English: Thank you, Dirprwy Lywydd. I'm pleased to take part in this very important debate today on the Health, Social Care and Sport Committee's report on endoscopy services in Wales. This is the first in a series of spotlight inquiries undertaken by the committee, and over the coming months we will bringing forward short debates on our findings in a number of areas, such as dentistry, hepatitis C and community and district nursing. The committee agreed to undertake a one-day inquiry into endoscopy services because, at that time, the majority of health boards in Wales were breaching waiting times for tests that can diagnose bowel cancer. We were also told that an alarmingly low number of eligible people take part in the bowel screening programme. Screening is the best way to diagnose bowel cancer early, but, between April 2017 and March 2018, only 55.7 per cent of people eligible to take the bowel screening test in Wales actually completed it. Uptake is higher in females compared to men. There is also a strong correlation with deprivation. Uptake in the most deprived areas is 45.6 per cent compared to uptake in the least deprived areas at 63.3 per cent. In terms of the introduction of the FIT test, from January 2019, Wales began replacing the current screening test with a simpler and more accurate one called the faecal immunochemical test - the FIT test - which is expected to increase the uptake of screening. There are concerns, however, that endoscopy units in Welsh hospitals are already struggling to cope with demand, and so, even though the new screening test is a positive improvement, it could put more strain on an already overstretched service. We recognise that demand has to be properly managed, but we are disappointed that the thresholds for FIT testing are lower in Wales, and we're concerned that Wales, without a clear plan to optimise the programme, will fall further behind its counterparts in other parts of the UK. We would like to see the Welsh Government, through the national endoscopy improvement programme, set out milestones for achieving programme optimisation in terms of age and sensitivity, so that these can be measured and progress can be monitored in the hope of achieving full optimisation earlier than 2023. Turning to waiting times, in 2015, the Welsh Government committed additional funding to improve waiting times for diagnostic tests, including those waiting for endoscopy procedures following a positive screening result. Additional funding was also provided in 2016-17. However, despite this extra funding, waiting time statistics still give cause for concern, and there needs to be a clear commitment that health boards will deliver the maximum waiting time target for diagnostic tests, namely eight weeks, by the end of 2019. Witnesses to our inquiry described the Welsh Government's approach to tackling issues related to capacity as reactive and short-term. A number of health boards provided details of hospitals contracting with external private providers for insourcing services to deliver endoscopy procedures within the health board on weekends, as well as outsourcing, where patients are sent to private providers at sites outside the health board, to cope with demand. While more investment is needed to get waiting times under control, there also needs to be a more sustainable approach, as outsourcing and insourcing are expensive and do not deliver a long-term solution. To the workforce now: changes are needed to the nature and skills of the current workforce, with a commitment not only to increase the number of gastroenterologists and other medical endoscopists, but also to develop nurse and other non-medical endoscopists. The committee was therefore disappointed to hear that some nurses are paid less than others in Wales to perform endoscopy. This needs to