ddeddf Iechyd Meddwl a'r adolygiad sy'n digwydd ledled Cymru a Lloegr gyda'r Ddeddf Galluedd Meddyliol, ac yn benodol amddifadedd trefniadau diogelu rhag colli rhyddid. Felly, rydym ni'n cydnabod bod gwaith y mae angen ei wneud drwy'r system yn ei chyfanrwydd, nid dim ond yng Nghymru, ac rydym ni'n gweithio gyda phartneriaid yn y pedair gwlad i ddeall sut y bydd angen inni fynd ati yn y dyfodol, oherwydd gall hynny fod yn anodd i'r unigolyn, i'w teulu a'r system iechyd a gofal ei hun hefyd. Rydym ni eisoes wedi darparu buddsoddiad blynyddol dros dro o fwy na £300,000 i gefnogi byrddau iechyd ac awdurdodau lleol i ymdrin â'r her hon. 

Ynglŷn â'r Ddeddf Lefelau Staff Nyrsio, bydd yn rhaid i mi drafod hynny â chi maes o law, ac rwy'n hapus iawn i roi datganiad i'r Aelodau, ar y gwaith yr ydym ni'n ei wneud i gyflawni ymrwymiad y Llywodraeth i ymestyn y Ddeddf Lefelau Staff Nyrsio. Mae sawl dewis gwahanol a blaenoriaethau posibl yr wyf i wedi adrodd arnyn nhw o'r blaen, ac mae'n debyg ei bod hi'n bryd imi roi'r wybodaeth ddiweddaraf, p'un a yw hynny yn canolbwyntio ar ofal pediatrig cleifion mewnol, neu'n canolbwyntio ar nyrsio cymunedol neu, yn wir, ar ofal ar gyfer oedolion hŷn yn ogystal. Felly, byddaf yn rhoi mwy o fanylion ynglŷn â hynny, ac mae'n broc defnyddiol i'r cof ei bod hi'n bryd i mi roi'r diweddariad ysgrifenedig ffeithiol hwnnw i Aelodau.

15:15

A gaf i ddiolch i'r Ysgrifennydd Cabinet am ei ddatganiad y prynhawn yma? Fel nifer o Aelodau, rydw i'n teimlo ei bod hi'n anffodus bod yr adroddiad yma yn taro tôn neu'n creu tôn sydd bron iawn yn cwestiynu llais y dioddefwyr a theuluoedd y dioddefwyr. Hynny yw, rydym ni'n darllen cymalau yn yr adroddiad sy'n sôn amdanyn nhw'n ailgastio eu profiad yn sgil pethau a oedd wedi datblygu yn ddiweddarach. Mae yna godi cwestiynau ynglŷn ag ymddygiad a rhyw bethau felly. Wrth gwrs, mae'n pwyntio at rai teuluoedd sydd wedi cael profiadau da. Mae hynny'n ddigon teg, ond ni ddylai hynny, wrth gwrs, mewn unrhyw ystyr, fod yn gwneud profiadau a thystiolaeth y rhai sydd wedi cael profiad gwahanol yn llai dilys, os liciwch chi.

Un cwestiwn syml sydd gen i, ac un pwynt syml rydw i eisiau ei wneud, i bob pwrpas. Mae hanes wedi ein dysgu ni yn y gorffennol tan i lais y dioddefwyr gael ei gredu yna nid oes dim cyfiawnder. Rydw i jest eisiau gofyn i'r Ysgrifennydd Cabinet: a ydy'r Llywodraeth yn credu tystiolaeth teuluoedd y dioddefwyr? Oherwydd os nad ŷch chi, yna pa ryfedd na fydd gan nifer ohonyn nhw ffydd yn y broses yma? 

May I thank the Cabinet Secretary for his statement this afternoon? Like many Members, I do feel it's unfortunate that this report does create a tone that almost questions the voice of the victims and the families of the victims. We read sections of the report that talk about them recasting their experiences in light of things that have developed later. Questions are raised on the behaviour of some families and things such as that. Of course, it points to some families who have had a positive experience, and that's fair enough, but that, in no sense, should actually invalidate the families who have had different experiences.

I have one simple question, and I want to make one simple point. History has told us that, until the victim's voice is believed, then there can be no justice. I just want to ask the Cabinet Secretary: does the Government believe the evidence of the families of the victims here? If you don't, then it's no surprise that many of them will have no faith in this process. 

I think it's important that HASCAS were given a remit to independently investigate and reflect back on the evidence they found. That was the remit that they were given. You then have to accept that when that independent review is undertaken, when you accept the integrity of the people, that may well provide very difficult messages that are critical of the Government, critical of the health service, and don't always support all of the conclusions reached by individual Members of the public. That does not, though, mean that those people are not being honest. I refer back to what HASCAS themselves have said: 'Our report does not accuse any of the families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.'

When you look at the conclusions reached by HASCAS, it is very clear that they substantiate a wide range of the concerns and complaints made by families. Our challenge is how we deal with those and how we actually set out to properly improve upon those, to try and make sure that other families don't go through the same experience. That's partly about the individual care, but it is much more about the systemic failures that took place within north Wales. That's not—to go back to the point that the leader of the opposition made in a question to the First Minister—to say that, in principle, creating Betsi Cadwaladr was the wrong thing to do, but the report is very critical of the way in which the health board went about its business in those first few years, having a medically led model of delivery. The clinical programme groups in particular have been criticised previously, and it's no surprise that HASCAS, in their investigation, have criticised that model as providing a disjointed health board—so, the disconnection of the different clinical programme groups that didn't speak to each other, effectively quasi-autonomous organisations within the health board, and the three different cultures of the three provider trusts that previously existed. And it has produced challenges that are still here with us today. That is one of the significant challenges we still have to address to make sure, as I say, that once and for all those are addressed, confronted and resolved, to make it a better place for staff to work, but crucially a better place to deliver health and care for our people.

Rwy'n credu ei bod hi'n bwysig y rhoddwyd cylch gwaith i HASCAS gael ymchwilio'n annibynnol ac adrodd yn ôl ar y dystiolaeth a ganfuasent. Dyna oedd y cylch gwaith a roddwyd iddynt. Mae'n rhaid ichi dderbyn wedyn pan gynhelir yr adolygiad annibynnol hwnnw, pan fyddwch chi'n derbyn didwylledd y bobl, mae'n bosib iawn y bydd hynny'n darparu negeseuon anodd iawn sy'n feirniadol o'r Llywodraeth, yn feirniadol o'r gwasanaeth iechyd, ac na fyddant bob amser yn cefnogi pob un o'r casgliadau y daethpwyd iddyn nhw gan aelodau unigol o'r cyhoedd. Nid yw hynny, fodd bynnag, yn golygu nad yw'r bobl hynny yn nod yn onest. Rwy'n cyfeirio'n ôl at yr hyn y mae HASCAS eu hunain wedi'i ddweud: nad yw eu hadroddiad yn cyhuddo unrhyw un o'r teuluoedd o newid neu ymhelaethu ar eu straeon. Mae, fodd bynnag, yn ei gwneud hi'n glir bod yna lawer o deuluoedd nad oedd ganddynt unrhyw bryderon hyd nes cafwyd cyhoeddusrwydd yn ymwneud ag adroddiad cynharach. Yna, roedden nhw eisiau gwybod a oedd eu hanwyliaid wedi cael eu cam-drin, a cheisio sicrwydd yn hyn o beth.

Pan fyddwch chi'n edrych ar y casgliadau y daethpwyd iddyn nhw gan HASCAS, mae'n glir iawn eu bod yn cadarnhau'r amrywiaeth eang o bryderon a chwynion a wnaed gan deuluoedd. Ein her ni yw sut i ymdrin â'r rheini a sut yr ydym ni'n mynd ati mewn gwirionedd i wella ar y rheini, i geisio gwneud yn siŵr nad yw teuluoedd eraill yn cael yr un profiad. Mae hynny'n ymwneud yn rhannol â gofal unigol, ond mae'n ymwneud yn fwy o lawer â'r methiannau systemig a fu yn y gogledd. Nid yw hynny—i fynd yn ôl at y sylw a wnaeth arweinydd yr wrthblaid mewn cwestiwn i'r Prif Weinidog—yn gyfystyr â dweud, mewn egwyddor, bod creu Betsi Cadwaladr yn beth anghywir i'w wneud, ond mae'r adroddiad yn feirniadol iawn o'r ffordd y bu'r Bwrdd Iechyd yn gweithredu yn ystod y blynyddoedd cyntaf hynny, gan fod â model darpariaeth oedd yn seiliedig ar yr agweddau meddygol. Mae'r grwpiau rhaglen clinigol yn arbennig wedi eu beirniadu o'r blaen, ac nid yw'n syndod bod HASCAS, yn eu hymchwiliad, wedi beirniadu'r model hwnnw fel rhywbeth sy'n creu Bwrdd Iechyd datgymalog—felly, datgysylltiad y grwpiau rhaglen clinigol gwahanol nad oedden nhw'n siarad â'i gilydd, i bob pwrpas, sefydliadau lled-ymreolaethol yn y Bwrdd Iechyd, a thri diwylliant gwahanol iawn y tair ymddiriedolaeth a oedd yn bodoli o'r blaen. Ac mae hynny wedi creu heriau sylweddol sydd yn dal i fod gyda ni heddiw. Dyna un o'r heriau y mae'n rhaid inni fynd i'r afael â hi er mwyn sicrhau, fel yr wyf yn ei ddweud, y caiff yr agweddau hynny i gyd eu hwynebu, eu trin a'u datrys unwaith ac am byth, i'w wneud yn lle gwell i staff weithio, ond yn hanfodol, yn lle gwell i ddarparu gwasanaethau iechyd a gofal ar gyfer ein pobl.  

15:20

Thank you very much, Cabinet Secretary. 

Diolch yn fawr iawn, Ysgrifennydd y Cabinet.

4. Datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol: Adroddiad y Grŵp Gorchwyl a Gorffen ar gyfer Adolygu'r Defnydd o Rwyllau Synthetig Gweiniol
4. Statement by the Cabinet Secretary for Health and Social Services: The Report of the Welsh Task and Finish Group to Review the Use of Vaginal Synthetic Mesh

Item 4 is a statement by the Cabinet Secretary for Health and Social Services on the report of the Welsh task and finish group to review the use of vaginal synthetic mesh. I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething.

Eitem 4 yw datganiad gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol ar adroddiad y grŵp gorchwyl a gorffen i adolygu'r defnydd o rwyll synthetig y wain. Galwaf ar Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol, Vaughan Gething.

Diolch, Dirprwy Lywydd. On Friday, I published the report of the task and finish group that I established to review the use of vaginal synthetic mesh tape and sheets in the treatment of stress urinary incontinence and pelvic organ prolapse. This report provides a comprehensive account of the use of mesh in Wales and the problems associated with it. Importantly, it makes recommendations on what action we should now take to make necessary and rapid improvement. I thank the members of the task and finish group for the work they have undertaken. I do want to acknowledge the courage and commitment of those women who have worked tirelessly to highlight this issue. Whilst, understandably, they chose not to participate directly in the group’s work, the evidence that they provided has informed the findings and recommendations—and, of course, I've previously reported meeting a group of mesh survivors themselves. 

All reviews to date have shown how difficult it has been to have a reliable assessment of the scale of the problem that can be linked to the use of vaginal mesh. However, what is clear is that while many women may have benefited from such treatment, some women have suffered serious and life-changing complications as a consequence. The report reaffirms this and provides clear advice on what needs to be done to support those who are living with the debilitating effects of mesh complications. It is also clear about the need to improve our approach to the management of pelvic health problems going forward.

There are clear limitations with the adequacy of our data to understand the level of complications. The report explains why this is the case and proposes some short term and longer term solutions to address this. However, what is clear from the data presented is the sharp downward trend in the number of patients who have had mesh procedures in Wales over past 10 years. During the course of this review, the National Institute for Health and Care Excellence published new guidance, in December 2017, stating very clearly that transvaginal mesh repair for vaginal wall prolapse should only be used in the context of research. I note the task and finish group welcomed this decision by NICE and had reached the same view. I, of course, expect that advice to be followed in Wales.

The report’s overall findings and recommendations fall within five key areas: the initial care pathway required to support women’s pelvic health and well-being, which includes access to multidisciplinary teams of clinicians incorporating continence care, physiotherapy, pain management and, where appropriate, psychology skills; providing better information for patients to ensure they can make a fully informed and shared decision about treatment options; ensuring GPs can have direct access to specialist advice, so they can better support their patients; making significant improvements in the processes associated with data capture of both procedures undertaken and any implants used; and ensuring access to specialist support for mesh removal by developing one or more fully accredited multidisciplinary specialist centres. I now want to ensure that the report’s recommendations are taken forward at pace.

What is particularly clear to me, after reading this report, is that we need to have a fundamental change in the way that the NHS supports women with pelvic health problems, moving to a focus on prevention and conservative therapies, with surgical intervention as a last resort. At the same time, we need to ensure there is early access to specialist support for those with treatment complications to prevent the worst outcomes. I am therefore establishing a ministerially directed implementation group to oversee specific areas of women’s health requiring urgent attention and improvement. In the first instance, its priority will be to oversee the implementation of the recommendations from the vaginal mesh and tape review. Alongside this, I also want the group to consider any recommendations arising from the endometriosis and faecal incontinence reviews that are in progress. The mesh and tape review highlights that we can expect there to be a number of overlapping areas that need to be brought together.

