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I would like to start by thanking ambulance staff and A\&E staff in each Health Board area, for their efforts over the summer to improve our emergency medical service. I am pleased to announce that figures released this morning reflect these efforts with the achievement of the 65% eight\-minute target in October. This now provides a solid basis for performance over the winter months.


The NHS has also focused over the summer months on reducing the number of patients waiting over 62 days for their cancer treatment. This has resulted in an increase in the number of people having their first outpatient appointment within 10 working days, and performance moving closer to the 62 day target. It is encouraging to note that the performance against the 31\- day target has been achieved and sustained since July 2013\.


For other unscheduled care measures: 


* there were fewer people waiting 12 hours or more in A\&E departments in the combined period from August to October 2013 (2,133\) than in the single month of April 2013 (2,254\);
* there have been fewer patients waiting over an hour for handover from ambulance crews to A\&E staff over the whole of the past six months from May to October (4,306\)  than in March and April 2013 (4,333\);
* There have been fewer ‘lost ambulance hours’ accrued at A\&E departments around Wales in the past five months (from June to October) than in March and April combined.


 


I congratulate the ambulance staff for achieving the target and for their ongoing commitment to patients and improvement in delivery. However, I must emphasise, as did the McClelland Review, that the eight\-minute target itself is, only very weakly backed by clinical evidence as a measure of best outcomes for patients.


 


At the end of October 2013, the National Audit Office (NAO) reported again on the perverse outcomes being driven by the four hour target in A\&E departments, which it identified as the most significant factor in increasing unnecessary emergency admissions, at a time of high winter pressures.  It also noted  that nearly a quarter of all admissions from A\&E took place in the 10 minutes before the four\-hour limit was reached, casting further doubt on the extent to which such action reflect genuinely clinical priorities.


Nor are unscheduled care targets the only ones which fail to promote the best outcomes for patients. I continue to be advised by the most senior oncologists in Wales that the distinction between 31 and 62 day cases is not one which reflects today’s highest standards of patient care.


I am concerned that there may be many other examples where existing measurement systems do not promote the best outcome for patients. Therefore in line with the commitment in ‘Together for Health’ to develop an Outcome Framework for the NHS, my Department is in the process of developing proposals for an outcome driven delivery model.


It is important that the public and the service are engaged in this development and I am clear that any new framework needs to be co\-designed. To date there have been 16 patient, clinician and stakeholder events held across Wales.


These events have resulted in seven draft outcomes that stakeholders, patients and clinicians have identified as being important to support the NHS in delivering meaningful outcomes for the citizens of Wales.   Work needs to be undertaken on these draft outcomes to ensure that these really reflect the key drivers of the NHS. This work will be undertaken in the coming weeks in conjunction with stakeholders, patients and clinicians.


In that work I have asked my Department to prioritise the development of unscheduled care measures including both the ambulance service and A\&E departments.  Events with clinicians and patients took place in early November to apply the seven outcomes to the unscheduled care pathway. As a priority I have asked the national clinical lead for unscheduled care to work with clinicians across Wales to come forward with any necessary proposals for change.


This will then be supported by more detailed pilot work to explore appropriate measures across the unscheduled care pathway. These will be tested with clinical leads across Wales, with the aim of piloting some new measures **from April 2014** where data collection can be achieved within that timescale.


I have also asked senior clinicians to provide me with advice concerning targets for access to cancer services. That advice will focus on identifying how we can best be assured that any target regime is firmly based on achieving best clinical outcomes for patients. If there are immediate changes recommended, I will consider them rapidly. Wider work will proceed through clinical engagement between now and April 2014\.


I also intend to secure advice concerning the refinement of Referral To Treatment (RTT) regime for the future. In the short term, that advice will focus upon ophthalmology services where opportunities exist to improve access by better stratification of referrals, according to clinical priority. I expect such work to inform wider engagement with clinicians on a reformed application of RTT principles in other conditions in the future.


 







Translation:


 
Hoffwn ddechrau drwy ddiolch i'r staff ambiwlans a'r staff damweiniau ac achosion brys ym mhob Bwrdd Iechyd am eu hymdrechion dros yr haf i wella'n gwasanaeth meddygol brys. Rwy'n falch o gyhoeddi bod y ffigurau a gyhoeddwyd heddiw yn adlewyrchu'r ymdrechion hyn, gyda'r targed wyth munud o 65% yn cael ei gyflawni ym mis Hydref. Mae hyn yn sylfaen gadarn ar gyfer misoedd y gaeaf.

Mae'r GIG hefyd wedi canolbwyntio dros fisoedd yr haf ar leihau nifer y cleifion sy'n aros dros 62 diwrnod am driniaeth canser. Mae hyn wedi arwain at gynnydd yn nifer y bobl sy'n cael apwyntiad cyntaf fel claf allanol o fewn 10 diwrnod gwaith, a chynnydd tuag at y targed 62 diwrnod. Mae’n galonogol nodi bod y targed 31 diwrnod wedi’i gyflawni a’i gynnal ers mis Gorffennaf 2013\.

Yn achos mesurau eraill ar gyfer gofal heb ei drefnu,   


* roedd llai o bobl yn aros 12 awr neu fwy mewn adrannau damweiniau ac achosion brys yn y cyfnod cyfunol rhwng mis Awst a mis Hydref 2013 (2,133\) nag ym mis Ebrill 2013 ar ei ben ei hun (2,254\);
* roedd llai o gleifion yn aros dros awr i gael eu trosglwyddo o griwiau ambiwlans i staff damweiniau ac achosion brys dros y chwe mis diwethaf o fis Mai i fis Hydref (4,306\) nag ym mis Mawrth a mis Ebrill 2013 (4,333\);
* collwyd llai o oriau ambiwlans mewn adrannau damweiniau ac achosion brys yng Nghymru dros y pum mis diwethaf (mis Mehefin i fis Hydref) nag ym mis Mawrth a mis Ebrill gyda'i gilydd.

