English: Thank you, Deputy Presiding Officer. I have listened carefully to the comments that were made in the debate today, and I recognise the Member for raising what is an important issue. All of us in this room are aware that diabetes can cause significant long-term health problems and, in rare circumstances, it can be fatal. Members here want to at the outset recognise the commitment, and, as Lynne Neagle said, the courage, of the Baldwin family in using their tragic experience to want to campaign to raise money for the cause but also awareness to try and improve outcomes for other families. I know it's been an incredibly difficult time for them as they've gone through the loss of a child to want to make sure that, as far as possible, other parents don't have to go through that. I'm pleased that Janet Finch-Saunders clarified during her contribution that she is not calling for the regular routine testing of children. From the subject of the debate, it appeared to me that that would be the call that would be made, so I'm grateful that she clarified that during the course of her contribution. We know that there are researchers who are looking to develop a blood test that can identify the antibodies that attack cells in the pancreas years before the ultimate symptoms, though those tests aren't sufficiently accurate for use in population screening. In fact, in the Diabetes UK written evidence to the Petitions Committee, they recognised that population screening was not something that they would support; there isn't evidence to suggest that it would be the right thing to do and it would, in any event, be difficult. Now, the challenge is how we get to the testing based on clinical judgment and recognising that it isn't practical to test all unwell children for type 1 diabetes. So, the challenge is how we prompt the diagnosis once an individual shows signs of type 1 diabetes in a more effective approach, as is recommended by NICE. This goes back to the evidence in the Petitions Committee. They support the current approach to test children and young people for type 1 diabetes when they present to a clinician with symptoms. The challenge there again is how do we get that being more consistent. That's why we've recognised in our updated diabetes delivery plan the need to support the awareness of symptoms to prompt people to seek early help from health services, and the plan committed to develop an awareness campaign led by Diabetes UK Cymru - and, of course, they've had significant support and impetus from the Baldwin family in doing so. And, again, as Janet Finch-Saunders recognised, I don't think it hurts to remind ourselves of the four common symptoms: the need to go to the toilet a lot more and the onset of bed-wetting in a previously dry child; being really thirsty and not able to quench that thirst; feeling more tired than usual; and losing weight or being thinner than usual. In those circumstances, the encouragement is for parents to seek advice from their GP. But, given the number of health measures that are directed at the public and the small number of children who do develop type 1 diabetes, there are of course limitations that we should recognise in relying only on general public awareness raising. That's why our national plan highlights the need for health boards to ensure that staff are sufficiently knowledgeable to appropriately identify and refer on for suspected type 1 diabetes, because we do believe that the focus should be on the implementation of the evidence-based guidelines from NICE on testing and referral. As Janet Finch-Saunders set out, NICE recommend same-day referral to a specialist diabetes service for suspected type 1 diabetes and immediate blood glucose testing for children presenting with nausea or vomiting, abdominal pain, hyperventilation, dehydration or reduced consciousness. We do want to ensure, as Janet's outlined and as, indeed, the petition as it's changed from its initial call to where it is now - . We want to ensure there is consistency among health services, and that is why the children and young people's diabetes network is developing a type 1 referral pathway. That should re-emphasise how people with suspected type 1 diabetes should be identified and referred for testing. On this point specifically, I'll come back to Lynne Neagle's specific ask about the availability of blood glucose meters, as I set out in my letter to the Petitions Committee of 6 October this year and indeed as has come from