Translate the text from English to Welsh.



 
On June 11, 2013, *Together for Health – Delivery Plan for the Critically Ill: A Delivery Plan up to 2016 for NHS Wales* was published. It sets out actions to improve the experience and outcomes of people who are critically ill, reducing inequalities and variability in access to services to ensure patients who need critical care receive it in an appropriate environment, cared for by sufficient numbers of suitably qualified and experienced staff.


That plan represented the start of a programme of action with a focus on improving the efficiency of critical care, identified as a priority within health boards.


Critical care beds are not always used appropriately. For example, not all patients in critical care beds need that intense level of care and some patients in critical care beds may be waiting to be transferred to a normal hospital ward for ongoing care and support. Delays in transferring patients can result in cancelled operations or critically ill patients having to be transferred to another hospital because of a shortage of available critical care beds. Wales’ critical care beds are spread over a large number of hospitals but there is a growing consensus of opinion among clinicians that they may be better be concentrated on fewer sites.


I accepted it was unlikely that efficiencies alone would be enough to meet the increasing demand for critical care and investment to increase capacity may be necessary. A commitment was given that work would be undertaken to quantify the additional number of beds needed in Wales and to provide an update on progress.


Two reports – the first annual report for the critically ill and an assessment of the unmet need for critical care in Wales, which was produced by the all\-Wales implementation group – are today being published.


The annual report on critical care services sets a clear baseline for the provision of services for the critically ill and will complement health board service and delivery plans.


It presents an overview of NHS performance and identifies what health boards need to do to improve care for patients. It highlights a number of important initiatives already in place and establishes a baseline against which future progress can be monitored.


Across Wales, the NHS provides good quality critical care services and has a committed workforce. All health boards have developed and are implementing robust delivery plans supported and developed by clinicians.


The care for people who are critically ill does not begin and end in the critical care unit. Health boards have developed ways in which critically ill patients can be proactively identified and treated across hospital wards. Hospitals which do not provide critical care also have a responsibility to ensuring their patients receive the best possible care when they are critically ill. This includes stabilisation, transport and retrieval and repatriation when their critical care stay is over.


The Welsh Government has developed a number of outcome and assurance indicators to measure how critical care services are improving in Wales. Progress against these, showing that critical care services are developing:


* Survival rates are improving \- the number of patients being transferred back to the ward after being admitted to a critical care unit is increasing. In 2012, just over 80% of patients were discharged to another ward, up from 79% in 2011;
* The NHS is meeting the demand for critical care, which has been slowly increasing over time. In 2011 there were 8,991 admissions and in 2012 there were 9,887 admissions – an increase of 896 admissions, almost 10%;
* Readmissions to critical care within 48 hours are very low – less than 2% of all discharges, indicating ward\-based care and the discharge process are effective;
* Since the introduction of the critical care networks, improvements have been made in the safe transfer of people who are critically ill between hospitals through training and continuous audit \- 80% of all transfers are graded as good or excellent;
* The Intensive Care Society’s carers’ feedback questionnaire has been introduced to obtain the views of carers.  Hospitals which have taken part have reported excellent satisfaction rates on communication, facilities and medical and nursing staff.


We must continue to maintain and improve performance in these areas and ensure progress is made in those areas where performance has not been as good as anticipated.


The NHS is continuing to work to ensure health services in Wales are sustainable and meet the evolving needs of the Welsh population. As part of their service and reconfiguration plans health boards must consider the best location and function of their critical care units.


The annual report acknowledges it may be appropriate to concentrate critical care services in fewer hospitals than they are currently provided. This might mean bringing together intensive care services – level three care – but ensuring other hospitals maintain the facilities to resuscitate and stabilise critically ill patients before they can be transferred to an intensive care unit.


The assessment of unmet need for critical care report concludes that Wales may need another 73 critical care beds in the future. In the last year, an additional 10 critical care beds have been opened across Wales and health boards have plans for eight more.


However, both reports highlight the problems Wales currently experience with delayed transfers from critical care units, which can result in the loss of up to 14 beds a year. Until this problem is addressed and the rate of delayed transfers is reduced, as the report acknowledges creating scores of new critical care beds is unlikely to alleviate the problem.


