English: Thank you, Dirprwy Lywydd, and it's my pleasure to open this debate today in the name of Darren Millar. There are a number of very important reasons for bringing this debate forward on what is the national awareness day for less survivable cancers, with the main one being that we need to highlight both to the Welsh Government and Members across this Chamber that, tragically, Wales has the highest mortality rate due to liver disease across all four nations of the UK, with death rates almost doubling in the last 10 years, from 5.7 per 100,000 to 11 people per 100,000. And this is, sadly, because of the stark inequalities in prognosis between different cancers. Moreover, we have a chronic workforce shortage of hepatologists and liver nurse specialists across Wales, which is exacerbating these inequalities, particularly in deprived areas and underserved health boards. In Cardiff and the Vale health board, within the region I represent, liver cancer mortality rates are 50 per cent higher than the Welsh national average and have increased by 28 per cent in 2019-20 alone. And I make no apologies when I say that this is proof enough that we are failing liver cancer and liver disease patients here in Wales. The second reason that we need this debate is that we cannot bury our heads in the sand on this issue. We need to realise that this problem is not going to go away but will more than likely get even worse. The number of people diagnosed with liver disease in Wales has now more than tripled in the last 20 years to the highest level ever recorded, meaning that at a time when NHS services are experiencing their greatest pressure, more patients are needing to be treated. Thirdly, we need to acknowledge that liver disease patients in Wales face huge geographical inequalities in accessing specialist care. Thousands die unnecessarily because they cannot gain sufficient access to the expertise they need, as liver services in health boards are being consistently overlooked and underresourced. The final reason is that we need to recognise how Wales is behind other UK nations in tackling health problems. Wales is now the only UK nation not to have a target of achieving hepatitis C elimination. Hepatitis C can cause a range of health impacts and primarily affects the liver. And whilst NHS England is on track to achieve hepatitis C elimination by 2025, Northern Ireland has set the same target and Scotland is going further by aiming to achieve elimination by 2024, Wales is woefully behind. In fact, recent modelling found that, without any target and the continuation of current treatment rates, Wales would not eliminate hepatitis C until at least 2040, which is quite shocking, really, as the estimated number of people affected is 8,300 and hep C is easily curable through the use of direct-acting antiviral treatments. Liver cancer has the second-lowest five-year survival rate amongst all less survivable cancers. In Wales, around nine out of 10 people diagnosed will not survive more than five years, which is more than the UK national average. And this means that we urgently need more investment in research and a dedicated focus on earlier and faster diagnosis in order to help patients. I urge the Government to recognise that this investment is desperately needed and can help to drastically increase life expectancy as well as to improve the quality of life of thousands of people in Wales and for the Welsh Government to acknowledge that this should be a higher priority for health boards. The liver disease crisis we are facing in Wales is placing a huge burden on the NHS and is projected to rise further. Hospital admissions due to liver disease surged by 25 per cent in 2020-21, with nearly 26,000 crisis-point admissions last year alone. Yet despite this, in Wales, there are fewer than 14 liver doctors supporting a population in excess of 3.1 million people, and nine of them are based in Cardiff and Gwent. In June 2022, the health Minister acknowledged that liver disease has resulted in a significant rise in out-patient and in-patient episodes, and an an expansion in hepatology consultants is required. I want to point out that, to address this workforce crisis, we desperately need the quality statement for liver disease, published in November, to have a long-term funding settlement in order to