Translate the text from English to Welsh.



 
We are moving out of a period of COVID\-19 critical planning and response and into a longer period where our health and care system must remain both prepared for any future peaks and effectively providing essential services and other high quality care and treatment for the people of Wales.


In March I made a number of decisions to ensure early and decisive action to continue to provide care and support to the most vulnerable people in our communities, whilst also making sure organisations and professionals were supported to prepare local responses to the public health emergency. The NHS in Wales has already delivered a remarkable response to the COVID\-19 health emergency since receiving the first coronavirus patients and now we must take the next steps.


To maintain momentum and to ensure the system continues to focus its attention on the provision of a wider range of services, I have issued an NHS Wales COVID\-19 operating framework for quarter 1 (2020/21\)*.*


The document highlights four types of harm that could emanate from COVID\-19 which we must remain focused on and guard against. These are;


* Harm from COVID\-19 itself
* Harm from an overwhelmed NHS and social care system
* Harm from a reduction in non COVID\-19 activity
* Harm from a wider societal actions/lockdown


This framework will drive, even further, our systems focus on the two components of ensuring both a continued effective response to COVID\-19 whilst providing other essential services in a careful and balanced manner.


I have taken advice from professional colleagues, including NHS Chief Executives and Medical Directors. This advice demonstrates consensus across the health and care system that we must ensure delivery of essential services for our population and where possible recommence more routine care. The advice I have received also says that this must be done progressively, with caution and in a flexible and agile manner to ensure confidence for the public and staff. 


This framework is set under a number of themes;


**New ways of working and workforce wellbeing** \-Staff have created and quickly embraced new ways of working to respond to the COVID\-19 challenge, offering benefits in terms of safety and quality to both staff and patients whilst also contributing to reduced congestion in primary care and hospital settings. We must continue to build on this work and harness the opportunities it has provided.


Examples of the scale of transformation include the rollout of video consultations safely to primary care. Locally and nationally these new ways of working must be sustainably embedded.


This framework recognises the importance of the wellbeing of our workforce, and in particular those staff who have been under significant pressure in responding to COVID\-19 and they must be at the forefront of our minds.  Pressures may increase again in the next few months. I am clear that appropriate testing systems must be in place and be informed by the impending Testing Strategy being developed to support and help sustain staff.


**Managing COVID\-19** – It will always be difficult to guarantee that health and social settings will be COVID free, however patients using the NHS must be confident that hospital environments are as safe as possible. The key criterion I will looking to organisations to be assured on include:


* Ongoing and consistent application of Infection Prevention and Control guidance.
* Identification of COVID “zones” and dedicated isolation facilities. I will be anticipating that regional solutions are explored along with the targeted use of independent sector hospitals and field hospitals to support the separation of COVID and non\-COVID activity in the immediate term.
* New service or specialty based triage and streaming processes in both unscheduled and planned care to support the separation of patient services.
* Continued implementation of Acute Pathways for COVID\-19 and the related rehabilitation
* Assurance on the availability of sufficient physical and workforce capacity that reflect the need to maintain social distancing and infection prevention and control measures.


The framework reflects my determination that we retain our ability to quickly activate additional critical care capacity, if we enter into another peak.


**“Essential” services** \- I am clear that Essential Services should be maintained at all times throughout the pandemic. An Essential Services technical document has been developed in line with The World Health Organization (WHO) guidance. If, in any areas of essential services, the response to COVID\-19 has led to backlogs they must be urgently addressed. Ultimately I recognise that some decisions on treatment will rest between patients and their clinicians, taking account of their specific risks during the COVID outbreak.


**“Routine” services** \- We know that capacity exists in some parts of our system to support the re\-introduction of routine services. The reintroduction of these services is a local operational decision for Health Boards and Trusts in conjunction with relevant partners. These decisions must be taken with care, and organisations need to assure themselves that it is safe and appropriate to do so. I outline how they need to assure themselves in the framework.


**Primary care \-** For General Medical Services we have seen a shift to telephone first triage; this must remain in place during Quarter 1 and I encourage it longer term. Equally our community pharmacy services have been under significant pressure and have introduced new ways of working to manage patient care safely and efficiently, these too must continue where the benefits are clear.


