English: First of all, I'd like to pay tribute to the women and families with lived experience of perinatal mental health challenges who gave the committee the benefit of their hard-won experience during the inquiry. I was horrified by the stories from women and families, who I cannot help feeling have in some cases been grossly let down - but not by the health professionals who are striving to help women in a health system that clearly needs considerable improvement. I think it's a testament to the tenacity and commitment of health professionals and charities that women are still receiving services despite the difficult circumstances. The most shocking thing for me was that, despite the significant number of women in Wales who may need in-patient care, there is no in-patient care facility in Wales and there hasn't been any since 2013 when Wales's one and only MBU shut. Since then, the committee estimates that up to 100 women a year have either had to take up in-patient care in England, as far as London or Nottingham, or been treated in an adult unit and separated from their baby. The Royal College of Midwives note that the numbers of women admitted to in-patient care given by the WHSSC would suggest that between 45 and 65 women needing in-patient care are not receiving it. That's an awful lot of women who are missing out on the relevant care. It's a most glaring deficiency to me. As pointed out in the report, NICE guidelines state that women should ideally be in a mother and baby unit, unless there are compelling reasons for her not to be there. These compelling reasons aren't existing at the moment. The fact that we don't have one - that's not a compelling reason for a woman. Why don't we have one? The reasons for closing Wales's one and only MBU, according to the evidence provided, were: insufficient funding, misunderstanding about who could access the unit, the unit being too small to develop the necessary specialisms and less interest in, or acknowledgement of, perinatal health issues at the time. To me, none of these reasons justified the closure of the unit. The solution to keeping the previous MBU open was in the hands of the local health board and the Welsh Government. In my opinion, they let a lot of women and their families down by closing that unit. The report refers to a lack of information being provided to women about the benefits of a mother and baby unit, but I would suggest that uptake of in-patient care would inevitably be better if barriers, such as distance or separation from their child, were not there in the first place. As well, I'd suggest that it's pretty pointless advising women about the benefits of in-patient care or a mother and baby unit when the right care is not going to be available to them. I am, therefore, pleased to note that the Cabinet Secretary has accepted the committee's recommendation that an MBU be restored in south Wales. Whilst I'm pleased that the Cabinet Secretary is developing those plans, it won't be accessible for women and families in north Wales. The report acknowledges that north Wales doesn't have a sufficiently high birth rate to make a north Wales MBU viable, as does the Cabinet Secretary. I note that the Cabinet Secretary has asked the Welsh Health Specialised Services Committee to discuss the options for north Wales, but his detailed response falls short of an undertaking to establish an MBU in north Wales that is accessible to people in north Wales and mid Wales, whether shared with England or not. It appears to be simply a promise to think about it. Personally, I believe that the proposal for an MBU in north-east Wales, to be shared with England, is an excellent one. The present situation, whereby Wales relies on in-patient beds in England, is untenable. South Wales may get an MBU, but people in most parts of the rest of Wales will still have to rely on Wales's ability to commission beds in England. The WHSSC stated that obtaining an MBU bed is becoming increasingly difficult. This leaves Wales, especially until we have our own MBU, at the mercy of decisions made by