English: Minister, thank you for this statement. I'm very, very well aware that my colleague Darren Millar has called before for a review on both the independent patient fund and, of course, the Welsh Conservatives have been calling for some kind of treatment fund for many, many years. Going through your statement, I've just got a couple of questions. The first is that you referred to some of the new medicines that come with a very high price tag, which I think we're all absolutely aware of, and you talk about the resources invested where the proven benefit for patients is in balance with the cost. I wondered if you might be able to give us an indication if that proven benefit would be condition related or, in a more holistic sense, where the drug may actually prevent a side effect or a continuum - you know, something that would develop in time as a successor, if you like, to whatever the ailment is that the person has. I ask that because recently in England there was a court case where a judge was talking about how the exceptionality, the way that a drug might behave on a person, made it valid whether it behaved on the person because they were unique, or their condition was unique, or whether it was simply because the - I can't think of the word for it - continuing problems that might be associated with the condition were not unique and were coming along later but you could still bring forward the drug to prevent that from happening - a bit chicken and egg. So, I just wondered whether you were going to consider that in deciding what becomes an emergency treatment. So, therefore, that comes to my next question, which is on the stakeholders. Which stakeholders have you consulted to decide what will be? Is it just NICE; is it just the all-Wales medicines group; are you talking to consultants; are you talking to drug companies to decide what kind of drugs would be the best ones that would go into your treatment fund? I know that the Plaid Cymru spokesperson discussed with you the resources available - the £80 million that you're going to bring forward. It's not just that, though. I wondered if you could outline what strategic planning and modelling has been undertaken by the Welsh Government. I did listen to your answers to Rhun ap Iorwerth about what happens when health boards take on board the drugs, and what happens at the end of the 12 months, but if I could just cite a case in point, because you refer in your statement to treatment for hepatitis C. Incredibly successful; a 90 per cent cure rate once somebody gets it, and yet it's still a postcode lottery throughout Wales. Although the Welsh Government funded the roll-out, and that then went out to the health boards, not all health boards have picked it up because it is eye-wateringly expensive. They haven't incorporated it into their run rate, and people are not being given it when they need it. We have evidence that we can offer to you to prove this. I would hate to see in 12 months' time, with all of these other wonderful treatments that you are going to look at, the same kind of things happen because some of them will be extremely, extremely expensive. Therefore, I would like to understand what strategic planning and modelling you have applied to this. I would like to have greater clarity as to how some of the conditionality decisions have been arrived at, at present. I would like to understand where the money for this is coming from. I don't think I managed to pick that up from either your statement or your answer to the Plaid Cymru spokesperson. In regard to the independent patient funding request, there's no information on the individual patient funding request by health board. I put a written question in to you, and you came back and said that there was no central data. That kind of thing makes me very, very concerned that if we don't have the evidence, how can we evidence the success of IPFRs? How can we evidence the methodology? How can we stop postcode funding? How can we ensure that fairness and that