English: It also means that services are better able to manage demand and, increasingly, capacity and better manage workloads. For example, the bay cluster in Swansea makes prudent use of a paramedic to carry out house calls. That has resulted in people, often the elderly, being seen sooner and not having to wait for the GP to finish surgery. And, in the Llanelli cluster, they've appointed two social prescribers who are helping people access the care they need from a wide range of non-clinical services that are available from the third sector, and that's reduced the call on GP time. Some of the people who've been supported by these services have actually gone on themselves to become involved in volunteering and helping others as a result. Now, to keep people at home and avoid inappropriate emergency admissions to hospital, the cluster in north Powys is making prudent use of the new professional roles of urgent care practitioners and physician associates. I expect the pace and scale of innovation and improvement to continue to increase. I do welcome the fact that the body of the committee report recognised the wide range of good work being undertaken by clusters. This has developed since the national plan for a primary care service in Wales was published in 2014. However, while I gently disagree with some of the tenor of the recommendations, I note that they fully recognise the progress made by clusters in what is a relatively short period of time. At the outset - and I'm not saying this because there was a different Minister at the time - there was a significant current of antipathy and ambivalence within primary care towards the creation of clusters. People doubted that they'd make any difference, and, worse, many people said they would simply take up time, and there'd be more meetings to attend and more forms to fill. There is now a significantly different attitude and approach to clusters within not just general practitioners, but the broader teams of local healthcare. And, as we heard from Jenny Rathbone, more people want to be engaged and involved in the discussion and the decision making, and the value that brings. For my part, I will continue to encourage clusters to evolve and mature as the right approach to planning accessible and sustainable local healthcare. I outlined in both my written and my oral evidence to committee, and again in my response to the recommendations, that there are already a number of key pieces of work already under way or planned that address the lines of enquiry and the recommendations. I make it clear in my evidence that we have to be careful to avoid being overly prescriptive about how clusters should develop. We set out to ensure they had the flexibility to respond to local challenges and needs assessments whilst providing a framework within which clusters and health boards operate. The time is now right for some collective national action to support clusters to evolve. That will be informed by learning and the innovative solutions so far undertaken. So, I've asked the national primary care board to agree a set of national governance arrangements for cluster working by June of this year. And, importantly, I've asked for those governance arrangements to be enabling and not overly prescriptive. I expect them to be designed to support each cluster's individual development journey. And I set out in my response that this work will address a number of the recommendations in the report. I recognise that committee members will always be disappointed where a Government rejects recommendations, but I would gently say that I don't think it's unacceptable for a Government to reject