Translate the text from English to Welsh.



 
 


 


In an age of austerity, the NHS in Wales, like other healthcare systems around the world, is facing the twin challenges of rising costs and increasing demand, while continuing to improve the quality of care.  

  

Informed by the work of the Bevan Commission and others around the world, the NHS in Wales is embracing the principles of prudent healthcare as it seeks to respond to these challenges.  Prudent healthcare puts NHS Wales at the forefront of a growing international movement to secure greater value from healthcare systems for patients.    

  

Some aspects of prudent healthcare are already evident in the working practices of every health board and NHS trust in Wales. However, the NHS must now work together to enshrine the value\-based principles encouraged by prudent healthcare across its entire system.    

  

Through placing greater value on patient outcomes rather than the volume of activity and procedures delivered, as we currently do, prudent healthcare aims to rebalance the NHS and create a patient\-centred system. An NHS based on prudent healthcare principles ensures patients receive the most appropriate treatments to achieve mutually\-agreed goals, which reflect the contribution individuals can make to their own health and wellbeing.  

  

Prudent healthcare is built around a set of principles, which state that any service or person providing care should:  

 


* Do no harm. The principle that interventions which do harm or provide no clinical benefit are eliminated;
* Carry out the minimum appropriate intervention. The principle that treatment should begin with the basic proven tests and interventions. The intensity of testing and treatment is consistent with the seriousness of the illness and the patient’s goals;
* Organise the workforce around the “only do, what only you can do” principle.  The principle that all people working for the NHS in Wales should operate at the top of their clinical competence. Nobody should be seen routinely by a consultant, for example, when their needs could be appropriately dealt with by an advanced nurse practitioner.
* Promote equity. The principle that it is the individual’s clinical need which matters when it comes to deciding NHS treatment;
* Remodel the relationship between user and provider on the basis of co\-production.


  

All these principles are underlined by a commitment to rebalance the healthcare system by strengthening primary and community\-based care to support the establishment of a more equal relationship between patient and professionals and changing the relationship between healthcare services and the public, characterised by a shared responsibility for securing improved health outcomes.    

  

In addition to prudent professionals, prudent healthcare requires prudent patients. The NHS is there to help us in our time of need but with that comes a responsibility to use its resources wisely. The NHS is free from charge but not free from obligation. This is the new bargain in this ongoing age of austerity – it is the bargain of co\-production at an individual and population level where patients and the NHS each make a contribution to improve health and wellbeing  

  

The first half of this year has seen a period of engagement and debate to gather the views of people in the NHS, including clinical teams in four treatment areas – orthopaedics, pain management, prescribing, and ear, nose, and throat services \- on the impact prudent healthcare could have, if applied to the NHS in Wales. Debates have started with the public too.     

  

Prudent healthcare has been widely welcomed. The engagement exercise found examples of imprudent practice but it also found many examples where organising services around the principles could deliver increased value.    

  

The way in which heart failure teams, led by advanced nurse practitioners, are already exemplifying the only\-do\-what\-only\-you\-can\-do principle and Cardiff and Vale University Health Board’s optimising outcomes policy, which demonstrates the co\-productive approach, are just two examples  

  

It was clear from the engagement work that prudent healthcare will not be delivered by the actions of NHS Wales alone.  Continuing to secure best value from our investments in healthcare requires a move away from only treating diseases, to an approach which also treats the related conditions, complications, and circumstances. This will only be achieved with meaningful partnerships between all sectors and industry. The Tredegar Deep Place Study and the Caerphilly Cohort Study demonstrate the strong relationships between poverty, place and public health and, by implication, the importance of effective partnerships to delivering prudent healthcare. Both provide further evidence to support one of the key conclusions from the Commission on Public Service Governance and Delivery that public services must take action to prevent the preventable.  

  

The Caerphilly study in particular shows that substantial reductions in serious health conditions are linked to five healthy lifestyle behaviours \- not smoking; a low body mass index; regular exercise; a plant\-based diet and alcohol consumption within guidelines. By maintaining four or five of these the study showed there was a 73% reduction in type 2 diabetes; a 67% reduction in vascular disease; an 18% reduction in cancer and a 64% reduction in dementia. If these health improvements were realised across the population, they would make a significant contribution to a sustainable NHS in Wales.    

