English: Thank you, Deputy Presiding Officer. I'd like to start by thanking the Health, Social Care and Sport Committee for bringing forward today's debate on their report following their inquiry into this important issue. I recognise this is an issue that has not had much focus and attention in terms of committee reports and scrutiny in the past, and I think it's a good thing that that has taken place now. It provides questions for the Government and it's the case that we don't always have comfortable answers, but there are honest answers in our response about the current position, and indeed about our commitment to invest the time and effort that is required to deliver the sort of service that all of us in this Chamber would want for our constituents. Because I do recognise that endoscopy services are vital if we are to be in a position to deliver timely and high-quality investigations for a range of treatment areas. It's a prerequisite for delivering the diagnostic and cancer waiting times, achieving endoscopy unit accreditation, and of course delivering better outcomes for conditions such as cancer. However, we should not underestimate the very real challenges that face our NHS. It does involve necessary improvements in data and planning, recruitment and training, revising and standardising our clinical pathways, as well as capital investment in units and new digital enablers. So, it is a multifaceted challenge, all against a background of genuine year-on-year increases in demand, which are driven both by an ageing population and changing clinical guidance. So, it requires some immediate action, of course, but that must come together with the longer-term and sustained focus that I know the committee have recognised and urged on the Government. And we agree on that, so it is not simply a matter of turning on additional funding to reduce waiting lists. That is why we will publish an endoscopy action plan as the committee recommended by the end of this October, and I will ensure it addresses the points that the committee has raised. In the meantime we have taken a range of immediate action that is required and put in place a detailed and comprehensive national programme. I have published a written statement today, which I know the Chair referred to, to outline in more detail the approach that we are taking, the progress that has been made to date, and of course the work that is due to take place in the coming months. So, we will then need to move quickly to the medium-term objective and actions that are required to stabilise endoscopy services, and then the longer-term objectives and actions needed to achieve a genuinely sustainable service. So, the programme has been set up as a nationally directed service by the Government, rather than led by the NHS, and that is consistent, if you like, in context with the ambitions that we set out in 'A Healthier Wales'. There will be times when we'll need to take a stronger, central guiding hand. So, the new endoscopy programme board is chaired by the deputy chief executive of the NHS and the deputy chief medical officer. The board is comprised of senior health board representatives and people who represent important allied programmes of work like cancer, pathology and bowel screening. I'm thinking about Hefin David's point about the interest that Norgine have in this area, and I think it might be appropriate to see if they would meet and have direct discussion with the endoscopy board. I'll take that up in a conversation with him about the local company. But that board will oversee four work streams, looking at demand and capacity planning, workforce education and training, clinical pathway development and facilities and infrastructure requirements. Significant support is already being provided by the NHS collaborative. That includes the national programme lead and their team, as well as clinical and managerial leads for each of the four work streams that I've outlined. This programme will be supported by the £1 million allocation that I've put in place