Translate the text from English to Welsh.



 
As an integrated health and social care system, our priority is getting each individual to the right setting safely, to support their recovery, avoid deconditioning and promote their wellbeing.


Our Covid discharge guidance is based on the principle of “home first”, the Discharge to Recover then Assess pathways and a collective focus on rehabilitation and reablement, and this will remain the case when we recover from this pandemic.


If we get the transfer from hospital to the next stage of care right, patient flow is maintained. This means that the people who urgently need acute hospital care can access it promptly, whilst vulnerable people, including older people, especially those with frailties, are protected from the risks of deconditioning and of Health Care Acquired Infections that extended stays in hospital pose.


On the other hand, it is vital that we avoid importing infection into care homes or other settings, or exposing people to infection unnecessarily. This balance is what I mean by getting hospital discharge right.


To balance the imperative to get people to where they can best be cared for against the need to protect care homes and other settings from accidental transmission, we have requirements in place around discharge and also around when a care home or other setting, having had an outbreak, can be declared Covid\-free.


As we gather more data on Covid and our understanding develops, it is right that we should revise our approaches to these key questions. We have advice from the Technical Advisory Group, which I am publishing today, around these two topics, and this underpins the positions on discharge testing and on duration of outbreaks which I am announcing today.


For patients who have had COVID\-19, the key point in relation to discharge is infectivity. We now know that the best indicators of cessation of infectivity are lapse of time and remission of symptoms, with a test playing a confirmatory role. It is essential now, more than ever, that people who are no longer infectious with COVID\-19 are not inappropriately retained in health care settings. We can now say with confidence that a person who has a test result with a Cycle Threshold (Ct) number of 35 or above is no longer infectious and therefore can return to their home or a social care setting without posing a risk of COVID\-19 to others, or facing the need to isolate for a period of time.


For that reason I am changing the guidance on discharge with immediate effect so that people with a negative Covid test, or a test with a Ct number of 35 or above, may be discharged to home or a social care setting. This will be provided that the other criteria of 14 days having elapsed since the last positive test or onset of symptoms, the person having been free from fever for three days, and other symptoms having shown improvement, are all met. The guidance remains that patients who are infectious, but no longer need acute care, should move to a Covid\-infectious step\-down facility. This applies to patients who have had COVID\-19; for patients who have not had evidence of COVID\-19, the current requirements for a negative test prior to discharge and an isolation period will remain in place, to address the risk of acquiring infection after the test is taken.


Similarly, for determination of outbreaks; our growing understanding of COVID\-19 allows for a better understanding of the duration of incubation periods and infectivity. This is a matter of considerable importance given the impact of care home closures stemming from outbreaks on the ability to allow new admissions into homes and, indeed, to permit visitors to those already in residence. Our latest advice indicates that we can say with a high degree of confidence that – provided proper Infection Prevention and Control processes have been applied – individuals are very unlikely to still be infectious 20 days after the last case in a closed setting has been identified. I intend therefore to allow multi\-disciplinary teams, having taken into account the specific circumstances of individual homes, to declare outbreaks over after 20 days have elapsed since the last positive test or manifestation of symptoms. This modification of the current 28\-day requirement will be subject to a confirmatory round of negative or low positive (Ct score ≥35\) tests at the 14 day point.


Technical Advisory Group: updated consensus statement on recommended testing criteria for discharge of asymptomatic patients to care homes.







Translation:


 
Fel system iechyd a gofal cymdeithasol integredig, ein blaenoriaeth yw sicrhau bod pob unigolyn cael ei roi yn y lleoliad cywir yn ddiogel, er mwyn ei helpu i wella, osgoi datgyflyru a hybu ei les.


Mae ein canllawiau rhyddhau mewn perthynas â COVID\-19 wedi’u seilio ar yr egwyddor “gartref yn gyntaf”, y llwybrau Rhyddhau i Adfer yna Asesu a chanolbwyntio ar y cyd ar adsefydlu ac ailalluogi. Bydd hyn yn parhau’n berthnasol pan fyddwn yn adfer o’r pandemig hwn.


Drwy sicrhau proses briodol ar gyfer trosglwyddo unigolion o’r ysbyty i’r cam nesaf o ofal, caiff llif cleifion ei chynnal. Bydd hyn yn golygu y bydd y rhai sydd angen gofal ysbyty acíwt ar fyrder yn gallu cael y gofal hwnnw yn brydlon, tra bydd pobl agored i niwed, gan gynnwys pobl hŷn, ac yn enwedig y rhai bregus, yn cael eu diogelu rhag y risg o ddatgyflyru a Heintiau a Ddelir Wrth Gael Gofal Iechyd yn sgil cyfnod estynedig yn yr ysbyty.


Ar y llaw arall, mae’n hanfodol ein bod yn osgoi cyflwyno haint i gartrefi gofal neu leoliadau eraill, neu ddod â haint i gysylltiad â phobl yn ddiangen. Y cydbwysedd hwn yw’r hyn rwy’n ei olygu wrth sôn am broses briodol ar gyfer rhyddhau cleifion o’r ysbyty.


