English: Thank you, Deputy Presiding Officer. I'd like to start by apologising to the Chamber for being late for the first minute of this debate, but in particular to apologise to Peter's family for missing part of what is a very important and emotionally charged debate about the work done by Assembly Members considering their petition, and indeed not just the response by the Government but more importantly the response of our national health service. And so I would like to thank the Petitions Committee and every Member who's contributed today, whether on the committee or not. Many others have been struck by not just the story of Peter Baldwin but actually that determination to then try to make sure that the family's determination to make sure that it leads to improvement actually drives the conduct of politicians in this place and beyond. And that's been helped by the work of the petitioner and the wider family, together with Diabetes UK Cymru, to help improve awareness of type 1 diabetes amongst the public and, crucially, amongst healthcare professionals in Wales. And all of us can empathise with the grief and the upset for Peter Baldwin's family, but, more than that, like every other Member who has spoken and those who have not, I really do admire the courage that the family has shown in talking about their experience, which is difficult and painful in itself, but in trying to make a difference for other families too. The Welsh Government notes the report and the motion, which we will be supporting. We did not support the original petition, because of the absence of evidence for the effectiveness of a population screening programme. And that's a point that's been acknowledged through the life of the petition and the committee's work by both the petitioner and Diabetes UK Cymru. However, I do welcome the specific recommendations that were made by the committee after their inquiry. Again, like other Members, I acknowledge the importance of the early detection of type 1 diabetes and, as has been said, it does feature prominently in the diabetes delivery plan for Wales. So, I was pleased to accept or accept in principle all of the recommendations made by the committee. They are very much in line with work that is already under way or has been completed by health boards in Wales to improve diabetes care. We accept in principle recommendation 1. The Government endorses the recommendations of the National Institute for Health and Care Excellence, NICE, and that does guide healthcare professionals and organisations on the identification and investigation of suspected diabetes. But their guidance does not recommend that all unwell children are asked about the symptoms of type 1 diabetes. As the Chair said in his introduction, clinicians must use their clinical judgment, based on their training and available guidance, to guide investigations of unwell children, and that includes the additional training that we are rolling out through the service. And that is consistent with Diabetes UK Cymru's evidence that finger-prick testing should follow if any of the symptoms are present. Health boards in Wales have routine processes for disseminating NICE guidance, and clinicians are aware of their responsibilities in relation to the use of such guidance. In addition, the referral pathway has been issued to all health boards, and that reinforces the criteria and the approach to the assessment of suspected diabetes amongst children and young people. The diabetes delivery plan for Wales commits us to a public awareness-raising campaign led by Diabetes UK Cymru as partners on the diabetes implementation group, and that has been delivered in conjunction with Diabetes UK Cymru, the petitioner and the wider family. The Welsh Government accepts recommendation 2, as a national referral pathway based on NICE guidance, as well as awareness