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Morgan: Answers essential over knee operation concerns

Speech to the National Assembly for Wales.

"I start by welcoming the fact that the Minister has made a statement to the Assembly this afternoon, since I submitted an urgent question on this yesterday.

I would like to raise a number of points with the Minister, of which he may or may not be aware, because the detail, or, rather, lack of detail, in his statement, is worrying.

I do not know whether he is aware of what I am about to tell him and has chosen not to mention it, but there are a large number of concerns that I will now raise with him, as I have made my own inquiries in the past few hours to ascertain the background to this problem and what did, in fact, occur.

I understand, Minister, that surgeons in south Wales, who otherwise would have operated on those patients, were not told that their patients had been removed from their list and only found out when their patients presented with complications as a result of being operated on in Weston.

In many cases, the procedures recommended by the south Wales surgeons were not even followed in Weston, and many patients received procedures that had not been determined by their surgeons in south Wales.

The knee replacement that is on offer in Weston, is, I understand, called a Kinemax. It is not on offer in south Wales, because here only two particular replacements are used: one is called a PFC Sigma, and the other a NexGen.

I understand from surgeons in south Wales that they do not have the equipment to correct problems that arise from a patient's having been given a Kinemax knee replacement. Furthermore, many south Wales surgeons have had to perform additional replacements since those complications have arisen.

I also understand that the surgeons operating in Weston were not specialist knee surgeons, but general orthopaedic surgeons. Looking at the 384 people who were referred to Weston for knee surgery, how many of those received a Kinemax knee replacement and how many of those have now had corrective surgery as a result?

How many have had additional knee replacements by south Wales surgeons in order to remove the defective knee replacements that had been put in by the Swedish surgeons who were operating in Weston?

Why were the south Wales surgeons unaware of the fact that patients had been removed from their lists? That needs careful examination, if the second-offer scheme is to gain people's confidence for the future.

Surgeons who have been working closely with their patients, who have then found that those patients have been removed from their lists, need to have confidence in the system. Patients ought to be aware of the fact that their surgeons did not know that they had been removed from the list. That should form part of your inquiries.

Why were many of the procedures that were recommended by the south Wales surgeons not undertaken by the surgeons in Weston? It makes sense to me that if a surgeon in south Wales has determined that a patient should follow a particular procedure, then that is the procedure that should be followed in surgery.

I have been told that what was being done in Weston, in many cases, was different from what had been determined by surgeons in south Wales. The surgeons who had been flown in from Sweden were, according to the Weston Area Health NHS Trust, there to undertake a specific project. Was the second-offer scheme that specific project?

Were they flown in specifically to treat Welsh patients who had been sent there under the second-offer scheme? If so, what checks had been done as to the level of competence of those surgeons before Welsh patients were treated? Minister, in light of the fact that the patients who were treated in Weston were not operated on by specialist knee surgeons, why did the second-offer scheme allow patients to be treated by general orthopaedic surgeons?

If they had been treated locally, the chances are that that operation would have been undertaken by a specialist knee surgeon.

Finally, Minister, I hope that you can allay my fears that the Assembly Government has put the welfare and treatment of patients at risk by using a cheap quick-fix in order to respond to political pressure to bring down waiting lists.

There have been too many complications arising out of the treatment that these people have received across the border. It is time that the Government gave them some straight answers."

"Dechreuaf drwy groesawu'r ffaith bod y Gweinidog wedi gwneud datganiad i'r Cynulliad y prynhawn yma, ers imi gyflwyno cwestiwn brys ar hyn ddoe.

Hoffwn godi nifer o bwyntiau gyda'r Gweinidog, y gallai fod yn ymwybodol ohonynt, ond efallai nad yw, am fod y manylion, neu'r diffyg manylion, yn ei ddatganiad yn peri pryder. Ni wn a yw'n ymwybodol o'r hyn yr wyf ar fin ei ddweud wrtho a'i fod wedi dewis peidio â sôn amdano, ond mae nifer fawr o bryderon y byddaf yn eu rhoi ger ei fron yn awr, gan fy mod wedi gwneud fy ymholiadau fy hun yn ystod yr ychydig oriau diwethaf i gael y cefndir i'r broblem hon, a'r hyn a ddigwyddodd mewn gwirionedd.

Deallaf, Weinidog, na chafodd llawfeddygon yn y de, a fyddai fel arall wedi cynnal llawdriniaeth ar y cleifion hynny, eu hysbysu o'r ffaith bod eu cleifion wedi cael eu tynnu oddi ar eu rhestr a dim ond pan oedd cleifion yn wynebu cymhlethdodau o ganlyniad i gael eu trin yn Weston y daethant yn ymwybodol o hyn.