All routine primary care dental treatments and check\-ups continue to be cancelled. Dental practices with NHS contracts remain ‘open’ for remote triage, the provision of advice and the issuing of prescription. Further guidance will be issued separately to this framework about the future status and restoration of dental services.  In optometry services, a number of practices remain open for emergency and essential eye care services. Health boards must continue to ensure urgent patients are seen.


**Social Care Interface** \- Finally the framework makes clear that NHS organisations must continue to work with partners to ensure an effective interface with social care. This is in line with the approach set out in “A Healthier Wales” and the framework makes clear how this must happen.


There has been clear and consistent messages for the public that the NHS is still available at times of need despite COVID\-19\. We must continue to ensure that key services are available and patients can access them, now and in the future.


To help patients access these services over the last eight to ten weeks there has been a seismic level of transformation across our system. We must reflect on these changes but not dwell on them. They must be adopted, adapted and applied. This framework supports the health and care system in moving to the next phase of providing services.  


Essential health services during COVID\-19







Translation:


 
Rydym yn symud y tu hwnt i gyfnod o gynllunio ac ymateb allweddol o ran COVID\-19 ac i gyfnod hirach pan fydd rhaid i’n system iechyd a gofal barhau i fod yn barod am unrhyw gynnydd mawr mewn achosion yn y dyfodol a pharhau i ddarparu gwasanaethau hanfodol a gofal a thriniaeth arall i bobl Cymru yn effeithiol.


Fis Mawrth, gwnes i gyfres o benderfyniadau i sicrhau bod camau cynnar a phendant yn cael eu cymryd i barhau i ddarparu gofal a chymorth i’r bobl fwyaf agored i niwed yn ein cymunedau, gan hefyd sicrhau bod sefydliadau a gweithwyr proffesiynol yn cael eu cefnogi i baratoi ymatebion lleol i’r argyfwng iechyd y cyhoedd. Mae GIG Cymru eisoes wedi ymateb yn rhagorol i argyfwng iechyd COVID\-19 ers derbyn y cleifion coronafeirws cyntaf. Rhaid inni nawr gymryd y camau nesaf.


I gynnal momentwm a sicrhau bod y system yn parhau i ganolbwyntio ar ddarparu ystod ehangach o wasanaethau, rwyf wedi cyhoeddi *Fframwaith gweithredu COVID\-19 GIG Cymru ar gyfer chwarter 1 (2020/21\).*


Mae’r ddogfen yn nodi pedwar math o niwed a allai ddeillio o COVID\-19 y mae rhaid inni barhau i gadw llygad arnynt a diogelu rhagddynt, sef;


* Niwed o COVID\-19 ei hun
* Niwed o Wasanaethau Iechyd a system gofal cymdeithasol sydd wedi’u gorlethu
* Niwed o leihad mewn gweithgarwch nad yw’n gysylltiedig â COVID\-19
* Niwed o gamau / cyfyngiadau cymdeithasol ehangach


Bydd y fframwaith hwn yn sicrhau ymhellach bod ein systemau yn canolbwyntio ar y ddwy elfen dan sylw sef parhau i ymateb yn effeithiol i COVID\-19 a darparu gwasanaethau hanfodol eraill mewn modd gofalus a chytbwys.


Rwyf wedi cymryd cyngor cydweithwyr proffesiynol, gan gynnwys Prif Weithredwyr a Chyfarwyddwyr Meddygol y GIG. Mae’r cyngor hwn yn dangos bod cytundeb ar draws y system iechyd a gofal bod rhaid inni sicrhau y bydd gwasanaethau hanfodol yn cael eu darparu i’n poblogaeth a bod rhaid, pan fo’n bosibl, ailddechrau gofal mwy cyffredinol. Mae’r cyngor yr wyf wedi’i gael yn dweud hefyd bod rhaid gwneud hyn yn raddol, yn ofalus ac mewn modd hyblyg ac ystwyth er mwyn ennyn hyder y cyhoedd a staff. 


