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Cyfarfu’r Cynulliad am 13:30 gyda’r Dirprwy Lywydd (David Melding) yn y Gadair.
The Assembly met at 13:30 with the Deputy Presiding Officer (David Melding) in the Chair.
 
13:30
Y Dirprwy Lywydd / The Deputy Presiding OfficerBywgraffiadBiography
Order, order. The National Assembly is in session.
 
Cwestiynau i'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol
Questions to the Minister for Health and Social Services
Gofal Iechyd Meddwl
Mental Health Care
 
13:30
1. Pa asesiad y mae’r Gweinidog wedi’i wneud o hygyrchedd gofal iechyd meddwl i blant a’r glasoed? OAQ(4)0502(HSS)
1. What assessment has the Minister made of the accessibility of mental health care for children and adolescents? OAQ(4)0502(HSS)
 
13:30
Mark DrakefordBywgraffiadBiographyY Gweinidog Iechyd a Gwasanaethau Cymdeithasol / The Minister for Health and Social Services
Diolch yn fawr am y cwestiwn. Mae gofal arbenigol i blant a phobl ifanc sydd ag anghenion iechyd meddwl difrifol a chymhleth yn cael ei ddarparu gan y gwasanaeth iechyd meddwl i blant a’r glasoed. Mae gofal iechyd meddwl hefyd ar gael mewn ysgolion, ac ym maes gofal sylfaenol. Mae ymateb i les emosiynol pobl ifanc yn gyfrifoldeb ar bob gwasanaeth y mae’r bobl ifanc yn dod i gysylltiad ag ef.
Thank you for the question. Specialist care is for children and young people with serious and complex mental health needs is provided by the child and adolescent mental health services. Mental health care is also available in schools, and in primary care. Responding to the emotional wellbeing of young people is the responsibility of each service that the young people come into contact with it.
 
13:30
Diolch am yr ateb, Weinidog. Byddwch yn gwybod bod y Pwyllgor Plant, Pobl Ifanc ac Addysg wedi bod yn ymchwilio i’r pwnc hwn, ac rydw i wedi gweld, wrth gwrs, yr holl dystiolaeth honno. Mae gennyf ddau bryder mawr ar hyn o bryd ynglŷn â gofal iechyd meddwl ar gyfer plant a phobl ifanc. Yn gyntaf, cyfeirir pobl ymlaen at wasanaeth arbenigol y gwasanaethau iechyd meddwl plant a’r glasoed heb fod triniaeth ddigonol ar y lefel gynradd gan feddyg teulu neu, fel yr ydych newydd sôn amdano, ysgolion, neu beth bynnag. Yn ail, mae presgripsiynau yn cael eu rhoi ar gyfer pethau megis anhwylder diffyg canolbwyntio a gorfywiogrwydd, a rhai pethau eraill, heb fod ymgais i ymdrin â’r cyflyrau mewn ffordd amgen. A ydych yn rhannu’r pryderon hyn, a beth ydych yn ei wneud i fynd i’r afael â’r mater?
Thank you for that response, Minister. You will know that the Children, Young People and Education Committee has been conducting an inquiry into this topic, and I have seen, of course, all that evidence. I have two major concerns at present about mental health care for children and young people. First, people are referred to a specialist child and adolescent mental health service without adequate treatment at the primary level by GPs or, as you have just mentioned, schools or whatever. Secondly, prescriptions are provided for things such as attention deficit hyperactivity disorder, and some other things, without an attempt to deal with the conditions in an alternative way. Do you share these concerns, and what are you doing to tackle them?
 
13:31
Mark DrakefordBywgraffiadBiography
May I thank Simon Thomas for that supplementary question? I say to him that I share both of his anxieties. There has been a 103% increase in referrals to CAMHS in a four-year period. What that says to me is that the service is not being used in the way for which it was intended, and that there are young people whose needs ought to be, and can be, effectively attended to at lower levels of intervention than that specialist and mental health service is best placed to provide.
A gaf fi ddiolch i Simon Thomas am y cwestiwn atodol? Rwy’n dweud wrtho fy mod yn rhannu ei bryderon. Mae cynnydd o 103% wedi bod yn yr atgyfeiriadau i’r Gwasanaethau Iechyd Meddwl Plant a’r Glasoed (CAMHS) mewn cyfnod o bedair blynedd. Mae hynny’n dweud wrthyf nad yw’r gwasanaeth yn cael ei ddefnyddio yn y modd y’i bwriadwyd a bod yna bobl ifanc y dylai ac y gallai eu hanghenion gael sylw effeithiol ar lefelau is o ymyrraeth na’r lefel arbenigol y mae’r gwasanaeth iechyd meddwl yn ei ddarparu orau.
 
Now, there are a range of things that are there in order to provide that different level of service. Over 20% of the people presenting themselves to the Aneurin Bevan local primary care mental health service—the new service—over the summer were under the age of 18. So, that new primary care service is being used by children and young people. We have put £4.5 million into the revenue support grant to support school counselling, as recently as April 2013, and the mental health first aid for young people programme is intended to strengthen the ability of that wide range of professionals who come into contact with young people who are experiencing troubled times in their lives.
Yn awr, ceir amryw o bethau sydd yno er mwyn darparu’r lefel wahanol honno o wasanaeth. Roedd dros 20% o’r bobl a drodd at wasanaethau iechyd meddwl gofal sylfaenol lleol Aneurin Bevan—y gwasanaeth newydd—dros yr haf yn iau na 18 oed. Felly, mae’r gwasanaeth gofal sylfaenol newydd hwn yn cael ei ddefnyddio gan blant a phobl ifanc. Rhoesom £4.5 miliwn tuag at y grant cynnal refeniw i gefnogi cwnsela mewn ysgolion mor ddiweddar ag Ebrill 2013, a bwriedir i’r rhaglen cymorth cyntaf iechyd meddwl ar gyfer pobl ifanc gryfhau gallu’r ystod eang o weithwyr proffesiynol sy’n dod i gysylltiad â phobl ifanc sy’n dioddef cyfnodau cythryblus yn eu bywydau.
 