recommendations any more than it is acceptable for a committee to make recommendations that are difficult or challenging. We, as a Government, have to accept the need to come here for scrutiny and explain what we're doing and why, just as, I think, committees need to know that there is good faith in either rejecting or accepting only in principle. I just want to turn to recommendation 10. I think there's something here about recommending a national lead to deal with all these local services. I don't think that would actually deliver the sort of improvement that I know Members are generally looking for in training. And, in response to recommendation 11, I just want to point out that we've made £10 million available on a recurrent basis for clusters to decide how to invest, and I recognise some of the evidence given, both to the committee and that I've heard individually, about some of the variance in the agility with which clusters can use that money together with their local health board. But clusters do take different decisions on how best to use moneys. They have different cluster development plans that they themselves have been involved in designing, and, while it's used to test innovative solutions, I have asked health boards to review their planning processes to ensure systematic evaluation. I'm trying to deal here, again, with recommendation 13, in part, because that three-year rolling planning process, at cluster and at health board level, has to ensure that unsuccessful initiatives are stopped and successful ones are scaled up and funded from health boards core discretionary resources. I expect that to release funding at cluster level to invest in new innovative projects to drive continuous improvement. Just on a specific point mentioned by the UKIP spokesperson, I'm happy to confirm that David Bailey, Dr David Bailey from the BMA, will be taking part in the February workshop, so there will be doctor representation there from the ground. I think we also need to reflect, having had the report and having had the series of responses to the recommendations, that we also yesterday had the parliamentary review, and the significant status and thought given to the role of primary care within that review, and recommendations about planning and about the role of primary care being more specific in the integrated medium term plan process, and indeed changes they've recommended for the IMTP process itself and about the relationship with local government. They're things that we need to be open minded to and to take on board in actually coming to our final response to it. So, this isn't a point in time where there is a closed door on everything and anything. I expect to see more evidence for the efficacy of clusters in different parts of Wales in the quality and outcomes framework we already have for primary care. That should really help us to understand and evaluate the real impact of clusters. There will of course be learning about what works and what is not working. I think the committee report and its recommendations have been a useful exercise to help take us forward and to actually spread more understanding about the work that clusters are undertaking. Having noted the recommendations, I'm pleased again to recognise that a range of them centre on areas of work that we too have already recognised and expect to report back to the Assembly upon. As I said in my response, action is under way or planned, and the committee's report and the wealth of evidence it contains will help to inform our work and our future consideration.
