English: For me, this is absolutely a human rights issue. It is sometimes said that the measure of a decent society is how we treat our most vulnerable citizens, and, for me, that goes to the heart of the matter on this issue. As the Chair has said, only one antipsychotic, risperidone, is licensed to treat the behavioural and psychological symptoms of dementia, yet we know that there is widespread prescribing of other antipsychotics to those living with dementia, and that these antipsychotics bring with them dangerous side effects, risks of falls and risk of early death. Serious concerns have been raised about that practice by the Older People's Commissioner for Wales on numerous occasions, and in other reports to Welsh Government. This very issue is highlighted in the legacy report of the health committee in the fourth Assembly. So, the question for me today is whether the response of the Welsh Government provides the assurance the committee is looking for: that we are going to see concerted action to stop the inappropriate prescribing of antipsychotics. And I have to say, regrettably, that, for me, it does not. Why has the Welsh Government only accepted in principle the call that all health boards should collect and publish standardised data on the use of this medication in care homes? The committee heard evidence that some health boards are already doing this. Why is it not possible for them all to do it? Why has the Welsh Government only accepted in principle the call that all health boards are fully compliant with NICE guidance on dementia? The question we should be asking today is: why are they already not? Now, I really dislike the term 'challenging behaviour' to describe the behaviour that, more often than not, people living with dementia exhibit when their needs are not being met - when they are in pain, when they need the toilet, when they are lonely or bored. More often than not, it is those unmet needs that lead to the inappropriate prescribing of antipsychotics. That's why a number of the committee's recommendations focus on the need to ensure that high-quality, person-centred care is delivered by well-trained staff. Now, as has been highlighted, recommendation 9, which was designed to ensure that we have the right number of staff with the appropriate skill mix in care homes, was rejected. I know that the Cabinet Secretary has issued some further clarification on the reasoning behind that, but I would like to have further assurances from him today that the measures that he's referred to, the regulations that are going through, but also the nurse staffing levels Act, which doesn't actually apply to care homes - how that is going to improve the situation for care home residents. Recommendation 10 calls for national standards to be developed to ensure that all staff working with people with dementia are trained in managing challenging behaviour. That was accepted in principle. Again, we have known for years that this is an issue. It was in the Older People's Commissioner for Wales report, 'A Place to Call Home?' It should not be beyond the wherewithal of us to ensure that everybody working with our vulnerable citizens with dementia have that basic level of dementia training, and we've got a brilliant model for it in our Dementia Friends training. It's also vital to remember that there is really good practice out there in terms of things like inter-generational work. I had Griffithstown Primary School visit the cross-party group on dementia the other day, who spoke in such fantastic terms about the work they are doing with people living with dementia, which brings not just those people great benefits but also has been transformative for those children and young people. I wanted to just conclude by just mentioning the final recommendation, which relates to the need to undertake some further work to look at the extent of the prescribing of antipsychotics to people on older persons' mental health wards in Wales. This is a subject close to my heart, as the Cabinet Secretary has heard me say before. These are some of our most voiceless citizens in Wales, and I believe we have a particular duty to ensure that their rights are upheld. That particular recommendation was accepted in principle, but it does sound, from reading the narrative, that that is something that the Cabinet Secretary is going to look seriously at, but I would implore him to do that with pace now. It is also vital that he takes forward with pace the work on extending the nurse staffing levels legislation to hospital ward settings for people with dementia because they need that person-centred care. We have a duty, all of us, to listen to the voices of those people living with dementia to ensure that those voices are heard and to uphold their rights.