be addressed. The message from witnesses was that focus and pace is needed to ensure that Wales doesn't fall behind other nations. Bowel Cancer UK, for example, wanted to see a national action plan with key milestones, so that the Welsh Government could be held to account for delivery and implementation of the plan. Witnesses also made the point that there had been a number of reviews, and that the issues, or the problems, were clear. Actions and solutions are what is needed now. We therefore made one overarching recommendation in our report: by October 2019, the Welsh Government should work with the national endoscopy improvement programme to create and publish a national endoscopy action plan that addresses current and future demand for services, with clear timescales and targets for improvement. I welcome the Minister's positive response to our report, and I'm pleased to say that the Welsh Government has accepted this recommendation and has committed to publishing an action plan for endoscopy services within the six-month timeframe requested by the committee. I thank the Minister for the written statement, which provided an update on the progress of the national endoscopy programme, earlier today. I am pleased that the action plan has been drafted, and I look forward to its publication, in accordance with the committee's recommendation. To close, as the Minister said himself, it's vital to maintain the sustainability of endoscopy services so that people can reach the examinations that have been set for them in order to have the best results possible. It's now time for progress to be made, and I'm confident that the Welsh Government will provide the strong leadership that is needed to deliver this agenda. Thank you very much.
Welsh: Diolch yn fawr, Dirprwy Lywydd. Dwi'n falch iawn o gymryd rhan yn y ddadl bwysig iawn yma heddiw ar adroddiad y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon ar wasanaethau endosgopi yma yng Nghymru. Dyma'r cyntaf mewn cyfres o ymchwiliadau manwl a gynhaliwyd gan y pwyllgor, a thros y misoedd nesaf byddwn yn cyflwyno dadleuon byr ar ein canfyddiadau mewn nifer o feysydd, fel deintyddiaeth, hepatitis C a gwasanaethau nyrsio cymunedol a nyrsio ardal. Cytunodd y pwyllgor i gynnal ymchwiliad undydd i wasanaethau endosgopi oherwydd, ar yr adeg honno, roedd mwyafrif y byrddau iechyd yng Nghymru yn methu â chyflawni amseroedd aros am brofion a all wneud diagnosis o ganser y coluddyn. Dywedwyd wrthym hefyd fod nifer frawychus o fach o bobl gymwys yn cymryd rhan yn y rhaglen sgrinio coluddion. Sgrinio ydy'r ffordd orau i wneud diagnosis o ganser y coluddyn yn gynnar, ond, rhwng mis Ebrill 2017 a mis Mawrth 2018, dim ond 55 y cant o'r bobl sy'n gymwys i sefyll y prawf sgrinio coluddyn yng Nghymru a gwblhaodd y broses. Mae nifer y rhai sy'n manteisio yn uwch ymhlith menywod o'i gymharu â dynion. Mae cydberthynas gref hefyd ag amddifadedd, oherwydd mae nifer y rhai sy'n cymryd rhan yn yr ardaloedd mwyaf difreintiedig yn 45 y cant o'i gymharu â'r ardaloedd lleiaf difreintiedig, sy'n 63.3 y cant. Ynglŷn â chyflwyno'r prawf FIT, ers mis Ionawr 2019, dechreuodd Cymru ddisodli'r prawf sgrinio cyfredol gyda phrawf symlach a chywirach o'r enw prawf imiwnogemegol ysgarthol - y prawf FIT - y disgwylir iddo gynyddu nifer y bobl sy'n cael eu sgrinio. Mae pryderon, fodd bynnag, bod unedau endosgopi yn ysbytai Cymru eisoes yn ei chael hi'n anodd ymdopi efo'r galw, ac felly, er bod y prawf sgrinio newydd yn welliant cadarnhaol, gallai roi rhagor o straen ar wasanaeth sydd eisoes wedi'i or-ymestyn. Rydym yn derbyn bod yn rhaid rheoli'r galw'n briodol, ond rydym yn siomedig bod y trothwyon ar gyfer y profion imiwnogemegol ysgarthol yn is yng Nghymru, ac rydym yn pryderu y bydd Cymru, heb gynllun clir i wneud y defnydd gorau o'r rhaglen, yn cwympo ymhellach y tu ôl