English: Transformation and prevention. Following last year's budget scrutiny, we raised concerns around the ability of health and social care organisations to mainstream service transformation activity, given the demand and cost pressures on them and the continuing failure of the majority of health boards to break even. The position this year isn't much better and, as such, we remain concerned about capacity in all areas of the system to drive transformation at the scale and pace needed. In relation to prevention, and given the increasing focus in this area, it is disappointing that the Future Generations Commissioner for Wales describes having seen 'limited evidence that Government have tried to apply the prevention definition across spend in a systematic and robust manner.' We note that work is being undertaken by Public Health Wales to improve measurement of spend on prevention. Nevertheless, we are concerned that this budget fails to evidence a demonstrable shift towards mainstreaming prevention and service transformation. We have therefore recommended that, in future budget rounds, the Welsh Government demonstrates how its funding allocations will support long-term, sustainable change in the delivery of integrated health and social care services. And as part of this, we expect to see a greater strategic focus on transformation and prevention in the budget, and a clearer presentation of the funding allocated for prevention and transformation purposes. The continued inability of a number of health boards to manage their finances remains a cause for concern. Only three health boards are meeting their statutory financial duties of achieving financial balance and having an approved three-year integrated medium-term plan. This raises serious questions about how all health boards will be able to invest in and secure service transformation, given that specific transformation funding will end in 2021. We know that £83 million has been provided to Betsi Cadwaladr over a three-year period for intervention and improvement support. However, it is not clear how much money is being provided to support the remaining three health boards in targeted intervention, or what this money is being used for. As such, we have recommended that the Welsh Government makes these details available, along with details of how this money is being spent, how that spend is monitored, and how it is achieving value for money. In our scrutiny of last year's draft budget, a significant concern for us was that the proportion of health board spending that goes on primary care has remained broadly consistent over the last few years. This suggested that the shift in resources towards primary care was not being realised. We therefore recommend that the Welsh Government provides clarity in future budget rounds, to enable us to see more clearly how funding is supporting the shift in resources to the community. As regards mental health, we remain concerned that there is still a lack of parity between mental and physical health, and the way in which they are supported. In our report into suicide prevention in Wales, 'Everybody's Business', we noted that it's unacceptable that mental health services are not prioritised in the same way as physical health. While we welcome the commitment of a further £13 million investment in mental health services - bringing the ring-fenced allocation to more than £700 million - we are concerned about our ability to effectively scrutinise spend on mental health, given the lack of a detailed breakdown of the ring-fenced allocation and the inconsistency in the way health boards collect and provide information. We therefore recommend that the Welsh Government provides us with a breakdown of this £700 million. Turning to social care, we remain concerned about the social care workforce and the fragility of services. The disparity between the health and social care workforce in respect of terms and conditions of employment and esteem was a key concern. And, obviously, we addressed a number of these issues in the earlier statement. We would say, funding for social care should be directed to services to stop people getting ill in the first place and needing health and social care services - a truly transformational fund, To close, which brings me to third sector funding, finally. A recurring theme throughout our inquiries in this Assembly has been the need for a long-term, sustainable and streamlined funding arrangement for third sector organisations to enable more effective planning, resulting in sustained and consistently delivered services. We have advocated that funding be provided on a three-yearly basis as a minimum, and have urged the Welsh Government to move towards this as a matter of priority. It is therefore extremely disappointing to hear from a number of organisations, which are providing vital services to some of our most vulnerable groups, that their funding will not be renewed from April 2020. Diolch yn fawr.
