English: Thank you, Deputy Presiding Officer. I'm happy to respond to today's debate, and begin by acknowledging the comments already made, that earlier diagnosis of cancer will allow for that less aggressive and less expensive treatment, and, in particular, improved patient experience, but also quality of life that, crucially, should lead to better outcomes. But I don't agree with the central implication of the motion, which is that a target time for diagnosis is the way to go about improving detection or necessarily outcomes. I accept that targets have a part to play in any healthcare system, but they can create perverse behaviours in different parts of the service, including in complex cancer care pathways. And on cancer waiting times to start treatment, we continue to do better than England, but our challenge is how we do better still rather than simply comparing ourselves with the English system. And I do acknowledge what's been said about the English cancer taskforce recommendations that Plaid Cymru refer to in their motion. They don't apply to Wales, and we do have a different health system. It isn't being pedantic; it's one that is delivered differently on the base of integrated primary and secondary care, health boards, on a planned rather than a commissioned model, on the basis of collaboration not fines, targets and tariffs. Now, earlier diagnosis is a major focus of the refreshed cancer delivery plan that was published and launched within the last two weeks. We know that the Cancer Network is working with primary care on implementing the NICE suspected cancer referral guidelines, and that, in itself, is a real challenge for the whole service. The network is looking to reform diagnostic pathways, learning from their visit to Denmark, about additional referral pathways for vague symptoms. We know that is a significant challenge as well. And, through the GP contract, clusters are analysing the learning from GP referral practice. And the framework for cancer programme is developing support for GPs to better diagnose, refer and support people who have a diagnosis as well. On screening, it's been mentioned that more than 400,000 are routinely screened in Wales each year as part of our highly regarded breast, bowel and cervical screening programmes. We've already extensively modified the breast cancer screening, and we've recently agreed to implement better and more acceptable testing for cervical cancer and bowel cancer screening. And, in fact, that is one of the big barriers to improving the number of people who actually attend and undertake a bowel cancer test. Now, the NHS workforce strategy, and the imaging and pathology programme boards are addressing key workforce shortages in both pathology and radiology. The introduction of national informatics systems will better integrate care across sites and organisations with common pathology and imaging systems. So, there is no complacency on our part that we have everything perfect in our system. We continue to challenge, to reform and to progress different aspects of cancer care right across Wales. And I'm pleased that points have been made on diagnostic waits, and in particular the recognition by David Rees that we've improved our performance on diagnostic waits over the last year. I expect to see more improvement again through the end of this performance year, and I did recently announce a £6 million investment in the diagnostic hub in Cwm Taf. We're already making use of some mobile diagnostic services as well. But, we will, in the future, invest again heavily in replacing and in providing new diagnostic equipment, including CT, MRI and PET imaging techniques, as well as a further £15 million earmarked for diagnostic equipment following the draft budget agreement with Plaid Cymru. We have a national endoscopy implementation group working to reduce waits and improve quality, and I've recently announced an extra £3 million in capital spending on decontamination equipment for these units. And I'm pleased at this point to recognise the points made by Rhianon Passmore about the investment we already make, and continue to make, on an increasing basis, for cancer services, and our backing of the new £200 million Velindre cancer centre. Now, I understand the sentiment and the drive behind the motion, and the recommendation it makes, but I simply don't agree that an arbitrary 28-day target