English: The role of the neurological conditions implementation group, or NCIG, is clearly defined within the NCDP. However, when the NCDP was first introduced, there was little or no co-ordination across neurological services at an all-Wales level. Networks for conditions such as cancer, cardiac and renal services were well established by that stage, but this was not the case for neurological services. As a result, the task that NCIG faced was complex and difficult. The majority of evidence that was submitted to the cross-party group's report with regard to progress in raising awareness under the NCDP related to activity rather than outcomes or impacts. Co-production activity between NCIG, third sector organisations and individuals with neurological conditions was welcomed. In particular, contributors cited the joint working between NCIG and the Wales Neurological Alliance to create a patient-reported experience measure, or PREM, as a positive step. Discrete educational activity was cited by NCIG as a positive. However, as the report states: 'Contributors questioned the extent to which the plan had enabled genuine coproduction and participation with people with neurological conditions and carers. They expressed disappointment with the lack of discernible progress in setting up a Neurological Conditions Service User Forum in every LHB. One third sector organisation told this inquiry "Neurological Service User Forums have not been established acros Wales as intended by the plan. It is not evident whether Health Boards or NCIG have drawn on feedback from service user forums."' Although the report states that partnership working with 'Third sector involvement in NCIG was perceived as positive', it also states that 'concerns were shared that third sector involvement generally is patchy, inconsistent and not equitable across Wales or by condition.' The greatest success of the NCDP is that it's created a focus on the needs of people with neurological conditions in Wales. It has thrown a spotlight on the factors that have been missing in terms of strategic delivery of services for neurological conditions, for example, networks such as those that exist for cancer, cardiac and other conditions. Furthermore, it has provided an opportunity and structure for individuals and third sector organisations to share their concerns and poor experiences. As a result, it has allowed those involved in implementation to begin to take action to address unmet need and to find solutions to challenges. The appointment of a clinical lead role for neurological conditions is welcomed. The clinical lead has begun defining the areas of required intervention and identifying clinical pathways underpinning clinical services and principles. However, the appointment was made relatively late in the implementation process and it only has one day per week of ring-fenced funding. NCIG has worked hard to establish a baseline and is beginning to promote good practice and to marshal pragmatic improvement activity. However, it's vital that this group should continue to exist and be embedded more permanently in order to deliver a better network approach to promoting ongoing improvement and efficiency across Wales. There are so many challenges that need to be resolved. It is clear that this focus should be sustained. Remaining challenges pertaining to the implementation of NCDP include maintaining the work of NCIG, for it would be extremely detrimental to lose the focus on service improvements and networked approach that they've introduced; funded posts for a clinical lead and a co-ordinator, emphasising the seriousness of intent for the delivery plan to effect real change; accountability for delivery - NCIG monitors the progress of the NCDP, but does not have a mandate to hold local health boards to account for critical elements of implementation like workforce development strategy; if this is indeed not the role of NCIG, it could be suggested that this accountability should be provided by another means in order to effectively incentivise service change.