of materials developed by Diabetes UK Cymru, has been issued to every health board. The Welsh Government also accepts recommendation 3, and this is a point that a number of Members referred to in their contributions. The guidance on point-of-care testing has already been issued to health boards, and it was recently reiterated as part of the dissemination of the referral pathway. The Welsh Government is seeking assurance from assistant medical directors for primary care regarding the availability of glucose meters in primary care. Our understanding is that they are widely available, but assistant medical directors are considering a survey for all practices to include this point-of-care testing equipment, and I'll be happy to report back to Members on this point to confirm the action taking place to provide that reassurance, but also the results of that exercise. The Welsh Government accepts recommendations 4, 5 and 6. We've already written to health boards regarding the national referral pathway and, in doing so, we've highlighted the availability of awareness-raising materials and e-learning for type 1 diabetes in children and young people. That includes specific training provided for GPs by the Primary Care Diabetes Society. The Welsh Government accepts recommendation 7, as a diagnosis of type 1 diabetes is monitored and reported to the national paediatric diabetes audit. We also accept recommendation 8. Health boards should already report suboptimal diagnosis as patient safety incidents. That's not so much about that accountability; it's actually to promote learning amongst healthcare professionals. It's in our interest for healthcare professionals to be open when things have gone wrong, to learn, and to try to make sure that we actually reduce, minimise and eliminate those incidents in the future. We accept, in principle, recommendation 9, and this was dealt with in the Chair's initial contribution. The provision of symptom information to parents during pregnancy or early years for what is acknowledged as a relatively uncommon condition - and it typically presents long after childbirth. So, the available evidence is that it's unlikely to support the earlier identification of type 1 diabetes. However, Diabetes UK Cymru has delivered a public awareness campaign, as committed to in the diabetes delivery plan, and we do want to help draw parents' attention to the relevant symptoms. We also accept, in principle, recommendation 10. We will continue to work with partners to promote the four Ts: thirst, tired, toilet and thinner. We've already included it as part of the referral pathway for healthcare professionals. However, in terms of creating awareness in early years and education settings, we have to be mindful that there isn't always the evidence to support that being an effective campaign for the early identification of conditions like type 1 diabetes. A recent study from New Zealand has shown no effect following a two-year public information campaign, but we will continue to look for ways to ensure that appropriate staff, including those who work directly with children and young people, like health visitors and school nurses, are aware of key resources issued by Diabetes UK Cymru and others, and, of course, of the relevant NICE recommendations. I want to finish, again, by recognising that we're here today because of a very personal tragedy, but more than that, the determination of Peter Baldwin's family to make a difference, and they have already made a considerable difference. We will continue to listen to the evidence and to learn from what we are already committed to do, and I look forward to further scrutiny on what we and our NHS are doing and will do and, crucially, to see what difference we have made and what more we can still do.