recruit and train a resilient and better distributed liver-care workforce. We need to ensure that the move from the liver disease implementation group to the quality statement does not diminish the priority of liver disease within the NHS and health boards in Wales, and we need the Government to ensure that the new quality statement for liver disease is effectively implemented. This will require having a dedicated liver health strategic clinical network to drive progress and to keep up momentum following the termination of funding for the previous liver disease delivery group and the liver disease delivery plan. The sad truth is that 90 per cent of liver disease is preventable, and though it is predominately caused by alcohol misuse, obesity and viral hepatitis also play their part. We know that hospital admissions are four times higher in the most deprived areas compared to the most affluent, and we also know that Wales is facing an obesity epidemic, with around two thirds of the adult population in Wales being overweight or obese, and one in three having early stage fatty liver disease. It is estimated that around one in five of these will ultimately go on to develop more serious diseases. Therefore, we need to think more carefully about the long-term prevention strategies that are needed on how to raise awareness of the dangers of alcohol misuse and of being overweight or obese. I acknowledge the efforts by the Government to try and encourage healthier lifestyles with initiatives to help people to cycle, access safe walking routes and to tackle carbon emissions, but the reality is that we need to do more to maintain longer term habits and behavioural change. We need to do much more in addressing the massive geographical variation that exists in accessing pathways for early diagnosis of liver disease in primary care, and addressing the stigma that is associated with liver disease because of perceived alcohol misuse. Indeed, a recent British Liver Trust survey of over 1,400 people revealed that almost half of those surveyed had experienced stigma from healthcare professionals, and this culture desperately needs to change, because it is hampering early diagnosis as people become too afraid to seek help and attend routine or repeat appointments. Unfortunately, the symptoms of liver disease often don't present until the damage is irreversible, and we believe, like many others, that a national screening programme is needed, where GPs can refer people if they have concerns or where there's a family history of liver problems. As the Minister will know, chronic liver disease is the most significant risk factor for hepatocellular carcinoma, the most common form of primary liver cancer. It is therefore vital that in order to improve liver cancer survival, we must diagnose people with liver disease earlier and provide a clear strategy for the surveillance of people with liver disease to detect hepatocellular carcinoma liver cancer cells, and introduce better and more robust mechanisms to review. This will not only help save lives, but save huge resources for the NHS by reducing the need for very costly treatments at later stages. An example of what this would look like can be found in the British Liver Trust's campaign to make early diagnosis of liver disease routine. It was launched in Wales last year and aims to drive public awareness of the liver disease crisis. In closing my contribution, I'd like to point out that I recognise that the Welsh Government have broken new ground by introducing the all-Wales abnormal blood test pathway in October 2021, and this has the potential to improve liver disease diagnosis. However, I would like to remind the Government that it is only of any real use if this pathway is annually audited and regularly monitored, so that it can be used to drive improvements to earlier detection and address persistent disparities in care outcomes across boards. Finally, I would like to thank the British Liver Trust for their tremendous work in campaigning for better liver services, diagnosis and treatments, and I'd like to urge everyone here to support this motion today. Thank you.