  

Prudent healthcare and the work of people in Wales to secure better health outcomes for the population of Wales will be captured in an e\-book to be published this autumn. Contributors have been challenged to set out what more can be done to advance the movement at pace.  

  

Alongside this e\-book, Welsh Government, NHS Wales and key partners will take forward action by organising their work around prudent healthcare principles. Key aspects will include:


 


 


* Build on the recent strengthening of the NHS Wales planning system. The planning requirements and outcomes framework are being refreshed to embody the prudent healthcare principles to ensure they are embedded within health boards and NHS trusts;
* Draw on the Choosing Wisely work, which has been developed in the US and Canada. The Choosing Wisely campaigns help clinicians and patients make smart and effective choices about tests, treatments and procedures;
* National guidelines for interventions not normally undertaken and National Institute for Health and Care Excellence “do not do” guidance are being refreshed, alongside the introduction of enhanced compliance at health board and NHS trust level.  This will be complemented by the planned care work programme, which is developing prudent surgical and medical pathways;
* The re\-vamped Bevan Commission will improve the evidence base for, and advice around, prudent healthcare as well as championing the agenda;
* Continuing to work with the Department of Economy, Science and Transport on initiatives which will drive healthcare improvement and economic development. This will develop a more systematic approach to product and process innovation, including for example applied research to address clinical needs and challenges, co\-ordinated adoption of new technology into practice and more engagement with industry.


  

Prudent healthcare will not suddenly happen overnight. We are at the start of a journey which will ensure that public value is at the heart of our healthcare system; there is always a culture of putting people first and there is an expectation of constant measurable improvement in the delivery of health and better care for all.


 


 


 


 


 


 







Translation:


 
Mewn oes o galedi ariannol, mae GIG Cymru yn wynebu dwy her: costau cynyddol a galw cynyddol. Ar yr un pryd, mae’n ceisio gwella safonau gofal. Mae’r un peth yn wir am systemau gofal iechyd eraill ar draws y byd.  
   
 Mae GIG Cymru yn mabwysiadu egwyddorion gofal iechyd darbodus wrth geisio ymateb i’r heriau hyn, ar sail gwaith Comisiwn Bevan a ffynonellau eraill o bob cwr o’r byd. Mae gofal iechyd darbodus yn rhoi GIG Cymru ar y blaen mewn symudiad rhyngwladol sy’n ennill tir, i sicrhau bod systemau gofal iechyd yn darparu mwy o werth i gleifion.    
   
 Mae pob un o fyrddau iechyd ac ymddiriedolaethau GIG Cymru eisoes wedi mabwysiadu arferion gweithio sy’n cynnwys rhai agweddau ar ofal iechyd darbodus. Ond rhaid i’r GIG gydweithio yn awr i ymgorffori egwyddorion gofal iechyd darbodus, sy’n seiliedig ar ddarparu gwerth, ar draws y system gyfan.    
   
 Nod gofal iechyd darbodus yw creu gwell cydbwysedd o fewn y GIG a chreu system sy’n canolbwyntio ar y claf, drwy roi mwy o bwyslais ar ganlyniadau i gleifion, yn hytrach na swm y gweithgarwch a’r triniaethau, fel sy’n digwydd ar hyn o bryd.  Mae GIG sy’n seiliedig ar egwyddorion gofal iechyd darbodus yn sicrhau bod cleifion yn cael y triniaethau mwyaf priodol er mwyn cyflawni nodau a gytunir gan y naill ochr a’r llall. Nodau sy’n adlewyrchu cyfraniad unigolion i’w hiechyd a’u lles eu hunain yw’r rhain.  
   
 Mae gofal iechyd darbodus yn seiliedig ar set o egwyddorion sy’n datgan y dylai unrhyw wasanaeth neu unigolyn sy’n darparu gofal:  
   
