English: Thank you, Deputy Presiding Officer. I'd like to thank Members for their views on this important issue that we've discussed before and I hope we can discuss again in the future once a decision is made. The United Kingdom's independent expert panel on immunisation matters that we've heard about today - the Joint Committee on Vaccination and Immunisation - gave further consideration to extending HPV vaccination to boys at its latest meeting on 6 June. Reports on the discussion at that meeting have appeared in some parts of the media, but the JCVI has yet to publish a statement giving its final conclusions and advice. I expect that to be available very shortly, and certainly before the end of July. So, the advice is imminent. Now, I can't, despite the urging of Members today, pre-empt what that statement will say, but I do want to respond to some of today's discussion. As has been said, on the advice of the JCVI HPV vaccination has been routinely offered to adolescent girls since 2008, and a recent study by Public Health England showed that, since its introduction, the number of young women infected with HPV has fallen dramatically by up to 86 per cent between 2010 and 2016. Protection is expected to be long term, and eventually saving hundreds of lives a year. As a number of Members have said today, this is about saving lives. The good news is that the HPV vaccination in girls does provide some indirect protection for boys, and I know that Rhun ap Iorwerth's commented on this, and in particular he commented on vaccination rates. Actually, vaccination rates in Wales are relatively high. The last figures were 83 per cent and improving, with 89 per cent in Cwm Taf and 79 per cent in Powys. So, there is always more to do. But, in April 2017, again in response to the JCVI's advice, we introduced a targeted programme for men who have sex with men, and that was done in a prompt manner, acting on the updated advice from the JCVI. Notwithstanding those positive developments, I note from today's debate and previous correspondence from others, including a range of clinicians in a number of different spheres, that concerns remain about the issues of equality of access to HPV immunisation and the reliance of herd immunity rather than offering direct protection to men and boys. I am aware that these concerns were raised with the JCVI by a number of sources as part of the consultation following the publication of its interim statement last year. Now, their review since then has taken longer than anyone of us would have wanted, but it is now reaching a conclusion, as I referred to in my earlier remarks. That review looked at a number of complex issues that the JCVI itself is best placed to assess, not least in respect of cost-effectiveness, albeit there will be a decision for me to make at the end of it. I don't think we should shy away from cost-effectiveness being important because we need to fairly, consistency and robustly evaluate the potential benefits of national programmes. We need to deliver value for money and the greatest health benefit possible to the population. I do disagree with Angela Burns's point about how easy it could be to remove four or five named items from the prescription list. I don't think you could avoid reintroducing an expensive means test to do so, and I don't think it either is easy, as was suggested, or, indeed, that you would deliver the cost savings that she refers to, and, of course, there are differences of principles about our continued free prescriptions policy. But I just want to make this clear because I know a number of people referred to evidence and the views of other campaign groups and interest groups in this area who all want to see positive change, but I just don't think you can put aside the JCVI as the authoritative body that the whole of the NHS UK family relies upon to help make evidence-led choices on immunisation and vaccination. Once their statement is available in the very near future, I will, of course, listen to the advice carefully before deciding how best to proceed in Wales. However, I do want to assure Members that I will prioritise consideration of that advice and I will then make a decision for which I will be accountable, but I will do so in a timely manner, certainly without any lengthy delay.