Welsh: Diolch yn fawr, Ddirprwy Lywydd, ac mae'n bleser gennyf agor y ddadl hon heddiw yn enw Darren Millar. Mae nifer o resymau pwysig iawn dros gyflwyno'r ddadl hon ar ddiwrnod cenedlaethol ymwybyddiaeth canserau llai goroesadwy, a'r prif reswm yw bod angen inni dynnu sylw Llywodraeth Cymru ac Aelodau ar draws y Siambr hon at y ffaith mai Cymru, yn drasig, sydd â'r gyfradd farwolaethau uchaf o ganlyniad i glefyd yr afu ar draws pedair gwlad y DU, gyda chyfraddau marwolaeth bron â dyblu yn y 10 mlynedd diwethaf, o 5.7 fesul 100,000 i 11 o bobl fesul 100,000. Ac mae hyn, yn anffodus, oherwydd yr anghydraddoldeb mawr yn y prognosis rhwng gwahanol ganserau. Ar ben hynny, mae gennym brinder cronig yn y gweithlu o hepatolegwyr a nyrsys arbenigol yr afu ledled Cymru, sy'n gwaethygu'r anghydraddoldebau hyn, yn enwedig mewn ardaloedd difreintiedig a byrddau iechyd heb wasanaeth digonol. Ym mwrdd iechyd Caerdydd a'r Fro, o fewn y rhanbarth rwy'n ei gynrychioli, mae cyfraddau marwolaeth canser yr afu 50 y cant yn uwch na chyfartaledd cenedlaethol Cymru ac maent wedi cynyddu 28 y cant yn 2019-20 yn unig. Ac nid wyf yn ymddiheuro pan ddywedaf fod hyn yn brawf ein bod yn gwenud cam â chleifion canser yr afu a chleifion clefyd yr afu yma yng Nghymru. Yr ail reswm pam mae angen y ddadl hon yw oherwydd na allwn gladdu ein pennau yn y tywod ynghylch y mater hwn. Mae angen inni sylweddoli na fydd y broblem yn diflannu ac mae'n debygol o waethygu. Mae nifer y bobl sy'n cael diagnosis o glefyd yr afu yng Nghymru bellach wedi mwy na threblu yn yr 20 mlynedd ddiwethaf i'r lefel uchaf erioed, sy'n golygu bod angen trin mwy o gleifion ar adeg pan fo gwasanaethau'r GIG o dan y pwysau mwyaf. Yn drydydd, mae angen inni gydnabod bod cleifion clefyd yr afu yng Nghymru yn wynebu anghydraddoldeb daearyddol enfawr o ran cael mynediad at ofal arbenigol. Mae miloedd yn marw'n ddiangen oherwydd na allant gael digon o fynediad at yr arbenigedd y maent ei angen, gan fod gwasanaethau'r afu mewn byrddau iechyd yn cael eu hesgeuluso a'u tangyllido'n gyson. Y rheswm olaf yw bod angen inni gydnabod y modd y mae Cymru'n llusgo ar ôl gwledydd eraill y DU wrth fynd i'r afael â phroblemau iechyd. Cymru yw'r unig un o wledydd y DU heb darged i ddileu hepatitis C. Gall hepatitis C achosi ystod o effeithiau ar iechyd ac mae'n effeithio'n bennaf ar yr afu. A thra bo GIG Lloegr ar y trywydd cywir i ddileu hepatitis C erbyn 2025, a Gogledd Iwerddon wedi gosod yr un targed a'r Alban wedi mynd gam ymhellach drwy anelu at ddileu hepatitis C erbyn 2024, mae Cymru ar ei hôl hi'n ofnadwy. Mewn gwirionedd, canfu gwaith modelu diweddar na fyddai Cymru, heb unrhyw darged, ac os bydd cyfraddau triniaeth cyfredol yn parhau, yn cael gwared ar hepatitis C tan o leiaf 2040, sy'n frawychus mewn gwirionedd, gan fod amcangyfrifiad o'r nifer o bobl yr effeithiwyd arnynt yn 8,300 a bod hep C yn hawdd i'w drin drwy ddefnyddio triniaethau gwrthfeirysol sy'n gweithredu'n uniongyrchol. Canser yr afu sydd â'r gyfradd oroesi pum mlynedd waethaf ond un o blith yr holl ganserau llai goroesadwy. Yng Nghymru, ni fydd tua naw o bob 10 person sydd wedi cael diagnosis yn goroesi mwy na phum mlynedd, sy'n fwy na chyfartaledd cenedlaethol y DU. A golyga hyn ein bod angen mwy o fuddsoddi ar frys mewn ymchwil a ffocws penodol ar ddiagnosis cynharach a chyflymach er mwyn helpu cleifion. Rwy'n annog y Llywodraeth i gydnabod bod gwir angen y buddsoddiad hwn ac y gall helpu i gynyddu disgwyliad oes yn sylweddol yn ogystal â gwella ansawdd bywyd miloedd o bobl yng Nghymru ac rwy'n annog Llywodraeth Cymru i gydnabod y dylai'r byrddau iechyd roi blaenoriaeth uwch i hyn. Mae'r argyfwng clefyd yr afu a wynebwn yng Nghymru yn rhoi baich enfawr ar y GIG a rhagamcanir y bydd yn gwaethygu ymhellach. Yn 2020-21, gwelwyd cynnydd o 25 y cant yn nifer y cleifion a gafodd eu derbyn i'r ysbyty o ganlyniad i glefyd yr afu, gyda bron i 26,000 achos o dderbyn i'r ysbyty ar y pwynt argyfwng y llynedd yn unig. Ond er hyn, yng Nghymru, ceir llai na 14 o feddygon yr afu i gefnogi poblogaeth o fwy na 3.1 miliwn o bobl, ac mae naw ohonynt wedi'u lleoli yng Nghaerdydd a Gwent. Ym mis Mehefin 2022, fe wnaeth y Gweinidog iechyd gydnabod bod clefyd yr afu wedi arwain at gynnydd sylweddol yn nifer y cleifion allanol a chleifion mewnol, ac mae angen mwy o feddygon ymgynghorol hepatoleg. Er mwyn mynd i'r afael â'r argyfwng gweithlu, hoffwn nodi bod gwir angen i'r datganiad ansawdd ar gyfer clefyd yr afu a gyhoeddwyd ym mis Tachwedd gael setliad ariannol hirdymor er mwyn recriwtio a