Following this initial focus, I will take advice from the chief medical officer and the chief nursing officer in determining what the group’s next priorities should be. The membership of this group will need to be flexible as, although the initial focus will be on mesh and tape, the group will require appropriate representation—both professional and lay representation—from across other areas of women’s health. I'm pleased that Tracy Myhill, the chief executive of Abertawe Bro Morgannwg university health board, has kindly agreed to chair the group.

I've made funding of up to £1 million a year available to support the improvements needed. There will, of course, be much that can be done within existing resources, through service redesign and potentially the shift of services from hospitals to communities, to ensure that a community-based pelvic health and well-being pathway is put in place in each health board across Wales. This resource should help these pathways becoming the norm across Wales on a consistent basis. In the meantime, I expect all health boards to consider the report’s findings and recommendations to consider what local improvements can be made immediately. Our aim must be to ensure women receive the best possible care and treatment when they present with stress urinary incontinence or pelvic organ prolapse, or any other complications as a result of existing treatment.

I've asked my officials to set up the implementation group without delay, and I will expect regular updates on progress. It will, of course, be important for the work to be underpinned by a range of measures in order to be able to demonstrate improvements in patient outcomes and experience. The group will also need to keep its work under regular review in line with any new evidence that emerges. I have also shared the report of the task and finish group with the chairs of the Medicines and Healthcare Products Regulatory Agency and NICE, and asked that it informs their ongoing work in this area. I believe these steps provide the opportunity to have a much-needed focus on women’s health and enable the NHS to tackle key areas that have long needed improvement.

Diolch, Dirprwy Lywydd. Ddydd Gwener, cyhoeddais adroddiad y grŵp gorchwyl a gorffen a sefydlais i adolygu'r defnydd o dâp a llieiniau rhwyll synthetig y wain i drin anymataliaeth wrinol sy'n gysylltiedig â straen a phrolaps organau'r pelfis. Mae'r adroddiad hwn yn rhoi cyfrif cynhwysfawr o'r defnydd o rwyll yng Nghymru a'r problemau sy'n gysylltiedig ag ef. Yn bwysig, mae'n gwneud argymhellion ar y camau y dylem ni yn awr eu cymryd i wneud gwelliannau angenrheidiol a chyflym. Diolch i aelodau'r grŵp gorchwyl a gorffen am eu gwaith. Hoffwn gydnabod dewrder ac ymrwymiad y menywod hynny sydd wedi gweithio'n ddiflino i dynnu sylw at y mater hwn. Er iddynt ddewis peidio, yn ddealladwy, â chymryd rhan uniongyrchol yng ngwaith y grŵp, mae'r dystiolaeth y maen nhw wedi'i darparu wedi hysbysu'r canfyddiadau a'r argymhellion—ac, wrth gwrs, rwyf wedi dweud o'r blaen fy mod wedi cyfarfod â grŵp o oroeswyr rhwyll.

Mae pob adolygiad hyd yn hyn wedi dangos pa mor anodd fu cael asesiad dibynadwy o faint y broblem a all fod yn gysylltiedig â defnyddio rhwyll y wain. Fodd bynnag, yr hyn sy'n glir, er y gallai fod llawer o fenywod wedi elwa o driniaeth o'r fath, yw bod rhai menywod wedi dioddef cymhlethdodau difrifol sydd wedi newid eu bywydau o ganlyniad i hyn. Mae'r adroddiad hwn yn ailddatgan hyn ac yn darparu cyngor clir ar beth sydd angen ei wneud i gefnogi'r rhai hynny sy'n byw gydag effeithiau gwanychol cymhlethdodau rhwyll. Mae hefyd yn glir bod angen gwella ein dull o reoli problemau iechyd y pelfis wrth symud ymlaen.

Ceir cyfyngiadau clir o ran digonolrwydd ein data er mwyn deall lefel y cymhlethdodau. Mae'r adroddiad yn egluro pam mae hyn yn wir ac yn cynnig rhai atebion tymor byr a thymor hwy i fynd i'r afael â hyn. Fodd bynnag, yr hyn sy'n amlwg o'r data a gyflwynwyd yw'r gostyngiad sydyn yn nifer y cleifion sydd wedi cael triniaethau rhwyll yng Nghymru dros y 10 mlynedd diwethaf. Yn ystod yr adolygiad hwn, cyhoeddodd y Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal ganllawiau newydd, ym mis Rhagfyr 2017, yn datgan yn glir iawn na ddylid atgyweirio prolaps wal y wain â rhwyll drwy'r wain ond yng nghyd-destun ymchwil. Rwy'n nodi bod y grŵp gorchwyl a gorffen wedi croesawu'r penderfyniad hwn gan NICE a'u bod wedi dod i'r un farn. Rwyf i, wrth gwrs, yn disgwyl i'r cyngor hwnnw gael ei ddilyn yng Nghymru.

Mae canfyddiadau cyffredinol ac argymhellion yr adroddiad yn dod o fewn pum maes allweddol: y llwybr gofal cychwynnol gofynnol i gefnogi menywod o ran iechyd a lles y pelfis, sy'n cynnwys mynediad at dimau amlddisgyblaethol o glinigwyr sy'n ymgorffori gofal ymataliaeth, ffisiotherapi, rheoli poen a, phan fo'n briodol, sgiliau seicoleg; rhoi gwybodaeth well i gleifion er mwyn sicrhau y gallan nhw wneud penderfyniad cytbwys a rennir am opsiynau triniaeth; sicrhau bod gan feddygon teulu y gallu uniongyrchol i gael cyngor arbenigol, fel y gallan nhw gefnogi eu cleifion yn well; gwneud gwelliannau sylweddol yn y prosesau sy'n gysylltiedig â chasglu data o'r triniaethau a roddir ac unrhyw fewnblaniadau a ddefnyddir; a sicrhau mynediad at gymorth arbenigol ar gyfer tynnu rhwyll drwy ddatblygu un neu fwy o ganolfannau amlddisgyblaethol arbenigol wedi'u hachredu'n llawn. Rwyf nawr eisiau sicrhau ein bod yn bwrw ymlaen ag argymhellion yr adroddiad yn gyflym.

Yr hyn sy'n arbennig o glîr i mi, ar ôl darllen yr adroddiad hwn, yw bod angen inni gael newid sylfaenol yn y ffordd y mae'r GIG yn cefnogi menywod sydd â phroblemau iechyd y pelfis, gan symud ymlaen i ganolbwyntio ar atal a therapïau ceidwadol, gydag ymyrraeth lawfeddygol fel dewis olaf. Ar yr un pryd, mae angen inni sicrhau bod cymorth arbenigol ar gael yn gynnar i'r rhai hynny â chymhlethdodau triniaeth er mwyn atal y canlyniadau gwaethaf. Rwyf felly yn sefydlu grŵp gweithredu dan gyfarwyddyd gweinidogol i oruchwylio'r meysydd penodol o iechyd menywod sydd angen sylw a'u gwella ar frys. Yn y lle cyntaf, ei flaenoriaeth fydd goruchwylio'r gwaith o weithredu'r argymhellion o'r adolygiad o dâp a rhwyll y wain. Ochr yn ochr â hyn, rwyf hefyd eisiau i'r grŵp ystyried unrhyw argymhellion sy'n codi o'r adolygiadau endometriosis ac anymataliaeth ysgarthol sydd ar y gweill. Mae'r adolygiad tâp a rhwyll yn amlygu y gallwn ni ddisgwyl y bydd nifer o feysydd sy'n gorgyffwrdd y mae angen eu dwyn ynghyd.

Yn dilyn y pwyslais cychwynnol hwn, byddaf yn cymryd cyngor gan y prif swyddog meddygol a'r prif swyddog nyrsio wrth benderfynu beth ddylai fod yn flaenoriaethau nesaf i'r grŵp. Bydd angen i aelodaeth y grŵp hwn fod yn hyblyg oherwydd, er y bydd y pwyslais cychwynnol ar rwyll a thâp, bydd angen cynrychiolaeth briodol ar y grŵp—cynrychiolaeth broffesiynol a lleyg—ar draws meysydd eraill iechyd menywod. Rwy'n falch bod Tracy Myhill, prif weithredwr Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg, wedi cytuno'n garedig i gadeirio'r grŵp.

Rwyf wedi sicrhau bod hyd at £1 miliwn y flwyddyn o gyllid ar gael i gefnogi'r gwelliannau sydd eu hangen. Wrth gwrs, bydd llawer y gallwn ni ei wneud o fewn yr adnoddau presennol, drwy ailgynllunio gwasanaethau ac o bosib symud gwasanaethau o ysbytai i gymunedau, i sicrhau bod llwybr iechyd a lles y pelfis yn y gymuned yn cael ei roi ar waith ym mhob bwrdd iechyd ledled Cymru. Dylai'r adnodd hwn helpu'r llwybrau hyn i fod y drefn arferol ledled Cymru ar sail gyson. Yn y cyfamser, rwy'n disgwyl i bob bwrdd iechyd ystyried canfyddiadau ac argymhellion yr adroddiad i ystyried pa welliannau lleol y gellir eu gwneud ar unwaith. Yn sicr, ein nod yw sicrhau bod menywod yn cael y gofal a'r driniaeth orau bosib pan fyddan nhw'n dod atom yn dioddef o anymataliaeth wrinol sy'n gysylltiedig â straen neu brolaps organau'r pelfis, neu unrhyw gymhlethdodau eraill o ganlyniad i driniaeth bresennol.

Rwyf wedi gofyn i fy swyddogion sefydlu grŵp gweithredu yn ddi-oed, a byddaf yn disgwyl diweddariadau rheolaidd ar y cynnydd. Wrth gwrs, bydd yn bwysig i'r gwaith gael ei ategu gan amrywiaeth o fesurau er mwyn gallu dangos gwelliannau yng nghanlyniadau a phrofiad cleifion. Bydd angen i'r grŵp hefyd barhau i adolygu ei waith yn rheolaidd yn unol ag unrhyw dystiolaeth newydd a ddaw i'r amlwg. Rwyf hefyd wedi rhannu adroddiad y grŵp gorchwyl a gorffen gyda chadeiryddion yr Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd a NICE, ac wedi gofyn iddo lywio'r gwaith parhaus yn y maes hwn. Rwy'n credu bod y camau hyn yn gyfle i roi pwyslais mawr ei angen ar iechyd menywod a galluogi'r GIG i fynd i'r afael â meysydd allweddol yr oedd angen eu gwella ers amser.

15:25

I'd like to begin by thanking the Cabinet Secretary for taking many of the concerns forward by commissioning this work in the first place and then, again, through your statement here today. Because I've got to be honest, I was totally, myself, oblivious to this issue until it started presenting to me in my own constituency office. Some of the numbers that I've had, and the harrowing experiences by, I have to say, predominantly women, have being quite, quite startling. Then, of course, I've been well aware that many patients that have suffered are now taking to social media, and trying to—you know, we've all been copied in. I admire these people because many of them are patients who have suffered, and they're not suffering in silence. They are getting out there and trying to put out the warnings about just how unpleasant—if things go wrong—this mesh is.

Of course, I need to remind the Chamber that the issue of synthetic vaginal mesh, or the tape, is not one that just affects women, because I think there has been a tendency for it to appear that it's just an issue affecting women. I understand that where it could apply to affecting men hasn't been part of the review. But, of course, it can be used as a hernia mesh for male and female patients. The side effects of the problems caused by mesh are wide-ranging. We're not only talking about the physical pain that patients are constantly in, but also the associated mental issues related as a consequence. Confidence is lost and many people suffer depression whilst struggling to cope, and evidence does suggest that the numbers are increasing as the years roll by, because it is, actually, after a number of years post operation that problems can start. Many patients are calling for an overall ban on this procedure, and I worry that this is something that you will not confirm from your statement today. The National Institute for Health and Care Excellence in England have called for a ban of the use of vaginal mesh, an action that has been taken in New Zealand and Australia, and where it has been referred to as the biggest health scandal since thalidomide. Across the UK, about one in 11 women have experienced problems. In Scotland, former Scottish health Secretary, Alex Neil, requested a suspension of mesh implants by the NHS in 2014, but figures obtained by the BBC in December 2016 showed that hundreds of operations have been performed since. And it is worth noting that a number of Scottish health boards have stopped using mesh implants all together. 

Cabinet Secretary, we are grateful for this statement, but it doesn't go far enough. There is clearly the evidence, the public support and examples of where this mesh treatment is causing horrendous, life-changing problems. Therefore, why will you not commit to following the examples of Australia and New Zealand and bring in an outright ban at the earliest possible opportunity? Now, the dilemma for me here today is that in my own constituency I have a number of patients who have approached me, and I'm dealing with their casework, who are, as they describe, living in agony. But at the same time, I have cases where the mesh procedure is to be implemented quite soon on patients who are suffering. Now, they've raised concerns, or tried to, with the consultants, and it has to be said, they get fobbed off. They raised their concerns with GPs, and there just isn't a clear line on this, and I do think that we need something more definite from you as the health Cabinet Secretary responsible for the health our women and men across Wales. 

So, would you explain why the report has based all its figures on mesh implants, mesh removal and over-sewing. Why have outpatient appointments, covering all documented side effects, been omitted? In recommendation 3.2, you state:

'Meaningful estimates of complication rates related to mesh procedures
would require a retrospective audit'.

Does this mean you will instruct an audit to take place? If not, why not? I certainly would if I was in your shoes.