Now, we need to do more, and we need to strengthen that further. We also need to get the message across, I think, to those many professionals who work with young people, that discharging your obligation to young people facing troubled times in their lives is not met by making a referral to somebody else. There are things that you are able, and ought, to do, and strengthening your ability to do it is part of our purpose.
Yn awr, mae angen i ni wneud mwy, ac mae angen i ni gryfhau hynny ymhellach. Hefyd, mae angen i ni gyfleu’r neges, rwy’n meddwl, i’r nifer o weithwyr proffesiynol sy’n gweithio gyda phobl ifanc, nad ydych yn cyflawni eich dyletswydd i bobl ifanc sy’n wynebu cyfnodau cythryblus yn eu bywydau drwy eu cyfeirio at rywun arall. Mae pethau y gallwch, ac y dylech, eu gwneud ac mae cryfhau eich gallu i wneud hynny yn rhan o’n pwrpas.
 
I am concerned as well at the second point that Simon Thomas raised—the level of prescribing for people who have mental health conditions at a very young age. I believe that the children’s committee may want to take a particular look at that issue, and I think that that would be a very valuable piece of work, if it was able to undertake it.
Rwyf hefyd yn bryderus ynglŷn â’r ail bwynt a gododd Simon Thomas—lefel presgripsiynu ar gyfer pobl sydd â chyflyrau iechyd meddwl yn ifanc iawn. Rwy’n credu efallai y bydd y pwyllgor plant yn awyddus i edrych yn benodol ar y mater hwnnw ac rwy’n credu y byddai’n waith gwerthfawr iawn pe bai’n gallu gwneud hynny.
 
13:33
Minister, I thank you for those answers to Simon Thomas. He has highlighted the issues that the Children, Young People and Education Committee actually identified, and you have also, in your response to that committee, indicated some funding for talking therapies. What area are we going to promote further, because that is an area where, not just for young people, but for older people as well, there is a shortage of cognitive-based therapies, in which we can allow people to talk? Again in your letter, you identified inappropriate referrals to the specialised unit, but many of these are where this type of approach can be beneficial. So, how are we going to develop that approach across Wales, on a wider basis?
Weinidog, diolch i chi am eich atebion i Simon Thomas. Mae wedi tynnu sylw at y materion y nododd y Pwyllgor Plant, Pobl Ifanc ac Addysg mewn gwirionedd, ac rydych chi hefyd, yn eich ymateb i’r pwyllgor hwnnw, wedi nodi peth cyllid ar gyfer therapïau siarad. Pa faes rydym am ei hyrwyddo ymhellach, oherwydd mae hwnnw’n faes lle mae prinder o therapïau gwybyddol y gallwn adael i bobl siarad ynddynt, nid ar gyfer pobl ifanc yn unig, ond i bobl hŷn yn ogystal? Unwaith eto yn eich llythyr, rydych wedi nodi atgyfeiriadau amhriodol i’r uned arbenigol ond mae llawer o’r rhain yn sefyllfaoedd lle y gall y math hwn o ddull fod yn fuddiol. Felly, sut ydym yn mynd i ddatblygu’r dull hwnnw ledled Cymru, ar sail ehangach?
 
13:34
Mark DrakefordBywgraffiadBiography
Thanks to David Rees for that question. We have been able to provide £650,000 new investment in the provision of psychological therapies in this financial year. That is to support services for all ages, and they quite certainly do include services for young people who would otherwise—as Simon Thomas suggested—be prescribed medication, in medically driven services. We have now had the therapy plans in from all the health boards and have agreed them all, and we are confident that the money that we have provided will be put to good use for the purpose that David Rees has identified.
Diolch i David Rees am y cwestiwn. Rydym wedi gallu darparu £650,000 o fuddsoddiad newydd yn y ddarpariaeth o therapïau seicolegol yn y flwyddyn ariannol hon. Mae hynny i gefnogi gwasanaethau ar gyfer pob oedran, gan gynnwys gwasanaethau ar gyfer pobl ifanc yn sicr a fyddai fel arall—fel yr awgrymodd Simon Thomas—yn cael meddyginiaeth ar bresgripsiwn drwy’r gwasanaethau meddygol. Rydym bellach wedi cael y cynlluniau therapi gan yr holl fyrddau iechyd ac wedi cytuno arnynt oll, ac rydym yn hyderus y gwneir defnydd da o’r arian rydym wedi’i ddarparu at y diben y mae David Rees wedi’i nodi.
 
13:35
Minister, I wonder if you could provide us with an update on the work of Public Health Wales and Swansea University, I think it was, in developing a tool to measure the effectiveness of the various interventions in mental health care for children and young people.
Weinidog, tybed a allwch roi diweddariad i ni ar waith Iechyd Cyhoeddus Cymru a Phrifysgol Abertawe, rwy’n credu, i ddatblygu adnodd i fesur effeithiolrwydd y gwahanol ymyriadau ym maes gofal iechyd meddwl i blant a phobl ifanc.
 
13:35
Mark DrakefordBywgraffiadBiography
Public Health Wales is leading that piece of work. It is looking at a range of different interventions that have been developed over the years in the public health field, including those in the field of mental health. She is absolutely right to point to the fact that, in this field, as in too many others, we are very well supplied with information about inputs and outputs and less well supplied than we need to be with evidence of outcomes and impacts from all the work that goes on. That is the focus of the work that Public Health Wales is leading on. I think that it will be very valuable to us in making decisions in the future as to where investment is best made in order to secure the outcomes for young people that we are seeking.
Iechyd Cyhoeddus Cymru sy’n arwain y gwaith. Mae’n edrych ar ystod o wahanol ymyriadau a ddatblygwyd dros y blynyddoedd ym maes iechyd y cyhoedd, gan gynnwys y rhai ym maes iechyd meddwl. Mae hi’n llygad ei lle i dynnu sylw at y ffaith ein bod, yn y maes hwn, fel mewn gormod o rai eraill, yn cael llawer iawn o wybodaeth am fewnbynnau ac allbynnau ac yn cael llai o dystiolaeth nag y dylem am ganlyniadau ac effeithiau’r holl waith sy’n digwydd. Dyna ffocws y gwaith y mae Iechyd Cyhoeddus Cymru yn ei arwain. Rwy’n credu y bydd yn werthfawr iawn i ni wrth wneud penderfyniadau yn y dyfodol o ran dewis y pethau gorau i fuddsoddi ynddynt er mwyn sicrhau’r canlyniadau rydym yn ceisio eu cael ar gyfer y bobl ifanc.
 