Welsh: Mae hefyd yn golygu bod gwasanaethau'n gallu rheoli'r galw a llwythi gwaith yn well, yn ogystal â'r capasiti yn gynyddol. Er enghraifft, mae clwstwr bae Abertawe yn gwneud defnydd doeth o barafeddyg i alw yn nhai pobl. Mae hynny wedi arwain at sicrhau bod pobl, yr henoed yn aml, yn cael eu gweld yn gynt heb orfod aros i'r meddyg teulu orffen gwaith yn y feddygfa. Ac yng nghlwstwr Llanelli, maent wedi penodi dau bresgripsiynydd cymdeithasol sy'n helpu pobl i gael mynediad at y gofal sydd ei angen arnynt gan ystod eang o wasanaethau anghlinigol sydd ar gael gan y trydydd sector, ac mae hynny wedi lleihau'r galw ar amser meddygon teulu. Mae rhai o'r bobl sydd wedi cael cymorth gan y gwasanaethau hyn wedi mynd ati eu hunain wedyn i wneud gwaith gwirfoddol a helpu eraill o ganlyniad i hynny. Nawr, er mwyn cadw pobl yn y cartref ac osgoi derbyniadau brys amhriodol i'r ysbyty, mae'r clwstwr yng ngogledd Powys yn gwneud defnydd doeth o rolau proffesiynol newydd ymarferwyr gofal brys a chymdeithion meddygol. Rwy'n disgwyl i gyflymder a maint arloesedd a gwelliannau barhau i gynyddu. Rwy'n croesawu'r ffaith fod corff adroddiad y pwyllgor wedi cydnabod yr ystod eang o waith da sy'n cael ei wneud gan glystyrau. Mae hyn wedi datblygu ers y cyhoeddwyd y cynllun cenedlaethol ar gyfer gwasanaeth gofal sylfaenol yng Nghymru yn 2014. Fodd bynnag, er fy mod yn anghytuno braidd â pheth o swm a sylwedd yr argymhellion, nodaf eu bod yn cydnabod yn llawn y cynnydd a wnaed gan glystyrau mewn cyfnod cymharol fyr o amser. Ar y dechrau - ac nid wyf yn dweud hyn oherwydd mai Gweinidog arall oedd wrthi ar y pryd - roedd cryn ddrwgdeimlad ac amwysedd o fewn gofal sylfaenol tuag at greu clystyrau. Roedd pobl yn amau y byddent yn gwneud unrhyw wahaniaeth, ac yn waeth na hynny, dywedodd llawer o bobl na fyddent ond yn mynd ag amser, ac y byddai mwy o gyfarfodydd i'w mynychu a mwy o ffurflenni i'w llenwi. Bellach, ceir agwedd go wahanol tuag at glystyrau ymhlith meddygon teulu, yn ogystal â thimau ehangach gofal iechyd lleol. Ac fel y clywsom gan Jenny Rathbone, mae mwy o bobl eisiau bod yn rhan o hyn a chael eu cynnwys yn y drafodaeth a'r broses o wneud penderfyniadau, a'r gwerth a ddaw yn sgil hynny. O 'm rhan i, byddaf yn parhau i annog clystyrau i esblygu ac aeddfedu fel y dull cywir o gynllunio gofal iechyd lleol hygyrch a chynaliadwy. Amlinellais yn fy nhystiolaeth ysgrifenedig a fy nhystiolaeth lafar i'r pwyllgor, ac eto yn fy ymateb i'r argymhellion, fod yna eisoes nifer o ddarnau allweddol o waith ar y gweill neu wedi'i gynllunio sy'n mynd i'r afael â llinellau ymholi ac argymhellion. Rwy'n dweud yn glir yn fy nhystiolaeth fod yn rhaid inni fod yn ofalus i osgoi bod yn rhy gyfarwyddol ynglŷn â sut y dylai clystyrau ddatblygu. Ein bwriad oedd sicrhau bod ganddynt hyblygrwydd i ymateb i heriau ac asesiadau o anghenion lleol gan ddarparu fframwaith i glystyrau a byrddau iechyd allu gweithredu o'i fewn. Nawr yw'r amser ar gyfer camau cenedlaethol ar y cyd i gynorthwyo clystyrau i esblygu. Caiff hynny ei lywio gan wersi a ddysgwyd a'r atebion arloesol a gyflawnwyd hyd yma. Felly, rwyf wedi gofyn i'r bwrdd cenedlaethol gofal sylfaenol gytuno ar set o drefniadau llywodraethu cenedlaethol ar gyfer gwaith clwstwr erbyn mis Mehefin eleni. Ac yn bwysig, rwyf wedi gofyn i'r trefniadau llywodraethu hynny alluogi yn hytrach na bod yn rhy gyfarwyddol. Rwy'n disgwyl iddynt gael eu cynllunio i gefnogi taith ddatblygu unigol pob clwstwr. A nodais yn fy ymateb y bydd y gwaith hwn yn ymdrin â nifer o'r argymhellion yn yr adroddiad. Rwy'n cydnabod y bydd aelodau'r pwyllgor bob amser yn siomedig pan fo'r Llywodraeth yn gwrthod argymhellion, ond mentraf ddweud nad wyf yn meddwl ei bod hi'n annerbyniol i'r Llywodraeth wrthod argymhellion fwy nag y mae'n