In recommendation 3.21, do you not agree that the low numbers reported in Wales could be due to it not being mandatory for clinicians to report adverse incidents to the MHRA, and also the difficult nature that may mean that the numbers held by the MHRA are inaccurate? You really should be going all out on this now to establish the absolute and exact state of play here.

What can be done to rectify this? Recommendation 5(c) states that

'Only one health board in Wales currently has a multi-disciplinary pelvic
pain clinic.'

So, you know the natural progression there is to make sure that we've got that available again for everybody in Wales. However, in a response provided to Neil McEvoy in Plenary on December 13 last year, you stated:

'My understanding is that, yes, we do have multidisciplinary teams around each surgical procedure. ' 

Can you now clarify which is accurate—your report or your response to Neil six months ago in Plenary?

Recommendation 6(a) states that

'Ways for GPs to have direct access to specialist advice should be
established.'

How will this be monitored and how soon will it be rolled out? 

Finally, Cabinet Secretary, why, when the UK Government has conducted an audit into the effects of vaginal mesh implants, is your Government still stubbornly refusing to do so? What are you worried about? Why are you not putting the interests of Welsh patients first? And I respond to you today on behalf of myself, but also on behalf of Angela Burns, Assembly Member, who sadly cannot be with us today. She is very concerned about this. She is speaking to the people, like I am, on this. We have this issue approaching us as Assembly Members on a very regular basis. It is down to you, Cabinet Secretary, to make sure that you have a very steadfast approach to these concerns. Thank you. 

Hoffwn ddechrau drwy ddiolch i Ysgrifennydd y Cabinet am fwrw ymlaen â llawer o'r pryderon drwy gomisiynu'r gwaith hwn yn y lle cyntaf ac yna, unwaith eto, drwy eich datganiad chi yma heddiw. Mae'n rhaid i mi fod yn onest, doeddwn i ddim yn ymwybodol o'r mater hwn o gwbl, fy hun, hyd nes y dechreuodd pobl ddod ataf yn fy swyddfa etholaeth. Mae rhai o'r niferoedd yr wyf i wedi'u cael, a'r profiadau dirdynnol gan fenywod yn bennaf, mae'n rhaid i fi ddweud, wedi bod yn bur frawychus. Ac yna, wrth gwrs, rwyf wedi bod yn ymwybodol iawn bod llawer o gleifion sydd wedi dioddef yn awr yn mynd at y cyfryngau cymdeithasol, ac yn ceisio—wyddoch chi, rydym ni i gyd wedi cael ein cynnwys. Rwy'n edmygu'r bobl hyn oherwydd mae llawer ohonyn nhw'n gleifion sydd wedi dioddef, ac nid ydyn nhw'n dioddef yn dawel. Maen nhw'n mynd allan yno ac yn ceisio rhybuddio pa mor annymunol—os bydd pethau'n mynd o'i le—yw'r rhwyll hwn.

Wrth gwrs, mae angen imi atgoffa'r Siambr nad yw'r mater rhwyll synthetig y wain, neu'r tâp, yn un sy'n effeithio ar fenywod yn unig, oherwydd rwy'n credu y bu tuedd iddo ymddangos yn fater sy'n effeithio ar fenywod yn unig. Rwy'n deall nad yw'r meysydd lle y gallai fod yn berthnasol i effeithio ar ddynion wedi bod yn rhan o'r adolygiad. Ond, wrth gwrs, gellir ei ddefnyddio fel rhwyll torgest ar gyfer cleifion gwrywaidd a benywaidd. Mae sgîl-effeithiau problemau a achosir gan rwyll yn eang. Nid ydym yn sôn yn unig am y boen gorfforol y mae cleifion ynddo'n gyson, ond hefyd y problemau iechyd meddwl cysylltiedig o ganlyniad i hynny. Mae'n fater o golli hyder ac mae llawer o bobl yn dioddef iselder wrth ei chael yn anodd ymdopi, ac mae'r dystiolaeth yn awgrymu bod y niferoedd yn cynyddu wrth i'r blynyddoedd fynd yn eu blaen, oherwydd gall y problemau ddechrau, mewn gwirionedd, nifer o flynyddoedd ar ôl y llawdriniaeth. Mae llawer o gleifion yn galw am waharddiad cyffredinol ar y driniaeth hon, ac rwy'n poeni bod hyn yn rhywbeth na fyddwch chi'n ei gadarnhau o'ch datganiad heddiw. Mae'r Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal yn Lloegr wedi galw am wahardd y defnydd o rwyll y wain, cam a gymerwyd yn Seland Newydd ac Awstralia, a lle y cyfeiriwyd ato fel y sgandal iechyd fwyaf ers thalidomid. Ledled y DU, mae tua un ym mhob 11 o fenywod wedi cael problemau. Yn yr Alban, gofynnodd cyn Ysgrifennydd iechyd yr Alban, Alex Neil, am atal dros dro fewnblaniadau rhwyll gan y GIG yn 2014. Ond dangosodd ffigurau a gafwyd gan y BBC ym mis Rhagfyr 2016 bod cannoedd o lawdriniaethau wedi'u cynnal ers hynny. Ac mae'n werth nodi bod nifer o fyrddau iechyd yr Alban wedi stopio defnyddio mewnblaniadau rhwyll yn gyfan gwbl.

Ysgrifennydd y Cabinet, rydym ni'n ddiolchgar am y datganiad hwn, ond nid yw'n mynd yn ddigon pell. Mae'n amlwg bod tystiolaeth, cefnogaeth y cyhoedd, ac enghreifftiau o'r driniaeth rhwyll hon yn achosi problemau erchyll, sy'n newid bywydau. Felly, pam na wnewch chi ymrwymo i ddilyn esiampl Awstralia a Seland Newydd a chyflwyno gwaharddiad llwyr ar y cyfle cynharaf posibl? Nawr, y cyfyng-gyngor i mi yma heddiw yw bod gennyf nifer o gleifion sydd wedi cysylltu â mi yn fy etholaeth i fy hun,  sydd, fel y maen nhw'n ei ddisgrifio, yn byw mewn poen, ac rwy'n ymdrin â'u gwaith achos. Ond ar yr un pryd, mae gen i achosion syn golygu bod y driniaeth rhwyll i'w gweithredu yn fuan iawn ar gleifion sy'n dioddef. Nawr, maen nhw wedi codi pryderon, neu wedi ceisio codi pryderon, gyda'r meddygon ymgynghorol, ac mae'n rhaid dweud eu bod wed cael eu troi ymaith. Maen nhw wedi codi eu pryderon gyda meddygon teulu, a does dim barn glir ar hyn, a chredaf fod angen rhywbeth mwy pendant arnom gennych chi fel Ysgrifennydd y Cabinet dros Iechyd sy'n gyfrifol am iechyd ein menywod a'n dynion ledled Cymru.

Felly, a wnewch chi egluro pam mae'r adroddiad wedi seilio ei ffigurau ar fewnblaniadau rhwyll, tynnu rhwyll a gor-wnïo. Pam mae apwyntiadau cleifion allanol, sy'n cwmpasu'r holl sgil-effeithiau a gofnodwyd, wedi'u hepgor? Yn argymhelliad 3.2, rydych chi'n nodi

y byddai angen archwiliad ôl-weithredol ar amcangyfrifon ystyrlon o gyfraddau cymhlethdod sy'n gysylltiedig â thriniaethau rhwyll.

A yw hyn yn golygu y byddwch chi'n gofyn i archwiliad gael ei gynnal? Os na, pam ddim? Byddwn i yn sicr yn gwneud hynny pe byddwn i yn eich sefyllfa chi.

Yn argymhelliad 3.21, a ydych chi'n cytuno y gallai'r niferoedd isel yr adroddwyd arnynt yng Nghymru fod oherwydd nad yw'n orfodol i glinigwyr adrodd am ddigwyddiadau andwyol i'r Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd, a hefyd natur anodd y pwnc a allai olygu bod y niferoedd sydd gan yr Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd yn anghywir? Dylech mewn gwirionedd fod yn gwneud popeth posib nawr i sefydlu beth yw'r union sefyllfa absoliwt yn y fan yma.

Beth y gellir ei wneud i unioni hyn? Mae argymhelliad 5(c) yn dweud

mai dim ond un bwrdd iechyd yng Nghymru ar hyn o bryd sydd â chlinig poen y pelfis aml-ddisgyblaethol.

Felly, fe wyddoch chi mai'r dilyniant naturiol yw gwneud yn siŵr bod hynny ar gael eto ar gyfer pawb yng Nghymru. Fodd bynnag, mewn ymateb a roddwyd i Neil McEvoy yn y cyfarfod llawn ar 13 Rhagfyr y llynedd, dywedasoch hyn:

'Fy nealltwriaeth i yw, oes, mae gennym ni dimau amlddisgyblaethol i bob triniaeth lawfeddygol.'

A allwch chi egluro nawr pa un sy'n gywir—eich adroddiad neu eich ymateb i Neil chwe mis yn ôl yn y cyfarfod llawn?

Dywed argymhelliad 6(a) y dylid

sefydlu ffyrdd y gallai meddygon teulu gael mynediad uniongyrchol at gyngor arbenigol.

Sut bydd hyn yn cael ei fonitro a pha mor fuan y caiff ei gyflwyno?

Yn olaf, Ysgrifennydd y Cabinet, pam, pan fo Llywodraeth y DU wedi cynnal archwiliad i effeithiau mewnblaniadau rhwyll y wain, fod eich Llywodraeth chi yn dal i fod yn ystyfnig ac yn gwrthod gwneud hynny? Beth sy'n eich poeni? Pam nad ydych chi'n blaenoriaethu buddiannau cleifion Cymru? Ac rwy'n ymateb i chi heddiw o'm rhan fy hun, ond hefyd ar ran Angela Burns, Aelod Cynulliad, na all yn anffodus fod gyda ni heddiw. Mae hi'n bryderus iawn am hyn. Mae hi'n siarad gyda phobl, fel yr wyf i, am hyn. Mae'r mater hwn yn dod atom ni fel Aelodau Cynulliad yn rheolaidd iawn. Eich cyfrifoldeb chi, Ysgrifennydd y Cabinet, yw gwneud yn siŵr bod gennych chi ddull cadarn iawn o ymdrin â'r pryderon hyn. Diolch i chi.

15:30

Thank you for those questions and comments. I make no apology for saying that the hernia issues are separate matters, with a different group of surgeons and a different process in place to understand the level of complications that exists. This has been unashamedly focused on women's health issues, and, bluntly, if the same level of complications had affected men's health issues, I suspect we would have heard about them much sooner.  

I'll deal with your final point first about the multidisciplinary teams. Of course, recommendation 5 deals with multidisciplinary teams for pelvic pain clinics, as opposed to broader multidisciplinary teams that are in place around surgery. There's a challenge here about making sure that we have the right number of multidisciplinary teams in place, including, of course, for a specialist centre for mesh removal, and to look at one or more of those, and in particular about what happens currently in south Wales and having an accredited multidisciplinary surgical removal centre, but also about the continued use of Manchester for patients in north Wales. 

On your points around the banning of—. No, I'll deal with your audit point first, before I come back to the point about banning mesh, which has featured very heavily in what we've been asked to do over a period of time. If we look at the auditing that's taken place in England, they're looking at it on an experimental basis in England to try and retrospectively audit what has happened. What's been helpful is that, between officials in the Welsh Government and the Department for Health for the UK Government, acting for England, there has been a really constructive transfer of information about the audit taking place, and there are similarities in the range of challenges that we expect the audit in England to reveal. Before I look to undertake retrospective action, where we can't be sure of the exact value of that, I am interested, though, in understanding what happens in England and what lessons we can learn from that, as well as looking more proactively at the issues for new implants of medical devices.

There is an European Union directive, due to be implemented in 2020 or 2021. Of course, that will still be an issue for us, regardless of what the transitional deal is or isn't agreed by the United Kingdom Government and our relationship with the European Union. But that is looking at being able to understand and have a proper register what devices have been implanted into people more generally. Now, there is a challenge there about understanding whether they're able to scan that and understand how that's done, and that is covered in the recommendations in the report. In taking forward these recommendations, we'll need to determine what our approach to that will be. That is not something that is simply covered over or about to be forgotten. And that will help us to deal with some of the requests from the women involved. In the requests they gave us, I think on pretty much every area we're going to be able to show progress, apart from the issue of a ban. 

You mentioned Scotland, and the request for a suspension made by the Scottish health Secretary. Well, it's a matter for the Scottish health Secretary to answer for themselves about their approach, but, as you say, a range of people have still undergone mesh implants since that time. That's because the Scottish health Secretary, just like me, doesn't have the power to ban mesh implants. The challenge is that whilst these are regulated devices that are available, and are available for use, it is an issue of consent between the health provider and the individual citizen about whether they wish to have the surgery provided.

Now, as I say, there are a number of women who have had the surgery without complication. Part of what the women asked us to look at, and part of the terms of reference for the task and finish group, was about properly informed consent to make sure that people really did have the challenges and the risks explained to them, to make sure it really is a very last resort. And even then, some women will choose not to have the surgery, and that should be an informed choice to make, just as women who do choose to have surgery, if that is their choice—it must be their choice on a properly informed basis.