Welsh: Diolch i chi, Ddirprwy Lywydd. Hoffwn ddechrau drwy ymddiheuro i'r Siambr am fod yn hwyr ar gyfer munud gyntaf y ddadl hon, ond yn arbennig i deulu Peter am golli rhan o ddadl bwysig ac emosiynol iawn am y gwaith a wnaed gan Aelodau Cynulliad sy'n ystyried eu deiseb, ac yn wir nid yn unig yr ymateb gan y Llywodraeth ond yn bwysicach ymateb ein gwasanaeth iechyd gwladol. Ac felly hoffwn ddiolch i'r Pwyllgor Deisebau a phob Aelod sydd wedi cyfrannu heddiw, boed yn aelodau o'r pwyllgor neu beidio. Cafodd llawer o bobl eraill eu taro nid yn unig gan stori Peter Baldwin, ond mewn gwirionedd gan y penderfyniad hwnnw wedyn i geisio gwneud yn siŵr fod penderfyniad y teulu i sicrhau ei fod yn arwain at welliant yn gyrru ymddygiad gwleidyddion yn y lle hwn a thu hwnt. Ac mae hynny wedi cael ei helpu gan waith y deisebydd a'r teulu ehangach, ynghyd â Diabetes UK Cymru, i helpu i wella ymwybyddiaeth o ddiabetes math 1 ymhlith y cyhoedd ac yn hollbwysig, ymhlith gweithwyr proffesiynol gofal iechyd yng Nghymru. A gall pob un ohonom gydymdeimlo â galar a gofid teulu Peter Baldwin, ond yn fwy na hynny, fel pob Aelod arall sydd wedi siarad a'r rhai nad ydynt wedi siarad, rwy'n edmygu'n fawr y dewrder a ddangosodd y teulu wrth sôn am eu profiad, sy'n anodd ac yn boenus ynddo'i hun, ond wrth geisio gwneud gwahaniaeth i deuluoedd eraill hefyd. Mae Llywodraeth Cymru yn nodi'r adroddiad a'r cynnig, a byddwn yn ei gefnogi. Ni wnaethom gefnogi'r ddeiseb wreiddiol, oherwydd diffyg tystiolaeth ynglŷn ag effeithiolrwydd y rhaglen sgrinio poblogaeth. A dyna bwynt sydd wedi cael ei gydnabod trwy gydol oes y ddeiseb a gwaith y pwyllgor gan y deisebydd a Diabetes UK Cymru. Fodd bynnag, rwy'n croesawu'r argymhellion penodol a wnaed gan y pwyllgor ar ôl eu hymchwiliad. Unwaith eto, fel Aelodau eraill, rwy'n cydnabod pwysigrwydd canfod diabetes math 1 yn gynnar ac fel y dywedwyd, mae'n cael sylw amlwg yn y cynllun cyflawni ar gyfer diabetes yng Nghymru. Felly, roeddwn yn falch o dderbyn pob un o'r argymhellion a wnaed gan y pwyllgor yn llwyr neu mewn egwyddor. Maent yn sicr yn cyd-fynd â gwaith sydd eisoes ar y gweill neu sydd wedi'i gwblhau gan y byrddau iechyd yng Nghymru i wella gofal diabetes. Rydym yn derbyn argymhelliad 1 mewn egwyddor. Mae'r Llywodraeth yn cymeradwyo argymhellion y Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal, NICE, ac mae'r sefydliad hwnnw'n arwain gweithwyr gofal iechyd proffesiynol a sefydliadau ar ganfod diabetes ac archwilio cleifion yr amheuir bod ganddynt ddiabetes. Ond nid yw eu canllawiau'n argymell y dylid gofyn i bob plentyn sâl ynghylch symptomau diabetes math 1. Fel y dywedodd y cadeirydd yn ei gyflwyniad, rhaid i glinigwyr ddefnyddio'u crebwyll clinigol, yn seiliedig ar eu hyfforddiant a'r canllawiau sydd ar gael, i arwain archwiliadau o blant sâl, ac mae hynny'n cynnwys yr hyfforddiant ychwanegol y byddwn yn ei gyflwyno drwy'r gwasanaeth. Ac mae hynny'n gyson â thystiolaeth Diabetes UK Cymru y dylid gwneud profion pigo bys os bydd unrhyw un o'r symptomau'n bresennol. Mae gan y byrddau iechyd yng Nghymru brosesau rheolaidd ar gyfer dosbarthu canllawiau NICE, ac mae clinigwyr yn ymwybodol o'u cyfrifoldebau mewn perthynas â defnyddio canllawiau o'r fath. Yn ogystal, dosbarthwyd y llwybr atgyfeirio i bob bwrdd iechyd, ac mae hwnnw'n atgyfnerthu'r meini prawf a'r dull o asesu plant a phobl ifanc yr amheuir bod ganddynt ddiabetes. Mae'r cynllun cyflawni ar gyfer diabetes yng Nghymru yn ein hymrwymo i ymgyrch ymwybyddiaeth gyhoeddus a arweinir gan Diabetes UK Cymru fel partneriaid yn y grŵp gweithredu ar ddiabetes, a chyflawnwyd hynny ar y cyd â Diabetes UK Cymru, y deisebydd a'r teulu ehangach. Mae Llywodraeth Cymru yn derbyn argymhelliad 2, gan fod llwybr atgyfeirio cenedlaethol yn seiliedig ar arweiniad NICE, yn ogystal ag ymwybyddiaeth o ddeunyddiau a ddatblygwyd gan Diabetes UK Cymru, wedi'i ddosbarthu i bob bwrdd iechyd. Mae Llywodraeth Cymru hefyd yn derbyn argymhelliad 