Gwasanaethau y Tu Allan i Oriau yn Ynys Môn
Out-of-Hours Services in Anglesey
 
13:36
Rhun ap IorwerthBywgraffiadBiography
2. A wnaiff y Gweinidog ddatganiad ar wasanaethau y tu allan i oriau yn Ynys Môn? OAQ(4)0511(HSS)
2. Will the Minister make a statement on out-of-hours services in Anglesey? OAQ(4)0511(HSS)
 
13:36
Vaughan GethingBywgraffiadBiographyY Dirprwy Weinidog Iechyd / The Deputy Minister for Health
Thank you for the question. Health boards are responsible for providing out-of-hours services for their population. Each health board needs to ensure that its out-of-hours service is safe and sustainable. This should be clearly articulated in the integrated three-year plan that Betsi Cadwaladr University Local Health Board is developing.
Diolch am y cwestiwn. Mae’r byrddau iechyd yn gyfrifol am ddarparu gwasanaethau y tu allan i oriau ar gyfer eu poblogaeth. Mae angen i bob bwrdd iechyd sicrhau bod ei wasanaeth y tu allan i oriau yn ddiogel ac yn gynaliadwy. Dylai hyn gael ei fynegi’n glir yn y cynllun tair blynedd integredig y mae Bwrdd Iechyd Lleol Prifysgol Betsi Cadwaladr yn ei ddatblygu. 
 
13:36
Rhun ap IorwerthBywgraffiadBiography
Diolch yn fawr i’r Dirprwy Weinidog. Mae’r sefyllfa o ran diffyg meddygon teulu y tu allan i oriau yn fy etholaeth yn argyfyngus. Derbyniais lythyr yn ddiweddar gan un wraig oedrannus a oedd wedi gorfod aros 15 awr a mwy am ymweliad gan feddyg dros y Sul. A yw’r Dirprwy Weinidog yn ymwybodol nad oes un meddyg teulu ar alwad yn Ynys Môn dros y Sul? A yw’r Dirprwy Weinidog yn sylweddoli mai dim ond un meddyg sy’n gallu ymweld â chartrefi pobl, nid yn unig yn Ynys Môn ond hefyd mewn rhan helaeth o Wynedd, dros y Sul? A yw’r Dirprwy Weinidog yn meddwl bod y lefel honno o wasanaeth yn dderbyniol a pha gynlluniau sydd ganddo i fynd i’r afael â’r broblem?
I thank the Deputy Minister. The situation in terms of a shortage of out-of-hours GPs in my constituency is critical. I received a letter recently from an elderly lady who had to wait 15 hours and more for a doctor’s visit over the weekend. Is the Deputy Minister aware that there is not one GP on call in Anglesey over the weekend? Does the Deputy Minister realise that there is only one doctor who can make home visits, not only in Anglesey but also in a large part of Gwynedd, at the weekend? Does the Deputy Minister think that that level of service is acceptable and what plans does he have to tackle the problem?
 
13:37
Vaughan GethingBywgraffiadBiography
I thank the Member for the supplementary question. If he wants to write to me on the individual case that he raises, I would be happy to look at that and to discuss with the health board what the reason is and how it intends to respond to that as a challenge going forward. The model that Anglesey runs relies on an advanced nurse practitioner service dealing with a range of the calls that initially come in. Feedback from patients has been positive about their experience. If you look at the overall responses, about 40% of the calls to the out-of-hours service are dealt with by telephone advice, which is a good thing. About 14% of the calls result in a home call and the rest come in to a centre. The model that Anglesey runs has GP support that is available in a centre. If that access, in this particular case, was not there, that is not the model that the health board is running on the island of Anglesey. However, we need to look at the out-of-hours service as a medical service for the patient and not simply a GP service. It is about having the access to appropriate medical support and advice and getting the person to the right clinician at the right time. So, I would not accept that the service has to rely solely on GPs running the services. It is about having proper access to a range of medical practitioners and who is that first person. I am quite satisfied that having an advanced nurse practitioner as the initial point of contact is an appropriate model to run.
Diolch i’r Aelod am y cwestiwn atodol. Os yw’n dymuno ysgrifennu ataf ynghylch yr achos unigol y mae’n cyfeirio ato, buaswn yn hapus i edrych ar hynny ac i drafod gyda’r bwrdd iechyd beth yw’r rheswm a sut y mae’n bwriadu ymateb i hynny fel her wrth symud ymlaen. Mae’r model y mae Ynys Môn yn ei weithredu yn dibynnu ar wasanaeth uwch-ymarferydd nyrsio sy’n ymwneud ag ystod o’r galwadau a ddaw i mewn yn y lle cyntaf. Mae adborth gan gleifion sy’n sôn am eu profiad wedi bod yn gadarnhaol. Os edrychwch ar yr ymatebion yn gyffredinol, mae tua 40% o’r galwadau i’r gwasanaeth y tu allan i oriau yn cael eu trin drwy gyngor dros y ffôn, sy’n beth da. Mae tua 14% o’r galwadau’n arwain at ymweliad â’r cartref ac mae’r gweddill yn mynd i un o’r canolfannau. Mae’r model y mae Ynys Môn yn ei weithredu yn cael cefnogaeth meddygon teulu yn y ganolfan. Os nad oedd mynediad o’r fath ar gael yn yr achos penodol hwn, nid dyna’r model y mae’r bwrdd iechyd yn ei weithredu ar Ynys Môn. Fodd bynnag, mae angen i ni edrych ar y gwasanaeth y tu allan i oriau fel gwasanaeth meddygol ar gyfer y claf ac nid gwasanaeth meddygon teulu yn unig. Mae’n ymwneud â chael mynediad at gymorth a chyngor meddygol priodol a sicrhau bod y person yn cyrraedd y clinigydd cywir ar yr amser cywir. Felly, ni fyddwn yn derbyn bod rhaid i’r gwasanaeth ddibynnu’n llwyr ar feddygon teulu i redeg y gwasanaethau. Mae’n ymwneud â chael mynediad priodol at ystod o ymarferwyr meddygol a phwy yw’r person cyntaf hwnnw. Rwy’n eithaf bodlon fod cael uwch-ymarferydd nyrsio fel y pwynt cyswllt cyntaf yn fodel priodol i’w weithredu.
 