I have, though, written to the MHRA asking them to reflect on the regulated decisions in Australia and New Zealand in particular to ban mesh. The MHRA have responded and said that they do not intend to do so. However, since then, the Cumberlege review is in place to look again at a number of these issues, and there will be engagement both from the NHS and the Government in that review, and I expect women from across Wales will engage in that review too. So, this is not an issue that's about to go away. Whilst I don't have the power—and you'll understand why politicians don't have the power to ban in particular surgical devices or equipment available for the health service—we are fixed with a proper division between a regulator's power and the power that a politician has. But as I say, I have provided them with a copy of this review, and I look forward to the Cumberlege review and what that will tell us and about this decision being kept properly under review in light of the evidence available. 

Diolch ichi am y sylwadau a'r cwestiynau hynny. Dydw i ddim yn mynd i ymddiheuro am ddweud bod y materion torgest yn faterion ar wahân, gyda grŵp gwahanol o lawfeddygon a phroses wahanol ar waith i ddeall lefel y cymhlethdodau sy'n bodoli. Mae hwn wedi canolbwyntio yn ddiedifar ar faterion iechyd menywod, ac, yn blwmp ac yn blaen, pe byddai'r lefel hon o gymhlethdodau wedi effeithio ar faterion iechyd dynion, rwy'n tybio y byddem wedi clywed amdanyn nhw'n gynt o lawer.

Fe wnaf i ymdrin â'ch pwynt olaf yn gyntaf am y timau amlddisgyblaethol. Wrth gwrs, mae argymhelliad 5 yn ymdrin â thimau amlddisgyblaethol ar gyfer clinigau poen y pelfis, yn hytrach na thimau amlddisgyblaethol ehangach sydd ar waith mewn llawdriniaeth. Mae her yma i wneud yn siŵr fod gennym y nifer gywir o dimau amlddisgyblaethol ar waith, gan gynnwys, wrth gwrs, ganolfan arbenigol ar gyfer tynnu rhwyllau, ac i ystyried un neu fwy o'r rheini, ac yn benodol yr hyn sy'n digwydd ar hyn o bryd yn y de a chael canolfan lawfeddygol amlddisgyblaethol achrededig, ond hefyd am barhau i ddefnyddio Manceinion ar gyfer cleifion yn y gogledd.

O ran eich pwyntiau ynghylch gwahardd—. Na, fe wnaf ymdrin â'ch pwynt am archwilio yn gyntaf, cyn imi ddod yn ôl at y pwynt am wahardd rhwyll, sydd wedi ymddangos yn amlwg iawn yn yr hyn y gofynnwyd i ni ei wneud dros gyfnod o amser. Os edrychwn ni ar yr archwilio hynny sydd wedi digwydd yn Lloegr, maen nhw'n ei ystyried ar sail arbrofol yn Lloegr i geisio archwilio'n ôl-weithredol yr hyn sydd wedi digwydd. Yr hyn sydd wedi bod yn ddefnyddiol yw, rhwng swyddogion yn Llywodraeth Cymru ac Adran Iechyd Llywodraeth y DU, sy'n gweithredu ar ran Lloegr, y cafwyd trosglwyddiad adeiladol iawn o wybodaeth am yr archwiliad sy'n digwydd, ac mae tebygrwydd yn yr ystod o heriau yr ydym yn disgwyl i'r archwiliad yn Lloegr eu datgelu. Cyn i mi ystyried cymryd camau ôl-weithredol, lle na allwn ni fod yn siŵr o union werth hynny, mae gennyf ddiddordeb, er hynny, mewn deall beth sy'n digwydd yn Lloegr a pha wersi y gallwn ni eu dysgu o hynny, yn ogystal ag edrych yn fwy rhagweithiol ar y materion ar gyfer mewnblaniadau newydd o ddyfeisiau meddygol.

Mae yna gyfarwyddeb yr Undeb Ewropeaidd, a fydd yn cael ei rhoi ar waith yn 2020 neu 2021. Wrth gwrs, bydd hwnnw'n dal i fod yn fater i ni, ni waeth pa fargen drosiannol y mae Llywodraeth y Deyrnas Unedig yn cytuno arni neu ddim yn cytuno arni a'n perthynas ni gyda'r Undeb Ewropeaidd. Ond mae hynny'n ystyried gallu deall a bod â chofrestr briodol o ba ddyfeisiau sydd wedi'u mewnblannu mewn pobl yn fwy cyffredinol. Nawr, mae yna her yn y fan honno ynghylch deall a ydyn nhw'n gallu sganio hynny a deall sut y gwneir hynny, a chaiff hynny ei gynnwys yn yr argymhellion yn yr adroddiad. Wrth ddatblygu'r argymhellion hyn, bydd angen inni benderfynu beth fydd ein dull o wneud hynny. Nid yw hynny'n rhywbeth a gaiff ei guddio neu sydd ar fin cael ei anghofio. A bydd hynny'n ein helpu ni i ymdrin â rhai o'r ceisiadau gan y menywod dan sylw. Yn y ceisiadau a roddwyd i ni, rwy'n credu y byddwn yn gallu dangos cynnydd ym mhob maes fwy neu lai, ar wahân i fater y gwaharddiad.

Soniasoch am yr Alban, a'r cais i atal dros dro a wnaed gan Ysgrifennydd Iechyd yr Alban. Wel, mater i Ysgrifennydd Iechyd yr Alban yw ateb drosto ei hun am ei ddull gweithredu, ond, fel y dywedwch chi, mae amrywiaeth o bobl yn dal wedi cael mewnblaniadau rhwyll ers yr amser hwnnw. Mae hynny oherwydd nad oes gan Ysgrifennydd Iechyd yr Alban, fel fi, y grym i wahardd mewnblaniadau rhwyll. Yr her yw, er bod y rhain yn ddyfeisiau a reoleiddir sydd ar gael, ac maen nhw ar gael i'w defnyddio, ei bod yn fater o ganiatâd rhwng y darparwr iechyd a'r dinesydd unigol ynghylch a yw'n dymuno cael y llawdriniaeth.

Nawr, fel y dywedaf, mae yna nifer o fenywod sydd wedi cael y llawdriniaeth heb gymhlethdod. Rhan o'r hyn y gofynnodd y menywod inni ei ystyried, a rhan o gylch gorchwyl y grŵp gorchwyl a gorffen, oedd cael cydsyniad gwybodus priodol i wneud yn siŵr bod pobl mewn gwirionedd yn cael eglurhad o'r heriau a'r risgiau, i wneud yn siŵr mai hwn yw'r  dewis olaf un. A hyd yn oed wedyn, bydd rhai menywod yn dewis peidio â chael y llawdriniaeth, a dylai hwnnw fod yn ddewis gwybodus i'w wneud, yn yr un modd ag y mae menywod sy'n dewis cael llawdriniaeth, os dyna yw eu dewis—mae'n rhaid iddyn nhw ddewis hynny ar sail gwybodaeth briodol.

Er hynny, rwyf wedi ysgrifennu at yr Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd yn gofyn iddyn nhw ystyried y penderfyniadau a reoleiddiwyd yn Awstralia a Seland Newydd yn benodol i wahardd rhwyll. Mae'r Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd wedi ymateb ac wedi dweud nad ydyn nhw'n bwriadu gwneud hynny. Fodd bynnag, ers hynny, mae arolwg Cumberlege yn mynd i edrych eto ar nifer o'r materion hyn, a bydd ymgysylltiad gan y GIG a'r Llywodraeth yn yr adolygiad hwnnw, ac rwy'n disgwyl y bydd menywod ledled Cymru yn cymryd rhan yn yr adolygiad hwnnw hefyd. Felly, nid yw hwn yn fater sy'n mynd i ddiflannu. Er nad oes gennyf i'r grym—a byddwch chi'n deall pam nad oes gan wleidyddion y grym i wahardd yn benodol ddyfeisiau neu gyfarpar llawfeddygol sydd ar gael ar gyfer y gwasanaeth iechyd—mae gennym ni sefyllfa sydd â rhaniad priodol rhwng grym y rheoleiddiwr a grym y gwleidydd. Ond fel rwy'n dweud, rwyf wedi rhoi copi o'r adolygiad hwn iddyn nhw, ac edrychaf ymlaen at adolygiad Cumberlege a'r hyn y bydd ganddo i'w ddweud, ac am barhau i adolygu'r penderfyniad hwn yn briodol ar sail y dystiolaeth sydd ar gael.

15:35

A gaf i ddiolch am y datganiad? A diolch hefyd, wrth gwrs, i'r merched hynny a wnaeth ddangos y dewrder a'r ymroddiad i weithio'n ddiflino, fel y dywedasoch chi, i danlinellu’r mater hwn. A, do, mae merched wedi dioddef cymhlethdodau sydd wedi eu bywydau nhw. Rydw i'n croesawu’r elfennau yn yr adroddiad sy’n ymwneud â sawl elfen o hyn: yr angen i weithio’n rhagweithiol ar yr elfen ymataliol i atal merched rhag bod angen triniaeth a llawdriniaeth yn y lle cyntaf; yr angen i gadw at ganllawiau NICE a chynyddu ymwybyddiaeth o’r canllawiau hynny—fel efo cymaint o bethau, mae o’n wendid mawr yn y ffordd y mae’r Llywodraeth yma’n gweithio yn gyffredinol, y methiant i gadw’r math o ddata sydd yn caniatáu inni gynllunio gwasanaeth iechyd gwell; a hefyd y ganolfan ar gyfer cael gwared ar y mesh—canolfan arbenigol, felly—a’r arian a fydd yn mynd ar hynny, wrth gwrs, ac mae hynny i’w groesawu. Mae gen i nifer o gwestiynau, serch hynny.

May I thank the Cabinet Secretary for the statement? And I thank those women as well who showed such bravery and commitment in working tirelessly, as you said, to underline this issue.  And, yes, women have suffered complications that have changed their lives. I welcome elements in the report relating to several elements of this: the need to work proactively on the preventative aspect to prevent women from having to have surgery in the first instance; the need to stick to NICE guidelines and increase awareness of those guidelines—as with so many things, there's a weakness in the way that this Government operates in general, the failure to keep the kind of data that allows us to plan better health services; and also the specialist centre for tackling the mesh issue—the funding for that is to be welcomed, of course. But, I have several questions, nevertheless.  

The report highlights that some women, having described their symptoms, were dismissed by medical professionals who had wrongly ascribed symptoms to normal post-operative pain, perhaps. Many women felt they were patronised as a result of that, describing their battles, frankly, to be taken seriously. And this isn't the first time that we've seen this kind of thing; we remember, back in the 1990s, with chronic fatigue syndrome. Can you, as Cabinet Secretary, be a little bit more specific about how that particular issue can be addressed, how awareness, for example, can be raised, and how attitudes can be changed, so that people with unexplained symptoms are regarded as patients first and foremost, with symptoms that need investigating, rather than as people who should frankly just accept a little bit of pain? Because we know now, through the hard work of people who have campaigned for change here, that what was dismissed now has to quite rightly be taken very, very seriously.

The report also highlights the weaknesses with the adverse reaction reporting system for medical equipment, for the medicines healthcare regulatory authority. It's not something that is devolved, but can you describe how your department is going to try to improve that system so that we have earlier warnings?

Finally, regarding the specialist centre for mesh removal, whilst welcome in itself, we could do with something a little bit more concrete in terms of timescales, so I'd be grateful for a proper timescale for that development, so that people can see that words now will turn into action in the not distant future.

Mae'r adroddiad yn tynnu sylw at y ffaith y diystyriwyd rhai menywod, ar ôl iddyn nhw ddisgrifio eu symptomau, gan weithwyr meddygol proffesiynol a oedd wedi priodoli yn anghywir y symptomau i boen ar ôl llawdriniaeth arferol, o bosib. Roedd llawer o fenywod o'r farn eu bod wedi'u trin yn nawddoglyd o ganlyniad i hynny, wrth ddisgrifio eu brwydrau, a dweud y gwir, i gael eu cymryd o ddifrif. Ac nid dyma'r tro cyntaf yr ydym ni wedi gweld y math hyn o beth; rydym ni'n cofio, yn ôl yn yr 1990au, syndrom blinder cronig. A allwch chi, fel Ysgrifennydd y Cabinet, fod ychydig yn fwy penodol ynghylch sut y gellir mynd i'r afael â'r mater penodol hwnnw, sut, er enghraifft, y gellir codi ymwybyddiaeth, a sut y gellir newid agweddau, fel bod pobl sydd â symptomau anesboniadwy yn cael eu hystyried yn gleifion yn gyntaf ac yn bennaf oll, â symptomau y mae angen ymchwilio iddynt, yn hytrach na fel pobl a ddylai, a dweud y gwir, fod yn fodlon derbyn ychydig o boen? Oherwydd rydym yn gwybod yn awr, drwy waith caled pobl a fu'n ymgyrchu dros newid yma, fod angen ystyried yn ddifrifol iawn, iawn bellach, yn gwbl briodol, yr hyn a ddiystyriwyd.

Mae'r adroddiad hefyd yn tynnu sylw at wendidau yn y system adrodd am adwaith andwyol ar gyfer cyfarpar meddygol, ar gyfer yr Asiantaeth Rheoleiddio Meddyginiaethau a Chynhyrchion Gofal Iechyd. Nid yw'n rhywbeth sydd wedi'i ddatganoli, ond a allwch chi ddisgrifio sut y mae eich adran yn mynd i geisio gwella'r system honno fel ein bod yn cael rhybuddion cynharach?

Yn olaf, ynghylch y ganolfan arbenigol ar gyfer tynnu rhwyllau, er bod croeso iddi, gallem wneud â rhywbeth ychydig yn fwy pendant o ran amserlenni, felly byddwn yn ddiolchgar am amserlen briodol ar gyfer y datblygiad hwnnw, fel y gall pobl weld y bydd geiriau yn awr yn troi'n weithred yn y dyfodol agos.