Welsh: Diolch, Ddirprwy Lywydd. Hoffwn ddiolch i'r Aelodau am eu safbwyntiau ar y mater pwysig hwn a drafodwyd gennym o'r blaen ac rwy'n gobeithio y gallwn ei drafod eto yn y dyfodol ar ôl gwneud penderfyniad. Yn ei gyfarfod diweddaraf ar 6 Mehefin, rhoddodd panel arbenigol annibynnol y Deyrnas Unedig ar faterion imiwneiddio y clywsom amdano heddiw - y Cyd-bwyllgor ar Imiwneiddio a Brechu - ystyriaeth bellach i ymestyn y brechiad HPV i gynnwys bechgyn. Mae adroddiadau ar y drafodaeth yn y cyfarfod hwnnw wedi ymddangos mewn rhai rhannau o'r cyfryngau, ond mae'r cyd-bwyllgor eto i gyhoeddi datganiad yn rhoi ei gasgliadau terfynol a chyngor. Rwy'n disgwyl i hwnnw fod ar gael yn fuan iawn, ac yn sicr cyn diwedd mis Gorffennaf. Felly, mae'r cyngor ar fin ymddangos. Nawr, er gwaethaf anogaeth yr Aelodau heddiw, ni allaf achub y blaen ar yr hyn y bydd y datganiad hwnnw yn ei ddweud, ond hoffwn ymateb i beth o'r drafodaeth heddiw. Fel y dywedwyd, ar gyngor y Cyd-bwyllgor ar Imiwneiddio a Brechu mae brechiadau HPV wedi cael eu cynnig fel mater o drefn i ferched yn eu harddegau ers 2008, ac ers ei gyflwyno, dangosodd astudiaeth ddiweddar gan Iechyd Cyhoeddus Lloegr, fod nifer y menywod ifanc a heintiwyd â HPV wedi gostwng yn ddramatig hyd at 86 y cant rhwng 2010 a 2016. Disgwylir y bydd yr amddiffyniad yn hirdymor, ac yn y pen draw yn achub cannoedd o fywydau y flwyddyn. Fel y dywedodd nifer o'r Aelodau heddiw, mae hyn yn ymwneud ag achub bywydau. Y newyddion da yw bod y brechiad HPV mewn merched yn darparu rhywfaint o amddiffyniad anuniongyrchol i fechgyn, a gwn fod Rhun ap Iorwerth wedi sôn am hyn, ac yn benodol soniodd am gyfraddau brechu. Mewn gwirionedd, mae cyfraddau brechu yng Nghymru yn gymharol uchel. Y ffigurau diwethaf oedd 83 y cant ac maent yn gwella, gydag 89 y cant yng Nghwm Taf a 79 y cant ym Mhowys. Felly, mae mwy i'w wneud bob amser. Ond ym mis Ebrill 2017, eto mewn ymateb i gyngor y cyd-bwyllgor, cyflwynwyd rhaglen gennym wedi'i thargedu ar gyfer dynion sy'n cael rhyw gyda dynion, a gwnaed hynny mewn modd amserol, gan weithredu ar y cyngor a ddiweddarwyd gan y cyd-bwyllgor. Er gwaethaf y datblygiadau cadarnhaol hynny, nodaf o'r ddadl heddiw a gohebiaeth flaenorol gan eraill, gan gynnwys amrywiaeth o glinigwyr mewn nifer o feysydd gwahanol, fod yna bryderon yn parhau ynglŷn â mynediad cyfartal at y brechiad HPV a dibyniaeth ar imiwnedd poblogaeth yn hytrach na chynnig amddiffyniad uniongyrchol i ddynion a bechgyn. Rwy'n ymwybodol fod y pryderon wedi'u dwyn i sylw'r cyd-bwyllgor gan nifer o ffynonellau fel rhan o'r ymgynghoriad yn dilyn cyhoeddi eu datganiad interim y llynedd. Nawr, mae eu hadolygiad ers hynny wedi cymryd mwy o amser nag y byddai neb ohonom wedi dymuno, ond mae bellach yn dod i gasgliad, fel y dywedais yn fy sylwadau cynharach. Roedd yr adolygiad hwnnw'n edrych ar nifer o faterion cymhleth a'r cyd-bwyllgor ei hun sydd yn y sefyllfa orau i'w hasesu, nid yn lleiaf mewn perthynas â chosteffeithiolrwydd, er y bydd yna benderfyniad i mi ei wneud ar ei ddiwedd. Ni chredaf y dylem droi cefn ar bwysigrwydd costeffeithiolrwydd oherwydd mae angen i ni werthuso manteision posibl rhaglenni cenedlaethol yn deg, yn gyson ac yn drylwyr. Mae angen inni sicrhau gwerth am arian a'r budd iechyd mwyaf sy'n bosibl i'r boblogaeth. Rwy'n anghytuno â phwynt Angela Burns ynglŷn â pha mor hawdd y gallai fod i dynnu'r pedwar neu bump eitem a enwyd oddi ar y rhestr bresgripsiynu. Nid wyf yn credu y gallech osgoi ailgyflwyno prawf modd drud ar gyfer gwneud hynny, ac nid wyf yn credu ychwaith ei fod yn hawdd, fel yr awgrymwyd, nac ychwaith y byddech yn sicrhau'r arbedion cost y mae hi'n eu nodi, ac wrth gwrs, ceir gwahaniaethau ar sail egwyddor ynglŷn â pharhad ein polisi presgripsiynau am ddim. Ond rwyf am wneud hyn yn glir oherwydd gwn fod nifer o bobl wedi cyfeirio at dystiolaeth a safbwyntiau grwpiau ymgyrchu eraill a grwpiau sydd â diddordeb yn y maes hwn ac sydd eisiau gweld newid cadarnhaol, ond nid wyf yn credu y gallwch ddiystyru'r Cyd-bwyllgor ar Imiwneiddio a Brechu fel y corff awdurdodol y mae holl deulu GIG y DU gyfan yn dibynnu arno i'w helpu i wneud dewisiadau a arweinir gan dystiolaeth ynghylch imiwneiddio a brechu. Pan fydd eu datganiad ar gael yn y dyfodol agos iawn, byddaf yn sicr yn gwrando ar y cyngor yn ofalus cyn penderfynu ar y ffordd orau o fwrw ymlaen yng Nghymru. Fodd bynnag, rwyf am sicrhau'r Aelodau y byddaf yn blaenoriaethu ystyriaeth o'r cyngor hwnnw ac yna'n gwneud penderfyniad y byddaf yn atebol amdano, ond byddaf yn gwneud hynny mewn modd amserol, yn sicr, heb unrhyw oedi hir.