Mewn nifer o achosion, ni chafodd y gweithdrefnau a gafodd eu hargymell gan lawfeddygon y de eu dilyn yn Weston, hyd yn oed, a chafodd llawer o gleifion eu trin mewn modd nad oedd eu llawfeddygon yn y de wedi penderfynu arno.

Deallaf mai'r brand a gynigir ar gyfer y weithdrefn lawfeddygol i osod pen-glin newydd yn Weston yw Kinemax. Ni chaiff ei gynnig yn y de, am mai dim ond dau frand a ddefnyddir: PRC Sigma yw un, a'r llall yw NexGen.

Yr wyf ar ddeall gan lawfeddygon yn y de nad oes ganddynt y cyfarpar i unioni problemau sy'n deillio o ddefnyddio Kinemax i osod pen-glin newydd. Ar ben hynny, mae llawer o lawfeddygon yn y de wedi gorfod cynnal llawdriniaethau ychwanegol i osod pen-glin newydd ers i'r cymhlethdodau hynny godi.

Deallaf hefyd nad oedd y llawfeddygon yn Weston yn llawfeddygon pen-glin arbenigol, ond yn llawfeddygon orthopedig cyffredinol. Gan ystyried y 384 o bobl a atgyfeiriwyd i Weston i gael llawdriniaeth ar eu pen-glin, faint ohonynt a gafodd Kinemax a faint o'r rheini sydd bellach wedi cael llawdriniaeth gywirol o ganlyniad i hynny?

Faint sydd wedi cael llawdriniaeth ychwanegol gan lawfeddygon y de i osod pen-glin newydd yn lle'r rhai diffygiol a osodwyd gan y llawfeddygon o Sweden a oedd yn cynnal llawdriniaethau yn Weston?

Pam nad oedd llawfeddygon y de yn ymwybodol o'r ffaith bod cleifion wedi cael eu tynnu oddi ar eu rhestrau? Rhaid archwilio hynny'n ofalus, os yw cynllun yr ail gynnig yn mynd i adennill hyder pobl ar gyfer y dyfodol.

Rhaid i lawfeddygon sydd wedi bod yn gweithio'n agos gyda'u cleifion, ac sydd yna wedi canfod bod y cleifion hynny wedi cael eu tynnu oddi ar eu rhestrau, gael hyder yn y system.

Dylai cleifion fod yn ymwybodol o'r ffaith na wyddai eu llawfeddygon eu bod wedi cael eu tynnu oddi ar y rhestr. Dylai hynny fod yn rhan o'ch ymholiadau.

Pam na chynhaliwyd llawer o'r gweithdrefnau a gafodd eu hargymell gan lawfeddygon y de gan y llawfeddygon yn Weston? Mae'n gwneud synnwyr imi os yw llawfeddyg yn y de wedi penderfynu y dylai claf ddilyn gweithdrefn lawfeddygol benodol, y dylai'r weithdrefn lawfeddygol honno gael ei dilyn yn ystod y llawdriniaeth.

Yr wyf wedi cael fy hysbysu bod yr hyn a oedd yn cael ei wneud yn Weston, mewn nifer o achosion, yn wahanol i'r hyn a benderfynwyd gan lawfeddygon yn y de. Yn ôl Ymddiriedolaeth Iechyd GIG Ardal Weston, yno i ymgymryd â phrosiect penodol oedd y llawfeddygon o Sweden. Ai cynllun yr ail gynnig oedd y prosiect penodol hwnnw?

A gawsant eu defnyddio'n benodol i drin cleifion o Gymru a oedd wedi cael eu hanfon yno o dan gynllun yr ail gynnig? Os felly, pa archwiliadau a gynhaliwyd o ran lefel cymhwysedd y llawfeddygon hynny cyn i gleifion Cymru gael eu trin?

Weinidog, yn sgîl y ffaith na chafodd y cleifion a gafodd eu trin yn Weston eu trin gan lawfeddygon pen-glin arbenigol, pam y caniataodd cynllun yr ail gynnig i gleifion gael eu trin gan lawfeddygon orthopedig cyffredinol? Pe baent wedi cael eu trin yn lleol, mae'n bur debyg y byddai'r llawdriniaeth wedi cael ei chynnal gan lawfeddyg pen-glin arbenigol.

Yn olaf, Weinidog, gobeithio y gallwch leddfu fy mhryderon bod Llywodraeth y Cynulliad wedi rhoi lles a thriniaeth cleifion yn y fantol wrth ddefnyddio dull cyflym a rhad er mwyn ymateb i bwysau gwleidyddol i leihau'r rhestrau aros. Mae gormod o gymhlethdodau wedi codi o'r driniaeth a gafodd y bobl hyn dros y ffin. Mae'n bryd i'r Llywodraeth roi atebion gonest iddynt."

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