parity that you discussed earlier? I really will work with you hard on trying to support a review of the IPFR. I think it is vital that we get this fairness across the board. But I have found that trying to get some of the evidence needed has been extremely difficult, and I would like to have a really clear understanding of how you see the group going forward and being able to extract the data that they will require from the health boards in order to ensure that this report is not just timely but that it is concise and, actually, that it is also really, really well evidenced. As I discussed with you when I had the good fortune to meet with you yesterday - and I am grateful to you for that meeting - I would also like to ensure, or ask, that you would ask the review panel that are going to look at the independent patient funding request to look at not just their overall strategic conclusions, but also how they think it could be delivered in an effective way. Conclusions are one thing; delivery is an entirely different thing. I think it would be really worth it if they could give some nod towards the level of resource - the level of financial resource and physical human resource - that you may have to commit to making this a uniform, consistent, fair practice across the entire country. Finally, Minister, I would like to again ask you to consider how best we get an advocate for the patient voice who can sit on this panel and really ensure that the patient voice is heard all through this. Sums are one thing, but when somebody is desperate for that little extra stretch of life because they have something very important they want to achieve - to see a wedding, to see a grandchild, or whatever it may be - or just because most of us don't want to die, then we've got to try to marry that desire for life with the money that you have in your pocket. By listening to the patients, perhaps they can help show a way that we can go.
Welsh: Weinidog, diolch i chi am y datganiad hwn. Rwy'n ymwybodol iawn, iawn bod fy nghyd-Aelod, Darren Millar wedi galw o'r blaen am adolygiad ar y gronfa cleifion annibynnol ac, wrth gwrs, mae'r Ceidwadwyr Cymreig wedi bod yn galw am ryw fath o gronfa triniaethau ers llawer o flynyddoedd. Wrth fynd drwy eich datganiad, mae gen i un neu ddau o gwestiynau. Y cyntaf yw eich bod wedi cyfeirio at rai o'r meddyginiaethau newydd sy'n gostus iawn, a chredaf ein bod ni i gyd yn hollol ymwybodol ohonynt, ac rydych yn siarad am yr adnoddau a fuddsoddwyd lle mae prawf o'r manteision i gleifion yn cydbwyso â'r gost. Roeddwn i'n meddwl tybed efallai y gallech chi roi syniad i ni os byddai'r prawf hwnnw o'r manteision yn perthyn i gyflwr neu, mewn ystyr fwy cyfannol, lle gall y cyffur mewn gwirionedd atal sgîl-effaith neu gontinwwm - chi'n gwybod, rhywbeth a fyddai'n datblygu mewn amser fel olynydd, os mynnwch chi, i beth bynnag yw'r anhwylder sydd gan y person. Gofynnaf hynny oherwydd yn ddiweddar yn Lloegr roedd achos llys lle'r oedd barnwr yn siarad am sut mae'r eithriadoldeb, y ffordd y gallai cyffur ymddwyn ar berson, yn ei wneud yn ddilys p'un a yw'n ymddwyn ar y person oherwydd ei fod yn unigryw, neu fod ei gyflwr yn unigryw, neu a oedd yn syml oherwydd nad oedd y - ni allaf feddwl am y gair amdano - problemau parhaus a allai fod yn gysylltiedig â'r cyflwr yn unigryw ac yn dod yn nes ymlaen, ond gallech gyflwyno'r cyffur o hyd i atal hynny rhag digwydd - rhyw fath o sefyllfa nad oes modd ei hennill. Felly, roeddwn yn meddwl tybed a ydych yn mynd i ystyried hynny wrth benderfynu ar yr hyn sy'n driniaeth frys. Felly, mae hynny'n dod at fy nghwestiwn nesaf, sy'n ymwneud â'r rhanddeiliaid. Pa randdeiliaid ydych chi wedi ymgynghori â nhw i benderfynu beth a fydd? Ai dim ond NICE; ai dim ond grŵp meddyginiaethau Cymru gyfan; ydych chi'n siarad â meddygon ymgynghorol; ydych chi'n siarad â chwmnïau cyffuriau i benderfynu pa fath o gyffuriau fyddai'r rhai gorau i fynd i mewn i'ch cronfa triniaethau? Gwn fod llefarydd Plaid Cymru wedi trafod gyda chi yr adnoddau sydd ar gael - yr £80 miliwn yr ydych yn mynd i'w gyflwyno. Ond nid dyna'r unig beth. Roeddwn yn meddwl tybed a allech amlinellu pa gynllunio strategol a modelu sydd wedi'i wneud gan Lywodraeth Cymru. Fe wnes i wrando ar eich atebion i Rhun ap Iorwerth am yr hyn sy'n digwydd pan fydd byrddau iechyd yn ystyried y cyffuriau, a beth sy'n digwydd ar ddiwedd y 12 mis, ond pe gallwn ddyfynnu enghraifft o hyn, oherwydd rydych yn cyfeirio yn eich datganiad at driniaeth ar gyfer hepatitis C. Yn anhygoel o lwyddiannus; cyfradd gwellhad o 90 y cant unwaith y bydd rhywun yn ei gael, ac eto mae'n dal i fod yn loteri cod post ledled Cymru. Er bod Llywodraeth Cymru wedi ariannu'r broses o'i chyflwyno, a bod hynny wedyn wedi mynd allan at y byrddau iechyd, nid yw pob bwrdd iechyd wedi manteisio arni oherwydd ei fod yn eithriadol o ddrud. Nid ydynt wedi ei chynnwys yn eu hamcangyfrif, ac nid yw pobl yn ei chael pan fydd ei hangen arnynt. Mae gennym dystiolaeth y gallwn ei gynnig i chi i brofi hyn. Byddai'n gas gennyf weld ymhen 12 mis, gyda phob un o'r triniaethau gwych eraill hyn yr ydych yn mynd i edrych arnynt, yr un math o bethau yn digwydd oherwydd bydd rhai ohonynt yn ddrud iawn, iawn. Felly, hoffwn i ddeall pa gynllunio strategol a modelu yr ydych chi wedi eu cymhwyso i hyn. Hoffwn gael mwy o eglurder ynghylch sut y mae rhai o'r penderfyniadau amodoldeb wedi cael eu gwneud, ar hyn o bryd. Hoffwn ddeall o ble mae'r arian ar gyfer hyn yn dod. Dwi ddim yn meddwl fy mod wedi llwyddo i ddeall hynny o'ch datganiad nac o'ch ateb i lefarydd Plaid Cymru. O ran y cais am gyllid i gleifion annibynnol, does dim gwybodaeth am y cais am gyllid ar gyfer cleifion unigol gan y bwrdd iechyd. Cyflwynais gwestiwn ysgrifenedig ichi, a daethoch yn ôl a dweud nad oedd unrhyw ddata canolog. Mae'r math hwnnw o beth yn fy ngwneud yn bryderus iawn, iawn os nad oes gennym y dystiolaeth, sut y gallwn ddangos llwyddiant IPFR? Sut allwn ni ddangos y fethodoleg? Sut allwn ni roi'r gorau i ariannu cod post? Sut allwn ni sicrhau'r tegwch a'r cydraddoldeb a drafodwyd yn gynharach? Byddaf yn wir yn gweithio'n galed gyda chi i geisio cefnogi adolygiad o'r IPFR. Rwy'n credu ei bod yn hanfodol ein bod yn cael y tegwch hwn ar draws y bwrdd. Ond rwyf wedi canfod bod ceisio cael rhywfaint o'r dystiolaeth sydd ei hangen wedi bod yn eithriadol o anodd, a hoffwn i gael dealltwriaeth wirioneddol glir o sut yr ydych yn gweld y grŵp yn symud ymlaen ac yn gallu cael y data y bydd ei angen arno o'r byrddau iechyd er mwyn sicrhau bod yr adroddiad hwn nid yn unig yn amserol, ond ei fod yn gryno ac, mewn gwirionedd, ei fod hefyd yn seiliedig ar dystiolaeth dda iawn. Fel y trafodais gyda chi pan oeddwn yn ddigon ffodus i gwrdd â chi ddoe - ac rwy'n ddiolchgar ichi am y cyfarfod hwnnw - byddwn hefyd yn hoffi sicrhau, neu ofyn, y byddech yn gofyn i'r panel adolygu sy'n mynd i edrych ar y cais cyllido cleifion annibynnol i edrych, nid yn unig ar eu casgliadau strategol cyffredinol, ond hefyd sut y maent yn meddwl y gellid ei gyflwyno mewn ffordd effeithiol. Mae casgliadau yn un peth; mae eu cyflwyno yn rhywbeth hollol wahanol. Rwy'n credu y byddai'n wir yn werth yr ymdrech pe gallent roi rhywfaint o arwydd o lefel yr adnoddau - lefel yr adnoddau ariannol a'r adnoddau dynol ffisegol - y bydd yn rhaid i chi ei hymrwymo i wneud hwn yn arfer unffurf, cyson a theg ar draws y wlad gyfan. Yn olaf, Weinidog, hoffwn ofyn eto i chi ystyried y ffordd orau i ni gael eiriolwr dros y claf sy'n gallu eistedd ar y panel hwn ac sy'n gallu sicrhau mewn gwirionedd bod llais y claf yn cael ei glywed drwy hyn i gyd. Mae symiau yn un peth, ond pan fydd rhywun yn daer i gael y mymryn ychwanegol hwnnw o fywyd oherwydd bod ganddynt rywbeth pwysig iawn y maent am ei gyflawni - gweld priodas, gweld ŵyr neu wyres, neu beth bynnag y bo - neu dim ond oherwydd nad yw'r rhan fwyaf ohonom yn dymuno marw, yna mae'n rhaid i ni geisio cyfuno'r awydd hwnnw am fywyd a'r arian sydd gennych yn eich poced. Drwy wrando ar y cleifion, efallai y gallan nhw helpu i ddangos y ffordd i ni.