hyfforddi gweithlu gwydn ac wedi'i ddosbarthu'n well. Mae angen inni sicrhau nad yw'r newid o'r grŵp gweithredu ar gyfer clefyd yr afu i'r datganiad ansawdd yn lleihau blaenoriaeth clefyd yr afu o fewn y GIG a byrddau iechyd yng Nghymru, ac rydym angen i'r Llywodraeth sicrhau bod y datganiad ansawdd newydd ar gyfer clefyd yr afu yn cael ei weithredu'n effeithiol. I wneud hyn, bydd angen sefydlu rhwydwaith clinigol strategol penodol ar gyfer iechyd yr afu i sbarduno cynnydd ac i gadw momentwm yn sgil dod â chyllid ar gyfer y grŵp cyflawni blaenorol ar gyfer clefyd yr afu a'r cynllun cyflawni ar gyfer clefyd yr afu i ben. Y gwirionedd trist yw bod modd atal 90 y cant o'r achosion o glefyd yr afu, ac er ei fod yn cael ei achosi'n bennaf gan gamddefnydd o alcohol, mae gordewdra a hepatitis feirysol hefyd yn chwarae eu rhan. Gwyddom fod nifer y derbyniadau i'r ysbyty bedair gwaith yn uwch yn yr ardaloedd mwyaf difreintiedig o'i gymharu â'r ardaloedd mwyaf cyfoethog, a gwyddom hefyd fod Cymru'n wynebu epidemig o ordewdra, gydag oddeutu dwy ran o dair o boblogaeth oedolion Cymru yn cario gormod o bwysau neu'n ordew, ac un o bob tri â chlefyd yr afu brasterog cam cynnar. Amcangyfrifir y bydd tua un o bob pump o'r rhain yn mynd ymlaen i ddatblygu clefydau mwy difrifol yn y pen draw. Felly, mae angen inni feddwl yn fwy gofalus am y strategaethau atal hirdymor sydd eu hangen er mwyn codi ymwybyddiaeth o beryglon camddefnyddio alcohol ac o fod dros bwysau neu'n ordew. Rwy'n cydnabod ymdrechion y Llywodraeth i geisio annog ffyrdd iachach o fyw gyda mentrau i helpu pobl i feicio, defnyddio llwybrau cerdded diogel ac i fynd i'r afael ag allyriadau carbon, ond y gwirionedd yw bod angen i ni wneud mwy i gynnal arferion mwy hirdymor a newid ymddygiad. Mae angen inni wneud llawer mwy i fynd i'r afael â'r amrywio daearyddol enfawr sy'n bodoli o ran cael mynediad at lwybrau diagnosis cynnar o glefyd yr afu mewn gofal sylfaenol, a mynd i'r afael â'r stigma sy'n gysylltiedig â chlefyd yr afu oherwydd y canfyddiad o gamddefnydd o alcohol. Yn wir, dangosodd arolwg diweddar o dros 1,400 o bobl, a gyhoeddwyd gan Ymddiriedolaeth Afu Prydain, fod bron i hanner y rhai a holwyd wedi profi stigma gan weithwyr gofal iechyd proffesiynol, ac mae gwir angen i'r diwylliant hwn newid, oherwydd mae'n llesteirio diagnosis cynnar am fod pobl yn rhy ofnus i ofyn am gymorth a mynychu apwyntiadau arferol neu apwyntiadau dilynol. Yn anffodus, yn aml ni fydd symptomau clefyd yr afu i'w canfod hyd nes na fydd modd dad-wneud y niwed, ac fel llawer o rai eraill, credwn fod angen rhaglen sgrinio genedlaethol, lle gall meddygon teulu atgyfeirio pobl os oes ganddynt bryderon neu lle ceir hanes teuluol o broblemau'r afu. Fel y bydd y Gweinidog yn gwybod, clefyd cronig yr afu yw'r ffactor risg mwyaf arwyddocaol ar gyfer carsinoma hepatogellol, y math mwyaf cyffredin o ganser yr afu cychwynnol. Felly, er mwyn gwella cyfraddau goroesi canser yr afu, mae'n hanfodol ein bod yn gwneud diagnosis o glefyd yr afu yn gynharach ac yn darparu strategaeth glir ar gyfer monitro pobl sydd â chlefyd yr afu i ganfod celloedd canser yr afu carsinoma hepatogellol, a chyflwyno mecanweithiau adolygu gwell a mwy trylwyr. Nid yn unig y bydd hyn yn helpu i achub bywydau, bydd yn arbed llawer o arian i'r GIG drwy leihau'r angen am driniaethau costus iawn ar gamau diweddarach. Gellir gweld enghraifft o sut y byddai hyn yn edrych yn ymgyrch Ymddiriedolaeth Afu Prydain i wella diagnosis cynnar o glefyd yr afu. Cafodd ei lansio yng Nghymru y llynedd a'i nod yw hybu ymwybyddiaeth y cyhoedd o'r argyfwng clefyd yr afu. I gloi fy nghyfraniad, hoffwn nodi fy mod yn cydnabod bod Llywodraeth Cymru wedi torri tir newydd drwy gyflwyno llwybr prawf gwaed annormal Cymru ym mis Hydref 2021, ac mae potensial iddo wella diagnosis o glefyd yr afu. Fodd bynnag, hoffwn atgoffa'r Llywodraeth na fydd y llwybr hwn o unrhyw ddefnydd gwirioneddol os na chaiff ei archwilio'n flynyddol a'i fonitro'n rheolaidd, fel y gellir ei ddefnyddio i ysgogi gwelliannau i nodi'r clefyd yn gynharach a mynd i'r afael â gwahaniaethau parhaus yn y canlyniadau gofal ar draws y byrddau. Yn olaf, hoffwn ddiolch i Ymddiriedolaeth Afu Prydain am eu gwaith aruthrol yn ymgyrchu am wasanaethau, diagnosis a thriniaethau gwell ar gyfer clefyd yr afu, a hoffwn annog pawb yma i gefnogi'r cynnig hwn heddiw. Diolch.