NHS England and the demands on those services in England. The report refers to a hidden demand for perinatal care, and I would like to see the Welsh Government properly address the call by the committee for the Welsh Government to identify the level of demand for an MBU in Wales. I would therefore ask the Cabinet Secretary to provide details about how the level of demand for an MBU across Wales is going to be assessed. Another point I'd like to speak about is continuity of care. A recurrent theme was that the women needed continuity of care, and we heard that women seldom, if ever, have this. One of the challenges identified during our inquiry was the under-reporting of perinatal mental health problems by women themselves. But, without continuity of care and the ability to form a relationship of trust with a health professional, how is a woman and her family able to feel confident to voice any concerns to those people about how that woman or her family might be feeling? The health professionals themselves have no reference point to assess mothers and offer assistance. So, the systematic and continued failure of Welsh and UK Governments to invest in training for the relevant professionals has produced this situation. We have failed to train our own staff and now find ourselves being unable to recruit professionals for our own health service. This is denying women the continuity of care and a relationship of trust with a regular health professional with whom they feel safe enough to discuss their mental health. Regardless of all of that, I am, however, encouraged by the Cabinet Secretary's initial response to the report. I look forward to hearing an update in due course on your progress in implementing the report's recommendations, in particular, recommendation 7 relating to the creation of an MBU in north Wales shared with England. Thank you.
Welsh: Yn gyntaf oll, hoffwn dalu teyrnged i'r menywod a'r teuluoedd sydd â phrofiad o heriau iechyd meddwl amenedigol a rannodd eu profiadau anodd gyda'r pwyllgor yn ystod yr ymchwiliad. Cefais fy mrawychu gan y straeon gan fenywod a theuluoedd, ac ni allaf lai na theimlo mewn rhai achosion eu bod wedi cael cam mawr - ond nid gan y gweithwyr iechyd proffesiynol sy'n ymdrechu i helpu menywod mewn system iechyd sy'n amlwg angen ei gwella'n sylweddol. Credaf mai tystiolaeth o ddycnwch ac ymrwymiad y gweithwyr iechyd proffesiynol ac elusennau yw'r ffaith bod menywod yn parhau i dderbyn gwasanaethau er gwaethaf yr amgylchiadau anodd. Y peth mwyaf syfrdanol i mi oedd deall, er gwaethaf y nifer sylweddol o fenywod yng Nghymru a allai fod angen gofal fel cleifion mewnol, nad oes unrhyw gyfleuster gofal ar gyfer cleifion mewnol yng Nghymru ac na fu ers 2013 pan gaewyd yr unig uned mamau a babanod yng Nghymru. Ers hynny, mae'r pwyllgor yn amcangyfrif bod hyd at 100 o fenywod bob blwyddyn naill ai wedi gorfod manteisio ar ofal cleifion mewnol yn Lloegr, cyn belled â Llundain neu Nottingham, neu wedi cael eu trin mewn uned oedolion a'u gwahanu oddi wrth eu babanod. Mae Coleg Brenhinol y Bydwragedd yn nodi y byddai nifer y menywod sy'n cael eu derbyn i ofal cleifion mewnol a roddir gan Bwyllgor Gwasanaethau Iechyd Arbenigol Cymru yn awgrymu nad yw rhwng 45 a 65 o fenywod sydd angen gofal fel cleifion mewnol yn ei gael. Mae hynny'n llawer iawn o fenywod sy'n colli cyfle i gael y gofal perthnasol. Mae'n ddiffyg eithriadol o amlwg i mi. Fel y nodwyd yn yr adroddiad, dywed canllawiau NICE y dylai menywod fod mewn uned mamau a babanod yn ddelfrydol, oni bai bod rhesymau cryf iawn dros iddynt beidio â bod yno. Nid yw'r rhesymau cryf hyn yn bodoli ar hyn o bryd. Y ffaith nad oes gennym un - nid yw hynny'n rheswm cryf i fenyw. Pam nad oes gennym un? Y rhesymau dros gau unig uned mamau a babanod Cymru, yn ôl y dystiolaeth a ddarparwyd, oedd: cyllid annigonol, camddealltwriaeth ynghylch pwy a allai gael mynediad i'r uned, fod yr uned yn rhy fach i ddatblygu arbenigeddau angenrheidiol a llai o ddiddordeb mewn, neu gydnabyddiaeth o faterion iechyd amenedigol ar y pryd. I mi, nid oedd yr un o'r rhesymau hyn yn cyfiawnhau