I'm very pleased to be able to take part in this debate and indeed support all parts of the motion. Can I start by commending Jenny Rathbone in setting the scene and explaining the issue in the full detail that this complex matter merits?

As has been mentioned, endometriosis is a condition where the lining of the endometrium—the lining of the womb—parts of it start to grow outside of the womb. We don't quite know why actually, but it starts to grow in other places, like the ovaries, fallopian tubes, bowel, bladder and other parts of the pelvis. And its effects can be devastating—surprisingly common, as we've heard, but the effects in some women can be devastating in terms of chronic, debilitating, severe pain.

Now, we all get pain from time to time, and when you're in the middle of a painful episode of whatever, we are usually reassured by the knowledge that it's not going to last that long, be it joint pain, toothache or whatever. It is a totally new level of debilitation to suffer from pain that is so severe that you cannot see a way out of it because it tends to go on for months, weeks, years. 

There's a relationship to the time of the month, in that it tends to be worse at the time of the period, but not always so. That's why there is a challenge to making the diagnosis in the first place, and it's not always period-related symptoms either. Yes, there's a chronic severe pain, but you can also have symptoms like constipation and diarrhoea when the endometriosis particularly involves the bowel. All of this can produce a huge impact on the woman's life and on the lives of people all around her, as we've heard: on relationships, on the ability to have a baby, on employment prospects. So, there are huge societal costs to not managing endometriosis effectively.

We certainly do, as we've heard, need more than one large, multidisciplinary tertiary specialised provision dedicated to endometriosis in Wales. The Cardiff unit is excellent, but it's the only one. And there's the devil's own challenge, from a GP point of view, trying to get women with endometriosis seen in secondary care in the first place—there has to be a level of severity. So, it's very difficult to get people seen early on in the process before they develop any severe symptoms. And sometimes, when women have severe symptoms, it is then also the devil's own challenge to get them seen in secondary care as well. With those women who have a complex type of endometriosis that involves multiple organs, really getting seen in Cardiff is the only way forward because it's not just a problem for gynaecology—it's a problem for those other parts of the anatomy as well. It's a problem for colorectal surgeons, it's a problem for urologists, bladder surgeons as well—it's not just a gynaecological issue, which is why we need those advanced tertiary multidisciplinary centres.

All in all, I think there should be a dedicated all-Wales endometriosis pathway, from presentation—from when the woman has the problem—to primary care, through secondary care, through to tertiary care. There should be a dedicated, badged pathway, and our specialised nurses have a prominent role to play in that.

But also, from the very start I think it does need to be part of education in the curriculum Bill, as Jenny Rathbone mentioned at the start. It needs to be part of menstrual education, what is normal for girls and women to have, and boys and young men need to know that as well so that there is empathy when these situations come along, because endometriosis needs to be considered whenever a woman has severe period pain, particularly when it's coupled with infertility issues. It should be right up there in diagnosis and it's not at the moment, sometimes not from the woman's point of view and certainly not from primary care's point of view, and occasionally even secondary care. Severe period pains, combined with inability to get pregnant, should be a warning sign.

But, all in all, in drawing my remarks to a conclusion, can I commend Jenny Rathbone and others who are supporting this motion? This motion deserves to succeed and we deserve to have an improved specialised service for our women with endometriosis, but also coupled with improved education at the start of menstrual life. Diolch yn fawr.