15:40

Thank you for those comments. There are broadly three questions provided in there. On the point about whether women who were not believed, and the battle to be believed, and how that will be overcome, well, the significant publicity around this—again generated by, as I said in my initial statement, the courageous and determined women who raised the isue—is part of that. The patient safety notice that was issued by the chief medical officer in 2014 is a part of that. The work undertaken by NICE is all a part of that. These are a range of different measures that are being undertaken to try and make sure that people are believed.

And there's also a broader challenge here about the way in which health and care are delivered, and it goes back to prudent healthcare, a concept started in the middle of the last Assembly term here in Wales. It's about understanding what matters to the patient, and about having a much more equal relationship with that person and the healthcare professional. And when that person raises concerns, rather than simply dismissing them and taking a rather more paternalistic approach, it's actually about listening to that person to understand what is happening and to recognise that they do have a continuing health and care need.

In addition to your point about GPs, I think it's worth while referring to recommendation 6 and how we take it forward in ensuring that there is access to specialist advice for GPs. It was part of the concern by the GP representative on the task and finish group to make sure that GPs themselves are properly equipped in being able to understand, not just potential symptoms, but then where they could go for that specialist advice, help and support. That comes back again to the opening of this that there was not a high level of awareness of the problems as they were being reported, and I do think, bluntly, that if there'd been a men's health issue, there'd have been a higher level of awareness and higher and more immediate acceptance of the challenges that people were facing in reality.

In terms of your point about when and how we'll be able to take forward the recommendations, including the specialist centres, well that's why I've announced there'll be an implementation group to take that forward, with the requisite level of weight within the health service. So, that's why there'll be a chief executive of one of our larger health boards taking forward and chairing that group, and understanding the right number of people who will need to be on that to understand how we draw up those service plans and then to make sure there is funding to try and advance that as well, rather than simply asking people to eat into current resources. You will understand that, in the financial position that we are in, adding new money to this area is a significant commitment when we're looking to make compromises in other areas of delivery.

So, this is a real priority, and I do recognise there is more that we will need to do. I mentioned the endometriosis review that is coming in as well, and the faecal incontinence review that is coming in as well, to make sure that we don't just see these issues in isolation, but understand them together, and make sure that we do see a real improvement. When I have more definite timescales, I will of course report back to you and other Assembly Members.

Diolch ichi am y sylwadau hynny. Yn fras mae yma dri chwestiwn. Ar y pwynt ynghylch menywod na chawsant eu credu, a'r frwydr i gael eu credu, a sut y bydd hynny'n cael ei oresgyn, wel, mae'r cyhoeddusrwydd sylweddol i hyn—eto a gynhyrchwyd gan, fel y dywedais yn fy natganiad cychwynnol, y menywod dewr a phenderfynol a gododd y mater—yn rhan o hynny. Mae'r rhybudd diogelwch cleifion a gyhoeddwyd gan y prif swyddog meddygol yn 2014 yn rhan o hynny. Mae'r holl waith a wnaed gan NICE yn rhan o hynny. Mae ystod o wahanol gamau gwahanol yn cael eu cymryd i geisio gwneud yn siŵr bod pobl yn cael eu credu.

Ac mae hefyd her ehangach yn y fan yma am y modd y darperir iechyd a gofal, ac mae'n mynd yn ôl i ofal iechyd darbodus, cysyniad a ddechreuodd yng nghanol tymor diwethaf y Cynulliad yma yng Nghymru. Mae'n ymwneud â deall yr hyn sy'n bwysig i'r claf, ac am gael perthynas llawer mwy cyfartal gyda'r person hwnnw a'r gweithiwr gofal iechyd proffesiynol. A phan fo'r person hwnnw yn codi pryderon, yn hytrach na dim ond ei ddiystyru a chymryd agwedd nawddoglyd, mewn gwirionedd mae'n ymwneud â gwrando ar y person hwnnw i ddeall beth sy'n digwydd ac i gydnabod bod angen iechyd a gofal parhaus arno.

Yn ychwanegol at eich pwynt am feddygon teulu, rwy'n credu ei bod yn werth cyfeirio at argymhelliad 6 a sut yr ydym yn bwrw ymlaen ag ef wrth sicrhau bod cyngor arbenigol ar gael i feddygon teulu. Roedd yn rhan o'r pryder gan gynrychiolydd y meddygon teulu yn y grŵp gorchwyl a gorffen i wneud yn siŵr bod gan feddygon teulu eu hunain y gallu i ddeall, nid dim ond y symptomau posib, ond yna ble y gallent fynd i gael y cyngor, cymorth a chefnogaeth arbenigol hwnnw. Daw hynny'n ôl eto at sylwadau agoriadol hyn nad oedd lefel uchel o ymwybyddiaeth o'r problemau wrth iddyn nhw gael eu hadrodd, ac rwy'n credu, yn blwmp ac yn blaen, pe byddai mater iechyd dynion wedi bod, byddai lefel uwch o ymwybyddiaeth a mwy o dderbyn ar unwaith bod pobl yn wynebu heriau mewn gwirionedd.

O ran eich pwynt ynghylch pryd a sut y byddwn ni'n gallu bwrw ymlaen â'r argymhellion, gan gynnwys y canolfannau arbenigol, wel dyna pam yr wyf i wedi cyhoeddi y bydd yna grŵp gweithredu i fwrw ymlaen â hynny, gyda'r lefel ofynnol o bwysoli yn y gwasanaeth iechyd. Felly, dyna pam y bydd prif weithredwr un o'n byrddau iechyd mwyaf yn bwrw ymlaen ac yn cadeirio'r grŵp hwnnw, ac yn deall y nifer cywir o bobl y bydd angen iddynt fod yn rhan o hwnnw i ddeall sut yr ydym ni'n cynllunio'r gwasanaeth hynny ac yna gwneud yn siŵr bod cyllid ar gael i geisio datblygu hynny hefyd, yn hytrach na dim ond gofyn i bobl ddefnyddio'r adnoddau presennol. Byddwch chi'n deall, yn y sefyllfa ariannol sydd ohoni, fod ychwanegu cyllid newydd i'r maes hwn yn ymrwymiad sylweddol pan rydym yn ceisio gwneud arbedion mewn meysydd darparu eraill.

Felly, mae hyn yn flaenoriaeth wirioneddol, ac rwy'n cydnabod y bydd angen inni wneud mwy. Soniais am yr adolygiad endometriosis sy'n digwydd a'r adolygiad anymataliaeth ysgarthol sydd hefyd yn digwydd. Bydd yn rhain yn gwneud yn siŵr nad ydym yn gweld y materion hyn fel materion ar wahân yn unig, ond yn eu deall gyda'i gilydd, ac yn gwneud yn siŵr ein bod yn gweld gwelliant gwirioneddol. Pan fydd gennyf amserlenni mwy pendant, fe wnaf wrth gwrs adrodd yn ôl i chi ac Aelodau eraill y Cynulliad.

15:45

Thank you for this and your earlier statement, Cabinet Secretary. Complications relating to vaginal mesh implants have left thousands of women, worldwide, living in constant, debilitating, chronic pain, and it is therefore welcome that the Welsh Government undertook a review of the use of such implants. I would like to thank Professor Emery and his team for their report.

Whilst survivor groups would like an immediate ban on all use of such mesh and tape implants, I accept that these implants have benefits for some women, but their use should not be widespread and should be controlled. I therefore welcome the task and finish group’s recommendations to improve the pathway, to encourage greater informed choice and to affirm that mesh surgery should be a last resort.

Cabinet Secretary, the task and finish group made a number of recommendations and I am grateful that you have indicated that you support their implementation. When do you expect the implementation group to complete its work and ensure that all recommendations are put in place?

Cabinet Secretary, are you aware of the research being undertaken at the University of Sheffield, published in the journal 'Neurourology and Urodynamics', which supports the use of a softer and more elastic material, better suited for use in the pelvic floor, and one that releases oestrogen into the surrounding pelvic tissue to form new blood vessels and ultimately speed up the healing process? They concluded that a different material, polyurethane, would be a much better material to use as a vaginal mesh due to its flexibility and its likeness to human tissue. The next step is clinical trials. Cabinet Secretary, can you ensure that Welsh patients have access to these trials?

I look forward to seeing the details of the new care pathway and support available to women who have stress urinary incontinence or pelvic organ prolapse. Diolch yn fawr, thank you very much.

Diolch i chi am hwn ac am eich datganiad cynharach, Ysgrifennydd y Cabinet. Mae cymhlethdodau sy'n ymwneud â mewnblaniadau rhwyll y wain wedi gadael miloedd o fenywod, ledled y byd, yn byw mewn poen cyson, gwanychol a chronig. Felly mae croeso i'r ffaith bod Llywodraeth Cymru wedi cynnal adolygiad o'r defnydd o fewnblaniadau o'r fath. Hoffwn ddiolch i'r Athro Emery a'i dîm am eu hadroddiad.

Er bod grwpiau goroeswyr yn dymuno cael gwaharddiad ar unwaith ar bob defnydd o fewnblaniadau rhwyll a thâp o'r fath, rwy'n derbyn bod y mewnblaniadau hyn o fudd i rai menywod. Serch hynny, ni ddylai eu defnydd fod yn eang a dylid ei reoli. Felly rwy'n croesawu argymhellion y grŵp gorchwyl a gorffen i wella'r llwybr, i annog mwy o ddewis gwybodus ac i gadarnhau y dylai llawdriniaeth rhwyll fod yn ddewis olaf.

Ysgrifennydd y Cabinet, gwnaed nifer o argymhellion gan y grŵp gorchwyl a gorffen ac rwy'n ddiolchgar eich bod wedi dweud eich bod yn cefnogi eu rhoi ar waith. Pryd ydych chi'n disgwyl i'r grŵp gweithredu gwblhau ei waith a sicrhau bod yr holl argymhellion yn cael eu rhoi ar waith?

Ysgrifennydd y Cabinet, a ydych chi'n ymwybodol o'r ymchwil a wnaed ym Mhrifysgol Sheffield, a gyhoeddwyd yn y cyfnodolyn 'Neurourology and Urodynamics', sy'n cefnogi'r defnydd o ddeunydd meddalach a mwy elastig, sy'n fwy addas i'w defnyddio yn llawr y pelfis, ac un sy'n rhyddhau oestrogen i'r meinweoedd pelfis cyfagos i ffurfio pibelli gwaed newydd a chyflymu'r broses o wella yn y pen draw? Daethant i'r casgliad y byddai deunydd gwahanol, sef polywrethan, yn ddeunydd gwell i'w ddefnyddio fel rhwyll y wain oherwydd ei hyblygrwydd a'i debygrwydd i feinwe dynol. Y cam nesaf yw treialon clinigol. Ysgrifennydd y Cabinet, a allwch chi sicrhau bod cleifion yng Nghymru yn cael mynediad at y treialon hyn?

Rwy'n edrych ymlaen at weld manylion y llwybr gofal newydd, a'r cymorth sydd ar gael i fenywod sydd ag anymataliaeth wrinol sy'n gysylltiedig â straen neu brolaps organau'r pelfis. Diolch yn fawr, diolch yn fawr iawn.

I'll try to deal with the point the first question raised about the implementation group and the timescale to complete their work. I will of course report back to Members, but as the group has yet to meet, and to consider how to take forward those recommendations, I'm not in a position to give an undertaking or commitment on that today, which I hope Members will understand. But I will report back about that.

On your second point about the research published by Sheffield, there's a variety of research that is carrying on about alternative surgical options, whether that is artificial or biological material to be implanted. But I can't really comment on the clinical trial that they're looking to undertake. I will, though, look to discuss with my officials to see if there is something useful that we can come back to Members with. But of course the Government isn't in control of those clinical trials and access to patients.

What's interesting in the task and finish group report is that I think there are some people they can identify who are more likely to be at greater risk of complications or having significant pain after the event. There's something about understanding and having that conversation about generally informed consent will be women that are involved. Because, as I say, whilst mesh has not been banned, whilst I do not have the power to ban mesh—even if I were minded to do so, I don't have the power to do it—we do need to make sure that consent is generally informed and that people understand the nature of what the current problem is and the treatment available for that, but also the risks and the potential benefits of any form of surgery, whether it involves mesh or not. And that was a really clear part of both the task and finish group's report, but also Members who wish to see a change in practice said, 'If we didn't have a ban, we need to make sure there was a real change in consent.' One of the more upsetting things that I heard about this particular issue was where people said that they just weren't told properly what the risks were, and that there was no problem at all with it. And that can't be a way to practice healthcare in the here-and-now today, let alone in the future.

Fe wnaf geisio ymdrin â phwynt y cwestiwn cyntaf a godwyd am y grŵp gweithredu a'r amserlen i gwblhau eu gwaith. Byddaf wrth gwrs yn adrodd yn ôl i'r Aelodau, ond gan nad yw'r grŵp wedi cyfarfod eto, ac nad ydynt wedi ystyried sut i ddatblygu'r argymhellion hynny, nid wyf mewn sefyllfa i roi sylwadau nac ymrwymiad ar hynny heddiw, a gobeithio y bydd yr Aelodau yn deall. Ond byddaf yn adrodd yn ôl ar hynny.