3, a dyma bwynt y cyfeiriodd nifer o'r Aelodau ato yn eu cyfraniadau. Dosbarthwyd y canllawiau ar brofion pwynt gofal i fyrddau iechyd eisoes, ac fe'u hailadroddwyd yn ddiweddar fel rhan o'r broses o ledaenu'r llwybr atgyfeirio. Mae Llywodraeth Cymru'n ceisio sicrwydd gan gyfarwyddwyr meddygol cynorthwyol gofal sylfaenol ynghylch argaeledd mesuryddion glwcos mewn gofal sylfaenol. Ein dealltwriaeth yw eu bod ar gael yn eang, ond mae cyfarwyddwyr meddygol cynorthwyol yn ystyried arolwg ar gyfer pob practis i gynnwys offer profion pwynt gofal o'r fath, a buaswn yn hapus i adrodd yn ôl i'r Aelodau ar y pwynt hwn er mwyn cadarnhau bod camau ar waith i ddarparu'r sicrwydd hwn, a chanlyniadau'r ymarfer hwnnw hefyd. Mae Llywodraeth Cymru yn derbyn argymhellion 4, 5 a 6. Rydym eisoes wedi ysgrifennu at y byrddau iechyd ynghylch y llwybr atgyfeirio cenedlaethol ac wrth wneud hynny, rydym wedi tynnu sylw at argaeledd deunyddiau codi ymwybyddiaeth ac e-ddysgu ar gyfer diabetes math 1 mewn plant a phobl ifanc. Mae hynny'n cynnwys hyfforddiant penodol ar gyfer meddygon teulu gan y Gymdeithas Diabetes Gofal Sylfaenol. Mae Llywodraeth Cymru yn derbyn argymhelliad 7, gan fod diagnosis o ddiabetes math 1 yn cael ei fonitro a'i adrodd i'r archwiliad diabetes pediatrig cenedlaethol. Rydym hefyd yn derbyn argymhelliad 8. Eisoes dylai byrddau iechyd fod yn cofnodi diagnosis annigonol fel achosion diogelwch cleifion. Nid yw hynny'n ymwneud cymaint ag atebolrwydd, ond yn hytrach er mwyn hyrwyddo dysgu ymysg gweithwyr gofal iechyd proffesiynol. Mae o fudd inni gael gweithwyr gofal iechyd proffesiynol sy'n agored pan fydd pethau wedi mynd o chwith, i ddysgu, ac i geisio gwneud yn siŵr ein bod yn lleihau nifer a chael gwared ar achosion o'r fath yn y dyfodol. Rydym yn derbyn argymhelliad 9 mewn egwyddor, a rhoddwyd sylw i hyn yng nghyfraniad cychwynnol y Cadeirydd. Darparu gwybodaeth am symptomau i rieni yn ystod beichiogrwydd neu'r blynyddoedd cynnar am yr hyn y cydnabyddir ei fod yn gyflwr cymharol anghyffredin - ac fel arfer daw'n amlwg gryn dipyn ar ôl geni'r plentyn. Felly, mae'r dystiolaeth sydd ar gael yn dangos ei fod yn annhebygol o fod o gymorth i nodi diabetes math 1 yn gynharach. Fodd bynnag, mae Diabetes UK Cymru wedi cyflwyno ymgyrch ymwybyddiaeth gyhoeddus, fel yr ymrwymwyd i'w wneud yn y cynllun cyflawni ar gyfer diabetes, ac rydym am helpu i dynnu sylw rhieni at y symptomau perthnasol. Rydym hefyd yn derbyn argymhelliad 10 mewn egwyddor. Byddwn yn parhau i weithio gyda phartneriaid i hyrwyddo'r 4T: teimlo'n sychedig, teimlo'n flinedig, tŷ bach, teneuach. Eisoes rydym wedi'i gynnwys yn rhan o'r llwybr atgyfeirio ar gyfer gweithwyr gofal iechyd proffesiynol. Fodd bynnag, o ran creu ymwybyddiaeth yn y blynyddoedd cynnar a lleoliadau addysg, rhaid inni gofio nad oes tystiolaeth bob amser i gefnogi honno fel ymgyrch effeithiol ar gyfer canfod cyflyrau fel diabetes math 1 yn gynnar. Mae astudiaeth ddiweddar o Seland Newydd wedi dangos nad oes unrhyw effaith yn dilyn ymgyrch wybodaeth gyhoeddus ddwy flynedd o hyd, ond byddwn yn parhau i edrych am ffyrdd o sicrhau bod staff priodol, gan gynnwys rhai sy'n gweithio'n uniongyrchol gyda phlant a phobl ifanc, fel ymwelwyr iechyd a nyrsys ysgol, yn ymwybodol o'r adnoddau allweddol a gyhoeddwyd gan Diabetes UK Cymru ac eraill, ac wrth gwrs, yr argymhellion NICE perthnasol. Rwyf am orffen, unwaith eto, drwy gydnabod ein bod ni yma heddiw oherwydd trasiedi bersonol iawn, ond yn fwy na hynny, oherwydd penderfyniad teulu Peter Baldwin i wneud gwahaniaeth, ac eisoes maent wedi gwneud gwahaniaeth sylweddol. Byddwn yn parhau i wrando ar y dystiolaeth ac i ddysgu o'r hyn yr ydym eisoes wedi ymrwymo i'w wneud, ac edrychaf ymlaen at graffu pellach ar yr hyn yr ydym ni a'n GIG yn ei wneud ac y byddwn yn ei wneud, ac yn hollbwysig, i weld pa wahaniaeth a wnaethom a beth arall y gallwn ei wneud.