* Beidio â gwneud unrhyw niwed. Dileu ymyriadau sy’n gwneud niwed, neu nad oes unrhyw fudd clinigol iddynt, yw’r egwyddor;
* Ymyrryd yn briodol, ond cyn lleied ag sydd angen. Dylai triniaeth gychwyn gyda’r profion a’r ymyriadau sylfaenol, y profwyd eu gwerth, yw’r egwyddor hon. Dylai dwyster y profion a’r driniaeth gyfateb i ddifrifoldeb y salwch a nodau’r claf ei hun;
* Trefnu’r gweithlu o amgylch yr egwyddor o “ddim ond gwneud yr hyn y gallwch chi, a neb arall, ei wneud”. Yn ôl yr egwyddor hon, dylai pawb sy’n gweithio i’r GIG yng Nghymru weithredu ar eithaf ei allu clinigol. Er enghraifft, ni ddylai unrhyw un gael ei weld gan feddyg ymgynghorol fel mater o drefn, os yw uwch\-ymarferydd nyrsio yn gallu diwallu ei anghenion yn briodol.
* Hybu tegwch. Yn ôl yr egwyddor hon, angen clinigol yr unigolyn sy’n bwysig o ran penderfynu pa driniaeth a ddarperir gan y GIG;
* Ail\-lunio’r berthynas rhwng y defnyddiwr a’r darparwr ar sail cydgynhyrchu.

 Yn sail i bob un o’r egwyddorion hyn ceir ymrwymiad i greu gwell cydbwysedd o fewn y system gofal iechyd, drwy gryfhau gofal sylfaenol a gofal yn y gymuned. Diben hynny yw helpu i sefydlu perthynas fwy cyfartal rhwng cleifion a gweithwyr proffesiynol, a newid y berthynas rhwng gwasanaethau gofal iechyd a’r cyhoedd fel eu bod yn rhannu’r cyfrifoldeb am sicrhau gwell canlyniadau iechyd.    
   
 Yn ogystal â gweithwyr iechyd proffesiynol darbodus, mae angen cleifion darbodus er mwyn sefydlu system o ofal iechyd darbodus. Mae’r GIG yno i’n helpu pan fyddwn mewn angen, ond ynghlwm â hynny mae cyfrifoldeb i ddefnyddio ei adnoddau’n ddoeth. Er bod y GIG yn ddi\-dâl, nid yw’n hynny’n golygu gwneud fel y mynnwn. Dyna sail y fargen newydd yn yr oes hon o galedi: cydgynhyrchu ar lefel unigol ac ar lefel y boblogaeth, a chleifion a’r GIG ill dau’n cyfrannu at wella iechyd a lles.    
   
 Cyfnod o drafod a chysylltu oedd hanner cyntaf y flwyddyn, er mwyn casglu barn pobl o fewn y GIG, gan gynnwys timau clinigol mewn pedwar maes triniaeth \- orthopedeg, rheoli poen, presgripsiynau, a gwasanaethau’r glust, y trwyn a’r gwddf \- ar yr effaith y gallai dilyn egwyddorion gofal iechyd darbodus ei chael ar GIG Cymru. Dechreuwyd trafod hyn â’r cyhoedd hefyd.       
   
 Mae gofal iechyd darbodus wedi derbyn croeso eang. Wrth drafod a chysylltu, daeth enghreifftiau o arferion annoeth i’r amlwg. Ond cafwyd sawl enghraifft hefyd oedd yn dangos y gallai trefnu gwasanaethau ar sail yr egwyddorion hyn ychwanegu at werth.    
   
 Un enghraifft o hyn yw’r ffordd y mae timau methiant y galon, dan arweiniad uwch\-ymarferwyr nyrsio, yn dilyn yr egwyddor o ddim ond gwneud yr hyn y gallant hwy, a heb arall, ei wneud. Enghraifft arall yw polisi Bwrdd Iechyd Prifysgol Caerdydd a’r Fro o sicrhau’r canlyniadau gorau posibl, yn unol ag egwyddor cydgynhyrchu.   
   
 Wrth drafod ag eraill daeth yn amlwg na fydd gweithredu ar ran GIG Cymru, ynddo’i hun, yn ddigon i ddarparu gofal iechyd darbodus. Mae angen symud oddi wrth drin afiechydon yn unig, a thrin y cyflyrau a’r cymhlethdodau cysylltiedig, gan ymateb i’r amgylchiadau, er mwyn parhau i sicrhau bod ein buddsoddiad mewn gofal iechyd yn rhoi’r gwerth gorau. Dim ond drwy sefydlu partneriaeth ystyrlon rhwng pob sector a byd diwydiant y gellir cyflawni hyn. Mae Astudiaeth Lle Dwfn Tredegar ac yr Astudiaeth Carfan Caerffili yn dangos y berthynas gref rhwng tlodi, lle ac iechyd y cyhoedd, ac mae hynny’n awgrymu pwysigrwydd partneriaethau effeithiol er mwyn darparu gofal iechyd darbodus. Mae’r naill a’r llall yn darparu tystiolaeth bellach i gefnogi un o brif gasgliadau’r Comisiwn Gwasanaethau Cyhoeddus, sef bod rhaid i wasanaethau cyhoeddus weithredu i osgoi’r pethau y gellir eu hatal.   
   