as part of the NHS budget for 2019-20. More than half of that has already been allocated to support the programme work that I have identified. In the coming months, all units across Wales will be receiving pre-assessment visits to determine what is required locally to achieve the accreditation standard set by the Royal College of Physicians. I won't try and deliver the full tile as Angel Burns bravely did, but there is a real challenge about making sure that the infrastructure is in place to meet those standards. I recently met with the team in the Royal Gwent and they recognise that they're unlikely to meet the standard because of the physical place in which they're currently located. And there's some perhaps not very interesting in terms of a political discussion, but the technical way in which you need to design an area, the space that you need - all those things are really important aspects of actually delivering the outcomes that all of us here want to see. So, it will require capital investment, which will take some time. We should know the condition within each of our units, so there is a national workshop planned to consider that further and the unit reports are due to be received by health boards by the end of the year. We've also scoped out - no pun intended - the training programme, secured key elements of its delivery, and I'm hopeful that the first clinical endoscopist trainees will begin their training before the end of this calendar year. And these roles will be key to sustainable services given the challenging recruitment pipeline for doctors, who have until now been the main providers of investigations and interventions. I can see that time is against us, Chair but I have provided a detailed response to the committee and I will, of course, keep Members and the committee itself updated on the actions that we are taken and progress that is made, and I have no doubt the committee themselves will return in the future to this report and the action the Government has undertaken to take today.
Welsh: Diolch, Ddirprwy Lywydd. Hoffwn ddechrau drwy ddiolch i'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon am gyflwyno'r ddadl heddiw ar eu hadroddiad yn dilyn eu hymchwiliad i'r mater pwysig hwn. Rwy'n cydnabod nad yw'r mater wedi cael llawer o ffocws a sylw o ran adroddiadau pwyllgor a gwaith craffu yn y gorffennol, ac rwy'n credu ei bod yn dda fod hynny wedi digwydd yn awr. Mae'n darparu cwestiynau i'r Llywodraeth ac mae'n wir nad oes gennym atebion cyfforddus bob amser, ond mae atebion gonest yn ein hymateb am y sefyllfa bresennol, ac yn wir, yn ein hymrwymiad i fuddsoddi'r amser a'r ymdrech sy'n angenrheidiol i gyflawni'r math o wasanaeth y byddai pob un ohonom yn y Siambr hon ei eisiau i'n hetholwyr. Oherwydd rwy'n cydnabod bod gwasanaethau endosgopi yn hanfodol os ydym am fod mewn sefyllfa i gynnal archwiliadau amserol o ansawdd uchel ar gyfer ystod o feysydd triniaeth. Mae'n rhagofyniad ar gyfer cyflawni'r amseroedd aros ar gyfer diagnosteg a chanser, cyflawni achrediad uned endosgopi, ac wrth gwrs darparu gwell canlyniadau ar gyfer cyflyrau fel canser. Fodd bynnag, ni ddylem ddiystyru'r heriau gwirioneddol sy'n wynebu ein GIG. Mae'n cynnwys gwelliannau angenrheidiol mewn data a chynllunio, recriwtio a hyfforddi, diwygio a safoni ein llwybrau clinigol, yn ogystal â buddsoddi cyfalaf mewn unedau a galluogwyr digidol newydd. Felly, mae'n her amlochrog, a'r cyfan yn erbyn cefndir o gynnydd gwirioneddol yn y galw o flwyddyn i flwyddyn, a gaiff ei lywio gan boblogaeth sy'n heneiddio a chanllawiau clinigol sy'n newid. Felly, mae'n galw am weithredu ar unwaith, wrth gwrs, ond mae'n rhaid i hynny gyd-fynd â'r ffocws mwy hirdymor a pharhaus y gwn fod y pwyllgor wedi'i gydnabod a'i ddeisyfu gan y Llywodraeth. Ac rydym yn cytuno ar hynny, felly nid mater syml o roi arian ychwanegol er mwyn lleihau rhestrau aros yw hyn. Dyna pam y byddwn yn cyhoeddi cynllun gweithredu endosgopi cenedlaethol fel yr argymhellwyd gan y pwyllgor erbyn diwedd mis Hydref, a byddaf yn sicrhau ei fod yn rhoi