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Morgan: Improving cancer care in Wales

Speech to the National Assembly for Wales.

"I join my colleagues in thanking those who contributed to this review, most notably our professors, our expert reference group and those who provided a huge wealth of evidence.

I am delighted with the outcome of the review, and I thank Members for accepting the recommendation that I made to them that we undertake a review into cancer services, although the committee did not need much convincing that this was an important piece of work for us to do. It was our final policy review as the Health and Social Services Committee, and it is probably one of the most important reviews undertaken in this Assembly.

It was also perhaps one of the most challenging reviews because, as the Chair of the committee has said, the range of issues that we could have discussed and examined was enormous. The review could have been longer and it certainly could have been broader in terms of the issues dealt with, but we were fairly strict in examining certain areas of concern.

This report not only makes interesting reading, but makes a valuable contribution in pointing the direction in which the third Assembly could go in developing services, the way those services are planned, where they are delivered, the types of research and professional support that we have and how we provide for palliative care at the crucial time for cancer sufferers.

The report points to several glaring omissions, one of which is that there are key shortfalls in the basic provision of cancer services in Wales, particularly in some treatments, radiotherapy, chemotherapy, and surgery.

We must ensure that the next Assembly Government begins to get the basics right. We must look at more innovative forms of treatment and provide and pay for all of those wonderful new developments that will be created in generations to come, but we must also ensure that we get the basics right, because if we cannot do that, we are in trouble.

The planning and delivery of services was a major concern and the range of evidence that was brought to us by experts and by groups suggested that the planning of services was at best patchy. Recommendation 4 of the report, which looks at the need for clarity and transparency in commissioning, is of fundamental importance, particularly given the confusion around what is provided and commissioned by local health boards on the one hand, and by Health Commission Wales on the other.

For example, local health boards are responsible for commissioning adult cancer services, but Health Commission Wales is responsible for commissioning children's cancer services. There is real confusion not only among patients, but among clinicians and those who work in the health sector, as to who is responsible for commissioning what and where services are best provided.

There is a need for us to provide clarity as to the role of cancer networks. Many of the clinicians whom we spoke to were unclear about what the cancer networks were there to achieve, and we need to ensure clarity in future. If there is just one example—and this has been raised by others this afternoon—of where planning of services and, in particular, of treatment and drugs is important, it is brachytherapy.

The decisions over that and the confusion over whether or not it could be provided for highlighted the real stupidity that we have seen in Wales in the planning of treatment and drugs. This needs to be tackled quickly and, in future, we need to ensure that the horizon scanning that is done by Health Commission Wales and by LHBs in planning for new treatments and drugs is much more strict and provides for patient treatment and care.

We have many excellent professionals working in Wales. I pay particular tribute to those who work at Velindre Hospital. We recently celebrated its fiftieth anniversary at a wonderful service at Llandaff cathedral in Cardiff and it was an amazing testament to the dedication and hard work of all those who work in cancer services.

For those who work in the palliative care sector, there can be no greater need than for the Assembly to start treating them not just as charity workers but as partners in the delivery of services. Those people are not just good at raising money, but experts at providing palliative care services. Unless we start treating them in that way, and invest in the infrastructure in our communities, we will never provide for those who wish to die at home and not in a hospice. We know that for many people, who are, sadly, at the end of their life, that choice is important both for them and their families.

There are huge issues here for the next Assembly to address, because the people of Wales deserve a better service than they are getting now."

"Ymunaf â'm cyd-Aelodau i ddiolch i'r rhai a gyfrannodd at yr adolygiad hwn, yn bennaf ein hathrawon, ein grwp cyfeirio arbenigol a'r rhai a roddodd lawer iawn o dystiolaeth. Yr wyf yn fodlon iawn ar ganlyniad yr adroddiad, a diolchaf i'r Aelodau am dderbyn yr argymhelliad a gynigiais iddynt sef ein bod yn cynnal adolygiad o wasanaethau canser, er nad oedd angen gwneud llawer i argyhoeddi'r pwyllgor bod hwn yn waith pwysig inni ei wneud. Dyna ein hadolygiad olaf o bolisi fel y Pwyllgor Iechyd a Gwasanaethau Cymdeithasol, ac mae'n debyg ei fod yn un o'r adolygiadau pwysicaf a gyflawnwyd yn y Cynulliad hwn.

Efallai, hefyd, ei fod yn un o'r adolygiadau mwyaf heriol oherwydd, fel y dywedodd Cadeirydd y pwyllgor, yr oedd yr amrywiaeth o faterion y gallem fod wedi'u trafod a'u harchwilio yn enfawr. Gallai'r adolygiad fod wedi bod yn hwy ac, yn sicr, gallai fod wedi bod yn ehangach o ran y materion yr ymdriniodd â hwy, ond yr oeddem yn eithaf llym wrth archwilio meysydd penodol a oedd yn peri pryder.