Ar eich ail bwynt am yr ymchwil a gyhoeddwyd gan Sheffield, mae yna amrywiaeth o waith ymchwil sy'n cael ei wneud ar opsiynau llawfeddygol amgen, boed hynny'n ddeunydd biolegol neu artiffisial i'w fewnblannu. Ond ni allaf wneud sylwadau ar y cynllun treialu clinigol y maen nhw'n gobeithio eu cynnal. Byddaf, er hyn, yn ceisio trafod gyda'm swyddogion i weld a oes rhywbeth defnyddiol y gallwn ni roi gwybod i'r Aelodau amdano. Ond wrth gwrs nid yw'r Llywodraeth yn rheoli'r treialon clinigol hynny a mynediad i gleifion.

Yr hyn sy'n ddiddorol yn adroddiad y grŵp gorchwyl a gorffen yw bod rhai pobl y gallan nhw eu nodi sydd yn fwy tebygol o fod mewn mwy o berygl o gymhlethdodau neu o gael poen sylweddol ar ôl y llawdriniaeth. Mae rhywbeth ynghylch deall, a'r menywod sy'n cymryd rhan fydd yn cael y sgwrs honno ynghylch cydsyniad deallus cyffredinol. Oherwydd, fel y dywedaf, er na chafodd rhwyll ei wahardd, ac er nad oes gennyf y pŵer i wahardd rhwyll—hyd yn oed pe byddai gennyf fwriad i wneud hynny, nid oes gennyf y pŵer i wneud hynny—mae angen i ni wneud yn siŵr bod cydsyniad yn seiliedig yn gyffredinol ar ddealltwriaeth a bod pobl yn deall natur y broblem bresennol a'r driniaeth sydd ar gael ar gyfer hynny, ond hefyd y risgiau a manteision posibl unrhyw fath o lawdriniaeth, boed hynny'n cynnwys rhwyll ai peidio. Ac roedd hynny'n rhan amlwg iawn o adroddiad y grŵp gorchwyl a gorffen, ond hefyd dywedodd yr Aelodau sy'n dymuno gweld newid mewn arfer, 'Os nad oedd gwaharddiad gennym, mae angen i ni sicrhau bod newid gwirioneddol mewn cydsyniad.' Un o'r pethau tristaf a glywais am y mater penodol hwn oedd pan ddywedodd pobl nad oedden nhw wedi cael gwybod yn iawn beth oedd y risgiau, ac nad oedd unrhyw broblem gydag ef. Ni all hynny fod yn ffordd o arfer gofal iechyd ar hyn o bryd, heb sôn am yn y dyfodol.

15:50

Can I thank the Cabinet Secretary for your statement today and can I welcome the recognition, at long last, of the adverse impact of the use of synthetic tape and surgical vaginal mesh sheets for treating pelvic organ prolapse and stress urinary incontinence, leading to appalling, long-term and life-changing consequences for women's health? I welcome the recommendations in your report that relate to preventative measures and conservative management of these conditions and with surgery as a last resort. I welcome also, for example, the recommendation for a new pelvic health and well-being pathway. And can I thank the Cabinet Secretary for meeting with my constituents, Jemima Williams and Nicola Hobbs, whose lives have been so adversely affected by vaginal mesh implants? I'd like to praise them for their courage and their leadership in the Welsh Mesh Survivors group. But can I clarify, Cabinet Secretary, the position regarding my constituents, Jemima and Nicola, and the task and finish group? Because in your written statement you said that they chose not to take part in the group, but can I draw attention to the context of their decision not to take engage? They were deeply concerned about the membership of the group, the papers presented to the group and the lack of notice and draft terms of reference, because both also are suffering from constant pain and severe ill-health.

But it was very helpful that you agreed to meet them, with me. Can you confirm that you took full account of their full and harrowing evidence at that meeting? They did provide an extensive folder of patient experience of adverse impact. And also, can you confirm and clarify, Cabinet Secretary, what cross-border engagement is taking place to share clinical expertise, evidence from patients, mesh sufferers and funding also that could be available for referral to mesh removal experts?

Finally, as you are aware, the Welsh Mesh Survivors group are calling for mesh use to be suspended until a full audit has been carried out. And it's hard to believe that the procedure can still take place in Wales, despite the point that you made today in your statement, that all reviews to date have shown how difficult it has been to have a reliable assessment of the scale of the problem that can be linked to the use of vaginal mesh. That is as we are today. So, Cabinet Secretary, will you consider holding a retrospective audit of the use of mesh in Wales and consider suspending the use of vaginal mesh until this takes place? Thank you.

A gaf i ddiolch i Ysgrifennydd y Cabinet am eich datganiad heddiw ac a gaf i groesawu'r gydnabyddiaeth, o'r diwedd, o effaith andwyol defnyddio tâp synthetig a llieiniau rhwyll y wain llawfeddygol i drin prolaps organau’r pelfis ac anymataliath wrinol sy'n gysylltiedig â straen, gan arwain at ganlyniadau ofnadwy a hirdymor i iechyd menywod, sy'n newid bywydau? Rwy'n croesawu'r argymhellion yn eich adroddiad sy'n ymwneud â mesurau ataliol a rheoli ceidwadol o'r cyflyrau hyn, ac â llawdriniaeth fel dewis olaf. Croesawaf hefyd, er enghraifft, yr argymhelliad ar gyfer llwybr iechyd a lles pelfis newydd. Ac a gaf i ddiolch i Ysgrifennydd y Cabinet am gyfarfod â'm hetholwyr, Jemima Williams a Nicola Hobbs, yr effeithiwyd ar eu bywydau mewn modd andwyol gan fewnblaniadau rhwyll y wain? Hoffwn i eu canmol am eu dewrder a'u harweinyddiaeth yn Grŵp Goroeswyr Rhwyll Cymru. Ond a gaf i egluro, Ysgrifennydd y Cabinet, y sefyllfa o ran fy etholwyr, Jemima a Nicola, a'r grŵp gorchwyl a gorffen? Oherwydd yn eich datganiad ysgrifenedig, dywedasoch eu bod wedi dewis peidio â chymryd rhan yn y grŵp, ond a gaf i dynnu sylw at gyd-destun eu penderfyniad i beidio â chymryd rhan? Roedden nhw'n pryderu'n fawr am aelodaeth y grŵp, y papurau a gyflwynwyd i'r grŵp a'r diffyg rhybudd a chylch gorchwyl drafft, oherwydd mae'r ddwy hefyd yn dioddef o boen cyson a salwch difrifol.

Ond roedd yn ddefnyddiol iawn eich bod wedi cytuno i gyfarfod â nhw, gyda fi. A allwch chi gadarnhau ichi roi ystyriaeth lawn i'w tystiolaeth lawn a dirdynnol nhw yn y cyfarfod hwnnw? Roeddent wedi darparu ffolder helaeth o brofiad cleifion o effeithiau andwyol. A hefyd, a allwch chi gadarnhau ac egluro, Ysgrifennydd y Cabinet, pa ymgysylltu trawsffiniol sy'n digwydd i rannu arbenigedd clinigol, tystiolaeth gan gleifion, dioddefwyr rhwyll a'r arian hefyd a allai fod ar gael ar gyfer atgyfeirio i arbenigwyr tynnu rhwyll?

Yn olaf, fel y byddwch yn gwybod, mae Grŵp Goroeswyr Rhwyll Cymru yn galw am atal dros dro y defnydd o rwyll hyd nes y cynhelir archwiliad llawn. Anodd yw credu y gall y driniaeth hon ddigwydd yng Nghymru o hyd, er gwaethaf y pwynt a wnaed gennych heddiw yn eich datganiad, fod yr holl adolygiadau hyd yn hyn wedi dangos pa mor anodd oedd cael asesiad dibynadwy o faint y broblem sy'n gysylltiedig â'r defnydd o rwyll y wain. Dyna'r sefyllfa fel ag y mae heddiw. Felly, Ysgrifennydd y Cabinet, a wnewch chi ystyried cynnal archwiliad ôl-weithredol o'r defnydd o rwyll yng Nghymru ac ystyried atal dros dro y defnydd o rwyll y wain hyd nes y bydd hyn yn digwydd? Diolch.

Thank you. I can confirm that in relation to your last point, and I'll link that to the cross-border work on evidence and progress, as I indicated in response to the first set of questions, the audit being undertaken in England is on an experimental basis and has not been undertaken in that way before. And I will, of course, be interested in the evidence provided by that and officials are engaged around the review being undertaken by the Department of Health. I would not expect there to be a significant difference in the number of problems that arise from these procedures. So, we have to start by recognising that there is a problem here in Wales. We know that because we have people who have survived complications and are living with them now. And part of our challenge is understanding the number of people and understanding the reluctance of some people to come forward. It is quite easy to understand why some people do not wish to highlight the problems that they have, particularly if they feel that they've not been believed at an early stage when complications were arising. And removal can be complicated and difficult and not always completely successful surgery. There are risks in that too.

As I've said in response to a number of people already and I tried to say at the outset, I'm not in a position to ban mesh. I'm not in a position to suspend its use either. What the report, though, does make clear is it should be a last resort. As I said, people then say, 'Well, what is a last resort?' Well, it's something about making sure that all of those conservative non-surgical treatment options are exhausted first, and that's why there has to be a proper focus on making sure that we have a more consistent arrangement surrounding the multidisciplinary teams to make sure those options are provided early, and then, when going through any treatment options, that the potential consequences of each of them are highlighted to the women involved. Because as I've said, I do recognise that some of the real challenges that we have understood are not that the risks have been explained and people have gone in with their eyes open about those risks, many women have said they were simply not given a genuinely informed basis upon which to make that choice about whether to consent to surgery or not.

In terms of the attempt that was made in attempting to try and have people who were living with the complications of mesh engaged in the task and finish group, having decided to set up the task and finish group, I wanted to make sure that there were people living with those complications who could input into that work. That meant the invitation was at relatively short notice, with the terms of reference, the people involved and indeed the evidence they would be considering. It wasn't just at that early stage, though, that an attempt was made to involve women in that work. Throughout the life of the task and finish group, for a number of months, we've tried to find a way in which they could have a real input, either to the whole group or to members of it. That proved not to be possible. I absolutely do not wish there to be any kind of criticism inferred or taken from that at all as to the decision that those women made not to engage directly in the work of the task and finish group. I think it's easy to understand why they chose not to do that. But, they did however continue to have an input around that.

As you are aware, we met your constituents to have that conversation and their accounts and the written evidence they provided were taken into account and were provided to the task and finish group, and it's part of the reason why the work of the task and finish group was extended, because they did consider the evidence that was provided by both Jemima Williams and Nicola Hobbs, and it's referenced in the report. So, I hope that does help provide some assurance that their evidence was taken seriously. And in taking forward the work of the implementation group, we need to find a way for women themselves who are living with complications to actually have an input into the work of that implementation group, as well as those people who are on the pathway already and are undergoing conservative treatment options in the here and now. So, there is much more for us to do and, as I've said in an earlier response, I will happily report back to Members on the work that is being undertaken and the progress that we're making.

Diolch. Gallaf gadarnhau o ran eich pwynt olaf, a byddaf yn cysylltu hwnnw â'r gwaith trawsffiniol ar dystiolaeth a chynnydd, fel y nodais mewn ymateb i'r gyfres gyntaf o gwestiynau, fod yr archwiliad a gynhelir yn Lloegr ar sail arbrofol ac ni chafodd ei gynnal yn y ffordd honno o'r blaen. Wrth gwrs, bydd gennyf ddiddordeb yn y dystiolaeth a ddarperir ac mae swyddogion yn cymryd rhan yn yr adolygiad a gynhelir gan yr Adran Iechyd. Ni fyddwn yn disgwyl y byddai gwahaniaeth sylweddol yn nifer y problemau sy'n deillio o'r triniaethau hyn. Felly, mae'n rhaid inni ddechrau drwy gydnabod bod yna broblem yma yng Nghymru. Rydym ni'n gwybod hynny oherwydd bod gennym ni bobl sydd wedi goroesi cymhlethdodau ac sy'n byw gyda nhw yn awr. A rhan o'r her i ni yw deall nifer y bobl a deall amharodrwydd rhai pobl i ddod ymlaen. Mae'n ddigon hawdd deall pam nad yw rhai pobl am dynnu sylw at y problemau sydd ganddyn nhw, yn enwedig os ydyn nhw'n teimlo nad ydyn nhw wedi cael eu credu ar gam cynnar pan oedd cymhlethdodau'n codi. A gall tynnu rhwyll fod yn llawdriniaeth gymhleth ac anodd nad yw bob amser yn gwbl lwyddiannus. Mae yna risgiau yn hynny hefyd.

Fel yr wyf wedi dweud mewn ymateb i nifer o bobl eisoes a cheisiais ddweud ar y dechrau, nid wyf mewn sefyllfa i wahardd rhwyll. Nid wyf mewn sefyllfa i atal ei ddefnydd dros dro ychwaith. Yr hyn y mae'r adroddiad yn ei egluro yw y dylai fod yn ddewis olaf. Fel y dywedais, mae pobl yn dweud wedyn, 'Wel, beth yw dewis olaf?' Wel, mae'n ymwneud â sicrhau y rhoddir cynnig ar bob un o'r opsiynau triniaeth ceidwadol hynny nad ydynt yn llawfeddygol yn gyntaf, a dyna pam y mae'n rhaid rhoi pwyslais priodol ar sicrhau bod gennym drefniant mwy cyson â'r timau amlddisgyblaethol i wneud yn siŵr y darperir yr opsiynau hynny yn gynnar, ac yna, wrth fynd trwy unrhyw opsiynau triniaeth, y tynnir sylw'r menywod hynny at ganlyniadau posibl pob un opsiwn. Fel y dywedais, rwy'n cydnabod mai rhai o'r heriau gwirioneddol yr ydym ni wedi'u deall yw nid fod y risgiau wedi'u hegluro a bod pobl wedi bwrw ymlaen yn gwbl ymwybodol o'r risgiau hynny, ond bod llawer o fenywod wedi dweud na roddwyd sail wirioneddol ddeallus iddyn nhw er mwyn gwneud y dewis hwnnw ynghylch rhoi caniatâd i lawdriniaeth neu beidio.