Rwy'n llongyfarch y staff ambiwlans am gyflawni'r targed ac am eu hymrwymiad parhaus i gleifion a gwella'r ddarpariaeth. Fodd bynnag, rhaid i mi bwysleisio, fel yn achos Adolygiad McClelland, mai gwan iawn yw'r dystiolaeth glinigol i gefnogi'r targed wyth munud fel mesur o ganlyniadau gorau i gleifion. Ddiwedd mis Hydref 2013, adroddodd y Swyddfa Archwilio Genedlaethol eto ar y canlyniadau gwrthnysig sy'n cael eu hachosi gan y targed pedair awr mewn adrannau damweiniau ac achosion brys, a nododd y Swyddfa Archwilio Genedlaethol mai dyma’r ffactor pwysicaf o ran y cynnydd mewn derbyniadau brys diangen ar adeg o bwysau mawr dros y gaeaf.  Roedd hefyd yn nodi bod bron chwarter yr holl dderbyniadau yn y 10 munud cyn diwedd y terfyn o bedair awr, sy'n peri mwy o amheuaeth ynghylch i ba raddau y mae cam gweithredu o'r fath yn adlewyrchu blaenoriaethau clinigol gwirioneddol.

Hefyd, nid targedau gofal heb ei drefnu yw'r unig rhai sy'n methu hyrwyddo'r canlyniadau gorau i gleifion.

Mae'r oncolegwyr mwyaf profiadol yng Nghymru yn fy nghynghori’n rheolaidd nad yw gwahaniaethu rhwng achosion 31 a 62 diwrnod yn adlewyrchu'r safonau uchaf cyfoes mewn gofal cleifion.

Rwy'n pryderu y gallai fod nifer o enghreifftiau eraill lle nad yw systemau mesur cyfredol yn hyrwyddo'r canlyniad gorau i  gleifion. Felly, yn unol â'r ymrwymiad yn 'Law yn Llaw at Iechyd' i ddatblygu Fframwaith Canlyniadau ar gyfer y GIG, mae fy Adran wrthi'n datblygu cynigion ar gyfer model cyflawni ar sail canlyniadau.

Mae'n bwysig bod y cyhoedd a'r gwasanaeth yn ymwneud â'r gwaith datblygu hwn ac rwy'n bendant bod angen cydgynllunio unrhyw fframwaith newydd. Hyd yn hyn, cynhaliwyd 16 o ddigwyddiadau ar gyfer cleifion, clinigwyr a rhanddeiliaid.

Mae'r digwyddiadau hyn wedi arwain at saith canlyniad drafft a nodwyd fel rhai pwysig gan randdeiliaid, cleifion a chlinigwyr i gefnogi’r GIG i sicrhau canlyniadau ystyrlon ar gyfer dinasyddion Cymru. Mae angen gweithio ar y canlyniadau drafft hyn i sicrhau eu bod wir yn adlewyrchu ysgogwyr allweddol y GIG. Bydd y gwaith hwn yn cael ei wneud dros yr wythnosau nesaf ar y cyd â rhanddeiliaid, cleifion a chlinigwyr.

O ran y gwaith hwnnw, rwyf wedi gofyn i fy Adran flaenoriaethu datblygu mesurau gofal heb ei drefnu, gan gynnwys y gwasanaeth ambiwlans ac adrannau damweiniau ac achosion brys.  Cynhaliwyd digwyddiadau gyda chlinigwyr a chleifion ddechrau mis Tachwedd i gymhwyso'r saith canlyniad i'r llwybr gofal heb ei drefnu. Fel blaenoriaeth, rwyf wedi gofyn i'r clinigydd arweiniol cenedlaethol ar gyfer gofal heb ei drefnu weithio gyda chlinigwyr ledled Cymru i ddatblygu unrhyw gynigion sy’n angenrheidiol ar gyfer newid.

Yna bydd gwaith peilot manylach yn cefnogi hyn i ymchwilio i fesurau priodol ar draws y llwybr gofal heb ei drefnu. Caiff y rhain eu profi gydag arweinwyr clinigol ledled Cymru, gyda'r nod o roi rhai mesurau newydd ar brawf o fis Ebrill 2014 lle mae modd casglu data erbyn hynny.

Rwyf hefyd wedi gofyn i uwch glinigwyr fy nghynghori ynghylch targedau ar gyfer mynediad at wasanaethau canser. Bydd y cyngor hwn yn canolbwyntio ar nodi’r ffordd orau i ni sicrhau bod targedau’n canolbwyntio’n bendant  ar sicrhau’r canlyniadau clinigol gorau i gleifion. Os argymhellir newidiadau ar unwaith, byddaf yn eu hystyried cyn gynted â phosibl. Bydd gwaith ehangach yn mynd yn ei flaen drwy ymgysylltu clinigol o nawr tan fis Ebrill 2014\.

Rwyf hefyd yn bwriadu cael cyngor ynghylch mireinio’r drefn Rhwng Atgyfeirio a Thriniaeth (RhAT) at y dyfodol. Yn y tymor byr, bydd y cyngor hwn yn canolbwyntio ar wasanaethau offthalmoleg lle ceir cyfleoedd i wella mynediad drwy haenu atgyfeiriadau’n well yn ôl blaenoriaeth glinigol. Rwy’n disgwyl i waith o’r fath lywio ymgysylltu ehangach gyda chlinigwyr ar gymhwyso egwyddorion RhAT o’r newydd ar gyfer cyflyrau eraill  yn y dyfodol.