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The ongoing impact of the pandemic on the NHS together with increased demand for emergency care continues to place intense pressure on the NHS, which is most visible in urgent and emergency care services.


This statement updates Members about the latest position and our plans to support and improve urgent and emergency care services across Wales.


Performance is not where we, the NHS or the public want it to be. Throughout the UK – and in many other parts of the world – health services are experiencing similar challenges, as a result of the combination of pandemic and emergency pressures.


However, despite this, every day our NHS continues to successfully treat tens of thousands of people who need emergency and urgent care. NHS staff provide life\-saving and life\-changing care, sometimes under challenging and stressful circumstances. I want to pay tribute to their hard work, determination and dedication to the service and to patient care.


A number of factors are combining to create the current pressures, which the NHS is experiencing, including increased demand; higher\-than\-normal levels of staff sickness absence, not just related to Covid\-19 and delays in discharging people who are ready to leave hospital. I have discussed these challenges with clinicians, professionals and managers, and have visited emergency departments all over Wales.


High levels of people who are medically fit to leave hospital but are unable to do so because of a lack of capacity in the community prevents flow within the whole health and care system, which is manifested in delays at the front door of the hospital – the emergency department. The lack of capacity in the community has been caused by a number of factors, including closures of care homes and beds in some areas of Wales, due to outbreaks of Covid\-19, and a wider shortage of social care staff across the sector.


We are working hard to address the wider issues facing the social care sector – last month we introduced the Real Living Wage for social care, which in turn is part of our work to improve terms and conditions and encourage more people to consider a rewarding career in care.


Ensuring people are able to access the right care, in the right place, at the first time when they need help is at the heart of our plan to support the NHS and improving access to urgent or emergency care.


Almost a month ago, I launched the new *Six Goals for Urgent and Emergency Care* programme, which is supported by £25m a year.


We have made some early progress:


* NHS 111 Wales is available all over Wales. People who have urgent care needs can be signposted to the right care, in the right place, first time. NHS data shows more than 146,000 people have used the service since it became available nationally.
* Eight urgent primary care centres have opened and another will follow this month. These have helped more than 70,000 people access care closer to home without needing to visit an emergency department.


* A new policy was introduced last month to enable some patients to be referred directly to new same\-day emergency care services by ambulance rather than being taken to an emergency department. Same\-day emergency care services are being phased in at hospital sites across Wales. These services are based next to emergency departments and are used to treat and observe people with certain conditions throughout the day with the intention that they will be able to be sent home later that day. We are working towards these new same\-day emergency care services becoming available 12\-hours\-a\-day, seven\-days\-a\-week.


* A new, world\-leading ambulance triage system is being introduced, which will eventually enable video assessment so people who call 999 can be assessed and some will be successfully helped without the need for an ambulance being dispatched.


The launch of the Six Goals programme is an early marker in our planning for winter 2022\-23\. I expect objectives to be progressed with pace and purpose over the remainder of the year to put the emergency care system in the best position possible for what will be a difficult winter period for health and social care services.


We will use a range of measures to track progress against the programme and have set service improvement trajectories for key parts of the urgent and emergency care system.


Given the complexity of the urgent and emergency care system, we must be realistic about the pace of improvement. However, we expect to see the following improvements this year and in the lead up to winter:


* Achievement of a ‘consult and close’ rate of 15% by the Welsh Ambulance Service, with more people safely discharged over the telephone without an ambulance dispatched, where appropriate
* Health boards will be expected to eradicate ambulance patient handover delays of more than four hours and reduce the average ambulance time lost per arrival by 25% (from the October 2021 level) at each hospital site
* Continuous improvement in accessibility to same\-day emergency care services throughout the year, helping more people to safely return home on the same day of their visit to hospital


* Continuous improvement  to reduce number of people who spend more than 21 days in a hospital bed following admission, helping them to maintain their independence and reduce the risk of re\-admission.


The Six Goals programme board will require health boards to present their plans in summer 2022 and again in October 2022 to understand progress as we approach winter. Delivery of plans will be subject to robust scrutiny.


The Emergency Ambulance Services Committee has allocated £1\.8m to the Welsh Ambulance Services NHS Trust as a short term measure to enable immediate continuation of support from St John Ambulance Cymru and provide other additional capacity to meet demand.


I will provide a further update on progress before the summer recess.







