English: Diolch, Llywydd, and thank you to Angela Burns for continuing to raise this very serious issue. I want to start by recognising that sepsis can be a difficult illness to diagnose, particularly in elderly people, but also in children. And that is part of the challenge in dealing with this successfully. Sepsis is estimated by the UK Sepsis Trust to cause the deaths of around 44,000 people every year in the UK, and that would equate to about 2,200 people here in Wales. The figures show that, over the last five years, the number of people who have died annually in a hospital setting in Wales as a result of sepsis decreased from 2,112 to 1,687, so a real reduction but still a real number of people who have continued to die within our hospitals. The number of incidents of sepsis in Welsh hospitals in the same period actually increased from 6,950 to 8,313. So, that does show that there is a greater awareness of the illness with more people being diagnosed, but the percentage of deaths is decreasing. Sadly, not all of those deaths will be avoidable, but we can be confident that a number of them are. That is why, since 2013, the Welsh Government has, together with the NHS, made the reduction of the avoidable harm and mortality caused by sepsis a high priority for NHS Wales. I well remember, on World Sepsis Day, when I was a Deputy Minister at the time, Mark Drakeford decided that he would do an event on World Sepsis Day to try and raise awareness, to raise the profile of the condition within the service. Now, we do recognise, frankly and honestly, that there is always more that needs to be done to combat what can be a deadly disease, but I do want to recognise some of the progress that we have made to tackle this life-threatening condition. To be fair, Angela Burns has recognised this as well. We should be proud of the fact that we are seen as leading the way in the UK in making sepsis recognition and treatment a top priority. Our fight to combat sepsis continues, and a huge amount of work has been done since 2012, when we were the first country in the world here in Wales to implement the national early warning score system, known as NEWS. That should ensure the early escalation of patients who are seen to be deteriorating. And that simple step should ensure that we're using a common language throughout NHS Wales to communicate about deterioration and sepsis. NEWS and sepsis screening have been introduced in all acute clinical areas, in the Welsh ambulance service trust and in many community and primary settings. We should be proud of the fact that, in Wales, NEWS has been standardised in all of our hospitals since 2013. The main vehicle for that change here in Wales has been the active participation of health boards and individuals in the 1000 Lives improvement service rapid response to acute illness learning set, commonly known as RRAILS - and I'm glad they have an acronym at least within the service. But it's clear that there's still lots of work for them to do. They're a huge important part in helping to try and drive system-wide improvement, because we have to continue to try and live up to the recognition that we received in 2016, when the progress NHS Wales had made in improving the treatment of sepsis was recognised by an award from the Global Sepsis Alliance in the 'governments and healthcare authorities' category. But, as with all things, we can't assume that progress is obvious, easy and inevitable. We have to constantly review what we are doing to ensure ongoing improvement. There is always more that we are able to do in keeping learning and improving, and peer review is an ideal and important part of