13:39
Mark IsherwoodBywgraffiadBiography
While the UK Government has launched a pilot scheme for surgeries in nine areas to bid for money to open from 8 a.m. to 8 p.m., seven days a week, Members who attended the 3 June briefing event in the Assembly by British Medical Association Cymru Wales and the north Wales local medical committee will have heard that patient/GP ratios in north Wales have risen to 3,800:1—double the safety rate normally recognised by the Welsh Government and health providers. How will this impact on out-of-hours services in Anglesey and more widely across the region? What urgent action is being taken to prioritise remedies to address this?
Er bod Llywodraeth y DU wedi lansio cynllun peilot i feddygfeydd mewn naw ardal wneud cais am arian i agor o 8am hyd 8pm, saith diwrnod yr wythnos, bydd yr Aelodau a fynychodd y digwyddiad briffio ar 3 Mehefin yn y Cynulliad gan Gymdeithas Feddygol Prydain (Cymru) a phwyllgor meddygol lleol Gogledd Cymru wedi clywed bod cymarebau claf/meddyg teulu yn y gogledd wedi codi i 3,800:1—dwbl y gyfradd ddiogelwch a gydnabyddir fel arfer gan Lywodraeth Cymru a darparwyr iechyd. Sut y bydd hyn yn effeithio ar wasanaethau y tu allan i oriau yn Ynys Môn ac yn fwy eang ar draws y rhanbarth? Pa gamau brys sy’n cael eu cymryd i flaenoriaethu atebion i fynd i’r afael â hyn?
 
13:39
Vaughan GethingBywgraffiadBiography
Again, I refer back to the response that I have just given to the Member for Ynys Môn. The model that is being run on the island of Anglesey has an initial point of contact to an advanced nurse practitioner. That is an entirely appropriate model to run for people to have access to out-of-hours medical support and advice. I do not see a reason to want to change or interfere with that model. It is, of course, entirely appropriate that that nurse-practitioner service has the support of other medical practitioners as appropriate, and that may be for the GP service that should be available to them at all points in the out-of-hours service. So, I would not accept that the figures that he has quoted show that this is a service that is not being run in an appropriate way that puts the needs of the patient, and the needs of a patient in an out-of-hours-context service, first, and I am quite satisfied that this is an appropriate use of resource.
Unwaith eto, rwy’n cyfeirio’n ôl at yr ateb rwyf newydd ei roi i’r Aelod dros Ynys Môn. Mae gan y model sy’n cael ei weithredu ar Ynys Môn bwynt cyswllt cychwynnol at uwch-ymarferydd nyrsio. Mae’n fodel cwbl briodol i’w weithredu i bobl gael cymorth a chyngor meddygol y tu allan i oriau. Nid wyf yn gweld rheswm dros fod eisiau newid neu ymyrryd â’r model hwn. Mae’n hollol briodol, wrth gwrs, fod y gwasanaeth ymarferydd nyrsio yn cael cefnogaeth ymarferwyr meddygol eraill fel y bo’n briodol, ac efallai y bydd hynny’n dod gan y gwasanaeth meddyg teulu a ddylai fod ar gael iddynt ar bob pwynt yn y gwasanaeth y tu allan i oriau. Felly, ni fyddwn yn derbyn bod y ffigurau y mae wedi’u dyfynnu’n dangos bod hwn yn wasanaeth nad yw’n cael ei redeg mewn ffordd briodol sy’n rhoi anghenion y claf, ac anghenion claf yng nghyd-destun y gwasanaeth y tu allan i oriau, yn gyntaf, ac rwy’n eithaf bodlon fod hyn yn ddefnydd priodol o adnoddau.
 
Cwestiynau Heb Rybudd gan Lefarwyr y Pleidiau
Questions Without Notice from Party Spokespeople
 
13:40
Y Dirprwy Lywydd / The Deputy Presiding OfficerBywgraffiadBiography
I now call the party spokespeople to question the Minister. The Welsh Conservatives’ spokesperson, Darren Millar.
Galwaf yn awr ar lefarwyr y pleidiau i holi cwestiynau i’r Gweinidog. Llefarydd y Ceidwadwyr Cymreig, Darren Millar.
 
13:40
Thank you, Deputy Presiding Officer. Minister, today has been an historic moment for the Assembly. A petition signed by some 98,000 people has been presented on the Senedd steps, calling for equality in access to cancer drugs between England and Wales. What is your response to their request?
Diolch, Ddirprwy Lywydd. Weinidog, mae heddiw wedi bod yn foment hanesyddol i’r Cynulliad. Cafodd deiseb wedi’i llofnodi gan tua 98,000 o bobl ei chyflwyno ar risiau’r Senedd yn galw am gydraddoldeb o ran mynediad at gyffuriau canser rhwng Cymru a Lloegr. Beth yw eich ymateb i’w cais?
 