Welsh: Trawsnewid ac atal. Yn dilyn y broses o graffu ar gyllideb y llynedd, fe wnaethom godi pryderon ynghylch gallu sefydliadau iechyd a gofal cymdeithasol i brif ffrydio gweithgareddau trawsnewid gwasanaethau, o gofio'r pwysau o ran galw a chost sydd arnyn nhw a methiant parhaus mwyafrif y byrddau iechyd i beidio â cholli arian. Nid yw'r sefyllfa eleni yn fawr gwell ac, felly, rydym yn parhau i bryderu am gapasiti ym mhob rhan o'r system i ysgogi trawsnewid ar y raddfa a'r cyflymder sydd ei hangen. Ynglŷn ag atal, ac o ystyried y pwyslais cynyddol yn y maes hwn, mae'n siomedig bod Comisiynydd Cenedlaethau'r Dyfodol Cymru yn disgrifio ei bod wedi gweld: tystiolaeth brin bod y Llywodraeth wedi ceisio cymhwyso'r diffiniad o atal ar draws gwariant mewn modd systematig a chadarn. Nodwn fod gwaith yn cael ei wneud gan Iechyd Cyhoeddus Cymru i wella'r broses o fesur gwariant ar atal. Serch hynny, rydym yn pryderu nad yw'r gyllideb hon yn dangos bod symudiad amlwg tuag at brif-ffrydio ataliad a thrawsnewid gwasanaethau. Felly, rydym wedi argymell bod Llywodraeth Cymru, yng nghylchoedd y gyllideb yn y dyfodol, yn dangos sut y bydd ei dyraniadau cyllid yn cefnogi newid hirdymor, cynaliadwy wrth ddarparu gwasanaethau iechyd a gofal cymdeithasol integredig. Ac yn rhan o hyn, rydym yn disgwyl gweld mwy o bwyslais strategol ar drawsnewid ac atal yn y gyllideb, a chyflwyniad cliriach o'r arian a ddyrennir ar gyfer dibenion atal a thrawsnewid. Mae anallu parhaus nifer o fyrddau iechyd i reoli eu cyllid yn parhau i beri pryder. Dim ond tri bwrdd iechyd sy'n cyflawni eu dyletswyddau ariannol statudol o gyflawni cydbwysedd ariannol a chael cynllun tymor canolig integredig cymeradwy dros dair blynedd. Mae hyn yn codi cwestiynau difrifol ynghylch sut y bydd pob bwrdd iechyd yn gallu buddsoddi mewn trawsnewid gwasanaethau a'u sicrhau, o gofio y bydd cyllid trawsnewid penodol yn dod i ben yn 2021. Gwyddom fod £83 miliwn wedi ei ddarparu i Betsi Cadwaladr dros gyfnod o dair blynedd ar gyfer cymorth ymyrraeth a gwella. Fodd bynnag, nid yw'n glir faint o arian sy'n cael ei ddarparu i gefnogi'r tri bwrdd iechyd arall mewn ymyraethau wedi eu targedu, na'r hyn y defnyddir yr arian hwn ar ei gyfer. Felly, rydym wedi argymell bod Llywodraeth Cymru yn sicrhau bod y manylion hyn ar gael, ynghyd â manylion am sut y caiff yr arian hwn ei wario, sut y caiff y gwariant hwnnw ei fonitro, a sut y mae'n sicrhau gwerth am arian. Wrth graffu ar gyllideb drafft y llynedd, un pryder sylweddol i ni oedd bod cyfran gwariant y byrddau iechyd sy'n mynd ar ofal sylfaenol wedi aros yn weddol gyson dros y blynyddoedd diwethaf. Roedd hyn yn awgrymu nad oedd y newid mewn adnoddau tuag at ofal sylfaenol yn cael ei wireddu. Rydym felly yn argymell bod Llywodraeth Cymru yn darparu eglurder mewn cylchoedd cyllideb yn y dyfodol, er mwyn ein galluogi i weld yn gliriach sut y mae'r cyllid yn cefnogi'r newid mewn adnoddau i'r gymuned. O ran iechyd meddwl, rydym yn dal yn bryderus bod diffyg cydraddoldeb o hyd rhwng iechyd meddwl a chorfforol, a'r ffordd y cânt eu cefnogi. Yn ein hadroddiad ar atal hunanladdiad yng Nghymru, 'Busnes Pawb', nodwyd gennym ei bod yn annerbyniol nad yw gwasanaethau iechyd meddwl yn cael eu blaenoriaethu yn yr un modd ag iechyd corfforol. Er ein bod yn croesawu'r ymrwymiad i fuddsoddi £13 miliwn ychwanegol mewn gwasanaethau iechyd meddwl - gan ddod â'r dyraniad sydd wedi ei neilltuo i fwy na £700 miliwn - rydym yn bryderus ynghylch ein gallu i graffu'n effeithiol ar wariant ar iechyd meddwl, o ystyried y diffyg dadansoddiad manwl o'r dyraniad sydd wedi ei neilltuo a'r anghysondeb yn y ffordd y mae byrddau iechyd yn casglu ac yn darparu gwybodaeth. Felly, rydym yn argymell bod Llywodraeth Cymru yn rhoi dadansoddiad i ni o'r £700 miliwn hwn. Gan droi at ofal cymdeithasol, rydym yn dal i bryderu am y gweithlu gofal cymdeithasol a breuder gwasanaethau. Roedd yr anghysondeb rhwng y gweithlu iechyd a gofal cymdeithasol o ran telerau ac amodau cyflogaeth, yn ogystal â pharch yn bryder allweddol. Ac, yn amlwg, aethom i'r afael â nifer o'r materion hyn yn y datganiad cynharach. Byddem yn dweud, y dylai cyllid ar gyfer gofal cymdeithasol gael ei gyfeirio at wasanaethau i atal pobl rhag mynd yn sâl yn y lle cyntaf a bod angen gwasanaethau iechyd a gofal cymdeithasol - cronfa wirioneddol drawsnewidiol, I gloi, sy'n dod â mi at gyllid y trydydd sector. Un thema a gododd dro ar ôl tro yn ystod ein hymchwiliadau yn y Cynulliad hwn oedd yr angen am drefniant ariannu cynaliadwy, syml a hirdymor ar gyfer cyrff y trydydd sector er mwyn gallu cynllunio'n fwy effeithiol, gan arwain at gyflawni gwasanaethau mewn modd cyson a chynaliadwy. Rydym wedi argymell y dylid darparu cyllid ar sail bob tair blynedd o leiaf, ac rydym wedi annog Llywodraeth Cymru i symud tuag at hyn fel mater o flaenoriaeth. Felly, mae'n siomedig iawn clywed gan nifer o sefydliadau, sy'n darparu gwasanaethau hanfodol i rai o'n grwpiau mwyaf agored i niwed, na fydd eu cyllid yn cael ei adnewyddu o fis Ebrill 2020 ymlaen. Diolch yn fawr.