i rannau eraill o'r Deyrnas Unedig. Hoffem pe bai Llywodraeth Cymru, drwy'r rhaglen gwella endosgopi genedlaethol, yn gosod cerrig milltir ar gyfer sicrhau bod y rhaglen yn cael ei defnyddio i'r eithaf, o ran oedran a sensitifrwydd, fel y gellir mesur yn ôl y cerrig milltir hyn a monitro cynnydd yn y gobaith y gellir sicrhau y gwneir y defnydd gorau posibl o'r rhaglen cyn 2023. Gan droi at amseroedd aros, yn 2015, ymrwymodd Llywodraeth Cymru arian ychwanegol i wella amseroedd aros am brofion diagnostig, gan gynnwys ar gyfer pobl sy'n aros am driniaethau endosgopi ar ôl cael canlyniad sgrinio cadarnhaol. Darparwyd cyllid ychwanegol hefyd yn 2016-17. Fodd bynnag, er gwaethaf y cyllid ychwanegol hwn, mae ystadegau amseroedd aros yn dal i beri pryder, ac mae angen ymrwymiad clir y bydd byrddau iechyd yn cyrraedd y targed amseroedd aros uchaf am brofion diagnostig, sef wyth wythnos, erbyn diwedd 2019. Disgrifiodd tystion yn ystod ein hymchwiliad ddull gweithredu Llywodraeth Cymru o fynd i'r afael â materion yn ymwneud â chapasiti fel dull adweithiol a thymor byr. Rhoddodd nifer o fyrddau iechyd fanylion am ysbytai sy'n contractio darparwyr allanol preifat ar gyfer darparu gwasanaethau'n fewnol i wneud triniaethau endosgopi o fewn y bwrdd iechyd ar benwythnosau, yn ogystal â rhoi gwaith ar gontract allanol, lle caiff cleifion eu hanfon at ddarparwyr preifat mewn safleoedd y tu allan i'r bwrdd iechyd, i ymdopi efo'r galw. Er bod angen rhagor o fuddsoddiad i reoli amseroedd aros, mae angen dull mwy cynaliadwy hefyd, gan fod rhoi gwaith ar gontract allanol a chontractau i ddarparu gwasanaethau'n fewnol yn ddrud ac nid yw'n darparu datrysiad hirdymor. At y gweithlu nawr: mae angen newidiadau i natur a sgiliau'r gweithlu presennol, ac ymrwymiad nid yn unig i gynyddu nifer y gastroenterolegwyr ac endosgopyddion meddygol eraill, ond hefyd i ddatblygu endosgopyddion nyrsio ac endosgopyddion anfeddygol eraill. Roedd y pwyllgor yn siomedig, felly, i glywed bod rhai nyrsys yn cael cyflogau llai nag eraill yng Nghymru i wneud gwaith endosgopi. Mae angen mynd i'r afael efo hyn. Y neges gan dystion oedd bod angen ffocws a brys i sicrhau nad yw Cymru ar ei hôl hi o'i chymharu â chenhedloedd eraill. Roedd Bowel Cancer UK, er enghraifft, eisiau gweld cynllun gweithredu cenedlaethol, gyda cherrig milltir allweddol, fel y gallai Llywodraeth Cymru gael ei dwyn i gyfrif am gyflawni a gweithredu'r cynllun. Nododd tystion y pwynt hefyd y bu nifer o adolygiadau, a bod y materion, neu'r problemau, yn amlwg. Gweithredu ac atebion yw'r hyn sydd ei angen nawr. Felly, gwnaethom un argymhelliad cyffredinol yn ein hadroddiad: erbyn mis Hydref 2019, dylai Llywodraeth Cymru weithio gyda'r rhaglen gwella endosgopi genedlaethol i greu a chyhoeddi cynllun gweithredu endosgopi cenedlaethol sy'n mynd i'r afael efo'r galw nawr ac yn y dyfodol am wasanaethau sydd ag amserlenni a thargedau clir ar gyfer gwella. Rwy'n croesawu ymateb cadarnhaol y Gweinidog i'n hadroddiad, a dwi'n falch o ddweud bod Llywodraeth Cymru wedi derbyn yr argymhelliad hwn, ac wedi ymrwymo i gyhoeddi cynllun gweithredu ar gyfer gwasanaethau endosgopi o fewn yr amserlen chwe mis a nodwyd gan y pwyllgor. Rwy'n diolch i'r Gweinidog am ei ddatganiad ysgrifenedig a oedd yn rhoi'r wybodaeth ddiweddaraf am gynnydd y rhaglen endosgopi genedlaethol yn gynharach heddiw. Dwi'n falch bod y cynllun gweithredu wedi ei ddrafftio, ac edrychaf ymlaen at ei gyhoeddi, yn unol ag argymhelliad y pwyllgor. I gloi, fel y dywed y Gweinidog ei hun, mae'n hanfodol ein bod yn sicrhau cynaliadwyedd y gwasanaethau endosgopi fel y gall pobl gyrraedd yr archwiliadau sydd eu hangen arnynt er mwyn cyflawni'r canlyniadau gorau posibl. Mae'n bryd gwneud cynnydd nawr, a hyderaf y bydd Llywodraeth Cymru yn rhoi'r arweinyddiaeth gref sydd ei hangen i gyflawni'r agenda hwn. Diolch yn fawr.