13:41
Mark DrakefordBywgraffiadBiography
The Welsh Government has no intention of introducing a cancer drugs fund in Wales, for a series of very good reasons, which have been extensively rehearsed here. It is a scheme that is not ethical, it lacks clinical support, it is unpopular with the public and would deliver a lesser service to cancer patients in Wales.
Nid oes gan Lywodraeth Cymru unrhyw fwriad i gyflwyno cronfa gyffuriau canser yng Nghymru am nifer o resymau da iawn sydd wedi cael eu hadrodd yn helaeth yma. Nid yw’n gynllun moesegol, ychydig o gefnogaeth glinigol sydd iddo, mae’n amhoblogaidd ymhlith y cyhoedd a byddai’n darparu llai o wasanaeth ar gyfer cleifion canser yng Nghymru.
 
13:41
Minister, the petition is in this box in front of me here. It is signed by 98,000 people. I think that that shows that it is a very popular demand among members of the public, not just in Wales, but around the UK, who see the obvious injustice that is being done to Welsh patients. It is popular; it is popular among those patients who have had the drugs denied to them that their clinicians want to be able to treat them with. Do you accept that many among the 55,000 people who have been granted access to drugs in England, are indeed securing better clinical outcomes as a direct result of their access to a cancer drugs fund in England?
Weinidog, mae’r ddeiseb yn y blwch hwn o fy mlaen. Mae wedi cael ei llofnodi gan 98,000 o bobl. Credaf fod hynny’n dangos ei bod yn alwad boblogaidd iawn ymhlith y cyhoedd, nid yn unig yng Nghymru, ond ledled y Deyrnas Unedig, sy’n gweld yr anghyfiawnder amlwg i gleifion yng Nghymru. Mae’n boblogaidd; mae’n boblogaidd ymhlith y cleifion hynny sydd heb gael y cyffuriau y mae eu clinigwyr eisiau gallu eu defnyddio i’w trin. A ydych yn derbyn bod llawer o blith y 55,000 o bobl sydd wedi cael mynediad at gyffuriau yn Lloegr, yn wir yn cael canlyniadau clinigol gwell o ganlyniad uniongyrchol i’w mynediad at gronfa gyffuriau canser yn Lloegr?
 
13:42
Mark DrakefordBywgraffiadBiography
I would rather rely on the chair of the cancer drugs fund in England, who wrote to Simon Stevens, the chief executive of NHS England at the end of August to say that there were drugs being prescribed by the cancer drugs fund that were neither effective nor cost-effective. I do not agree with what Darren Millar has said. Neither his visual aids nor his hectoring tone persuade me. [Laughter.]
Byddai’n well gennyf ddibynnu ar gadeirydd y gronfa gyffuriau canser yn Lloegr a ysgrifennodd at Simon Stevens, prif weithredwr NHS Lloegr, ddiwedd mis Awst i ddweud bod cyffuriau’n cael eu presgripsiynu gan y gronfa gyffuriau canser nad oedd yn effeithiol nac yn gosteffeithiol. Nid wyf yn cytuno â’r hyn y mae Darren Millar wedi’i ddweud. Nid yw ei gymhorthion gweledol na’i dôn sarrug yn fy mherswadio i. [Chwerthin.]
 
13:42
You may think that this is an amusing matter, and so might the people on the Government benches. I do not. I happen to think that this is an injustice. You will be aware, Minister, that, yesterday, the Assembly was visited by Rosemary Greenslade, who is now benefiting from a drug that she was initially denied, and subsequently, only through shaming the health board in which she lives, was given access to a drug, many months later than she would otherwise have been. She is responding well to that drug, as is Ann Wilkinson, who has been on the steps of the Senedd today. Why do you not meet with those patients and why do you refuse to attend the presentation of petitions that are calling upon you to take action on this important matter?
Efallai eich bod yn meddwl bod hwn yn fater doniol ac efallai fod y bobl ar feinciau’r Llywodraeth yn meddwl hynny hefyd. Nid wyf i’n meddwl hynny. Rwy’n digwydd credu ei fod yn anghyfiawn. Byddwch yn ymwybodol, Weinidog, fod Rosemary Greenslade wedi ymweld â’r Cynulliad ddoe, dynes sydd bellach yn cael budd o gyffur a gafodd ei wrthod iddi i ddechrau, ac ar ôl hynny, dim ond drwy godi cywilydd ar y bwrdd iechyd yn ei hardal y cafodd fynediad at gyffur, sawl mis yn hwyrach nag y byddai wedi’i gael fel arall. Mae hi’n ymateb yn dda i’r cyffur hwnnw, fel y mae Ann Wilkinson, sydd wedi bod ar risiau’r Senedd heddiw. Pam na wnewch chi gyfarfod â’r cleifion hynny a pham rydych chi’n gwrthod mynychu cyflwyniad y deisebau sy’n galw arnoch i weithredu ar y mater pwysig hwn?
 
Let me assure Darren Millar that I have never found him amusing nor do I agree with him that decisions in the Welsh NHS are made on the basis of shame; they are made on the basis of clinical representation and proper decision-making. People who will benefit from drugs get those drugs. More than half of the applications to the individual patient funding request process result in that drug being made available. We have a system that is fair to all patients, that is clinically driven and that provides good outcomes at a cost-effective price; that is the right way to do things.
Gadewch i mi sicrhau Darren Millar nad wyf i erioed wedi’i weld ef yn ddoniol ac nid wyf yn cytuno ag ef fod penderfyniadau GIG Cymru yn cael eu gwneud ar sail cywilydd; maent yn cael eu gwneud ar sail sylwadau clinigol a phenderfyniadau priodol. Bydd y bobl a fydd yn elwa o gyffuriau yn cael y cyffuriau hynny. Mae mwy na hanner y ceisiadau i’r broses ceisiadau cyllido cleifion unigol yn arwain at sicrhau bod y cyffur hwnnw ar gael. Mae gennym system sy’n deg i bob claf, system o dan arweiniad clinigwyr ac sy’n sicrhau canlyniadau da am bris costeffeithiol; dyna’r ffordd gywir i wneud pethau.
 