Both reports are clear that the NHS must focus on reducing delayed transfers of care from critical care units in Wales and ensuring all admissions are appropriate and in patients’ best interests in order to make best use of existing beds before proceeding with a large, planned expansion of bed numbers.


We must make the best use of the resources we already have and action must be accelerated to tackle inefficient use of our critical care beds. All health boards in Wales should have a plan in place to do tackle delayed transfers of care and will be required to deliver a phased reduction. This will require co\-operation and co\-ordination across the hospital.


Work is being carried out by Aneurin Bevan University Health Board and the critical care networks to develop a new developmental measure based on hours lost as a result of delayed transfers of care in critical care. Health boards will be expected to reduce the number of hours lost to delayed transfers of care from critical care units by 10% every quarter until they reach a position where no more than 5% of bed availability is being lost to delayed transfers.


This action will ensure the NHS is making best use its critical care beds and they are available for patients when they are needed.


The measure will be piloted as part of the new NHS outcomes framework.


This statement is being issued during recess in order to keep Members informed. Should Members wish me to make a further statement or to answer questions on this when the Assembly returns, I would be happy to do so.





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* #### Annex,
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Translation:


 
Ar 11 Mehefin 2013, cyhoeddwyd *Law yn Llaw at Iechyd – Cynllun Cyflawni ar gyfer y rhai sy’n Ddifrifol Wael: Cynllun Cyflawni hyd at 2016 ar gyfer GIG Cymru*. Mae'n pennu camau gweithredu i wella'r profiad a'r canlyniadau ar gyfer pobl sy’n ddifrifol wael, ac i leihau anghydraddoldeb ac amrywioldeb o ran mynediad at wasanaethau. Mae hynny er mwyn sicrhau bod cleifion sydd angen gofal critigol yn ei gael mewn amgylchedd priodol, gan dderbyn gofal gan niferoedd digonol o staff â chymwysterau a phrofiad addas.


Y cynllun hwn oedd dechrau rhaglen weithredu i ganolbwyntio ar wella effeithlonrwydd gofal critigol, a nodwyd fel blaenoriaeth i fyrddau iechyd.


Nid yw gwelyau gofal critigol yn cael eu defnyddio'n briodol bob amser. Er enghraifft, nid oes angen y lefel ddwys honno o ofal ar bob claf mewn gwely gofal critigol ac mae'n bosibl bod rhai cleifion mewn gwelyau gofal critigol yn aros i gael eu trosglwyddo i ward ysbyty arferol i barhau i gael gofal a chymorth. Gall oedi wrth drosglwyddo cleifion arwain at ganslo llawdriniaethau neu drosglwyddo cleifion sy’n ddifrifol wael i ysbyty arall oherwydd nad oes digon o welyau gofal critigol ar gael. Mae gwelyau gofal critigol yng Nghymru wedi'u gwasgaru dros nifer fawr o ysbytai, ond mae consensws cynyddol ymysg clinigwyr mai opsiwn gwell fyddai eu crynhoi ar nifer lai o safleoedd.


Roeddwn i'n derbyn ei bod yn annhebygol y byddai arbedion effeithlonrwydd ynddynt eu hunain yn ddigon i fodloni’r galw cynyddol am ofal critigol ac y gallai fod angen buddsoddiad i gynyddu capasiti. Rhoddwyd addewid y byddai gwaith yn cael ei wneud i fesur y nifer ychwanegol o welyau y mae eu hangen yng Nghymru ac y byddwn yn rhoi'r diweddaraf ar hynt y gwaith.


Mae dau adroddiad – yr adroddiad blynyddol cyntaf ar gyfer pobl sy’n ddifrifol wael ac sesiad o angen heb ei fodloni ar gyfer gofal critigol yng Nghymru, a luniwyd gan y grŵp gweithredu Cymru gyfan – yn cael eu cyhoeddi heddiw.