Welsh: Mae rôl y grŵp gweithredu ar gyflyrau niwrolegol wedi'i diffinio'n glir o fewn y cynllun cyflawni. Fodd bynnag, pan gyflwynwyd y cynllun cyflawni gyntaf, ychydig iawn o gydgysylltu, os o gwbl, a gafwyd ar draws gwasanaethau niwrolegol ar lefel Cymru gyfan. Roedd rhwydweithiau ar gyfer gwasanaethau canser, y galon a'r arennau wedi hen sefydlu erbyn hynny, ond nid oedd hynny'n wir am wasanaethau niwrolegol. O ganlyniad, roedd y dasg a wynebai'r grŵp gweithredu'n gymhleth ac yn anodd. Roedd y rhan fwyaf o'r dystiolaeth a gyflwynwyd i adroddiad y grŵp trawsbleidiol ar wella gwaith i godi ymwybyddiaeth o dan y cynllun cyflawni'n ymwneud â gweithgarwch yn hytrach na chanlyniadau neu effeithiau. Croesawyd gweithgarwch cydgynhyrchu rhwng y grŵp gweithredu, sefydliadau trydydd sector ac unigolion â chyflyrau niwrolegol. Yn fwyaf arbennig, cyfeiriodd cyfranwyr at y cydweithio rhwng y grŵp gweithredu a Chynghrair Niwrolegol Cymru ar greu mesur profiadau a adroddwyd gan gleifion, neu PREM, fel cam cadarnhaol. Cyfeiriodd y grŵp gweithredu at weithgarwch addysgol arwahanol fel elfen gadarnhaol. Fodd bynnag, fel y dywed yr adroddiad: 'Cwestiynodd cyfranwyr i ba raddau yr oedd y cynllun wedi galluogi cydgynhyrchu a chyfranogi go iawn gyda phobl â chyflyrau niwrolegol a gofalwyr. Gwnaethant fynegi siom o ran y diffyg cynnydd gweladwy wrth sefydlu Fforwm Defnyddwyr Gwasanaeth Cyflyrau Niwrolegol ym mhob bwrdd iechyd lleol. Dywedodd un sefydliad trydydd sector wrth yr ymchwiliad hwn nad yw Fforymau Defnyddwyr Gwasanaethau Niwrolegol wedi'u sefydlu ledled Cymru yn ôl bwriad y cynllun. Dywedodd nad yw'n amlwg a yw Byrddau Iechyd neu'r Grŵp Gweithredu wedi tynnu ar adborth o fforymau defnyddwyr gwasanaeth.' Er bod yr adroddiad yn nodi hyn: 'Ystyriwyd bod cyfranogiad y trydydd sector yn NCIG yn gadarnhaol', mae hefyd yn nodi 'bod cyfranogiad y trydydd sector yn gyffredinol yn dameidiog, yn anghyson ac nad yw wedi'i ddosbarthu'n deg ledled Cymru, neu yn ôl cyflwr' Llwyddiant mwyaf y cynllun cyflawni yw ei fod wedi creu ffocws ar anghenion pobl â chyflyrau niwrolegol yng Nghymru. Mae wedi tynnu sylw at y ffactorau sydd wedi bod ar goll o ran darparu gwasanaethau'n strategol ar gyfer cyflyrau niwrolegol, er enghraifft rhwydweithiau fel y rhai sy'n bodoli ar gyfer canser, y galon a chyflyrau eraill. At hynny, mae wedi rhoi cyfle a strwythur i unigolion a sefydliadau trydydd sector rannu eu pryderon a'u profiadau gwael. O ganlyniad, mae wedi caniatáu i'r rhai sy'n ymwneud â gweithredu ddechrau cymryd camau i fynd i'r afael ag angen nas diwallwyd ac i ddod o hyd i atebion i heriau. Croesawir y penodiad i rôl arweiniol glinigol ar gyfer cyflyrau niwrolegol. Mae'r arweinydd clinigol wedi dechrau diffinio meysydd ymyrraeth sy'n ofynnol a nodi llwybrau clinigol sy'n sail i wasanaethau ac egwyddorion clinigol. Fodd bynnag, gwnaed y penodiad yn gymharol hwyr yn y broses weithredu a dim ond un diwrnod yr wythnos o gyllid a glustnodwyd ar ei gyfer. Mae'r grŵp gweithredu wedi gweithio'n galed i sefydlu llinell sylfaen ac mae'n dechrau hyrwyddo arferion da a threfnu gweithgarwch gwella pragmatig. Fodd bynnag, mae'n hanfodol fod y grŵp yn parhau i fodoli ac yn cael ei ymgorffori'n fwy parhaol er mwyn darparu dull rhwydwaith gwell o hyrwyddo gwelliant ac effeithlonrwydd parhaus ledled Cymru. Ceir cymaint o heriau sydd angen eu datrys. Mae'n amlwg y dylid parhau â'r ffocws hwn. Ymhlith yr heriau eraill mewn perthynas â gweithredu'r cynllun cyflawni, mae cynnal gwaith y grŵp gweithredu, gan y byddai'n niweidiol iawn colli'r ffocws ar welliannau i wasanaethau a dull wedi'i rwydweithio ar ôl eu cyflwyno; swyddi a ariennir ar gyfer arweinydd clinigol a chydgysylltydd, gan bwysleisio difrifoldeb y bwriad i'r cynllun cyflawni sicrhau newid gwirioneddol; atebolrwydd am gyflawni - mae'r grŵp gweithredu'n monitro cynnydd y cynllun cyflawni, ond nid oes ganddo fandad i ddwyn byrddau iechyd lleol i gyfrif am elfennau allweddol o weithredu, megis strategaeth datblygu'r gweithlu; os nad rôl y grŵp gweithredu yw hyn yn wir, gellid awgrymu y dylai'r atebolrwydd hwn gael ei ddarparu drwy ddull arall er mwyn ysgogi newid effeithiol i wasanaethau.