Translation:


 
Mae effaith barhaus y pandemig ar y GIG, ynghyd â galw cynyddol am ofal mewn argyfwng, yn parhau i roi pwysau dwys ar y GIG, ac mae hynny i’w weld fwyaf mewn gwasanaethau gofal brys a gofal mewn argyfwng.


Mae’r datganiad hwn yn rhoi gwybodaeth i’r Aelodau am y sefyllfa ddiweddaraf a’n cynlluniau i gefnogi a gwella gwasanaethau gofal brys a gofal mewn argyfwng ledled Cymru.


Nid yw’r perfformiad fel y byddem ni, y GIG a’r cyhoedd am iddo fod. Ar draws y DU – ac mewn llawer o rannau eraill o’r byd – mae gwasanaethau iechyd yn wynebu heriau tebyg, yn sgil y cyfuniad o bwysau’r pandemig a phwysau brys.


Er hynny, bob dydd mae ein GIG yn parhau i lwyddo i drin degau o filoedd o bobl sydd angen gofal brys a gofal mewn argyfwng. Mae staff y GIG yn darparu gofal sy’n achub bywydau ac yn newid bywydau, weithiau o dan amgylchiadau heriol a llawn straen. Hoffwn i dalu teyrnged i’w gwaith caled, eu hagwedd benderfynol a’u hymroddiad i’r gwasanaeth ac i ofal cleifion.


Mae nifer o ffactorau yn cyfuno i greu’r pwysau presennol ar y GIG, gan gynnwys galw cynyddol; lefelau uwch na’r arfer o absenoldeb staff oherwydd salwch, nid yn sgil Covid\-19 yn unig, ac oedi cyn rhyddhau pobl sy’n barod i adael yr ysbyty. Rwyf wedi trafod yr heriau hyn â chlinigwyr, gweithwyr proffesiynol a rheolwyr, ac wedi ymweld ag adrannau achosion brys ledled Cymru.


Mae lefelau uchel o bobl sy’n barod yn feddygol i adael yr ysbyty ond sy’n methu â gwneud hynny oherwydd diffyg capasiti yn y gymuned yn atal llif yn y system iechyd a gofal gyfan. Effaith hyn yw oedi ger ‘drws ffrynt’ yr ysbyty – yr adran achosion brys. Mae’r diffyg capasiti yn y gymuned wedi’i achosi gan nifer o ffactorau, gan gynnwys cau cartrefi gofal a gwelyau mewn rhai rhannau o Gymru, oherwydd brigiadau o achosion o Covid\-19, a phrinder ehangach o staff gofal cymdeithasol ar draws y sector.


Rydym yn gweithio’n galed i fynd i’r afael â’r anawsterau ehangach yn y sector gofal cymdeithasol – gan gyflwyno, fis diwethaf, y Cyflog Byw Gwirioneddol ar gyfer gofal cymdeithasol. Mae hyn yn rhan o’n gwaith i wella telerau ac amodau ac annog mwy o bobl i ystyried gyrfa werth chweil ym maes gofal.


Wrth wraidd ein cynllun i gefnogi’r GIG a gwella mynediad at ofal brys neu ofal mewn argyfwng y mae sicrhau y gall pobl gael y gofal iawn, yn y lle iawn, y tro cyntaf pan fydd angen cymorth arnynt.


Bron i fis yn ôl, lansiais y rhaglen newydd o’r enw *Chwe Nod ar gyfer Gofal Brys a Gofal mewn Argyfwng*, a gefnogir gan £25 miliwn y flwyddyn.


Rydym wedi gwneud cynnydd cynnar:


* Mae GIG 111 Cymru ar gael ledled Cymru. Gall pobl sydd angen gofal brys gael eu cyfeirio at y gofal iawn, yn y lle iawn, y tro cyntaf. Mae data’r GIG yn dangos bod dros 146,000 o bobl wedi defnyddio’r gwasanaeth ers iddo ddechrau bod ar gael yn genedlaethol.


