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The NHS Finance (Wales) Act 2014 and associated NHS Wales Planning Framework signalled a new medium\-term approach to planning, requiring health boards and NHS trusts to set out how resources will be used over a three year period to:


 


* address areas of population health need and improve health outcomes
* improve the quality of care, and
* ensure best value from resources.


 


The Act and framework also contained a provision requiring my scrutiny and approval of plans, allowing, where necessary resource allocation adjustments between financial years as a key enabler to transformational change over a rolling three\-year period.


During the passage of the NHS Finances (Wales) Bill, the Auditor General for Wales, in his submission to the Finance Committee, commended the Welsh Government’s intention to create a requirement for health boards and NHS trusts to develop, scrutinise and approve Integrated Medium Term Plans, including balanced medium\-term financial plans and thereby to introduce a degree of managed flexibility.  


The Auditor General also recognised the vital role the Welsh Government’s approval of plans should play in ensuring that appropriate rigour and challenge is built into the planning process.


Health boards and NHS trusts have been developing their Integrated Medium Term Plans since autumn 2013 and, in line with the framework, submitted board\-considered draft plans to the Welsh Government for consideration on January 31 and final plans on March 31\.


Throughout the passage of the NHS Finance (Wales) Act 2014, I reassured Assembly Members on several occasions that plans would only be approved by the Welsh Government following board\-level robust scrutiny and approval of health board and NHS trust plans, and when they met the requirements of the NHS Wales planning framework.  


I was also clear that the Welsh Government’s approval of plans in no way abdicates health board and NHS trust board accountability for the delivery of services or prejudices the outcome of any due processes required to implement the plan. For example, any service changes should be carried out in line with the Guidance on Engagement and Consultation and would be subject to normal business case approval processes.


Following a robust scrutiny process, which has been quality assured by  external, independent assessors and recognised by the Auditor General for Wales, I am able to confirm I have approved the following Integrated Medium Term Plans – Cwm Taf University Health Board; Cardiff and Vale University Health Board and Velindre NHS Trust.  


Two further health boards – Aneurin Bevan University Health Board and Abertawe Bro Morgannwg University Health Board – have submitted Integrated Medium Term Plans that have been agreed in principle by their boards, with final agreement expected during May. This provides good evidence of the level of scrutiny and challenge individual boards have been applying to plans. I have agreed to the re\-submission of both plans by May 30 and, following further Welsh Government scrutiny, I will make a further statement when I approve these.  


The chief executive of NHS Wales will write to Abertawe Bro Morgannwg and Aneurin Bevan health boards, clarifying key deliverables and performance expectations for the intervening period.


Public Health Wales (PHW) has similarly submitted a medium\-term plan, which has been agreed in principle by its board. However, it is important the new chief executive, who is due to take up post on June 2, has time to contribute to it. In addition, the interdependency of services provided by PHW to other organisations and the dependency on action by health boards for delivery of some of PHW’s services means that aspects of the plan cannot be fully finalised until all other health board and NHS trust plans have been further developed.


The remaining health boards and NHS trusts have concluded, for good reasons, that they are unable to submit robust Integrated Medium Term Plans at this point.  


Betsi Cadwaladr University Health Board, Powys Teaching Health Board, and Hywel Dda University Health Board wish to respond meaningfully to the conclusions of the Mid Wales Study before committing to a medium\-term plan and are keen to allow sufficient time for recent or imminent changes to key board personnel to take hold.  


The Welsh Ambulance Services NHS Trust is advancing a number of the key reforms arising from the McClelland review, including the full establishment of the new commissioning arrangements, which will be vital to reviewing, inputting and approving a plan on a medium\-term basis.  The new legal framework governing the relationship between health boards and the ambulance trust and the newly\-appointed board, only came into being on April 1, 2014\.


For these reasons I have asked each of these organisations to finalise and sign off a one\-year plan before May 30\. The Welsh Government will work closely with each of these organisations to agree key milestones for the ongoing development of their medium\-term plan over the course of this financial year.  


Taken together, these decisions demonstrate the necessary rigour in putting into place the arrangements set out in the NHS Wales Planning Framework and the NHS Finance (Wales) Act 2014\. Progress has been made as three\-year planning arrangements mature within NHS organisations.


Managed financial flexibility has been afforded, at this point, to those health boards and NHS trust able to demonstrate a sufficiently\-integrated and prioritised three\-year plan, drawing together service, workforce and financial considerations.