our previous conversations, so I will come back specifically on that point. If the pilot that we're running is successful, and it shows an improvement in both identification and referral on, then the commitment that I've given is that we will roll that out across Wales, to have a consistent process and understanding to support clinicians. The network is already working with our NHS informatics provider to develop electronic prompts for clinicians to support adherence to the referral pathway if it is introduced. And, again, that's been part of the call from both Diabetes UK and the Baldwin family, and we specifically discussed that in the meeting with Lynne Neagle, colleagues and the Baldwin family. So, we're exploring a number of additional options which can support better diagnosis, such as the use of Datix reporting, which is a formal process of reporting adverse healthcare incidents, or where inappropriate tests are carried out. There is also the potential to use learning from these reports across the wider system to re-emphasise best and expected practice, and consideration is being given to making available an e-learning module for GPs. And, again, I'll come back to confirm how that is being taken forward. The sad truth is there's no easy answer to this problem. Only a small number of children will develop the disease, and based on the evidence we have, the onset is too sudden for a screening programme to be effective. So, the challenge is how we have the consistency in approach from our clinicians. So, we need to support them to embed good practice and work with health boards on the consistency of service delivery. And, of course, follow-up services, such as diabetic retinopathy, are important to monitor the health of individuals who are diagnosed as having diabetes. But our focus will remain on the prompt identification of symptoms, diagnosis and treatment, and I do expect to update Members in this place or in other committees on the work that we are doing, and the work that I've committed to do, on having a pilot and then considering a roll-out to improve the position for every family, so that other parents are spared the unfortunate and the tragic circumstances that Peter Baldwin's family have had to go through.
Welsh: Diolch, Ddirprwy Lywydd. Gwrandewais yn ofalus ar y sylwadau a wnaed yn y ddadl heddiw, ac rwy'n cydnabod yr Aelod am godi mater pwysig. Mae pob un ohonom yn yr ystafell hon yn ymwybodol y gall diabetes achosi problemau iechyd hirdymor sylweddol ac mewn amgylchiadau prin, gall fod yn angheuol. Ar y cychwyn, mae'r Aelodau yma am gydnabod ymrwymiad, a dewrder, fel y dywedodd Lynne Neagle, y teulu Baldwin yn defnyddio'u profiad trist i fod eisiau ymgyrchu i godi arian ar gyfer yr achos a chodi ymwybyddiaeth hefyd i geisio gwella canlyniadau ar gyfer teuluoedd eraill. Gwn ei fod wedi bod yn amser hynod o anodd iddynt gan eu bod wedi dioddef colli plentyn i fod eisiau gwneud yn siŵr, cyn belled ag bo modd, nad yw rhieni eraill yn gorfod mynd drwy hynny. Rwy'n falch bod Janet Finch-Saunders wedi egluro yn ystod ei chyfraniad nad yw hi'n galw am brofion rheolaidd fel mater o drefn i blant. O destun y ddadl, roedd yn ymddangos mai dyna a fyddai'r alwad a wneid, felly rwy'n ddiolchgar ei bod wedi egluro hynny yn ystod ei chyfraniad. Rydym yn gwybod bod yna ymchwilwyr sy'n ceisio datblygu prawf gwaed a all ganfod y gwrthgyrff sy'n ymosod ar gelloedd yn y pancreas flynyddoedd cyn i'r symptomau ymddangos yn y pen draw, er nad yw'r profion hynny'n ddigon cywir i'w defnyddio i sgrinio'r boblogaeth. Yn wir, mewn tystiolaeth ysgrifenedig i'r Pwyllgor Deisebau gan Diabetes UK, roeddent yn cydnabod nad oedd sgrinio'r boblogaeth yn rhywbeth y byddent yn ei gefnogi; nid oes tystiolaeth i awgrymu mai dyna fyddai'r peth iawn i'w wneud a beth bynnag, byddai'n anodd. Nawr, yr her yw sut y gallwn gael y profion yn seiliedig ar farn glinigol a chydnabod nad yw'n ymarferol cynnal profion diabetes math 1 ar bob plentyn sy'n sâl. Felly, yr her yw sut rydym yn ysgogi'r diagnosis pan fydd unigolyn yn dangos arwyddion o ddiabetes math 1 mewn dull mwy effeithiol, fel yr argymhellwyd gan NICE. Mae hyn yn mynd yn ôl at y dystiolaeth yn y Pwyllgor Deisebau. Maent yn cefnogi'r dull presennol o gynnal profion diabetes math 1 ar blant a phobl ifanc pan fyddant yn dangos symptomau i glinigydd. Yr her yno eto yw sut y gallwn ei gael i fod yn fwy cyson. Dyna pam rydym wedi cydnabod yn ein cynllun cyflawni ar gyfer diabetes sydd wedi'i ddiweddaru