Mae’r fframwaith hwn wedi’i rannu’n nifer o themâu;


**Ffyrdd newydd o weithio a lles y gweithlu –** Mae staff wedi creu a derbyn yn gyflym ffyrdd newydd o weithio mewn ymateb i her COVID\-19, gan gynnig manteision o ran diogelwch ac ansawdd i staff a chleifion. Ar yr un pryd, mae hyn wedi helpu i sicrhau nad yw lleoliadau gofal sylfaenol nac ysbytai wedi’u gorlethu. Rhaid inni barhau i ddatblygu’r gwaith hwn a manteisio ar y cyfleoedd y mae’n eu cynnig.


Un enghraifft o raddfa’r trawsnewid yw rhoi ymgyngoriadau fideo ar waith yn ddiogel ym maes gofal sylfaenol. Yn lleol ac yn genedlaethol, rhaid ymwreiddio’r ffyrdd newydd hyn o weithio mewn ffordd gynaliadwy.


Mae’r fframwaith hwn yn cydnabod pwysigrwydd llesiant ein gweithlu, ac yn enwedig yr aelodau hynny o staff sydd wedi bod dan bwysau sylweddol wrth ymateb i COVID\-19\. Rhaid iddyn nhw fod ar flaen ein meddyliau. Gallai’r pwysau gynyddu eto yn y misoedd i ddod. Rwy’n ei gwneud yn glir bod rhaid i systemau profi priodol fod yn eu lle, ac wedi’u seilio ar y Strategaeth Brofi sydd wrthi’n cael ei datblygu i gefnogi a chynnal staff.


**Rheoli COVID 19** – Bydd bob amser yn anodd sicrhau bod lleoliadau iechyd a chymdeithasol yn rhydd rhag COVID, ond mae’n rhaid i gleifion sy’n defnyddio’r GIG fod yn hyderus bod amgylcheddau ysbyty mor ddiogel â phosibl. Mae’r prif feini prawf y byddaf yn gofyn i sefydliadau eu sicrhau yn cynnwys:


* Rhoi canllawiau Rheoli ac Atal Haint ar waith yn barhaus ac yn gyson.
* Adnabod “parthau” COVID a chyfleusterau ynysu penodedig. Rwy’n rhagweld y bydd datrysiadau rhanbarthol yn cael eu harchwilio ynghyd â thargedu’r defnydd o ysbytai’r sector annibynnol ac ysbytai maes i gefnogi gwahanu gweithgarwch COVID a gweithgarwch nad yw’n gysylltiedig â COVID a hynny yn syth.
* Brysbennu gwasanaethau newydd neu wasanaethau arbenigol a phrosesau ffrydio mewn gofal heb ei drefnu a gofal wedi’i drefnu i gefnogi gwahanu gwasanaethau i gleifion.
* Parhau i roi Llwybrau Acíwt ar waith ar gyfer COVID 19 a chamau adfer perthnasol
* Sicrhau argaeledd capasiti ffisegol a gweithlu digonol sy’n adlewyrchu’r angen i gadw pellter cymdeithasol a mesurau atal a rheoli haint.


Mae’r fframwaith yn adlewyrchu’r ffaith fy mod yn benderfynol y gallwn barhau i fedru rhoi capasiti gofal critigol ychwanegol ar waith yn gyflym os bydd cynnydd mawr arall mewn achosion.


**Gwasanaethau “hanfodol”** – rwy’n benderfynol y dylid cynnal gwasanaethau hanfodol drwy gydol y pandemig. Datblygwyd dogfen dechnegol i wasanaethau hanfodol yn unol â chanllawiau Sefydliad Iechyd y Byd. Os yw’r ymateb i COVID 19 wedi arwain at ôl\-groniad mewn unrhyw wasanaethau hanfodol, mae’n rhaid mynd i’r afael â hyn ar fyrder. Yn y pen draw, rwy’n cydnabod y bydd rhai penderfyniadau ynglŷn â thriniaeth yn benderfyniadau i’w gwneud rhwng y claf a’r clinigwyr, gan ystyried y risgiau penodol yn ystod yr achosion o COVID.