Translation:


 
Roedd Deddf Cyllid Gwasanaeth Iechyd Gwladol (Cymru) 2014 a’r Fframwaith Cynllunio GIG Cymru cysylltiedig yn nodi dull newydd o weithredu cynlluniau tymor canolig, a bydd yn ofynnol i Fyrddau Iechyd ac Ymddiriedolaethau bennu sut y caiff adnoddau eu defnyddio dros gyfnod o dair blynedd er mwyn:

* ymdrin ag anghenion iechyd y boblogaeth a gwella canlyniadau iechyd;
* gwella ansawdd y gofal; a
* sicrhau gwerth gorau o’r adnoddau.

Roedd y Ddeddf a’r Fframwaith hefyd yn cynnwys darpariaeth sy’n gofyn i mi graffu a chymeradwyo cynlluniau, gan alluogi addasiadau yn ôl yr angen i ddyrannu adnoddau rhwng blynyddoedd ariannol. Bydd hyn yn allweddol ar gyfer y trawsnewid sydd ei angen dros gyfnod treigl tair blynedd.

Wrth i Ddeddf Cyllid Gwasanaeth Iechyd Gwladol (Cymru) fynd drwy’r Senedd, yn ei sylwadau gerbron y Pwyllgor Cyllid cymeradwyodd Archwilydd Cyffredinol Cymru fwriad Llywodraeth Cymru i’w gwneud yn ofynnol i Fyrddau Iechyd ac Ymddiriedolaethau’r GIG ddatblygu, craffu a chymeradwyo Cynlluniau Tymor Canolig Integredig, gan gynnwys cynlluniau ariannol tymor canolig cytbwys, a thrwy hynny gyflwyno elfen o hyblygrwydd a reolir.

Fe wnaeth yr Archwilydd Cyffredinol hefyd gydnabod rôl hanfodol Llywodraeth Cymru wrth gymeradwyo’r cynlluniau i sicrhau bod yr her a’r manylder priodol yn rhan o’r broses gynllunio.

Mae’r Byrddau Iechyd a’r Ymddiriedolaethau wedi bod yn datblygu eu Cynlluniau Tymor Canolig Integredig ers hydref 2013, ac yn unol â’r fframwaith maent wedi cyflwyno cynlluniau drafft a ystyriwyd gan y Byrddau gerbron Llywodraeth Cymru i’w hystyried ar 31 Ionawr, a’r cynlluniau terfynol ar 31 Mawrth.

Wrth i Ddeddf Cyllid Gwasanaeth Iechyd Gwladol (Cymru) 2014 fynd drwy’r Senedd, rhoddais sicrwydd i Aelodau’r Cynulliad ar sawl achlysur y byddai cynlluniau ond yn cael eu cymeradwyo gan Lywodraeth Cymru ar ôl craffu manwl a chymeradwyaeth ar lefel Bwrdd o gynlluniau’r Byrddau Iechyd a’r Ymddiriedolaethau, a phan fyddent wedi bodloni gofynion fframwaith cynllunio GIG Cymru.

Roeddwn hefyd wedi egluro nad yw cymeradwyaeth Llywodraeth Cymru o’r cynlluniau mewn unrhyw ffordd yn ymwrthod ag atebolrwydd Bwrdd Iechyd a Bwrdd Ymddiriedolaeth o ran darparu gwasanaethau, nac yn dylanwadu ar ganlyniad unrhyw brosesau sy’n ofynnol i weithredu’r cynllun. Er enghraifft, dylid cyflawni unrhyw newidiadau i wasanaethau yn unol â’r Canllawiau Ymgysylltu ac Ymgynghori, a byddent yn amodol ar brosesau cymeradwyo arferol achosion busnes.

Yn dilyn proses graffu gadarn, sydd wedi’i sicrhau o ran ansawdd gan aseswyr annibynnol, allanol a’i chydnabod gan Archwilydd Cyffredinol Cymru, gallaf gadarnhau fy mod wedi cymeradwyo’r Cynlluniau Tymor Canolig Integredig canlynol: Bwrdd Iechyd Prifysgol Cwm Taf; Bwrdd Iechyd Prifysgol Caerdydd a’r Fro, ac Ymddiriedolaeth GIG Felindre.