Nid yn unig y mae'r adroddiad yn ddiddorol, ond gwna gyfraniad gwerthfawr i nodi'r cyfeiriad y gallai'r trydydd Cynulliad fynd iddo wrth ddatblygu gwasanaethau, y ffordd y caiff y gwasanaethau hynny eu cynllunio, lle y cânt eu darparu, y mathau o ymchwil a chymorth proffesiynol sydd gennym a sut y darparwn ofal lliniarol ar yr adeg allweddol i'r rhai sy'n dioddef o ganser.

Mae'r adroddiad yn nodi sawl bwlch amlwg. Un o'r rhain yw bod diffygion allweddol yn y ddarpariaeth sylfaenol o wasanaethau canser yng Nghymru, yn arbennig mewn rhai mathau o driniaethau, radiotherapi, cemotherapi, a llawdriniaeth. Rhaid inni sicrhau bod y Llywodraeth Cynulliad nesaf yn dechrau cael yr hanfodion yn gywir.

Rhaid inni ystyried mathau mwy arloesol o driniaeth a darparu'r holl ddatblygiadau gwych newydd hynny a gaiff eu creu mewn cenedlaethau i ddod a thalu amdanynt, ond rhaid inni sicrhau hefyd ein bod yn cael yr hanfodion yn gywir, oherwydd os na allwn wneud hynny, yr ydym mewn trafferth.

Yr oedd y broses o gynllunio a darparu gwasanaethau yn peri pryder mawr ac awgrymodd yr amrywiaeth o dystiolaeth a gyflwynwyd inni gan arbenigwyr a grwpiau fod y gwaith o gynllunio gwasanaethau yn anghyson ar y gorau. Mae argymhelliad 4 o'r adroddiad, sy'n ystyried yr angen i sicrhau gwaith comisiynu clir a thryloyw, yn hollbwysig, yn arbennig o gofio'r dryswch o ran yr hyn a ddarperir ac a gomisiynir gan fyrddau iechyd lleol ar yr un llaw, a chan Gomisiwn Iechyd Cymru ar y llaw arall.

Er enghraifft, byrddau iechyd lleol sy'n gyfrifol am gomisiynu gwasanaethau canser i oedolion, ond Comisiwn Iechyd Cymru sy'n gyfrifol am gomisiynu gwasanaethau canser i blant. Mae dryswch gwirioneddol nid yn unig ymhlith cleifion, ond ymhlith clinigwyr a'r rhai sy'n gweithio yn y sector iechyd, o ran pwy sy'n gyfrifol am gomisiynu beth a'r lle gorau i ddarparu gwasanaethau.

Mae angen inni egluro rôl y rhwydweithiau canser. Nid oedd llawer o'r clinigwyr y gwnaethom siarad â hwy yn deall beth oedd nod y rhwydweithiau canser, ac mae angen inni egluro hynny yn y dyfodol. Un enghraifft—a chodwyd hyn gan eraill y prynhawn yma—lle y mae'r gwaith o gynllunio gwasanaethau ac, yn benodol, driniaeth a chyffuriau yn bwysig, yw brachytherapi. Amlygodd y penderfyniadau ynghylch hynny a'r dryswch ynghylch a ellid ei ddarparu ai peidio y gwiriondeb gwirioneddol a welsom yng Nghymru ym maes cynllunio triniaeth a chyffuriau.

Mae angen mynd i'r afael â hyn yn gyflym ac, yn y dyfodol, mae angen inni sicrhau bod y gwaith chwilio'r gorwelion a wneir gan Gomisiwn Iechyd Cymru a chan fyrddau iechyd lleol i gynllunio triniaethau a chyffuriau newydd yn llawer mwy llym ac yn darparu ar gyfer triniaeth a gofal cleifion.

Mae llawer o weithwyr proffesiynol ardderchog yn gweithio yng Nghymru. Talaf deyrnged arbennig i'r rhai sy'n gweithio yn Ysbyty Felindre. Dathlwyd ei hanner canmlwyddiant yn ddiweddar mewn gwasanaeth hyfryd yn eglwys gadeiriol Llandaf yng Nghaerdydd ac yr oedd yn dyst anhygoel i ymroddiad a gwaith caled pawb sy'n gweithio ym maes gwasanaethau canser. I'r rhai sy'n gweithio yn y sector gofal lliniarol, ni all fod angen mwy nag i'r Cynulliad ddechrau eu trin nid dim ond fel gweithwyr elusen ond fel partneriaid wrth ddarparu gwasanaethau.

Nid dim ond codi arian y gall y bobl hyn ei wneud, ond maent hefyd yn arbenigo mewn darparu gwasanaethau gofal lliniarol. Oni ddechreuwn eu trin yn y ffordd hon, a buddsoddi yn y seilwaith yn ein cymunedau, ni fyddwn byth yn darparu ar gyfer y rhai sydd am farw gartref yn hytrach nag mewn hosbis. Gwyddom fod y dewis hwnnw i lawer o bobl sydd, yn anffodus, ar ddiwedd eu hoes, yn bwysig iddynt hwy ac i'w teuluoedd.

Mae materion enfawr yma y bydd angen i'r Cynulliad nesaf ymdrin â hwy, am fod pobl Cymru yn haeddu gwasanaeth gwell nag a gânt ar hyn o bryd."

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