 Mae astudiaeth Caerffili yn dangos cysylltiad clir rhwng gostyngiad sylweddol mewn cyflyrau iechyd difrifol a phum agwedd ar fyw’n iach – peidio smygu; mynegai màs y corff isel; ymarfer corff rheolaidd; diet sy’n seiliedig ar blanhigion; a chadw o fewn y canllawiau yfed alcohol. Dangosodd yr astudiaeth fod cadw at bedwar neu bump o’r rhain yn arwain at ostyngiad o 73% mewn diabetes math 2; gostyngiad o 67% mewn afiechydon fasgwlaidd; gostyngiad o 18% mewn canser; a gostyngiad o 64% mewn dementia. Pe byddai iechyd y boblogaeth gyfan yn gwella fel hyn, byddai’n gwneud cyfraniad sylweddol at sicrhau bod GIG Cymru yn gynaliadwy.    
   
 Byddwn yn paratoi e\-gyhoeddiad yn yr hydref, a fydd yn disgrifio gofal iechyd darbodus a gwaith pobl Cymru i sicrhau gwell canlyniadau iechyd i’r boblogaeth. Gofynnwyd i’r cyfranwyr amlinellu beth yn ychwanegol y gellir ei wneud i sicrhau bod y symudiad yn dal i ennill tir.    
   
 Ochr yn ochr â’r cyhoeddiad hwn, bydd Llywodraeth Cymru, GIG Cymru a phartneriaid allweddol yn mynd ati i drefnu eu gwaith ar sail egwyddorion gofal iechyd darbodus. Prif agweddau hyn fydd:  
   
* Adeiladu ar y gwaith diweddar i gryfhau system gynllunio GIG Cymru, drwy ddiweddaru’r fframwaith canlyniadau a’r gofynion cynllunio er mwyn cynnwys egwyddorion gofal iechyd darbodus, a sicrhau bod byrddau iechyd ac ymddiriedolaethau’r GIG yn eu hymgorffori;
* Efelychu gwaith yr ymgyrch Choosing Wisely, a ddatblygwyd yng Nghanada a’r Unol Daleithiau. Mae Choosing Wisely yn ymgyrchu i helpu clinigwyr a chleifion i wneud dewisiadau doeth ac effeithiol am brofion a thriniaethau;
* Ailedrych ar ganllawiau cenedlaethol ar gyfer ymyriadau nas gwneir fel arfer, a chanllawiau “peidiwch â gwneud” y Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal, a chydymffurfio’n well â hwy ar lefel bwrdd iechyd ac ymddiriedolaeth GIG. Bydd y rhaglen gwaith gofal cynlluniedig, sy’n datblygu llwybrau llawfeddygol a meddygol darbodus, yn ategu hyn;
* Bydd Comisiwn Bevan, ar ei newydd wedd, yn gwella’r sylfaen dystiolaeth a’r cyngor ar ofal iechyd darbodus, ac yn hybu’r agenda; a
* Parhau i weithio gydag Adran yr Economi, Gwyddoniaeth a Thrafnidiaeth ar fentrau a fydd yn hybu gwelliannau mewn gofal iechyd ac yn datblygu’r economi. Bydd hyn yn arwain at greu cynnyrch a phrosesau arloesol mewn ffordd fwy systematig, gan gynnwys ymchwil gymhwysol sy’n ymateb i anghenion a heriau clinigol, mynd ati mewn ffordd drefnus i gynnwys technoleg newydd mewn arferion gwaith, a mwy o gyswllt â diwydiant, er enghraifft.

   
 Nid rhywbeth a fydd yn digwydd dros nos yw gofal iechyd darbodus. Rydym yn cychwyn ar daith a fydd yn sicrhau bod gwerth i’r cyhoedd yn ganolog i’n system gofal iechyd; bod diwylliant o roi pobl yn gyntaf bob amser; bod disgwyl i’r ffordd y caiff iechyd ei ddarparu wella’n gyson, a bod modd mesur hynny; a bod gwell gofal ar gael i bawb.