O ran yr ymgais a wnaed i geisio cael pobl a oedd yn byw gyda chymhlethdodau rhwyll i gymryd rhan yn y grŵp gorchwyl a gorffen, ar ôl penderfynu sefydlu'r grŵp hwnnw, roeddwn i eisiau gwneud yn siŵr bod pobl sy'n byw gyda rhai o'r cymhlethdodau hynny a allai gyfrannu at y gwaith hwnnw. Roedd hynny'n golygu bod y gwahoddiad wedi bod yn fyr rybudd, gyda'r cylch gorchwyl, y bobl dan sylw ac yn wir y dystiolaeth y byddent yn ei hystyried. Nid dim ond yn y cyfnod cynnar hwnnw yn unig, er hynny, y gwnaed ymgais i gynnwys menywod yn y gwaith hwnnw. Trwy gydol oes y grŵp gorchwyl a gorffen, am nifer o fisoedd, ceisiwyd dod o hyd i ffordd y gallen nhw gael mewnbwn gwirioneddol, naill ai i'r grŵp cyfan neu i aelodau ohono. Nid oedd hynny'n bosibl. Yn sicr, nid wyf yn dymuno gweld unrhyw fath o feirniadaeth  o gwbl ynghylch penderfyniad y menywod hynny i beidio ag ymwneud yn uniongyrchol â gwaith y grŵp gorchwyl a gorffen. Rwy'n credu ei bod hi'n hawdd deall pam y gwnaethon nhw ddewis peidio â gwneud hynny. Ond fe wnaethon nhw, er hynny, barhau i gyfrannu.

Fel y gwyddoch chi, cawsom gyfarfod â'ch etholwyr i gael y sgwrs honno a chymerwyd i ystyriaeth eu straeon a'r dystiolaeth ysgrifenedig a ddarparwyd ganddyn nhw a'u rhoi i'r grŵp gorchwyl a gorffen, ac mae'n rhan o'r rheswm pam yr estynnwyd gwaith y grŵp gorchwyl a gorffen. Oherwydd fe wnaethon nhw ystyried y dystiolaeth a ddarparwyd gan Jemima Williams a Nicola Hobbs, a chyfeirir ati yn yr adroddiad. Gobeithio felly bod hynny yn helpu i roi rhywfaint o sicrwydd bod eu tystiolaeth yn cael ei ystyried o ddifrif. Ac wrth ddatblygu gwaith y grŵp gweithredu, mae angen inni ddod o hyd i ffordd y gall y menywod eu hunain sy'n byw gyda'r cymhlethdodau gyfrannu mewn gwirionedd i waith y grŵp gweithredu, yn ogystal â'r bobl hynny sydd ar y llwybr eisoes ac sy'n ymgymryd ag opsiynau triniaeth geidwadol ar hyn o bryd. Felly, mae llawer mwy i ni ei wneud ac, fel y dywedais mewn ateb cynharach, byddaf yn hapus i adrodd yn ôl i'r Aelodau ar y gwaith a wneir a'r cynnydd yr ydym ni'n ei wneud.

15:55

Thank you, Cabinet Secretary, for your statement today, and I'm glad the Welsh Government's task and finish group have now completed their report. The Cabinet Secretary is aware that I, like many other Members here, have heard the heart-breaking experiences of constituents suffering from the impact of surgical pelvic mesh implants—experiences of women being left in agonising pain and with extreme worries about the future. For women like my constituent who first brought this to my attention, financial and professional worry still come with the long-term physical and emotional pain. Indeed, my constituent has said that this has had a devastating effect on both her and her family. I'd like to take this opportunity to pay tribute to my constituents and all the other women who have come forward to bravely share their harrowing experiences. So, whilst I welcome the task and finish group's report, can the Cabinet Secretary provide reassurances that any new pelvic health and well-being pathway will include listening to patients' ongoing concerns?

Diolch ichi, Ysgrifennydd y Cabinet, am eich datganiad heddiw, ac rwy'n falch bod grŵp gorchwyl a gorffen Llywodraeth Cymru bellach wedi cwblhau ei adroddiad. Mae Ysgrifennydd y Cabinet yn ymwybodol fy mod i, fel llawer o'r Aelodau eraill yn y fan yma, wedi clywed am brofiadau torcalonnus etholwyr yn dioddef o effaith mewnblaniadau llawfeddygol rhwyll y pelfis—profiadau menywod yn cael eu gadael mewn poen arteithiol ac yn gofidio'n fawr iawn am y dyfodol. I fenywod fel un o fy etholwyr a ddaeth â hyn at fy sylw i am y tro cyntaf, mae gofid ariannol a phroffesiynol yn dal i ddod gyda'r poen corfforol ac emosiynol hirdymor. Yn wir, mae fy etholwraig wedi dweud bod hyn wedi cael effaith ddinistriol arni hi a'i theulu. Hoffwn achub ar y cyfle hwn i dalu teyrnged i'm hetholwyr a'r holl fenywod eraill sydd wedi dod ymlaen i rannu eu profiadau dirdynnol yn ddewr. Felly, er fy mod yn croesawu adroddiad y grŵp gorchwyl a gorffen, a all Ysgrifennydd y Cabinet roi sicrwydd y bydd unrhyw lwybr newydd o ran iechyd a lles y pelfis yn cynnwys gwrando ar bryderon parhaus cleifion?

Yes, I really do recognise the life-changing consequences that mesh complications have had for a number of women, including the correspondence and your questions in this Chamber and the conversations we've had outside it, about the physical, social and financial consequences, but also about the very real impact on people's relationships, not just with partners, but with a whole range of other people that the pain and discomfort has caused, and also a lack of trust with people who they trusted at the outset about the advice given, and indeed trust between healthcare professionals as well about the treatment options that have been provided.

Your point about listening to people directly engaged and involved is essential, not just as part of our continued improvement and prudent healthcare and what the parliamentary review has told us we will be taking forward in particular; this really highlights where, if you don't understand what matters to the person and what risks they're prepared to accept, how they have genuinely informed consent, where information is made available to them not hidden from them, but genuinely made available to them so they can make choices about their treatment options, then you understand why people end up in this position where they don't trust everything that is done around them.

It is essential, therefore, that in taking forward the work of the implementation group and taking this report forward, the patient voice is absolutely central to what is done and how that is then explained. Much of the task and finish group's report does focus on how information is provided to people to make choices and for them to say what matters to them. So, I take on board the point, and I can give that reassurance that that will be an essential part of our work moving forward. 

Ydw, rwy'n sicr yn cydnabod y canlyniadau y mae cymhlethdodau rhwyll wedi eu hachosi i nifer o fenywod, gan newid eu bywydau. Rwy'n cydnabod hefyd yr ohebiaeth a'ch cwestiynau yn y Siambr hon a'r sgyrsiau yr ydym ni wedi'u cael y tu allan iddo, am y canlyniadau corfforol, cymdeithasol ac ariannol, ond hefyd yr effaith wirioneddol ar berthynas pobl, nid yn unig gyda'u phartneriaid, ond gyda llu o bobl eraill y mae'r poen a'r anghysur wedi'i achosi, a hefyd y diffyg ymddiriedaeth mewn pobl yr oeddent yn ymddiried ynddynt ar y cychwyn am y cyngor a roddwyd, ac yn wir ymddiriedaeth rhwng gweithwyr gofal iechyd proffesiynol yn ogystal ag opsiynau triniaeth a ddarparwyd.

Mae eich pwynt ynghylch gwrando ar bobl sy'n cymryd rhan ac sydd wedi'u cynnwys yn uniongyrchol yn hanfodol, nid yn unig fel rhan o'n gwelliant parhaus a gofal iechyd darbodus a'r hyn a ddywedodd yr arolwg seneddol wrthym y byddwn yn ei ddatblygu yn benodol; mae hyn mewn gwirionedd yn amlygu, os nad ydych chi'n deall yr hyn sy'n bwysig i'r unigolyn a pha risgiau y mae'n barod i'w derbyn, sut mae ganddyn nhw gydsyniad deallus, pan fo gwybodaeth ar gael iddyn nhw ac nid yw'n cael ei chuddio rhagddynt fel y gallant wneud dewisiadau ynghylch eu triniaeth, yna byddwch yn deall pam mae pobl yn canfod eu hunain yn y sefyllfa hon yn y pen draw pan nad ydyn nhw'n ymddiried ym mhopeth sy'n cael ei wneud o'u cwmpas.

Mae'n hanfodol, felly, bod llais y claf, wrth ddatblygu gwaith y grŵp gweithredu ac yn bwrw ymlaen â'r adroddiad hwn, yn gwbl ganolog i'r hyn a wneir a sut y caiff hyn ei esbonio wedyn. Mae llawer o adroddiad y grŵp gorchwyl a gorffen yn canolbwyntio ar sut y darperir gwybodaeth i bobl i wneud dewisiadau ac iddyn nhw ddweud beth sy'n bwysig iddyn nhw. Felly, rwy'n derbyn y pwynt, a gallaf roi'r sicrwydd hwnnw y bydd hynny yn rhan hanfodol o'n gwaith wrth symud ymlaen.

16:00

Cabinet Secretary, on 13 December I asked you:

'Given the growing number of mesh implant survivors, England has adopted multidisciplinary teams of specialists who support patients who have had issues with mesh and advise them on treatments. Do these multidisciplinary teams exist in Wales and, if so, where are they?'

You commented, as was mentioned earlier, that

'we do have multidisciplinary teams around each surgical procedure.'

Now, that is simply not the case, and I'd like you to correct the record today. 

Moving on, if we look at pages 6 and 7 of the report, people were informed incorrectly about the potential risks and life-changing effects in consequences. People were not warned of the potential devastating life-changing complications. There was an inadequate consent process. People's problems after operations were disregarded and put down to just simply post-operative symptoms. People were turned away and made to feel like they were making a fuss, and I read here that consultants reduced some people to tears, and that there were inappropriate referrals to other specialist areas, and so on. It's a pretty grim report, and people have been permanently disabled. So, another question that I have is: what is going to be done to compensate these people? 

Thirdly, an expert panel was set up in Scotland on this matter in 2013, in England in 2014. The Welsh NHS was invited to take part then. In December 2014, an oversight group was set up in Engand with no Welsh NHS input. Action was taken in the United States in 2014. So, why did the people of Wales have to wait until October 2017 for the task and finish group to be set up? Was it your negligence or was it the negligence of your predecessor? I don't understand why it's not mandatory to report on problems that have been reported to doctors after surgery has taken place.

I want to move on now to your—       

Ysgrifennydd y Cabinet, ar 13 Rhagfyr, gofynnais i i chi:

'O ystyried nifer cynyddol goroeswyr mewnblaniad rhwyll, mae Lloegr wedi mabwysiadu timau amlddisgyblaethol o arbenigwyr sy'n cefnogi cleifion sydd wedi cael problemau â rhwyll a rhoi cyngor iddynt ar driniaethau. A yw'r timau amlddisgyblaethol hyn yn bodoli yng Nghymru ac, os felly, ble maen nhw?'

Eich sylw chi, fel y soniwyd yn gynharach, oedd bod

gennym dimau amlddisgyblaethol ar gyfer pob triniaeth lawfeddygol.

Nawr, nid yw hynny'n wir, a hoffwn ichi gywiro'r cofnod heddiw.

Gan symud ymlaen, os edrychwn ni ar dudalennau 6 a 7 o'r adroddiad, rhoddwyd gwybodaeth anghywir i bobl ynghylch y risgiau posibl ac effeithiau sy'n newid bywydau. Ni rybuddiwyd pobl am y cymhlethdodau trychinebus posibl sy'n gallu newid bywydau. Roedd yn broses ganiatâd annigonol. Diystyrwyd problemau pobl ar ôl y llawdriniaethau a'u priodoli i symptomau ôl-driniaethol. Cafodd pobl eu troi ymaith a'u gwneud i deimlo eu bod yn gwneud ffwdan, a darllenais yma fod meddygon ymgynghorol wedi gwneud i rai pobl grio, a bod yna atgyfeiriadau amhriodol i feysydd arbenigol eraill, ac ati. Mae'n adroddiad eithaf digalon, ac mae rhai pobl bellach yn anabl yn barhaol. Felly, cwestiwn arall sydd gennyf i yw: beth fydd yn cael ei wneud i ddigolledu'r bobl hyn?

Yn drydydd, cafodd panel arbenigol ei sefydlu yn yr Alban ar y mater hwn yn 2013, ac yn Lloegr yn 2014. Gwahoddwyd GIG Cymru i gymryd rhan wedyn. Ym mis Rhagfyr 2014, sefydlwyd grŵp goruchwylio yn Lloegr heb unrhyw gyfraniad gan GIG Cymru. Cymerwyd camau yn yr Unol Daleithiau yn 2014. Felly, pam y bu'n rhaid i bobl Cymru aros tan fis Hydref 2017 i'r grŵp gorchwyl a gorffen gael ei sefydlu? Ai eich esgeulustod chi neu esgeulustod eich rhagflaenydd oedd hynny? Nid wyf yn deall pam nad yw'n orfodol adrodd am y problemau y soniwyd amdanynt wrth feddygon ar ôl y llawdriniaeth.