13:44
Y Dirprwy Lywydd / The Deputy Presiding OfficerBywgraffiadBiography
Now, the Welsh Liberal Democrats’ Kirsty Williams.
Yn awr, Kirsty Williams ar ran Democratiaid Rhyddfrydol Cymru.
 
13:44
Kirsty WilliamsBywgraffiadBiographyArweinydd Democratiaid Rhyddfrydol Cymru / The Leader of the Welsh Liberal Democrats
Minister, was the tripartite meeting held between the Welsh Government, the Wales Audit Office and Health Inspectorate Wales last Friday to discuss the situation at Betsi Cadwaladr health board a regular, planned meeting, or was it a special meeting? If it was a special one, could you outline what triggers caused that meeting to be held?
Weinidog, a oedd y cyfarfod triphlyg a gynhaliwyd rhwng Llywodraeth Cymru, Swyddfa Archwilio Cymru ac Arolygiaeth Iechyd Cymru ddydd Gwener diwethaf i drafod y sefyllfa ym mwrdd iechyd Betsi Cadwaladr yn gyfarfod arferol, wedi’i drefnu, neu a oedd yn gyfarfod arbennig? Os oedd yn un arbennig, a allech amlinellu beth oedd yr ysgogiad i gynnal y cyfarfod?
 
13:44
Mark DrakefordBywgraffiadBiography
Kirsty Williams will be aware, I am sure, that as a result of events at Betsi Cadwaladr last year, the WAO, HIW and the Welsh Government got together to agree a protocol through which intervention in the affairs of any local health board could be properly navigated. What we found from our previous experience was is that while all the different levers were available, there was insufficient certainty about which organisation was possessed with what power and how that power would be exercised. So, a protocol is drawn up. Part of the protocol is that those three organisations meet together twice a year to review the status of all health boards in Wales. There is a possibility in between those meetings for further meetings to be arranged. The meeting that took place last Friday was a meeting within the protocol. It looked at the current state of intervention in Betsi Cadwaladr and it made a recommendation that Welsh Government has agreed.
O ganlyniad i ddigwyddiadau yn Betsi Cadwaladr y llynedd, rwy’n siŵr y bydd Kirsty Williams yn ymwybodol fod Swyddfa Archwilio Cymru, Arolygiaeth Gofal Iechyd Cymru a Llywodraeth Cymru wedi dod at ei gilydd i gytuno ar brotocol lle y gellid mynd ati’n briodol i lywio ymyrraeth ym materion unrhyw fwrdd iechyd lleol. Yr hyn a welsom o’n profiad blaenorol oedd hyn: er bod pob un o’r gwahanol ysgogiadau ar gael, nid oedd digon o sicrwydd ynghylch pa bŵer oedd gan ba sefydliad a sut y byddai pŵer o’r fath yn cael ei ddefnyddio. Felly, mae protocol wedi cael ei lunio. Rhan o’r protocol yw bod y tri sefydliad yn cyfarfod â’i gilydd ddwywaith y flwyddyn i adolygu statws pob bwrdd iechyd yng Nghymru. Byddai modd trefnu cyfarfodydd pellach rhwng y cyfarfodydd hynny. Roedd y cyfarfod a gynhaliwyd ddydd Gwener diwethaf yn gyfarfod o fewn y protocol. Edrychodd ar y sefyllfa bresennol o ran ymyrryd yn Betsi Cadwaladr a gwnaeth argymhelliad y mae Llywodraeth Cymru wedi cytuno arno.
 
13:45
Kirsty WilliamsBywgraffiadBiography
In going forward, Minister, you have set out plans for escalation and de-escalation, following performance at Betsi Cadwaladr, and those plans will be discussed. Is it your intention to make those plans that will either necessitate escalation to special measures or de-escalation, public?
Wrth symud ymlaen, Weinidog, rydych wedi nodi cynlluniau ar gyfer trosglwyddo i lefel uwch a throsglwyddo o lefel uwch yn dilyn perfformiad yn Betsi Cadwaladr a bydd y cynlluniau hynny’n cael eu trafod. Ai eich bwriad yw cyhoeddi’r cynlluniau hynny a fydd naill ai’n golygu bod angen trosglwyddo i fesurau arbennig neu drosglwyddo o lefel uwch?
 
13:46
Mark DrakefordBywgraffiadBiography
Kirsty Williams makes an important point about the protocol, that it involves steps to de-escalate as well as to put people up the level of escalation. I might, Dirprwy Lywydd, correct an impression that was given on the floor yesterday that Betsi Cadwaladr is now at the extreme end of the escalation framework—it is not; it is at the third stage. There are four stages altogether. As we work with the health board and as we provide it with the extra assistance that we think that it needs in order to address three particular issues that were of concern to Health Inspectorate Wales, the Wales Audit Office and ourselves, I am sure that we will be happy to make that information available.
Mae Kirsty Williams yn gwneud pwynt pwysig am y protocol, ei fod yn cynnwys camau i drosglwyddo o lefel uwch yn ogystal ag i lefel uwch. Ddirprwy Lywydd, carwn gywiro’r argraff a roddwyd ar y llawr ddoe fod Betsi Cadwaladr bellach ar ben eithaf y fframwaith trosglwyddo i lefel uwch—nid yw hynny’n wir; mae ar y trydydd cam. Mae pedwar cam i gyd. Wrth i ni weithio gyda’r bwrdd iechyd a darparu’r cymorth ychwanegol y credwn sydd ei angen arno i fynd i’r afael â thri mater penodol a oedd yn peri pryder i Arolygiaeth Iechyd Cymru, Swyddfa Archwilio Cymru a ni ein hunain, rwy’n sicr y byddwn yn hapus i ddarparu’r wybodaeth honno.
 