Mae dau Fwrdd Iechyd arall \- Bwrdd Iechyd Prifysgol Aneurin Bevan a Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg \- wedi cyflwyno Cynlluniau Tymor Canolig Integredig y cytunwyd arnynt mewn egwyddor gan eu Byrddau, gyda chytundeb terfynol i’w ddisgwyl yn ystod mis Mai. Mae hyn yn dystiolaeth dda o lefel y craffu a’r her y mae’r Byrddau unigol wedi bod yn eu cymhwyso i gynlluniau. Rwyf wedi cytuno i ailgyflwyno’r ddau gynllun erbyn 30 Mai, ac yn dilyn craffu pellach gan Lywodraeth Cymru byddaf yn gwneud datganiad pellach pan fyddaf yn eu cymeradwyo.

Bydd Prif Weithredwr GIG Cymru yn ysgrifennu at Fyrddau Iechyd Abertawe Bro Morgannwg ac Aneurin Bevan, gan egluro’r disgwyliadau o ran perfformiad a’r cyflawniadau allweddol yn y cyfamser.

Yn yr un modd, mae Iechyd Cyhoeddus Cymru wedi cyflwyno Cynllun Tymor Canolig, y cytunwyd arno gan ei Fwrdd mewn egwyddor. Fodd bynnag, mae’n bwysig fod y Prif Weithredwr newydd, a fydd yn cychwyn ar ei swydd ar 2 Mehefin, yn cael amser i gyfrannu ato. Hefyd, mae cyd\-ddibyniaeth gwasanaethau a ddarperir gan Iechyd Cyhoeddus Cymru i sefydliadau eraill a’r ddibyniaeth ar weithredu gan Fyrddau Iechyd ar gyfer darparu rhai o wasanaethau Iechyd Cyhoeddus Cymru yn golygu na ellir cwblhau agweddau ar y cynllun nes y bydd holl gynlluniau’r Byrddau Iechyd a’r Ymddiriedolaethau eraill wedi’u datblygu ymhellach.

Daeth y Byrddau Iechyd a’r Ymddiriedolaethau sy’n weddill i’r casgliad, am resymau da, na allant gyflwyno Cynlluniau Tymor Canolig Integredig manwl ar hyn o bryd.

Mae Bwrdd Iechyd Prifysgol Betsi Cadwaladr, Bwrdd Addysgu Iechyd Powys a Bwrdd Iechyd Prifysgol Hywel Dda yn dymuno rhoi ymateb ystyrlon i gasgliadau Astudiaeth Canolbarth Cymru cyn ymrwymo i Gynllun Tymor Canolig. Maent hefyd yn awyddus i ganiatáu digon o amser i weld yr effaith a gaiff newidiadau diweddar, neu newidiadau sydd ar fin digwydd, i bersonél allweddol y Bwrdd.

Mae Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru yn datblygu nifer o ddiwygiadau allweddol sy’n deillio o adolygiad McClelland, gan gynnwys sefydlu’n llawn y trefniadau comisiynu newydd a fydd yn hanfodol i adolygu, mewnbynnu a chymeradwyo cynllun ar sail tymor canolig. Dim ond ar 1 Ebrill, 2014 y daeth y fframwaith cyfreithiol newydd i rym, sy’n rheoli’r berthynas rhwng y Byrddau Iechyd a’r Ymddiriedolaeth Ambiwlans a’r bwrdd sydd newydd ei benodi.

Am y rhesymau hyn rwyf wedi gofyn i bob un o’r sefydliadau hyn gwblhau a llofnodi cynllun blwyddyn cyn 30 Mai. Bydd Llywodraeth Cymru yn cydweithio’n agos â phob un o’r sefydliadau hyn i gytuno ar gerrig milltir allweddol ar gyfer parhau i ddatblygu eu Cynllun Tymor Canolig yn ystod y flwyddyn ariannol bresennol.

Gyda’i gilydd, mae’r penderfyniadau hyn yn dangos y manylder sydd ei angen er mwyn gwneud y trefniadau a amlinellir yn Fframwaith Cynllunio GIG Cymru a Deddf Cyllid Gwasanaeth Iechyd Gwladol (Cymru) 2014\. Gwnaed cynnydd wrth i drefniadau cynllunio tair blynedd aeddfedu o fewn sefydliadau’r GIG.

Rhoddwyd hyblygrwydd ariannol a reolir, ar hyn o bryd, i’r Byrddau Iechyd a’r Ymddiriedolaethau hynny sy’n gallu dangos bod ganddynt gynllun tair blynedd sy’n cynnwys blaenoriaethau digon integredig, gan gyfuno ystyriaethau o ran y gwasanaeth, o ran y gweithlu ac o ran cyllid.