cau'r uned. Roedd yr ateb i gadw'r uned mamau a babanod flaenorol ar agor yn nwylo'r bwrdd iechyd lleol a Llywodraeth Cymru. Yn fy marn i, gwnaethant gam â llawer o fenywod a'u teuluoedd drwy gau'r uned honno. Mae'r adroddiad yn cyfeirio at ddiffyg gwybodaeth i fenywod am fanteision uned mamau a babanod, ond buaswn yn awgrymu y byddai nifer y cleifion mewnol yn anochel o fod yn well pe na bai rhwystrau megis pellter neu gael eu gwahanu oddi wrth eu plant yno yn y lle cyntaf. Yn ogystal, buaswn yn awgrymu ei bod yn eithaf dibwrpas cynghori menywod am fanteision gofal cleifion mewnol neu uned mamau a babanod pan nad yw'r gofal cywir yn mynd i fod ar gael iddynt. Felly, rwy'n falch o nodi bod Ysgrifennydd y Cabinet wedi derbyn argymhelliad y pwyllgor y dylid adfer uned mamau a babanod yn ne Cymru. Er fy mod yn falch fod Ysgrifennydd y Cabinet yn datblygu'r cynlluniau hynny, ni fyddant yn hygyrch ar gyfer menywod a theuluoedd yng ngogledd Cymru. Mae'r adroddiad yn cydnabod, fel Ysgrifennydd y Cabinet, nad oes cyfradd eni ddigon uchel i allu cael uned mamau a babanod yng ngogledd Cymru. Nodaf fod Ysgrifennydd y Cabinet wedi gofyn i Bwyllgor Gwasanaethau Iechyd Arbenigol Cymru drafod yr opsiynau ar gyfer gogledd Cymru, ond nid yw'r ymateb manwl hwn yn mynd cyn belled ag ymrwymo i sefydlu uned mamau a babanod yng ngogledd Cymru sy'n hygyrch i bobl yng ngogledd Cymru a chanolbarth Cymru, boed yn cael ei rhannu gyda Lloegr neu beidio. Ymddengys nad yw'n ddim mwy nag addewid i feddwl amdano. Yn bersonol, credaf fod yr argymhelliad ynghylch uned mamau a babanod yng ngogledd-ddwyrain Cymru, i'w rhannu â Lloegr, yn un rhagorol. Mae'r sefyllfa bresennol, lle mae Cymru'n dibynnu ar welyau i gleifion mewnol yn Lloegr, yn anghynaliadwy. Gall de Cymru gael uned mamau a babanod, ond bydd pobl yn y rhan fwyaf o weddill Cymru yn dal i orfod dibynnu ar allu Cymru i gomisiynu gwelyau yn Lloegr. Dywedodd Pwyllgor Gwasanaethau Iechyd Arbenigol Cymru fod cael gwely mewn uned mamau a babanod yn dod yn fwyfwy anodd. Mae hyn yn gadael Cymru, yn enwedig hyd nes y cawn ein huned mamau a babanod ein hunain, ar drugaredd penderfyniadau a wneir gan GIG Lloegr a'r galwadau ar y gwasanaethau hynny yn Lloegr. Mae'r adroddiad yn cyfeirio at alw cudd am ofal amenedigol, a hoffwn weld Llywodraeth Cymru yn rhoi sylw priodol i'r alwad gan y pwyllgor ar Lywodraeth Cymru i nodi lefel y galw am uned mamau a babanod yng Nghymru. Felly, gofynnaf i Ysgrifennydd y Cabinet roi manylion ynglŷn â sut y mae lefel y galw am uned mamau a babanod ledled Cymru yn mynd i gael ei hasesu. Pwynt arall yr hoffwn siarad amdano yw gofal parhaus. Un thema amlwg oedd bod y menywod angen gofal parhaus, a chlywsom mai anaml iawn y câi menywod ofal parhaus, os o gwbl. Un o'r heriau a nodwyd yn ystod ein hymchwiliad oedd nad oedd menywod eu hunain yn barod i adrodd am broblemau iechyd meddwl amenedigol. Ond heb ofal parhaus a'r gallu i ffurfio perthynas o ymddiriedaeth gyda gweithiwr iechyd proffesiynol, sut y mae menyw a'i theulu yn gallu teimlo'n hyderus i leisio unrhyw bryderon wrth y bobl hynny ynglŷn â sut y gallai menyw neu ei theulu fod yn teimlo? Nid oes gan weithwyr iechyd proffesiynol eu hunain bwynt cyfeirio ar gyfer asesu mamau a chynnig cymorth. Felly, methiant systematig a pharhaus Llywodraethau Cymru a Llywodraeth y DU i fuddsoddi mewn hyfforddiant ar gyfer y gweithwyr proffesiynol perthnasol sydd wedi creu'r sefyllfa hon. Rydym wedi methu hyfforddi ein staff ein hunain a bellach ni allwn recriwtio gweithwyr proffesiynol i'n gwasanaeth iechyd ein hunain. Mae hyn yn amddifadu menywod o ofal parhaus a pherthynas o ymddiriedaeth gyda gweithiwr iechyd proffesiynol go iawn y byddant yn teimlo'n ddigon diogel i drafod eu hiechyd meddwl â hwy. Er gwaethaf hyn i gyd, fodd bynnag, caf fy nghalonogi gan ymateb cychwynnol Ysgrifennydd y Cabinet i'r adroddiad. Edrychaf ymlaen at glywed y newyddion diweddaraf maes o law am eich cynnydd yn gweithredu argymhellion yr adroddiad, yn enwedig argymhelliad 7 sy'n ymwneud â chreu uned mamau a babanod yng ngogledd Cymru i'w rhannu â Lloegr. Diolch.