fod angen cefnogi ymwybyddiaeth o symptomau er mwyn annog pobl i ofyn am gymorth yn gynnar gan y gwasanaethau iechyd, ac roedd y cynllun yn ymrwymo i ddatblygu ymgyrch godi ymwybyddiaeth dan arweiniad Diabetes UK Cymru - ac wrth gwrs, maent wedi cael cefnogaeth sylweddol ac ysgogiad gan y teulu Baldwin i wneud hynny. Ac unwaith eto, fel y cydnabu Janet Finch-Saunders, nid wyf yn meddwl y byddai'n brifo inni atgoffa ein hunain o'r pedwar symptom cyffredin: yr angen i fynd i'r toiled yn llawer mwy aml a gwlychu'r gwely mewn plentyn a oedd yn sych o'r blaen; bod yn sychedig iawn a methu torri syched; teimlo wedi blino mwy nag arfer; a cholli pwysau neu fod yn deneuach na'r arfer. Yn yr amgylchiadau hynny, anogir rhieni i ofyn am gyngor gan eu meddyg teulu. Ond o ystyried y nifer o fesurau iechyd a gyfeirir at y cyhoedd a'r nifer fach o blant sy'n datblygu diabetes math 1, mae yna gyfyngiadau y dylem eu cydnabod wrth gwrs wrth ddibynnu'n unig ar godi ymwybyddiaeth gyhoeddus yn gyffredinol. Dyna pam y mae ein cynllun cenedlaethol yn tynnu sylw at yr angen i fyrddau iechyd sicrhau bod staff yn ddigon gwybodus i allu nodi'r cyflwr yn briodol ac atgyfeirio pan geir amheuaeth o ddiabetes math 1, oherwydd credwn y dylai'r ffocws fod ar weithredu'r canllawiau sy'n seiliedig ar dystiolaeth gan NICE ar brofion ac atgyfeirio. Fel y nododd Janet Finch-Saunders, mae NICE yn argymell atgyfeirio ar yr un diwrnod at wasanaeth diabetes arbenigol pan geir amheuaeth o ddiabetes math 1 a phrofion glwcos gwaed ar unwaith i blant sy'n dangos arwyddion o gyfogi neu chwydu, poen yn yr abdomen, goranadlu, diffyg hylif neu o fod yn llai ymwybodol. Rydym eisiau sicrhau, fel y nododd Janet ac fel y mae'r ddeiseb yn ei nodi gan ei fod wedi newid o'i alwad gyntaf i'r hyn ydyw bellach - . Rydym am sicrhau cysondeb ymhlith y gwasanaethau iechyd, a dyna pam y mae'r rhwydwaith diabetes plant a phobl ifanc yn datblygu llwybr atgyfeirio ar gyfer math 1. Dylai ailbwysleisio sut y dylid nodi pobl yr amheuir eu bod yn dioddef o ddiabetes math 1 a'u hatgyfeirio i gael profion. Ar y pwynt hwn yn benodol, dychwelaf at gwestiwn penodol Lynne Neagle ynghylch argaeledd mesuryddion glwcos gwaed, fel y nodais yn fy llythyr at y Pwyllgor Deisebau ar 6 Hydref eleni ac yn wir, fel sydd wedi deillio o'n sgyrsiau blaenorol, felly byddaf yn adrodd yn ôl ar y pwynt hwnnw'n benodol. Os yw'r peilot rydym yn ei gynnal yn llwyddiannus, a'i fod yn dangos gwelliant o ran nodi ac atgyfeirio, yr ymrwymiad a roddais yw y byddwn yn cyflwyno hynny ledled Cymru, er mwyn cael proses gyson a dealltwriaeth i gynorthwyo clinigwyr. Mae'r rhwydwaith eisoes yn gweithio gyda'n darparwr gwybodeg GIG ar ddatblygu prociau electronig ar gyfer clinigwyr i gefnogi ymlyniad wrth y llwybr atgyfeirio os caiff ei gyflwyno. Ac unwaith eto, roedd hynny'n rhan o'r alwad gan Diabetes UK a'r teulu Baldwin, ac fe fuom yn trafod hynny'n benodol yn y cyfarfod gyda Lynne Neagle, cydweithwyr a'r teulu Baldwin. Felly, rydym yn archwilio nifer o opsiynau ychwanegol a all gefnogi gwell diagnosis, megis y defnydd o adroddiadau Datix, sef proses ffurfiol o adrodd am ddigwyddiadau gofal iechyd niweidiol, neu lle y cynhelir profion amhriodol. Ceir potensial hefyd i ddefnyddio gwersi a ddysgir o'r adroddiadau hyn ar draws y system ehangach i ailbwysleisio arferion gorau a'r hyn a ddisgwylir, a rhoddir ystyriaeth i sicrhau bod modiwl e-ddysgu ar gael ar gyfer meddygon teulu. Ac unwaith eto, fe ddof yn ôl i gadarnhau sut y mae hynny'n cael ei ddatblygu. Y gwir trist yw nad oes ateb hawdd i'r broblem hon. Nifer fach o blant a fydd yn datblygu'r clefyd, ac yn seiliedig ar y dystiolaeth sydd gennym, mae'n dechrau'n rhy sydyn i raglen sgrinio fod yn effeithiol. Felly, yr her yw sut y gallwn sicrhau dull cyson o weithredu ar ran ein clinigwyr. Felly, mae angen inni eu helpu i sefydlu arferion da a gweithio gyda byrddau iechyd ar gysondeb yn y ddarpariaeth. Ac wrth gwrs, mae gwasanaethau dilynol, fel retinopathi diabetig, yn bwysig er mwyn monitro iechyd unigolion sy'n cael diagnosis o ddiabetes. Ond bydd ein ffocws o hyd ar nodi symptomau, diagnosis a thriniaeth brydlon, a disgwyliaf allu rhoi'r newyddion diweddaraf i'r Aelodau yn y lle hwn neu mewn pwyllgorau eraill am y gwaith rydym yn ei wneud, a'r gwaith rwyf wedi ymrwymo i'w wneud, ar gael peilot ac yna ystyried ei gyflwyno i wella'r sefyllfa ar gyfer pob teulu, fel na fydd yn rhaid i rieni eraill wynebu'r amgylchiadau anffodus a thrasig y mae teulu Peter Baldwin wedi gorfod eu dioddef.