makes a meaningful contribution. I don't think it's the right way to take up the time, energy and effort of people within the service for them to make the best contribution to actually improving outcomes for cancer patients, because most patients on a 62-day pathway will have their definitive diagnosis already by that time, but some complex lung and oesophageal cancers can be hard to stage and diagnose within the 28 days. I don't think it's helpful to try and break up the pathway, rather than getting support in having a definitive diagnosis and definitive treatment actually starting. I think we need to give our clinical teams the time to interpret and use the diagnosis to agree and then begin that person-centred treatment plan within 62 days. I'm really happy to refer back to the fact that one-year and five-year survival rates are at all-time highs. They continue to improve, premature mortality continues to fall, and patient experience is exceptionally high. None of this means that we are complacent about where we are and where we want to be. And on diagnostics, as Tom Crosby, the medical director of the Wales cancer network said, 'We must lead a relentless drive towards earlier diagnosis.' There is no suggestion that we don't think diagnosis is important. But in Wales, I believe we already have a sound approach and a plan in place to do just that, and this plan is welcomed by both clinicians and the third sector. If you like, the previous cancer delivery plan was written for the service and given to them to get on with and deliver, and it was welcomed at the time. But the new cancer delivery plan has been written with the service and with the third sector, and we're working on the basis of evidence that we've gathered on what the right thing is to do to improve what we already do within Wales. The plan is widely supported, and it has a shared ambition to continually improve outcomes. And I look forward to working together with the service, the wider third sector and the public to do just that.
Welsh: Diolch, Ddirprwy Lywydd. Rwy'n hapus i ymateb i ddadl heddiw, a dechrau drwy gydnabod y sylwadau a wnaed eisoes, y bydd diagnosis cynharach o ganser yn galluogi pobl i gael triniaeth lai difrifol a llai costus, ac yn arbennig, profiad gwell i gleifion, ond hefyd ansawdd bywyd a ddylai arwain at ganlyniadau gwell, sy'n hollbwysig. Ond nid wyf yn cytuno â goblygiad canolog y cynnig, sef mai'r amser targed ar gyfer diagnosis yw'r ffordd i fynd ati i wella lefelau canfod canser neu ganlyniadau o reidrwydd. Rwy'n derbyn bod targedau'n chwarae rhan mewn unrhyw system ofal iechyd, ond gallant greu ymddygiadau gwrthnysig mewn gwahanol rannau o'r gwasanaeth, gan gynnwys mewn llwybrau gofal canser cymhleth. Ac ar amseroedd aros i ddechrau triniaeth ganser, rydym yn parhau i wneud yn well na Lloegr, ond ein her yw sut i wneud yn well byth yn hytrach na dim ond cymharu ein hunain â system Lloegr. Ac rwy'n cydnabod yr hyn a ddywedwyd am argymhellion tasglu canser Lloegr y cyfeiriodd Plaid Cymru atynt yn eu cynnig. Nid ydynt yn berthnasol i Gymru, ac mae gennym system iechyd wahanol. Nid bod yn bedantig yw hyn; mae'n system sy'n cael ei darparu mewn ffordd wahanol ar sail gofal sylfaenol a gofal eilaidd integredig, a byrddau iechyd, ar fodel wedi'i gynllunio yn hytrach na'i gomisiynu, ar sail cydweithio nid dirwyon, targedau a thariffau. Nawr, mae diagnosis cynharach yn brif ffocws y cynllun cyflawni canser diwygiedig a gyhoeddwyd ac a lansiwyd yn y pythefnos diwethaf. Gwyddom fod y Rhwydwaith Canser yn gweithio gyda gofal sylfaenol ar weithredu canllawiau atgyfeirio oherwydd amheuaeth o ganser y Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal, a bod hynny ynddo'i hun yn her go iawn i'r gwasanaeth cyfan. Mae'r rhwydwaith yn ystyried diwygio llwybrau diagnostig, gan ddysgu o'u hymweliad â Denmarc, ynglŷn â llwybrau atgyfeirio ychwanegol ar gyfer symptomau amwys. Rydym yn gwybod bod honno'n her sylweddol hefyd. A thrwy'r contract meddygon teulu, mae clystyrau'n dadansoddi'r gwersi a ddysgwyd o ymarfer atgyfeirio meddygon teulu. Ac mae rhaglen y fframwaith ar gyfer canser yn datblygu cymorth i feddygon teulu allu gwella diagnosis, atgyfeirio a chefnogaeth i bobl sydd wedi cael diagnosis hefyd. Ar sgrinio, soniwyd bod mwy na 400,000 yn cael eu sgrinio fel mater o drefn yng Nghymru bob blwyddyn yn rhan o'n rhaglenni uchel eu parch ar gyfer sgrinio'r