sylw i'r pwyntiau y mae'r pwyllgor wedi'u codi. Yn y cyfamser, rydym wedi gweithredu amryw o gamau brys sy'n ofynnol ac wedi rhoi rhaglen genedlaethol fanwl a chynhwysfawr ar waith. Rwyf wedi cyhoeddi datganiad ysgrifenedig heddiw, a gwn fod y Cadeirydd wedi cyfeirio ato, i amlinellu'r dull rydym wedi'i fabwysiadu yn fanylach, y cynnydd a wnaed hyd yma, ac wrth gwrs, y gwaith a fydd yn digwydd dros y misoedd nesaf. Felly, bydd angen inni symud yn gyflym wedyn at yr amcan a'r gweithredoedd sy'n ofynnol yn y tymor canolig er mwyn sefydlogi gwasanaethau endosgopi, ac yna'r amcanion a'r camau mwy hirdymor sydd eu hangen i sicrhau gwasanaeth gwirioneddol gynaliadwy. Felly, sefydlwyd y rhaglen fel gwasanaeth a gyfarwyddir yn genedlaethol gan y Llywodraeth, yn hytrach na'i harwain gan y GIG, ac mae hynny'n gyson, os mynnwch, yng nghyd-destun yr uchelgeisiau a nodwyd gennym yn 'Cymru Iachach'. Bydd yna adegau pan fydd angen i ni weithredu arweiniad canolog cryfach. Felly, cadeirir bwrdd y rhaglen endosgopi newydd gan ddirprwy brif weithredwr y GIG a'r dirprwy brif swyddog meddygol. Mae'r bwrdd yn cynnwys uwch gynrychiolwyr o'r byrddau iechyd a phobl sy'n cynrychioli rhaglenni gwaith cysylltiedig pwysig fel canser, patholeg a sgrinio'r coluddyn. Rwy'n meddwl am bwynt Hefin David ynglŷn â'r diddordeb sydd gan Norgine yn y maes hwn, ac rwy'n credu y gallai fod yn briodol gweld a fyddent yn cyfarfod ac yn cael trafodaeth uniongyrchol â'r bwrdd endosgopi. Fe af ar drywydd hynny mewn sgwrs gydag ef am y cwmni lleol. Ond bydd y bwrdd hwnnw'n goruchwylio pedair ffrwd waith, gan edrych ar gynllunio galw a chapasiti, addysg a hyfforddiant y gweithlu, datblygu llwybrau clinigol a gofynion cyfleusterau a seilwaith. Darparir cefnogaeth sylweddol eisoes gan gydweithrediaeth y GIG. Mae hynny'n cynnwys arweinydd y rhaglen genedlaethol a'u tîm, yn ogystal ag arweinwyr clinigol a rheolaethol ar gyfer pob un o'r pedair ffrwd waith a amlinellais. Cefnogir y rhaglen gan y £1 miliwn a ddyrannais fel rhan o gyllideb y GIG ar gyfer 2019-20. Mae mwy na hanner hwnnw wedi'i ddyrannu eisoes i gefnogi'r rhaglen waith a nodais. Yn ystod y misoedd nesaf, bydd pob uned ledled Cymru yn cael ymweliadau cyn-asesu i bennu'r hyn sydd ei angen yn lleol i gyflawni'r safon achredu a osodwyd gan Goleg Brenhinol y Meddygon. Nid wyf am geisio dweud y teitl llawn fel y bu Angela Burns yn ddigon dewr i wneud, ond mae yna her wirioneddol i sicrhau bod y seilwaith yn ei le er mwyn cyrraedd y safonau hynny. Yn ddiweddar, cyfarfûm â'r tîm yn Ysbyty Brenhinol Gwent ac maent yn cydnabod nad ydynt yn debygol o fodloni'r safon oherwydd eu lleoliad ffisegol ar hyn o bryd. Ac mae'n bosibl nad yw hyn yn ddiddorol iawn o ran trafodaeth wleidyddol, ond mae'r ffordd dechnegol y mae angen i chi gynllunio lle, y gofod sydd ei angen arnoch chi - mae'r holl bethau hynny'n elfennau gwirioneddol bwysig yn y gwaith o gyflawni'r canlyniadau y mae pob un ohonom yma eisiau eu gweld. Felly, bydd yn galw am fuddsoddiad cyfalaf, a fydd yn cymryd cryn dipyn o amser. Dylem wybod beth yw cyflwr pob un o'n hunedau, felly mae gweithdy cenedlaethol wedi'i gynllunio i roi ystyriaeth bellach i hynny a disgwylir y bydd adroddiadau'r unedau'n dod i law y byrddau iechyd erbyn diwedd y flwyddyn. Rydym hefyd wedi cwmpasu'r rhaglen hyfforddi, wedi sicrhau'r elfennau sy'n allweddol i'r gwaith o'i chyflawni, ac rwy'n gobeithio y bydd yr hyfforddeion endoscopi clinigol cyntaf yn dechrau ar eu hyfforddiant cyn diwedd y flwyddyn galendr hon. A bydd y rolau hyn yn allweddol i wasanaethau cynaliadwy o ystyried y sefyllfa recriwtio heriol ar gyfer meddygon, sef prif ddarparwyr archwiliadau ac ymyriadau hyd yma. Gallaf weld bod amser yn brin, Gadeirydd, ond rwyf wedi rhoi ymateb manwl i'r pwyllgor ac wrth gwrs, byddaf yn rhoi'r wybodaeth ddiweddaraf i'r Aelodau a'r pwyllgor ei hun ar y camau rydym yn eu cymryd a'r cynnydd a wneir, ac nid oes gennyf unrhyw amheuaeth y bydd y pwyllgor ei hun yn dychwelyd at yr adroddiad hwn yn y dyfodol, a'r camau y mae'r Llywodraeth wedi ymrwymo i'w cymryd heddiw.