* Mae wyth canolfan gofal sylfaenol brys wedi agor a bydd un arall yn agor fis hwn. Mae’r rhain wedi helpu dros 70,000 o bobl i gael gofal yn nes at eu cartrefi heb orfod mynd i adran achosion brys.
* Cyflwynwyd polisi newydd fis diwethaf i alluogi rhai cleifion i gael eu hatgyfeirio’n uniongyrchol drwy ambiwlans at wasanaethau newydd sy’n rhoi gofal mewn argyfwng yr un diwrnod, yn hytrach na mynd â nhw i adran achosion brys. Mae gwasanaethau gofal mewn argyfwng yr un diwrnod yn cael eu cyflwyno’n raddol mewn ysbytai ledled Cymru. Mae’r gwasanaethau hyn wedi’u lleoli ger adrannau achosion brys ac yn cael eu defnyddio i drin pobl â chyflyrau penodol, ac arsylwi arnynt, drwy gydol y dydd. Y bwriad yw y bydd modd iddynt gael eu hanfon adref yn nes ymlaen y diwrnod hwnnw. Rydym yn gweithio tuag at sefyllfa lle mae’r gwasanaethau newydd hyn sy’n rhoi gofal mewn argyfwng yr un diwrnod ar gael 12 awr y dydd, saith diwrnod yr wythnos.


* Mae system brysbennu ambiwlans newydd o’r radd flaenaf yn cael ei chyflwyno, a fydd, yn y pen draw, yn galluogi asesiadau fideo er mwyn asesu pobl sy’n ffonio 999 a bydd modd helpu rhai yn llwyddiannus heb angen anfon ambiwlans.


Mae lansio’r rhaglen Chwe Nod yn garreg filltir gynnar yn ein cynlluniau ar gyfer gaeaf 2022\-23\. Rwy’n disgwyl gweld gwaith cyflym a phwrpasol yn cael ei wneud tuag at yr amcanion yn ystod gweddill y flwyddyn er mwyn rhoi’r system gofal mewn argyfwng yn y sefyllfa orau posibl cyn y gaeaf, a fydd yn gyfnod anodd i wasanaethau iechyd a gofal cymdeithasol.


Byddwn yn defnyddio ystod o fesurau i olrhain cynnydd yn erbyn y rhaglen ac rydym wedi gosod llwybrau gwella gwasanaeth ar gyfer rhannau allweddol o’r system gofal brys a gofal mewn argyfwng.


O ystyried cymhlethdod y system gofal brys a gofal mewn argyfwng, rhaid inni fod yn realistig ynghylch cyflymder gwelliannau. Serch hynny, rydym yn disgwyl gweld y gwelliannau canlynol eleni ac yn y cyfnod cyn y gaeaf:


* Cyfradd ‘ymgynghori a chau’ o 15% yng Ngwasanaeth Ambiwlans Cymru, gyda mwy o achosion yn cael eu cwblhau yn ddiogel dros y ffôn heb anfon ambiwlans, pan fo hynny’n briodol


* Bydd disgwyl i fyrddau iechyd gael gwared ag oedi o dros bedair awr wrth drosglwyddo cleifion o ambiwlansys a sicrhau lleihad o 25% (o’r lefel ym mis Hydref 2021\) yn yr amser cyfartalog sy’n cael ei golli pan fydd ambiwlans yn cyrraedd safle ysbyty
* Gwelliant parhaus o ran pa mor hygyrch yw gwasanaethau gofal mewn argyfwng yr un diwrnod drwy gydol y flwyddyn, gan helpu mwy o bobl i ddychwelyd adref yn ddiogel ar yr un diwrnod â’u hymweliad â’r ysbyty


* Gwelliant parhaus i leihau nifer y bobl sy’n treulio mwy na 21 diwrnod mewn gwely ysbyty ar ôl cael eu derbyn i’r ysbyty, gan eu helpu i gadw eu hannibyniaeth a lleihau eu risg o gael eu haildderbyn


Bydd bwrdd y rhaglen Chwe Nod yn gofyn i fyrddau iechyd gyflwyno eu cynlluniau yn yr haf yn 2022 ac eto ym mis Hydref 2022 i ddeall cynnydd wrth i’r gaeaf ddynesu. Bydd y gwaith o gyflawni’r cynlluniau yn destun proses graffu gadarn.


Mae’r Pwyllgor Gwasanaethau Ambiwlans Brys wedi dyrannu £1\.8 miliwn i Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru fel mesur tymor byr i alluogi Ambiwlans St John Cymru i barhau i ddarparu cymorth ar unwaith. Bydd hyn hefyd yn darparu capasiti ychwanegol arall i ateb y galw.


Byddaf yn rhoi’r wybodaeth ddiweddaraf eto am y cynnydd cyn toriad yr haf.