13:46
Kirsty WilliamsBywgraffiadBiography
Minister, I am sure that you would agree that Betsi Cadwaladr university health board is facing severe challenges in managing its waiting times for diagnostic tests and also its referral-to-treatment times. What will the targeted intervention that your Government is now stating it intends to carry out look like for patients and staff in that region?
Weinidog, rwy’n siŵr y byddech yn cytuno bod bwrdd iechyd prifysgol Betsi Cadwaladr yn wynebu heriau difrifol wrth reoli ei amserau aros ar gyfer profion diagnostig a hefyd ei amseroedd aros rhwng atgyfeirio a thriniaeth. Pa ffurf fydd ar yr ymyrraeth wedi’i thargedu y mae eich Llywodraeth yn awr yn datgan ei bod yn bwriadu ei chyflawni o safbwynt cleifion a staff yn y rhanbarth?
 
13:47
Mark DrakefordBywgraffiadBiography
Again, Dirprwy Lywydd, I could maybe put on record the three particular issues that the enhanced level of intervention will address. It will address the budgetary-control issues at that health board. I have been very taken aback by the health board’s sudden increase in its estimate of its need to spend money in this financial year. It is not acceptable to me that it should suddenly tell me that it needs nearly £35 million more than it had told me originally that it would need in a single month. That will be part of the intervention. It is not acceptable to me that capital controls over some of its major projects have been found to be wanting and we will be give it extra assistance to make sure that it is properly able to manage major sums of investment that the Welsh Government is providing to it. The third aspect of intervention is not on waiting times, as was implied here yesterday, but in the field of mental health. Members here will have read about some of the issues that Betsi Cadwaladr faces in providing proper mental health services and the longer history of dispute between clinicians across that board as to the best way in which mental health services are to be provided. Those are the three things that extra intervention will focus on and those are the three things that we will work on to make sure that the local population gets the service that it requires.
Unwaith eto, Ddirprwy Lywydd, efallai y caf i gofnodi tri mater penodol y bydd y lefel uwch o ymyrraeth yn mynd i’r afael â hwy. Bydd yn mynd i’r afael â’r materion rheoli cyllideb yn y bwrdd iechyd. Rwyf wedi cael fy synnu gan y cynnydd sydyn yn amcangyfrif y bwrdd iechyd o’i anghenion gwario arian yn y flwyddyn ariannol hon. Nid yw’n dderbyniol i mi ei fod yn dweud wrthyf yn sydyn bod angen bron i £35 miliwn yn fwy nag y dywedodd yn wreiddiol y byddai ei angen mewn un mis. Bydd hynny’n rhan o’r ymyrraeth. Nid yw’n dderbyniol i mi fod rheolaethau cyfalaf dros rai o’i brosiectau mawr i’w gweld yn ddiffygiol a byddwn yn rhoi cymorth ychwanegol i wneud yn siŵr ei fod yn gwbl abl i reoli symiau mawr o fuddsoddiad y mae Llywodraeth Cymru yn eu darparu ar ei gyfer. Nid ymwneud ag amseroedd aros y mae’r drydedd agwedd ar ymyrraeth fel yr awgrymwyd yma ddoe, ond â maes iechyd meddwl. Bydd Aelodau yma wedi darllen am rai o’r materion y mae Betsi Cadwaladr yn eu hwynebu wrth ddarparu gwasanaethau iechyd meddwl priodol a’r hanes hir o anghydfod rhwng clinigwyr ar draws y bwrdd o ran y ffordd orau o ddarparu gwasanaethau iechyd meddwl. Dyna’r tri pheth y bydd ymyrraeth ychwanegol yn canolbwyntio arnynt a dyna’r tri pheth y byddwn yn gweithio arnynt i wneud yn siŵr fod y boblogaeth leol yn cael y gwasanaeth sydd ei angen arni.
 
13:48
Weinidog, fe fyddwch chi’n gwybod bod yr amserau aros ar gyfer MRI ‘scans’ lawer yn hirach yng Nghymru nag ydynt yn Lloegr a’r Alban. Bythefnos yn ôl yn y Siambr yma, fe geisiodd y Prif Weinidog esbonio hynny drwy ddweud fod yna gynnydd mewn galw. Mae eich ystadegau chi’n dangos bod cynnydd o 33% mewn galw yng Nghymru, ond bod cynnydd o 40% mewn galw yn Lloegr a chynnydd o 60% mewn galw dros y flwyddyn ddiwethaf yn yr Alban. Nid cynnydd mewn galw felly sy’n esbonio’r gwahaniaeth yn yr amserau hir yma yn yr ystadegau. Beth felly, yn eich barn chi, sy’n esbonio’r gwahaniaeth rhwng yr amser hir o ddisgwyl am MRI ‘scans’ yng Nghymru o’i gymharu â Lloegr a’r Alban?
Minister, you will know that the waiting times for MRI scans are much longer in Wales than they are in England and Scotland. A fortnight ago in this Chamber, the First Minister tried to explain that by saying that there was an increase in demand. Your statistics show that there is an increase of 33% in the demand in Wales, but an increase of 40% in demand in England and an increase of 60% in demand over the past year in Scotland. It is not an increase in demand, therefore, that explains that difference in these waiting times in the statistics. So, what, in your opinion, is the explanation for the difference in the waiting times for MRI scans in Wales as compared to England and Scotland?
 