fron, sgrinio serfigol a sgrinio coluddion. Rydym eisoes wedi addasu'r broses sgrinio canser y fron yn helaeth, ac yn ddiweddar rydym wedi cytuno i weithredu profion gwell a mwy derbyniol ar gyfer canser ceg y groth a sgrinio am ganser y coluddyn. Ac mewn gwirionedd, dyna un o'r rhwystrau mawr i wella nifer y bobl sy'n mynychu ac yn cael prawf canser y coluddyn. Nawr, mae strategaeth gweithlu'r GIG, a byrddau'r rhaglen ddelweddu a phatholeg yn mynd i'r afael â phrinder gweithlu allweddol mewn patholeg a radioleg. Bydd cyflwyno systemau gwybodeg cenedlaethol yn integreiddio gofal yn well ar draws safleoedd a sefydliadau sydd â systemau patholeg a delweddu cyffredin. Felly, nid oes unrhyw laesu dwylo ar ein rhan fod popeth yn berffaith yn ein system. Rydym yn parhau i herio, i ddiwygio ac i symud ymlaen gyda gwahanol agweddau ar ofal canser ledled Cymru. Ac rwy'n falch fod pwyntiau wedi'u gwneud ynglŷn ag amseroedd aros am ddiagnosis, ac yn arbennig y gydnabyddiaeth gan David Rees ein bod wedi gwella ein perfformiad mewn perthynas ag amseroedd aros diagnostig dros y flwyddyn ddiwethaf. Rwy'n disgwyl gweld mwy o welliant eto y tu hwnt i ddiwedd y flwyddyn berfformio hon, ac yn ddiweddar, cyhoeddais fuddsoddiad o £6 miliwn yn y ganolfan ddiagnostig yng Nghwm Taf. Rydym eisoes yn gwneud defnydd o rai gwasanaethau diagnostig symudol yn ogystal. Ond yn y dyfodol, byddwn yn buddsoddi'n drwm eto er mwyn darparu cyfarpar diagnostig newydd, gan gynnwys technegau delweddu CT, MRI a PET, yn ogystal â £15 miliwn pellach sydd wedi'i glustnodi ar gyfer offer diagnostig yn dilyn cytundeb y gyllideb ddrafft gyda Phlaid Cymru. Mae gennym grŵp gweithredu endosgopi cenedlaethol sy'n gweithio i leihau amseroedd aros a gwella ansawdd, ac yn ddiweddar cyhoeddais £3 miliwn ychwanegol mewn gwariant cyfalaf ar offer diheintio ar gyfer yr unedau hyn. Ac rwy'n falch ar y pwynt hwn i gydnabod y pwyntiau a wnaed gan Rhianon Passmore am y buddsoddiad rydym eisoes yn ei wneud, ac yn parhau i wneud, ar sail gynyddol, mewn gwasanaethau canser, a'n cefnogaeth i ganolfan ganser newydd Felindre sy'n werth £200 miliwn. Nawr, rwy'n deall y teimlad a'r egni sy'n sail i'r cynnig, a'r argymhelliad y mae'n ei wneud, ond yn syml iawn, nid wyf yn cytuno bod targed mympwyol o 28 diwrnod yn gyfraniad ystyrlon. Nid wyf yn credu mai dyna'r ffordd iawn i fanteisio ar amser, egni ac ymdrech pobl yn y gwasanaeth er mwyn iddynt wneud y cyfraniad gorau i wella canlyniadau i gleifion canser mewn gwirionedd, gan y bydd y rhan fwyaf o gleifion ar lwybr 62 diwrnod eisoes wedi cael diagnosis penodol erbyn hynny, ond gall fod yn anodd gwneud diagnosis a chanfod difrifoldeb rhai canserau'r ysgyfaint a chanserau'r oesoffagws o fewn y 28 diwrnod. Nid wyf yn credu ei bod yn ddefnyddiol ceisio rhannu'r llwybr, yn hytrach na chael cymorth i gael diagnosis pendant a dechrau triniaeth bendant mewn gwirionedd. Rwy'n credu bod angen i ni roi amser i'n timau clinigol ddehongli a defnyddio'r diagnosis i gytuno ac yna i ddechrau ar gynllun triniaeth sy'n canolbwyntio ar yr unigolyn o fewn 62 diwrnod. Rwy'n hapus iawn i gyfeirio'n ôl at y ffaith fod cyfraddau goroesi ar ôl blwyddyn ac ar ôl pum mlynedd yn uwch nag erioed. Maent yn parhau i wella, mae lefelau marwolaeth gynamserol yn parhau i ostwng, a phrofiad y claf yn eithriadol o uchel. Nid yw hyn yn golygu ein bod yn hunanfodlon ynglŷn â ble rydym a ble rydym eisiau bod. Ac ar ddiagnosteg, fel y dywedodd Tom Crosby, cyfarwyddwr meddygol rhwydwaith canser Cymru, Rhaid i ni fwrw iddi'n ddidrugaredd i sicrhau diagnosis cynharach. Nid oes unrhyw awgrym nad ydym yn credu bod diagnosis yn bwysig. Ond yng Nghymru, credaf fod gennym ddull cadarn o weithredu a chynllun ar waith i wneud hynny eisoes, ac mae'r cynllun hwn yn cael ei groesawu gan glinigwyr a'r trydydd sector. Os hoffech, ysgrifennwyd y cynllun cyflawni canser blaenorol ar gyfer y gwasanaeth a'i roi iddynt i fwrw ati i'w gyflawni, ac fe'i croesawyd ar y pryd. Ond mae'r cynllun cyflawni canser newydd wedi cael ei ysgrifennu gyda'r gwasanaeth a chyda'r trydydd sector, ac rydym yn gweithio ar sail y dystiolaeth a gasglwyd gennym ar y peth iawn i'w wneud i wella'r hyn rydym eisoes yn ei wneud yng Nghymru. Mae yna gefnogaeth eang i'r cynllun, ac mae'n rhannu uchelgais i wella canlyniadau yn barhaus. Ac edrychaf ymlaen at weithio gyda'n gilydd gyda'r gwasanaeth, y trydydd sector ehangach a'r cyhoedd i wneud hynny.