English: On the final point about the HPV vaccine, we'll continue to take advice from the relevant joint committee on the evidence base for undertaking any additional steps. We've already announced in this term of this Government - I believe it was Rebecca Evans in her former role who announced the extension of vaccination for men who have sex with men. There is still an ongoing debate. I know there are active members of the medical profession engaged in sexual health work who believe that the vaccine should be extended, but that is not a view that is currently supported by the relevant expert joint committee that every Government within the UK takes advice from. If the position changes - and I've said regularly in this place that there are times when you absolutely must be led by evidence, and the very best clinical evidence and advice - if the position changes on the evidence and advice, then the Government will change its position. So, I'm happy to give that assurance. I recognise what you say about education and prevention, and recognising that, actually, much of this is still about how we persuade people to reconsider the choices that they make. These aren't just adolescents making these choices, there are adults of a variety of ages who are making choices, and part of the challenge is how we have an effective education and prevention approach with those people. It's part of the reason why, in looking at the PrEP study, it wasn't simply about deciding to deliver the medication, it was also about looking at how that fits in with other services, about some of the conversations that need to take place about what is and isn't a risky behaviour and how to see that as part of it. You'll recall the rather obnoxious Daily Mail attack that suggested that PrEP was a licence to be promiscuous. And that isn't what it is, it's actually a means of understanding how we successfully treat people to prevent further infection in very practical terms. I'm confident it would save the national health service money and would allow people to make different choices about how they're able to live and enjoy their life. But there is an honest need to look at how we persuade and have that conversation with people about the choices from a behaviour point of view. I recognise what you and Andrew have both said about the demand on the service, about our levels of outcomes, our ability to maintain excellent outcomes, and we can't simply rely on the workforce being ultra committed and continue to run further and faster. Actually, the challenges around consistency and access were a large part of what persuaded the Government to undertake the review. So, that is work that we're absolutely doing, and if you look at the recommendations and the commentary in the review, we do see, not just the organisational challenge and a drop in the services, but a greater role for primary care, and the thing about how those services can be delivered and making better use of a whole primary care group of professionals. I go back to what Angela Burns said earlier - not every person may want to go to their pharmacy to receive part of their sexual health and contraceptive services, but a range of people will do, because almost every pharmacy, particularly all those that have an enhanced service, have the ability for people to go and see someone in a private room within the practice. When I have my medication review at a pharmacy walking distance from this building, I go into a private room, no-one knows what we're there to talk about and so it is a private consultation space. There will be a range of people who I think will be confident in going to different settings to receive part of the service. That is consistent with our broader drive to get people to use other healthcare professionals and not simply default to go and see the doctor, whether that's in a hospital or in general practice. So, I recognise the challenges that are real and are there and I'm confident that, in taking forward the work in response to the recommendations of the review, we will have a series of logically worked-through recommendations about how to do this, with a costed implementation plan. And the assurance that Members have is that the board is going to continue to be overseen by the chief medical officer; it isn't simply a matter of politicians deciding to do what we think is the right thing to do without the proper evidence base and without the best and most up-to-date clinical evidence and advice.