Rwyf eisiau symud ymlaen yn awr at eich—

No, sorry. You can't be moving on—

Na, mae'n ddrwg gen i. Allwch chi ddim symud ymlaen—

A question then, please, because we're short of time as well. Thank you. 

Cwestiwn felly, os gwelwch yn dda, oherwydd rydym ni'n brin o amser hefyd. Diolch.

So, that was a question. My next question is: what about men? You seem to dismiss hernia operations. People suffer the same problems using these meshes. I spoke to a constituent just before walking in this Chamber earlier, and he still does not know what material was put inside his body. That's an absolute scandal. Will you undertake to make sure that my constituent is told exactly what was put into his body without his consent? Will you undertake to do that? 

Felly, cwestiwn oedd hwnnw. Fy nghwestiwn nesaf yw: beth am ddynion? Mae'n ymddangos eich bod yn diystyru llawdriniaeth torgest. Mae pobl yn dioddef yr un problemau gan ddefnyddio'r rhwyllau hyn. Bûm i'n siarad ag etholwr ychydig cyn cerdded i mewn i'r Siambr hon yn gynharach, a dydy e'n dal ddim yn gwybod pa ddeunydd a roddwyd y tu mewn i'w gorff. Mae hynny'n gwbl warthus. A wnewch chi ymrwymo i wneud yn siŵr bod fy etholwr yn cael gwybod yn union beth a roddwyd yn ei gorff heb ei ganiatâd? A wnewch chi ymrwymo i wneud hynny?

Obviously, I can't comment on individual matters that I'm not aware of, but your constituent should approach the health board where the procedure was undertaken. I would expect that information to be made readily available to him. 

I also need to deal with the point about hernia that I mentioned in response to Janet Finch-Saunders at the outset. Of course, hernia operations are undertaken on men and women, and I've indicated previously in answer, I believe, to questions from Jenny Rathbone that we would be looking to undertake, and we are looking to undertake, a review of hernia procedures to understand if the same level of complications exist. But it is the case that people do react differently. It is the case that between men and women there are procedures undertaken that simply don't affect men. And, as I say—I make no apologies for saying it again—if a similar issue had affected men uniquely, then I do not believe that it would have taken this long for that problem to have been highlighted and for further action to be taken. I set up the implementation group to look at this issue and the issues that arise on the record for improvement and the range of linked women's health issues that I've mentioned, both endometriosis and faecal incontinence.

There is, of course, more that we need to do, to do consistently and at pace. That's why the implementation group that I have directed be created. And I certainly don't defend a failure to provide genuinely informed consent. I've made that very clear, both before today and on a number of occasions during today as well. I go back to multidisciplinary teams. Multidisciplinary teams do exist as a matter of course around surgical procedures. Our challenge that this report lays out for us is whether we have the requisite amount of expertise within those teams, whether they're as consistent as they need to be, and how we actually recommit ourselves to improvement. That does not mean that there is a widespread failure to do what is right. It does mean you need to take the opportunity to improve, and that means that you have to accept that there is a challenge to be resolved in the first place to be able to set yourselves out on a path to improve on current process and current action. So, I see no reason to correct the record. I'm accepting the recommendations that we have, and I look forward to reporting back to Members in the future on the action that the NHS will undertake to deliver that required improvement.

Yn amlwg, ni allaf wneud sylw ar faterion unigol nad wyf yn ymwybodol ohonyn nhw, ond dylai eich etholwr gysylltu â'r bwrdd iechyd lle cynhaliwyd y llawdriniaeth. Byddwn i'n disgwyl i'r wybodaeth honno fod ar gael yn rhwydd iddo.

Mae angen imi hefyd ymdrin â'r pwynt am dorgest a grybwyllais wrth ymateb i Janet Finch-Saunders ar y cychwyn. Wrth gwrs, cynhelir llawdriniaeth torgest ar ddynion a menywod, ac rwyf eisoes wedi dweud wrth ateb, rwy'n credu, gwestiynau gan Jenny Rathbone y byddem ni'n gobeithio cynnal, ac rydym ni yn gobeithio cynnal, adolygiad o lawdriniaeth torgest er mwyn deall a yw'r un lefel o gymhlethdodau yn bodoli. Ond mae'n wir fod pobl yn ymateb mewn ffordd wahanol. Mae'n wir, rhwng dynion a menywod, bod yna lawdriniaethau nad ydynt yn effeithio ar ddynion. Ac, fel y dywedaf—nid wyf yn ymddiheuro am ei ddweud eto—pe byddai mater tebyg wedi effeithio ar ddynion yn unig, yna nid wyf yn credu y byddai wedi cymryd cymaint â hyn o amser i'r broblem honno gael sylw ac i gamau pellach gael eu cymryd. Sefydlais y grŵp gweithredu i ystyried y mater hwn a'r materion sy'n codi ar y cofnod i'w gwella a'r amrywiaeth o faterion iechyd menywod cysylltiedig y soniais amdanyn nhw, endometriosis ac anymataliaeth ysgarthol.

Wrth gwrs, mae angen inni wneud mwy, a'i wneud yn gyson ac yn gyflym. Dyna pam yr wyf wedi gofyn i'r grŵp gweithredu gael ei greu. Ac yn sicr dydw i ddim yn amddiffyn methiant i roi cydsyniad deallus gwirioneddol. Rwyf wedi gwneud hynny'n glir iawn, cyn heddiw ac ar nifer o achlysuron heddiw hefyd. Af yn ôl at y timau amlddisgyblaethol. Mae timau amlddisgyblaethol yn bodoli fel mater o drefn ar gyfer triniaethau llawfeddygol. Yr her yn yr adroddiad hwn i ni yw a oes gennym ddigon o'r arbenigedd angenrheidiol yn y timau hynny, a ydyn nhw mor gyson ag y mae angen iddyn nhw fod, a sut yr ydym ni mewn gwirionedd yn ailymrwymo i sicrhau gwelliant. Nid yw hynny'n golygu bod methiant cyffredinol i wneud yr hyn sy'n iawn. Mae'n golygu bod angen ichi achub ar y cyfle i wella, ac mae hynny'n golygu bod yn rhaid ichi dderbyn bod yna her i'w datrys yn y lle cyntaf er mwyn gallu rhoi eich hunain ar lwybr i wella'r broses bresennol a'r camau gweithredu presennol. Felly, ni welaf unrhyw reswm i gywiro'r cofnod. Rwy'n derbyn yr argymhellion sydd gennym, ac edrychaf ymlaen at adrodd yn ôl i'r Aelodau yn y dyfodol ar y camau y bydd y GIG yn ymgymryd â nhw i gyflawni'r gwelliant gofynnol hwnnw.

16:05

Thank you very much. I'm particularly interested in prevention and causes, because, obviously, prevention is much better than treatment, and we need to obviously ensure that the treatment is appropriate. We have to remember that thalidomide was once prescribed as a way of dealing with morning sickness. So, clearly, this has been latched onto as something for dealing with incontinence and prolapse. The issue really is what we can do to support people not to have incontinence and prolapse—things like preventing third and fourth degree tears and, where possible, ensuring they're sutured by an appropriately qualified, appropriately skilled doctor.

I'm interested that other European countries systematically refer all women who've had babies to a physiotherapist prophylactically because, often, the problems that are later encountered by women aren't immediately evident but could be detected by a physiotherapist. So, a thought to bear in mind as we're considering future treatment. Of course, how much of this is something that women previously used to put up with because, before the NHS, women had to put up with incontinence and prolapse because they didn't have the money to get it rectified—. 

One of the issues that concerns me about the report is where we are told that the task and finish group approached both the British Society of Urogynaecology and the British Association of Urological Surgeons for data on the numbers who had undergone this procedure and, to date, they have not had a reply nor, indeed, the clarification that not all surgeons in Wales are necessarily registered with these bodies and, therefore, wouldn't have been able to record their data anyway. So, there's a clear indication there that we need to use digital technology to ensure that we have the data that my colleague Jane Hutt is now calling for retrospectively to be arrived at.

I'm very pleased that you're taking forward the task group in association with the anal sphincter injuries task group and the endometriosis task group, because, clearly, these are related matters, and I look forward to the linked reports when they're ready to be published. Thank you.

Diolch yn fawr iawn. Mae gen i ddiddordeb arbennig mewn atal ac achosion, oherwydd, yn amlwg, mae atal yn well o lawer na thriniaeth, ac, yn amlwg, mae angen inni sicrhau bod y driniaeth yn briodol. Mae'n rhaid inni gofio bod thalidomid yn cael ei ragnodi ar un adeg fel modd o drin salwch bore yn ystod beichiogrwydd. Felly, yn amlwg, mae hyn wedi'i ddefnyddio fel rhywbeth ar gyfer trin anymataliaeth a phrolaps. Y mater mewn gwirionedd yw'r hyn y gallwn ni ei wneud i gefnogi pobl rhag cael anymataliaeth a phrolaps—pethau fel atal rhwygiadau trydydd a phedwerydd gradd a, phan fo hynny'n bosibl, sicrhau eu bod nhw'n cael pwythau gan feddyg sydd â'r cymwysterau a'r sgiliau priodol.

Mae'n ddiddorol bod gwledydd eraill yn Ewrop yn atgyfeirio pob menyw sydd wedi cael baban, fel mater o drefn, at ffisiotherapydd mewn modd proffylactig oherwydd, yn aml, nid yw'r problemau a gaiff menywod yn ddiweddarach yn amlwg ar unwaith ond gallai ffisiotherapydd eu canfod. Felly, rhywbeth i'w gadw mewn cof wrth inni ystyried triniaeth yn y dyfodol. Wrth gwrs, faint o hyn sy'n rhywbeth yr oedd menywod yn dygymod ag ef yn y gorffennol oherwydd, cyn y GIG, roedd yn rhaid i fenywod ddioddef anymataliaeth a phrolaps gan nad oedd ganddyn nhw yr arian i'w gywiro—.

Un o'r materion sy'n peri pryder i mi ynghylch yr adroddiad yw pan ddywedir wrthym bod y grŵp gorchwyl a gorffen wedi cysylltu â'r British Society of Urogynaecology a'r British Association of Urological Surgeons i gael data am y niferoedd sydd wedi cael y driniaeth hon a, hyd yma, dydyn nhw heb gael ateb nac, yn wir, yr eglurhad nad yw pob llawfeddyg yng Nghymru, o reidrwydd, wedi'i gofrestru ag un o'r mudiadau hyn ac, felly, ni fyddent wedi gallu cofnodi eu data beth bynnag. Felly, mae arwydd clir yn y fan yna bod angen inni ddefnyddio technoleg ddigidol i sicrhau bod gennym y data y mae fy nghyd-Aelod Jane Hutt bellach yn galw amdano'n ôl-weithredol.

Rwy'n falch iawn eich bod chi'n bwrw ymlaen â'r grŵp gorchwyl ar y cyd â'r grŵp gorchwyl anafiadau sphincter yr anws a'r grŵp gorchwyl endometriosis, oherwydd, yn amlwg, mae'r rhain yn faterion cysylltiedig, ac edrychaf ymlaen at yr adroddiadau cysylltiedig pan fyddan nhw'n barod i'w cyhoeddi. Diolch.

I'll deal with—I think there are three particular points coming from that. The first is on a point you've made previously about physiotherapy, and what I'll do is I'll try and make sure that someone from the chief nurse's office is able to provide us with a note on care for women after pregnancy and to understand the role of physiotherapy. I know you've made the point in particular about France, for example, where physiotherapy is offered as a matter of course after birth.

I recognise the point you make about voluntary registries by the two relevant professional bodies, and it is disappointing that those two bodies did not provide information when requested to in the way that it was requested.

That leads into the point around medical coding and recommendation 7, which looks at the coding that we should have available, the improvements that we could and should make in the here and now, as well as the longer term choices we have to make about understanding which implants are put into people—of whatever form, not just in this area—and understanding where that is made available, but, crucially, the requirement will be that that information is publicly available, and so I think will provide real transparency about what has been implanted and where and allow us greater transparency and audit for the efficacy both of those operations and any post-operative complications. So, there is more work for us to do, and that is definitely covered by the recommendations the report has made, and, as I say, I look forward to reporting back to this place on the progress that has been made at a future point.

Byddaf yn ymdrin â—rwy'n credu bod tri phwynt penodol yn codi o hynny. Y cyntaf ar bwynt yr ydych chi wedi'i wneud o'r blaen am ffisiotherapi, a'r hyn yr wyf yn mynd i'w wneud yw sicrhau bod rhywun o swyddfa'r prif nyrs yn gallu rhoi nodyn inni ar y gofal i fenywod ar ôl beichiogrwydd a deall swyddogaeth ffisiotherapi. Gwn eich bod wedi gwneud y pwynt yn benodol am Ffrainc, er enghraifft, lle cynigir ffisiotherapi fel mater o drefn ar ôl y geni.

Rwy'n cydnabod y pwynt yr ydych chi'n ei wneud am gofrestru gwirfoddol gan y ddau gorff proffesiynol perthnasol, ac mae'n siomedig na wna