Er mwyn taro cydbwysedd rhwng y rheidrwydd i roi pobl yn y lleoliad cywir i gael y gofal gorau, a’r angen i ddiogelu cartrefi gofal a lleoliadau eraill rhag trosglwyddiad damweiniol, mae gennym ofynion mewn grym ynghylch rhyddhau cleifion a hefyd ynghylch pryd y caiff cartref gofal neu leoliad arall, lle mae brigiad o achosion wedi bod, gael ei ddynodi’n rhydd o COVID\-19\.


Wrth inni gasglu rhagor o ddata am COVID\-19 a dod i’w ddeall yn well, mae’n briodol y dylem ailystyried ein dulliau gweithredu mewn perthynas â’r cwestiynau allweddol hyn. Rydym wedi cael cyngor gan y Grŵp Cyngor Technegol ynglŷn â’r ddau bwnc hyn, ac rwy’n cyhoeddi’r cyngor hwnnw heddiw. Dyma sail y safbwyntiau a gyhoeddir heddiw ar brofion wrth ryddhau cleifion a hyd brigiadau o achosion.


O ran cleifion sydd wedi cael COVID\-19, y pwynt allweddol mewn perthynas â’u rhyddhau yw heintusrwydd. Gwyddom bellach mai’r dangosyddion gorau o ddiwedd heintusrwydd yw treigl amser a gwellhad o ran symptomau, gyda phrofion yn chwarae rôl gadarnhau. Mae’n hanfodol yn awr yn fwy nag erioed nad yw pobl nad ydynt bellach yn heintus gyda COVID\-19 yn cael eu cadw’n amhriodol mewn lleoliadau gofal iechyd. Gallwn nawr ddweud gyda hyder nad yw person sy’n cael canlyniad prawf gyda rhif Trothwy Cylch (Ct) o 35 neu uwch yn heintus bellach ac felly gall fynd adref neu i leoliad gofal cymdeithasol heb risg o heintio eraill gyda COVID\-19, a heb angen ynysu am gyfnod o amser.


O ganlyniad, rwy’n newid y canllawiau ar ryddhau cleifion o ysbytai, a hynny ar unwaith, fel y gall pobl sy’n cael prawf negatif am COVID\-19, neu brawf gyda rhif Ct o 35 neu uwch, gael eu rhyddhau i fynd adref neu i leoliad gofal cymdeithasol. Rhaid i’r meini prawf eraill fod wedi’u bodloni hefyd er mwyn gwneud hyn, sef bod 14 diwrnod wedi mynd heibio ers y prawf positif diwethaf neu ddechrau’r symptomau, nad yw’r person wedi bod â thymheredd uchel ers tridiau, a bod gwelliant wedi bod mewn symptomau eraill. Y canllawiau o hyd yw y dylai cleifion sy’n heintus, ond nad oes angen gofal acíwt arnynt bellach, symud i gyfleuster cam\-i\-lawr ar gyfer y rhai sy’n heintus â COVID\-19\. Dyma’r drefn ar gyfer cleifion sydd wedi cael COVID\-19\. O ran cleifion pan nad oes tystiolaeth o COVID\-19, bydd y gofynion presennol ar gyfer prawf negatif cyn eu rhyddhau a chyfnod ynysu yn parhau mewn grym, oherwydd y risg o ddal haint ar ôl cymryd y prawf.


Yn yr un modd, ar gyfer pennu brigiadau o achosion, mae ein dealltwriaeth gynyddol o COVID\-19 yn ein galluogi i ddeall hyd cyfnodau magu a heintusrwydd yn well. Mae hyn yn fater pwysig iawn o ystyried effaith cau cartref gofal yn sgil brigiad o achosion ar ei allu i ganiatáu derbyniadau newydd ac, yn wir, i ganiatáu ymweliadau â’r rhai sydd eisoes yn preswylio yno. Ar sail ein cyngor diweddaraf, gallwn ddweud gyda chryn hyder fod unigolion – cyhyd â bod prosesau Atal a Rheoli Heintiau wedi’u dilyn – yn annhebygol iawn o fod yn heintus 20 diwrnod ar ôl i’r achos diwethaf mewn lleoliad caeedig gael ei nodi. Felly, rwy’n bwriadu caniatáu i dimau amlddisgyblaethol, ar ôl ystyried amgylchiadau penodol cartrefi unigol, ddatgan bod brigiad drosodd ar ôl 20 diwrnod ers y prawf positif diwethaf neu ymddangosiad symptomau. Bydd y newid hwn yn y gofyniad presennol, sef 28 diwrnod, yn amodol ar rownd o brofion negatif neu bositif isel (rhif Ct ≥35\) i gadarnhau’r sefyllfa ar ôl 14 diwrnod.


Y Grŵp Cyngor Technegol: datganiad consensws wedi’i ddiweddaru ar y meini prawf profi a argymhellir ar gyfer rhyddhau cleifion asymptomatig i gartrefi gofal.