Welsh: Ynglŷn â'r sylw olaf am y brechlyn HPV, byddwn yn parhau i gymryd cyngor gan y cydbwyllgor perthnasol am y sail dystiolaeth ar gyfer unrhyw weithredu pellach. Rydym ni eisoes wedi cyhoeddi yn ystod tymor y Llywodraeth hon - rwy'n credu mai Rebecca Evans yn ei swyddogaeth flaenorol a gyhoeddodd ehangu brechu i ddynion sy'n cael rhyw gyda dynion. Mae'r ddadl yn parhau. Rwy'n gwybod bod rhai aelodau gweithgar o'r proffesiwn meddygol sy'n ymwneud â gwaith iechyd rhywiol yn credu y dylid ehangu'r brechlyn, ond nid yw'r cydbwyllgor arbenigol perthnasol y mae pob Llywodraeth o fewn y DU yn cymryd cyngor ganddo yn ategu'r farn honno ar hyn o bryd. Os bydd y sefyllfa'n newid - ac rwyf wedi dweud yn rheolaidd yn y lle hwn y ceir adegau pan mae'n hollbwysig ichi gael eich arwain gan dystiolaeth, a'r dystiolaeth a'r cyngor clinigol gorau oll - os bydd y sefyllfa'n newid o ran y dystiolaeth a'r cyngor, bydd y Llywodraeth yn newid ei safbwynt. Felly, rwy'n hapus i roi'r sicrwydd hwnnw. Rwy'n cydnabod yr hyn a ddywedwch am addysg ac atal, a chydnabod, a dweud y gwir, bod llawer o hyn yn dal i fod ynglŷn â sut y gallwn ni berswadio pobl i ailystyried y dewisiadau a wnânt. Nid dim ond pobl ifanc sy'n gwneud y dewisiadau hyn, mae oedolion o amrywiaeth o oedrannau'n gwneud dewisiadau, a rhan o'r her yw sut i ganfod dull effeithiol o addysgu ac atal gyda'r bobl hynny. Mae'n rhan o'r rheswm pam, wrth edrych ar yr astudiaeth PrEP, nad oedd mor syml â phenderfynu cyflenwi'r feddyginiaeth; roedd angen edrych hefyd ar sut y mae hynny'n cyd-fynd â gwasanaethau eraill, ar rai o'r sgyrsiau y mae angen eu cynnal ynglŷn â'r hyn sy'n ymddygiad peryglus a'r hyn nad yw, a sut i weld hynny'n rhan ohono. Fe gofiwch ymosodiad eithaf atgas y Daily Mail a awgrymodd fod PrEP yn drwydded i foesau llac. Ac nid dyna beth ydoedd; a dweud y gwir, mae'n ffordd o ddeall sut i drin pobl yn llwyddiannus i atal haint pellach mewn termau ymarferol iawn. Rwy'n ffyddiog y byddai'n arbed arian i'r gwasanaeth iechyd gwladol ac yn caniatáu i bobl wneud dewisiadau gwahanol ynglŷn â sut y maent yn gallu byw a mwynhau eu bywyd. Ond mae gwir angen edrych ar sut yr ydym ni'n perswadio ac yn cael y sgwrs honno gyda phobl am y dewisiadau o safbwynt ymddygiad. Rwy'n cydnabod hyn yr ydych chi ac Andrew ill dau wedi'i ddweud am y galw ar y gwasanaeth, am lefelau ein canlyniadau, am ein gallu i gynnal canlyniadau ardderchog, ac na allwn ni ddibynnu ar y gweithlu i fod yn arbennig o ymroddedig ac i barhau i redeg yn bellach ac yn gyflymach. A dweud y gwir, roedd heriau ynghylch cysondeb a hygyrchedd gwasanaethau yn rhan fawr o'r hyn a berswadiodd y Llywodraeth i gynnal yr adolygiad. Felly, rydym yn sicr yn gwneud y gwaith hwnnw, ac os edrychwch chi ar yr argymhellion a'r sylwadau yn yr adolygiad, rydym ni'n gweld, nid dim ond yr her sefydliadol a gostyngiad yn y gwasanaethau, ond mwy o swyddogaeth i ofal sylfaenol, a'r elfen ynglŷn â sut y gellir darparu'r gwasanaethau hynny a defnyddio grŵp cyfan o weithwyr gofal sylfaenol proffesiynol yn well. Rwy'n dychwelyd at yr hyn a ddywedodd Angela Burns yn gynharach - efallai na fydd ar bawb eisiau mynd i'w fferyllfa i gael rhan o'u gwasanaethau iechyd rhywiol ac atal cenhedlu, ond bydd ar rai pobl eisiau gwneud hynny, gan fod bron bob fferyllfa, yn enwedig pob un sydd â gwasanaeth mwy cynhwysfawr, yn caniatáu i bobl fynd i weld rhywun mewn ystafell breifat yn yr adeilad. Pan rwyf yn cael fy adolygiad meddyginiaeth mewn fferyllfa sydd bellter cerdded o'r adeilad hwn, rwy'n mynd i ystafell breifat, does neb yn gwybod beth yr ydym yno i siarad amdano, ac felly mae'n fan ymgynghori preifat. Bydd amrywiaeth o bobl, rwy'n credu, yn hyderus i fynd i wahanol leoliadau i gael rhan o'r gwasanaeth. Mae hynny'n gyson â'n hymgyrch ehangach i berswadio pobl i ddefnyddio gweithwyr gofal iechyd proffesiynol eraill ac nid dim ond mynd i weld y meddyg, boed hynny mewn ysbyty neu mewn meddygfa deulu. Felly, rwy'n cydnabod yr heriau go iawn sy'n bodoli ac rwy'n ffyddiog y bydd gennym ni, wrth fwrw ymlaen â'r gwaith mewn ymateb i argymhellion yr adolygiad, gyfres o argymhellion sydd wedi'u profi'n rhesymegol ynglŷn â sut i wneud hyn, gyda chynllun gweithredu wedi'i gostio. A'r sicrwydd sydd gan yr Aelodau yw y bydd y bwrdd yn parhau i gael ei oruchwylio gan y prif swyddog meddygol; nid yw'n sefyllfa lle mae gwleidyddion yn penderfynu gwneud yr hyn yr ydym ni'n credu sydd orau heb sylfaen dystiolaeth briodol a heb y dystiolaeth a'r cyngor clinigol gorau a diweddaraf.