Welsh: I mi, mae hwn yn fater sy'n ymwneud yn llwyr â hawliau dynol. Dywedir weithiau mai'r hyn sy'n dynodi cymdeithas wâr yw sut rydym yn trin ein dinasyddion mwyaf agored i niwed, ac i mi, mae hynny'n mynd at wraidd y mater hwn. Fel y dywedodd y Cadeirydd, un cyffur gwrthseicotig yn unig, risperidone, a drwyddedwyd i drin symptomau ymddygiadol a seicolegol dementia, ac eto gwyddom fod meddyginiaethau gwrthseicotig eraill yn cael eu rhagnodi'n eang i'r rheini sy'n byw gyda dementia, a bod sgil-effeithiau peryglus i'r meddyginiaethau gwrthseicotig hyn, risg o godymau a'r risg o farwolaeth gynnar. Mynegwyd pryderon difrifol ynghylch yr arfer hwn gan Gomisiynydd Pobl Hŷn Cymru ar sawl achlysur, ac mewn adroddiadau eraill i Lywodraeth Cymru. Tynnir sylw at yr union fater hwn yn adroddiad etifeddiaeth y pwyllgor iechyd yn y pedwerydd Cynulliad. Felly, y cwestiwn i mi heddiw yw a yw ymateb Llywodraeth Cymru yn darparu'r sicrwydd y mae'r pwyllgor yn chwilio amdano: ein bod yn mynd i weld gweithredu cyfunol i atal rhagnodi meddyginiaeth gwrthseicotig yn amhriodol. A rhaid imi ddweud, yn anffodus, nad yw'n gwneud hynny i mi. Pam fod Llywodraeth Cymru ond wedi derbyn yr alwad y dylai'r holl fyrddau iechyd gasglu a chyhoeddi data safonol ar y defnydd o'r feddyginiaeth hon mewn cartrefi gofal mewn egwyddor yn unig? Clywodd y pwyllgor dystiolaeth fod rhai byrddau iechyd eisoes yn gwneud hyn. Pam nad oes modd i bob un ohonynt wneud hynny? Pam fod Llywodraeth Cymru ond wedi derbyn mewn egwyddor yn unig yr alwad i sicrhau bod pob bwrdd iechyd yn cydymffurfio'n llawn â chanllawiau NICE ar ddementia? Y cwestiwn y dylem ei ofyn heddiw yw: pam nad ydynt yn gwneud hynny'n barod? Nawr, mae'n gas gennyf yr ymadrodd 'ymddygiad heriol' i ddisgrifio ymddygiad y bydd pobl sy'n byw gyda dementia yn ei arddangos, yn amlach na pheidio, pan na fydd eu hanghenion yn cael eu diwallu - pan fyddant mewn poen, pan fyddant angen y toiled, pan fyddant yn unig neu wedi diflasu. Yn amlach na pheidio, yr anghenion nas diwallwyd hynny sy'n arwain at ragnodi meddyginiaeth wrthseicotig yn amhriodol. Dyna pam fod nifer o argymhellion y pwyllgor yn canolbwyntio ar yr angen i sicrhau bod gofal safonol sy'n canolbwyntio ar yr unigolyn yn cael ei ddarparu gan staff sydd wedi'u hyfforddi'n dda. Nawr, fel y nodwyd, gwrthodwyd argymhelliad 9, a gynlluniwyd i sicrhau bod gennym y nifer gywir o staff gyda'r cymysgedd priodol o sgiliau mewn cartrefi gofal. Gwn fod Ysgrifennydd y Cabinet wedi cyhoeddi eglurhad pellach ar y rhesymau y tu ôl i hynny, ond hoffwn gael sicrwydd pellach ganddo heddiw fod y mesurau y cyfeiriodd atynt, y rheoliadau sy'n mynd drwodd, ond hefyd y Ddeddf lefelau staff nyrsio, nad yw'n berthnasol i gartrefi gofal - sut y mae honno'n mynd i wella'r sefyllfa ar gyfer preswylwyr cartrefi gofal. Mae argymhelliad 10 yn galw am ddatblygu safonau cenedlaethol i sicrhau bod yr holl staff sy'n gweithio gyda phobl â dementia yn cael hyfforddiant ar gyfer rheoli ymddygiad heriol. Derbyniwyd yr argymhelliad hwn mewn egwyddor. Unwaith eto, rydym wedi gwybod ers blynyddoedd fod hon yn broblem. Roedd yn adroddiad Comisiynydd Pobl Hŷn Cymru, 'Lle i'w Alw'n Gartref?' Ni ddylai fod y tu hwnt i'n gallu i sicrhau bod gan bawb sy'n gweithio gyda'n dinasyddion agored i niwed sydd â dementia y lefel sylfaenol honno o hyfforddiant dementia, ac mae gennym fodel ardderchog ar ei gyfer yn ein hyfforddiant Cyfeillion Dementia. Hefyd mae'n hanfodol cofio bod yna arferion da iawn i'w cael fel y gwelir gyda phethau fel gwaith pontio'r cenedlaethau. Gwahoddais Ysgol Gynradd Griffithstown i ymweld â'r grŵp trawsbleidiol ar ddementia y diwrnod o'r blaen, ac roeddent yn siarad yn frwdfrydig iawn am y gwaith y maent yn ei wneud gyda phobl sy'n byw gyda dementia, sy'n sicrhau manteision mawr i'r bobl hynny ac mae wedi bod yn drawsnewidiol i'r plant a'r bobl ifanc hynny hefyd. Roeddwn am orffen drwy sôn am yr argymhelliad olaf, sy'n ymwneud â'r angen i wneud gwaith pellach i edrych ar raddau rhagnodi meddyginiaeth wrthseicotig i bobl ar wardiau iechyd meddwl pobl hŷn yng Nghymru. Mae hwn yn bwnc sy'n agos at fy nghalon, fel y mae Ysgrifennydd y Cabinet wedi fy nghlywed yn dweud o'r blaen. Dyma rai o'n dinasyddion mwyaf di-lais yng Nghymru, a chredaf fod gennym ddyletswydd arbennig i sicrhau bod eu hawliau'n cael eu cynnal. Derbyniwyd yr argymhelliad penodol hwnnw mewn egwyddor, ond mae'n swnio, o ddarllen y naratif, fel pe bai'n rhywbeth y mae Ysgrifennydd y Cabinet yn mynd i edrych arno o ddifrif, ond buaswn yn erfyn arno i wneud hynny ar fyrder yn awr. Mae'n hanfodol hefyd ei fod yn bwrw iddi ar fyrder i wneud y gwaith ar ymestyn y ddeddfwriaeth lefelau staff nyrsio i gynnwys wardiau ysbytai ar gyfer pobl â dementia oherwydd maent angen y gofal hwnnw sy'n canolbwyntio ar yr unigolyn. Mae gennym ddyletswydd, bob un ohonom, i wrando ar leisiau'r bobl sy'n byw gyda dementia er mwyn sicrhau bod y lleisiau hynny'n cael eu clywed ac i gynnal eu hawliau.