Mae’r adroddiad blynyddol ar wasanaethau gofal critigol yn pennu safonau sylfaenol clir ar gyfer darparu gwasanaethau i'r rhai sy'n ddifrifol wael, a bydd yn ategu adroddiadau’r byrddau iechyd ar wasanaethau a chyflawni.


Mae'n rhoi trosolwg o berfformiad y GIG ac yn nodi’r hyn y mae angen i fyrddau iechyd ei wneud i wella gofal i gleifion. Mae'n tynnu sylw at nifer o fentrau pwysig sydd eisoes ar waith ac yn pennu safonau sylfaenol ar gyfer monitro cynnydd yn y dyfodol.


Ledled Cymru, mae’r GIG yn darparu gwasanaethau gofal critigol o ansawdd da ac mae ganddo weithlu ymroddgar. Mae'r holl fyrddau iechyd wedi datblygu ac wrthi'n rhoi cynlluniau cyflawni cadarn ar waith a gefnogir ac a ddatblygir gan glinigwyr.


Nid yw'r gofal i bobl sy'n ddifrifol wael yn dechrau ac yn gorffen yn yr uned gofal critigol. Mae’r byrddau iechyd wedi datblygu ffyrdd o fynd ati i nodi a rhoi triniaeth i gleifion sy'n ddifrifol wael ar draws wardiau ysbytai. Mae ysbytai nad ydynt yn darparu gofal critigol hefyd yn gyfrifol am sicrhau bod eu cleifion yn cael y gofal gorau posibl pan fyddant yn ddifrifol wael. Mae hyn yn cynnwys sefydlogi, cludo ac adalw ac ailgartrefu pan fydd y gofal critigol ar ben.


Mae Llywodraeth Cymru wedi datblygu nifer o ddangosyddion canlyniad a sicrwydd i fesur sut mae gwasanaethau gofal critigol yn gwella yng Nghymru. Mae cynnydd yn dangos bod gwasanaethau gofal critigol yn datblygu:


* Mae cyfraddau goroesi'n gwella – mae nifer y cleifion sy'n cael eu trosglwyddo'n ôl i'r ward ar ôl cael eu derbyn i uned gofal critigol yn cynyddu. Yn 2012, cafodd ychydig dros 80% o gleifion eu rhyddhau i ward arall, sef cynnydd o'i gymharu â 79% yn 2011;
* Mae’r GIG yn bodloni'r galw am ofal critigol, sydd wedi bod yn cynyddu'n araf dros gyfnod. Yn 2011 roedd 8,991 o dderbyniadau ac yn 2012 roedd 9,887 o dderbyniadau – cynnydd o 896 o dderbyniadau, bron 10%.
* Prin iawn yw'r aildderbyniadau i ofal critigol o fewn 48 awr – llai na 2% o'r holl gleifion sy'n cael eu rhyddhau, sy'n arwydd bod y gofal mewn wardiau a'r broses ryddhau yn effeithiol.
* Ers cyflwyno'r rhwydweithiau gofal critigol, mae gwelliannau wedi digwydd o ran trosglwyddo diogel ar gyfer pobl sy'n ddifrifol wael drwy hyfforddiant ac archwilio parhaus – mae 80% o'r holl drosglwyddiadau'n cael eu barnu'n dda neu'n rhagorol.
* Mae holiadur adborth gofalwyr y Gymdeithas Gofal Dwys wedi cael ei gyflwyno i gael barn gofalwyr. Mae ysbytai sydd wedi cymryd rhan wedi nodi cyfraddau boddhad rhagorol o ran cyfathrebu, cyfleusterau a staff meddygol a nyrsio.


Mae’n rhaid i ni barhau i gynnal a gwella perfformiad yn y meysydd hyn a sicrhau bod cynnydd yn digwydd yn y meysydd hynny lle nad yw perfformiad wedi bod cystal â'r disgwyl.


Mae’r GIG yn parhau i weithio i sicrhau bod gwasanaethau iechyd yng Nghymru yn gynaliadwy ac yn bodloni anghenion pobl Cymru wrth i’r anghenion hyn newid. Fel rhan o’u cynlluniau gwasanaeth ac ad\-drefnu, mae’n rhaid i’r byrddau iechyd ystyried y lleoliad a'r swyddogaeth orau ar gyfer eu hunedau gofal critigol.


