Thank you, acting Presiding Officer. If men suffered from prostate in the way women suffer from endometriosis, we would not have waited this long to get this profoundly debilitating and invasive condition recognised and addressed. Now women have stopped suffering in silence, considerably more attention has been paid to endometriosis.

There are now three 'endowalls' in Cardiff. I'm unable to show you the one created by Jaimee Rae McCormack in Cathays, which was the first, but I invite you to go to my website to see that and other pictures of the EndoMarch by women and their families in Cardiff on the last Saturday in March last year, which helped educate the general public about what endo does to women. These public awareness campaigns are needed, because half the country has never even heard of endometriosis, even though it is more common in women than asthma or diabetes.

This debate is timely, because it is while we are scrutinising the new curriculum Bill. Listen to one girl's experience: 'When I was 13, I fainted in school from horrendous stomach pains. I was taken to A&E where they did blood tests and ultrasound. A doctor told me that everything looked fine on the scans so it was nothing to do with gynae. This happened regularly for four years. I would be rushed to A&E with the same pain, would get told it was nothing and I just needed to learn to deal with period pain.'

One morning it was so bad her mother took her to the GP and from there they did get a referral to a gynaecologist, and they finally, five years after that story started, got that diagnosis. There are thousands more people like this young woman, unaware that it is not normal to have constant pain in your lower abdomen, pain when you go to the toilet or have sex. 

So listen up, members of the Children, Young People and Education Committee scrutinising the curriculum Bill: menstrual well-being education must become an integral part of young people's journey to become healthy and active informed citizens. Girls and young women, boys and young men too, need to know what a normal period is, and, if it's not normal, where they can get help. The school nurse, the teacher, the attendance officer all need to know this too, as well as the GP and the gynaecologist.

This is not a new condition, nor is it particular to Wales, but it is unacceptable that it takes eight GP appointments to get referred to a specialist. It is unsatisfactory that some gynaecologists miss endometriosis simply because it does not show up on ultrasound.

Debbie Shaffer, a founder member of Fair Treatment for the Women of Wales, spent 26 years trying to get an accurate diagnosis, at which point specialist care was beyond her reach. Their research revealed that most GPs and local gynaecologists are not even aware that specialist centres for treating endo even exist.

The Welsh Government has grasped the nettle. In 2017, a task and finish group was set up involving all stakeholders, and its thorough report was delivered to Welsh Government in April 2018. In line with National Institute for Health and Care Excellence guidance, Welsh Government is providing funds for all local health boards to have at least one endometriosis specialist nurse, and one of their first tasks must be to provide endo awareness training for GPs. This is all good stuff, but at least one third of women with endo need complex surgery that only specialists can provide. As with most conditions, the longer they wait, the more difficult and expensive it is to treat. 

South Wales has the one and only Welsh endometriosis centre, in Cardiff. North Wales women are referred to Arrowe Park in Birkenhead. The Cardiff team has three brilliant consultant gynaecologists and Wales's only endo specialist nurse for the last several years, and is widely recognised as a centre of excellence. Gynaecologists come from across the UK to acquire the skills to run these specialist centres, which are now springing up across England, but not in Wales. In England, the money follows the patients. Tariffs per patient range from £5,500 to £12,000. In Wales, health boards still operate a historic one in, one out local agreement, which is absurd for operations that last six to nine hours. Last year, four in 10 of the Cardiff patients were from outside Cardiff and Vale University Health Board. In England, that would have generated between £300,000 and £600,000 to pay for complex, minimal access pelvic surgery. Instead, the tab was picked up by Cardiff and Vale health board. This is financially unsustainable. It's impossible to expand the service to meet the huge unmet demand unless it's funded differently.

And we have to guarantee dedicated theatre time to the three existing endo consultants. Being on the Heath hospital site, they are constantly losing their precious theatre slots so medical emergencies can be dealt with. And COVID has aggravated the very long waiting lists already well beyond the 36-week referral-to-treatment target. To tackle this, the task and finish group recommended the immediate establishment of a virtual south Wales endometriosis centre, across Newport, Swansea, Bridgend and Cardiff. That's over two years ago. To support this, the Cardiff endo consultants are keen to do theatre sessions at the Royal Glamorgan Hospital and elsewhere to increase the number of people with their complex surgical skills. At least three more specialist endo-gynaecologists are needed for a tertiary service that does not need to be on the Heath site.

These are complex issues, difficult to resolve in the middle of a pandemic. But to honour all the grass-roots campaigners who have raised the profile of endometriosis in Wales, we must ensure that all women in Wales who need it have access to an endo specialist centre.