**Gwasanaethau “rheolaidd”** \- Gwyddom fod digon o gapasiti yn rhai rhannau o’n system i gefnogi ailgyflwyno gwasanaethau rheolaidd. Mae ailgyflwyno’r gwasanaethau hyn yn benderfyniad gweithredol lleol ar gyfer Byrddau Iechyd ac Ymddiriedolaethau mewn cysylltiad â phartneriaid perthnasol. Mae’n rhaid gwneud y penderfyniadau hyn yn ofalus, ac mae’n rhaid i sefydliadau sicrhau ei bod yn ddiogel ac yn briodol i wneud hynny. Rwy’n amlinellu yn y fframwaith sut y mae angen iddynt eu sicrhau eu hunain.


**Gofal sylfaenol –** Mewn Gwasanaethau Meddygol Cyffredinol, rydym wedi gweld newid i frysbennu dros y ffôn; mae’n rhaid i hyn barhau yn ystod Chwarter 1 ac rwy’n ei annog yn y tymor hir. Yn yr un modd, mae ein fferyllfeydd cymunedol wedi bod dan bwysau sylweddol ac wedi cyflwyno ffyrdd newydd o weithio i reoli gofal cleifion yn ddiogel ac yn effeithlon. Mae’n rhaid i hyn hefyd barhau os yw’r manteision yn amlwg.


Mae pob triniaeth ac archwiliad deintyddol gofal sylfaenol rheolaidd yn parhau i fod wedi’u canslo. Mae practisau deintyddol â chontractau GIG yn parhau i fod ‘ar agor’ i gynnal gwasanaeth brysbennu o bell, i roi cyngor ac i roi presgripsiynau. Bydd canllawiau pellach yn cael eu rhoi ar wahân i’r fframwaith hwn ynglŷn â statws ac adferiad gwasanaethau deintyddol yn y dyfodol. Mewn gwasanaethau optometreg, mae nifer o bractisau yn parhau i fod ar agor ar gyfer gwasanaethau gofal llygaid hanfodol a brys. Mae’n rhaid i fyrddau iechyd sicrhau bod cleifion brys yn cael eu gweld.


**Rhyng\-gysylltiad â Gofal Cymdeithasol** – Yn olaf, mae’r fframwaith yn nodi’n glir bod angen i sefydliadau’r GIG barhau i weithio gyda phartneriaid i sicrhau rhyng\-gysylltiad effeithiol gyda gofal cymdeithasol. Mae hyn yn unol â’r dull gweithredu a nodwyd yn “Cymru Iachach” ac mae’r fframwaith yn nodi’n glir sut y dylai hyn ddigwydd.


Mae negeseuon clir a chyson wedi’u rhoi i’r cyhoedd bod y GIG yn parhau i fod ar gael iddynt pan fyddant ei angen, er gwaethaf COVID\-19\. Mae’n rhaid inni barhau i sicrhau bod gwasanaethau allweddol ar gael ac y gall cleifion gael mynediad atynt, yn awr ac yn y dyfodol.


I helpu cleifion i gael y gwasanaethau hyn, bu trawsnewidiad enfawr ar draws ein system yn ystod yr wyth i ddeg wythnos diwethaf. Mae’n rhaid inni adlewyrchu ar y newidiadau hyn, ond peidio ag oedi gyda nhw. Mae’n rhaid eu mabwysiadu, eu haddasu a’u rhoi ar waith. Mae’r fframwaith hwn yn cefnogi’r system iechyd a gofal i symud i’r cam nesaf o ddarparu gwasanaethau.  


**Mae Fframwaith Gweithredu COVID\-19 GIG Cymru ar gyfer chwarter 1 (2020/21\) a’r Atodiad yn Crynhoi’r Gwasanaethau Allweddol wedi’u cynnwys yn y dolenni perthnasol isod:**


 


https://llyw.cymru/fframwaith\-gweithredu\-gig\-cymru\-chwarter\-1\-2020\-i\-2021


https://llyw.cymru/gwasanaethau\-iechyd\-hanfodol\-yn\-ystod\-covid\-19