Mae'r adroddiad blynyddol yn cydnabod y gallai fod yn briodol i ganoli gwasanaethau gofal critigol mewn llai o ysbytai nag sy’n digwydd ar hyn o bryd. Gallai hyn olygu tynnu gwasanaethau gofal dwys ynghyd – gofal lefel tri – ond sicrhau bod ysbytai eraill yn cynnal y cyfleusterau i ddadebru a sefydlogi cleifion difrifol wael cyn bod modd eu trosglwyddo i uned gofal dwys.


Mae adroddiad yr asesiad o angen heb ei fodloni ar gyfer gofal critigol yng Nghymru yn dod i’r casgliad y gallai fod angen 73 o welyau ychwanegol yng Nghymru yn y dyfodol. Yn y flwyddyn ddiwethaf, mae 10 o welyau gofal critigol ychwanegol wedi’u sicrhau ar draws Cymru ac mae gan fyrddau iechyd gynlluniau ar gyfer wyth arall.


Fodd bynnag, mae’r ddau adroddiad yn tynnu sylw at y broblem yng Nghymru ar hyn o bryd o ran oedi wrth drosglwyddo gofal o unedau gofal critigol, a all arwain at golli hyd at 14 o welyau y flwyddyn. Nes i’r broblem hon gael ei datrys a nes i’r gyfradd o oedi wrth drosglwyddo ostwng, mae creu degau ar ddegau o welyau gofal critigol newydd yn annhebygol o leddfu’r broblem, fel y mae adroddiad yr asesiad yn ei gydnabod.


Mae’r ddau adroddiad yn dweud yn glir bod yn rhaid i’r GIG ganolbwyntio ar leihau oedi wrth drosglwyddo gofal o unedau gofal critigol yng Nghymru, a sicrhau bod derbyniadau'n briodol ac er budd gorau cleifion er mwyn gwneud y defnydd gorau o welyau presennol, cyn bwrw ymlaen â chynyddu nifer y gwelyau ar raddfa helaeth.


Mae’n rhaid i ni wneud y defnydd gorau o'r adnoddau sydd gennym eisoes ac mae'n rhaid gweithredu'n gynt i fynd i'r afael â'r defnydd aneffeithlon o’n gwelyau gofal critigol. Dylai fod gan bob bwrdd iechyd yng Nghymru gynllun i fynd i'r afael ag oedi wrth drosglwyddo gofal a bydd gofyn iddynt sicrhau bod hyn yn lleihau'n raddol. Bydd hyn yn gofyn am gydweithredu a chydgysylltu ar draws ysbytai.


Mae gwaith yn digwydd gan Fwrdd Iechyd Prifysgol Aneurin Bevan a'r rhwydweithiau gofal critigol i lunio mesur datblygu newydd ar sail oriau a gollwyd yn sgil oedi wrth drosglwyddo gofal mewn gofal critigol. Bydd disgwyl i’r byrddau iechyd sicrhau gostyngiad o 10% bob chwarter yn nifer yr oriau a gollir trwy oedi wrth drosglwyddo gofal o unedau gofal critigol. Bydd disgwyl i’r gostyngiad hwn barhau hyd nes y byddant yn cyrraedd sefyllfa lle nad oes mwy na 5% o’r gwelyau sydd ar gael yn cael eu colli oherwydd oedi wrth drosglwyddo gofal.


Bydd y cam hwn yn sicrhau bod y GIG yn gwneud y defnydd gorau o’i welyau gofal critigol a bod y rheini ar gael i gleifion pan fo’u hangen.


Bydd y mesur hwn yn cael ei roi ar brawf fel rhan o fframwaith canlyniadau newydd y GIG.


Cyhoeddir y datganiad hwn yn ystod y toriad er mwyn rhoi’r wybodaeth ddiweddaraf i’r Aelodau. Os bydd yr Aelodau’n dymuno imi wneud datganiad pellach neu ateb cwestiynau am hyn pan fydd y Cynulliad yn ailagor, byddwn yn hapus i wneud hynny.





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