13:49
Mark DrakefordBywgraffiadBiography
I believe that there are three things that we have to do in order to tackle the position that Elin Jones has outlined. I do think that it is right that we look at demand as well as supply. There is no doubt that MRI scans are sometimes used for purposes that give very little clinical benefit. There is some very good advice emerging now from royal colleges, not just in this country, but elsewhere as well, that make it clear that inappropriate use of MRI scans actually causes more harm than it provides benefit to patients. It is right that we are confident that MRI scans are used only in circumstances where the gain is likely to be greater to the patient than any potential disbenefit. So, there is work to be done there.
Credaf fod tri pheth y mae’n rhaid i ni ei wneud er mwyn mynd i’r afael â’r sefyllfa y mae Elin Jones wedi’i hamlinellu. Rwy’n credu ei bod hi’n iawn i ni edrych ar y galw yn ogystal â’r cyflenwad. Nid oes amheuaeth bod sganiau MRI yn cael eu defnyddio weithiau at ddibenion nad ydynt yn cynnig fawr o fudd clinigol. Mae rhywfaint o gyngor da iawn yn dod i’r amlwg yn awr o’r colegau brenhinol, nid yn y wlad hon yn unig ond mewn mannau eraill hefyd, sy’n ei gwneud yn glir bod defnydd amhriodol o sganiau MRI mewn gwirionedd yn achosi mwy o ddrwg nag o fudd i gleifion. Mae’n iawn i ni allu bod yn hyderus na chaiff sganiau MRI eu defnyddio heblaw mewn amgylchiadau lle mae’r budd yn debygol o fod yn fwy i’r claf nag unrhyw anfantais bosibl. Felly, mae gwaith i’w wneud yno.
 
We need to look at the pattern of use of MRI scanners that we currently have in the Welsh NHS. I have seen the preliminary results of a piece of work mapping where every MRI scanner is in Wales, the hours that it is open, and the number of patients that it sees within those opening hours. You could make a plausible argument to say that we could be doing an awful lot more with the capacity that we already have, if that capacity was better organised. Therefore, the second strand is to make better use of what we already have. Then, there is a third strand, which is that some MRI scanners are reaching the latter part of their usable life; they will need replacement. The Welsh Government, through the Minister for finance, has made money available for that purpose and we will look selectively to invest in new diagnostic equipment where we are confident that that will provide a quicker and better service for patients.
Mae angen i ni edrych ar batrwm y defnydd o sganwyr MRI ar hyn o bryd yn y GIG yng Nghymru. Rwyf wedi gweld canlyniadau rhagarweiniol gwaith sy’n mapio ble mae pob sganiwr MRI yng Nghymru, yr oriau y mae ar agor, a nifer y cleifion y mae’n eu gweld yn ystod yr oriau agor. Gallech gynnig dadl deg i ddweud y gallem fod yn gwneud llawer iawn mwy gyda’r capasiti sydd gennym yn barod, pe bai’r capasiti hwnnw wedi’i drefnu’n well. Felly, yr ail elfen yw gwneud gwell defnydd o’r hyn sydd gennym yn barod. Yna, ceir trydedd elfen, sef bod rhai sganwyr MRI yn cyrraedd pen draw eu hoes ddefnyddiol; mae angen rhai newydd yn eu lle. Mae Llywodraeth Cymru, drwy gyfrwng y Gweinidog cyllid, wedi sicrhau bod arian ar gael at y diben hwnnw a byddwn yn ystyried opsiynau ar gyfer buddsoddi mewn offer diagnostig newydd lle rydym yn hyderus y bydd hynny’n darparu gwasanaeth cyflymach a gwell i gleifion.
 
13:51
Weinidog, yn ogystal ag MRI ‘scans’, mae’r amserau aros am CT ‘scans’ hefyd yn hirach yng Nghymru nag yn Lloegr a’r Alban. Mae’n fis hybu ymwybyddiaeth o ganser y pancreas, ac mae ‘access’ brys i CT ‘scan’ yn hollbwysig i ddiagnosis o ganser y pancreas. Mae Llywodraeth yr Alban wedi cyflwyno cynllun: os yw GP yn amau bod canser y pancreas ar unigolyn, mae llwybr brys uniongyrchol i CT ‘scan’ yn deillio allan o hynny. A ydych chi’n barod i edrych ar y model yn yr Alban er mwyn sicrhau ‘access’ brys i CT ‘scan’?
Minister, in addition to MRI scans, the waiting times for CT scans are also longer in Wales than in England and Scotland. It is pancreatic cancer awareness month, and urgent access to a CT scan is crucially important for the diagnosis of pancreatic cancer. The Scottish Government has introduced a scheme whereby, if a GP suspects that an individual has pancreatic cancer, an urgent direct route to a CT scan comes from that. Are you willing to look at the model in Scotland to ensure urgent access to CT scans?
 
13:51
Mark DrakefordBywgraffiadBiography
Wrth gwrs, mae hynny’n ddiddorol ac rwy’n hollol hapus i edrych mewn i beth maen nhw’n ei wneud yn yr Alban. Os ydym ni’n gallu dysgu gwersi o’r hyn maen nhw’n ei wneud yno a fydd yn ein helpu ni i’w wneud yn well yma yng Nghymru, wrth gwrs rwy’n fodlon edrych mewn i’r hyn mae’r Aelod wedi ei ddweud. Yn gyffredinol, wrth gwrs, yn y ‘pathway’ sydd gyda ni o 31 a 62 diwrnod, mae ‘diagnostics’ wedi eu cynnwys fel rhan o’r ‘pathway’ hwnnw. Rydym yn gwybod ein bod yn gwneud lot yn well yng Nghymru nag y maen nhw’n ei wneud yn Lloegr.
Of course, that is interesting and I am very happy to look at what they are doing in Scotland. However, if we can learn lessons from what they are doing there that will help us to do better here in Wales, of course I would be more than happy to look into the issues raised by the Member. Generally speaking, of course, in the pathway that we have of 31 and 62 days, diagnostics are included as part of that pathway. We know that we are doing far better in Wales than they are doing in England.
 
13:52
Fe glywodd nifer ohonom ni a oedd yn y digwyddiad hybu ymwybyddiaeth o ganser y pancreas, yma yn y Cynulliad amser cinio, fod 5% o farwolaethau Cymru o ganser ‘nawr yn farwolaethau o ganser y pancreas. A gaf ofyn i chi felly gadarnhau eich bod chi, fel Llywodraeth, yn edrych i greu ‘pathway’ clir sydd ag adnoddau digonol o gwmpas diagnosis, yn deillio o ymwybyddiaeth GPs, ac hefyd ar gyfer y systemau cefnogi sydd yno ar gyfer tri