dderbyniol i bwyllgor wneud argymhellion sy'n anodd neu'n heriol. Fel Llywodraeth, mae'n rhaid i ni dderbyn yr angen i ddod yma ar gyfer craffu ac egluro beth rydym yn ei wneud a pham, fel rwy'n meddwl bod angen i bwyllgorau wybod y ceir ewyllys da wrth wrthod neu dderbyn mewn egwyddor yn unig. Rwyf am droi at argymhelliad 10. Credaf fod rhywbeth yma am argymell arweiniad cenedlaethol i ymdrin â'r holl wasanaethau lleol hyn. Nid wyf yn meddwl mewn gwirionedd y byddai hynny'n cyflawni'r math o welliant y gwn fod yr Aelodau'n edrych amdano yn gyffredinol mewn hyfforddiant. Ac wrth ymateb i argymhelliad 11, rwyf am nodi ein bod wedi rhyddhau £10 miliwn o gyllid rheolaidd i glystyrau benderfynu sut i fuddsoddi, ac rwy'n cydnabod peth o'r dystiolaeth a roddwyd, i'r pwyllgor a'r hyn a glywais yn unigol, am beth o'r amrywio o ran hyblygrwydd i glystyrau allu defnyddio'r arian hwnnw gyda'u bwrdd iechyd lleol. Ond mae clystyrau'n gwneud penderfyniadau gwahanol ar y ffordd orau o ddefnyddio arian. Mae ganddynt gynlluniau datblygu clwstwr gwahanol y maent hwy eu hunain wedi bod yn rhan o'r gwaith o'u llunio, ac er y caiff ei ddefnyddio i brofi atebion arloesol, gofynnais i'r byrddau iechyd adolygu eu prosesau cynllunio er mwyn sicrhau prosesau gwerthuso systematig. Rwy'n ceisio ymdrin yma, unwaith eto, gydag argymhelliad 13, yn rhannol oherwydd bod yn rhaid i'r broses gynllunio dreigl dair blynedd ar lefel clwstwr ac ar lefel bwrdd iechyd, sicrhau bod y mentrau aflwyddiannus yn cael eu dirwyn i ben a rhai llwyddiannus yn cael eu datblygu a'u hariannu o adnoddau craidd disgresiynol byrddau iechyd. Rwy'n disgwyl i hynny ryddhau cyllid ar lefel clwstwr i'w fuddsoddi mewn prosiectau arloesol newydd i ysgogi gwelliant parhaus. Ar bwynt penodol y cyfeiriodd llefarydd UKIP ato, rwy'n hapus i gadarnhau y bydd David Bailey, Dr David Bailey o Gymdeithas Feddygol Prydain, yn cymryd rhan yn y gweithdy ym mis Chwefror, felly bydd meddygon ar lawr gwlad yn cael eu cynrychioli yno. Credaf fod angen inni fyfyrio hefyd, ar ôl cael yr adroddiad a'r gyfres o ymatebion i'r argymhellion, ein bod wedi cael yr adolygiad seneddol ddoe hefyd, a'r statws a'r meddwl sylweddol a roddwyd i rôl gofal sylfaenol yn yr adolygiad hwnnw, a'r argymhellion ynghylch cynllunio ac ynghylch rôl gofal sylfaenol yn bod yn fwy penodol ym mhroses y cynllun tymor canolig integredig, ac yn wir y newidiadau y maent wedi eu hargymell ar gyfer proses y cynllun tymor canolig integredig ei hun ac am y berthynas gyda llywodraeth leol. Maent yn bethau y mae angen inni fod â meddwl agored yn eu cylch a'u hystyried wrth ddod at ein hymateb terfynol iddo. Felly, nid yw hwn yn bwynt mewn amser lle y ceir drws caeedig i bopeth. Rwy'n disgwyl gweld mwy o dystiolaeth o effeithiolrwydd clystyrau mewn gwahanol rannau o Gymru yn y fframwaith ansawdd a chanlyniadau sydd gennym eisoes ar gyfer gofal sylfaenol. Dylai hynny ein helpu o ddifrif i ddeall a gwerthuso gwir effaith clystyrau. Wrth gwrs, bydd gwersi i'w dysgu ynglŷn â beth sy'n gweithio a beth nad yw'n gweithio. Credaf fod adroddiad y pwyllgor a'i argymhellion wedi bod yn ymarfer defnyddiol i'n helpu i symud yn ein blaenau ac i ledaenu mwy o ddealltwriaeth o'r gwaith y mae clystyrau yn ei gyflawni mewn gwirionedd. Ar ôl nodi'r argymhellion, rwy'n falch unwaith eto o gydnabod bod amrywiaeth ohonynt yn canolbwyntio ar feysydd gwaith yr ydym ninnau hefyd wedi eu cydnabod eisoes ac rydym yn disgwyl adrodd yn ôl i'r Cynulliad yn eu cylch. Fel y dywedais yn fy ymateb, mae gwaith ar y gweill neu wedi'i gynllunio, a bydd adroddiad y pwyllgor a'r cyfoeth o dystiolaeth sydd ynddo yn helpu i lywio ein gwaith a'n hystyriaethau yn y dyfodol.