that. The RRAILS programme involves peer review of the management of acutely deteriorating patients, and it's been developed to enable each health board and trust to develop a proper plan to approve the acute deterioration services that they have. It is good to hear that this work is already well under way, with a series of visits to health boards already having taken place, and more planned. Both the reviewers and the staff being part of that peer review recognises that it's been an important and helpful conversation for each of them. Recently, the public services ombudsman commended the 1000 Lives work around the peer review, and he acknowledged the impact that that work is having on improving services and saving lives. Other issues are under way, including the work on the development of a sepsis registry that Angela Burns referenced. But the results of a trial in the Cwm Taf 'sepsis 6 box' study suggest improvements in patient outcome, associated with the use of that box. That includes reduced mortality and intensive care unit admissions, and a significant reduction in NEWS at 24 hours, which is an important marker of patient recovery. I am seriously looking forward to a further evaluation of the trial results, so that final conclusions can be reached to see if we could and should roll that out across the whole country. I want to try and address the difficult question of a public awareness campaign. I say it's 'difficult' because I understand completely the case that is made about wanting to raise broader public awareness in the hope and the expectation that that would save more lives. The practical problem and question for me is whether the money and the resource we'd put into a public awareness-raising campaign would deliver the outcomes we want in having improved outcomes for people.
Welsh: Diolch, Lywydd, a diolch i Angela Burns am barhau i godi'r mater difrifol hwn. Rwyf am ddechrau drwy gydnabod y gall sepsis fod yn salwch anodd i wneud diagnosis ohono, yn arbennig mewn pobl oedrannus, ond hefyd mewn plant. Ac mae hynny'n rhan o'r her wrth ymdrin â hyn yn llwyddiannus. Amcangyfrifodd Ymddiriedolaeth Sepsis y DU fod sepsis yn achosi marwolaethau tua 44,000 o bobl bob blwyddyn yn y DU, a byddai hynny'n cyfateb i oddeutu 2,200 o bobl yma yng Nghymru. Dengys y ffigurau, dros y pum mlynedd diwethaf, fod nifer y bobl sydd wedi marw'n flynyddol mewn lleoliad ysbyty yng Nghymru o ganlyniad i sepsis wedi gostwng o 2,112 i 1,687, felly gostyngiad go iawn ond nifer dda o bobl o hyd sydd wedi marw yn ein hysbytai. Mewn gwirionedd, fe gynyddodd nifer yr achosion o sepsis yn ysbytai Cymru yn yr un cyfnod o 6,950 i 8,313. Felly, mae hynny'n dangos bod yna fwy o ymwybyddiaeth o'r salwch gyda mwy o bobl yn cael diagnosis, ond mae canran y marwolaethau'n gostwng. Yn anffodus, ni fydd modd osgoi pob un o'r marwolaethau hynny, ond gallwn fod yn hyderus fod modd gwneud hynny yn achos nifer ohonynt. Dyna pam, ers 2013, y mae Llywodraeth Cymru, gyda'r GIG, wedi gwneud lleihau niwed y gellir ei osgoi a marwolaethau a achosir gan sepsis yn flaenoriaeth uchel ar gyfer GIG Cymru. Rwy'n cofio'n iawn, ar Ddiwrnod Sepsis y Byd, pan oeddwn yn Ddirprwy Weinidog ar y pryd, penderfynodd Mark Drakeford ei fod am wneud digwyddiad i geisio codi ymwybyddiaeth ar Ddiwrnod Sepsis y Byd, i godi proffil y cyflwr o fewn y gwasanaeth. Nawr, rydym yn cydnabod, yn agored ac yn onest, fod yna bob amser fwy sydd angen ei wneud i fynd i'r afael â'r hyn a all fod yn afiechyd marwol, ond rwyf am gydnabod peth o'r cynnydd a wnaed gennym ar fynd i'r afael â'r cyflwr hwn sy'n bygwth bywyd. I fod yn deg, mae Angela Burns yn cydnabod hyn hefyd. Dylem fod yn falch o'r ffaith ein bod yn cael ein gweld yn arwain y ffordd yn y DU o ran gwneud adnabod a thrin sepsis yn brif flaenoriaeth. Mae ein brwydr yn erbyn sepsis yn parhau, ac mae llawer iawn o waith wedi'i wneud ers 2012, pan oeddem y wlad gyntaf yn y byd yma yng Nghymru i weithredu'r system sgorio rhybudd cynnar cenedlaethol a elwir yn NEWS. Dylai hon sicrhau bod cleifion y gwelir eu bod yn gwaethygu yn cael sylw cynnar. A dylai'r cam syml hwnnw sicrhau ein bod yn defnyddio iaith gyffredin drwy'r GIG yng Nghymru i gyfathrebu ynghylch dirywiad a sepsis. Cyflwynwyd NEWS a sgrinio sepsis ym mhob maes clinigol acíwt, yn Ymddiriedolaeth Gwasanaeth Ambiwlans Cymru ac mewn llawer o leoliadau cymunedol a sylfaenol. Dylem fod yn falch o'r ffaith bod NEWS wedi ei safoni ym mhob un o'n hysbytai yng Nghymru ers 2013. Y prif gyfrwng ar gyfer y newid hwnnw yma yng Nghymru oedd cyfranogiad gweithredol byrddau iechyd ac unigolion yn set ddysgu ymateb cyflym i salwch acíwt gwasanaeth gwella 1000 o Fywydau sy'n cael ei adnabod yn gyffredinol fel RRAILS - ac rwy'n falch fod ganddynt acronym o fewn y gwasanaeth o leiaf. Ond mae'n amlwg fod llawer o waith ganddynt i'w wneud o hyd. Maent yn rhan bwysig o'r gwaith o helpu i geisio sbarduno gwelliant ar draws y system gyfan, oherwydd rhaid inni barhau i geisio cyfiawnhau'r gydnabyddiaeth a gawsom yn 2016, pan gafodd y cynnydd yr oedd GIG Cymru wedi'i wneud yn gwella triniaeth sepsis ei gydnabod â gwobr gan Gynghrair Sepsis y Byd yn y categori 'llywodraethau ac awdurdodau gofal iechyd'. Ond fel gyda phopeth, ni allwn ragdybio bod cynnydd yn amlwg, yn hawdd nac yn anochel. Rhaid inni adolygu'n gyson yr hyn a wnawn i sicrhau gwelliant parhaus. Mae yna bob amser ragor y gallwn ei wneud er mwyn dal ati i ddysgu a gwella, ac mae adolygiadau gan gymheiriaid yn rhan ddelfrydol a phwysig o hynny. Mae'r rhaglen RRAILS yn cynnwys adolygiadau gan gymheiriaid o'r drefn ar gyfer rheoli cleifion sy'n dangos dirywiad acíwt, ac fe'u datblygwyd i alluogi pob bwrdd ac ymddiriedolaeth iechyd i ddatblygu cynllun priodol i gymeradwyo'r gwasanaethau dirywiad acíwt sydd ganddynt. Mae'n dda clywed bod y gwaith hwn eisoes yn mynd rhagddo, gyda chyfres o ymweliadau â byrddau iechyd wedi digwydd yn barod, a rhagor wedi'u cynllunio. Mae adolygwyr a staff a fu'n rhan o'r adolygiad gan gymheiriaid yn cydnabod ei bod yn sgwrs bwysig a buddiol i bawb ohonynt. Yn ddiweddar, canmolodd yr ombwdsmon gwasanaethau cyhoeddus y gwaith 1000 o Fywydau ar yr adolygiad gan gymheiriaid, a chydnabu'r effaith y mae'r gwaith hwnnw'n ei gael ar wella gwasanaethau ac achub bywydau. Mae pethau eraill ar y gweill, gan gynnwys gwaith ar ddatblygu'r gofrestrfa sepsis y cyfeiriodd Angela Burns ati. Ond mae canlyniadau treial yn astudiaeth '6 blwch sepsis' Cwm Taf yn awgrymu bod gwelliannau yn y canlyniadau i gleifion yn gysylltiedig â defnyddio'r blwch hwnnw. Mae'n cynnwys llai o farwolaethau a derbyniadau i unedau gofal dwys, a gostyngiad sylweddol mewn NEWS ar ôl 24 awr, sy'n arwydd pwysig o adferiad cleifion. Rwy'n edrych ymlaen yn fawr at werthusiad pellach o ganlyniadau'r prawf, fel y gellir dod i gasgliadau terfynol er mwyn gweld a allem ac a ddylem gyflwyno hynny ar draws y wlad gyfan. Rwyf am geisio ateb y cwestiwn anodd ynghylch ymgyrch ymwybyddiaeth y cyhoedd. Rwy'n dweud ei fod yn 'anodd' am fy mod yn deall y ddadl a wneir ynghylch codi ymwybyddiaeth ehangach ymhlith y cyhoedd yn y gobaith a'r disgwyliad y byddai hynny'n achub mwy o fywydau. Y broblem ymarferol a'r cwestiwn i mi yw a fyddai'r arian a'r adnoddau y byddem yn eu rhoi tuag at ymgyrch ymwybyddiaeth gyhoeddus yn cyflawni'r canlyniadau y dymunwn eu cael o ran gwella canlyniadau i bobl.