English: I think it is important for us to understand that the Welsh ambulance service trust has reported a significant increase in calls of between about 20 to 30 per cent compared to this time last year, and I think it's worth noting that 18 per cent of 999 ambulance calls are COVID-related. So, it's not just about the pressures in the system - COVID is still a major issue here. And it's also worth pointing out that this is not an issue that is unique to Wales. We've seen recent announcements in England, in Scotland, and there is a need to explore all of the possible avenues of support to maintain safe delivery of care and health services. Now, these system-wide flow challenges manifest in different ways across all parts of the system. Of particular concern is the significant impact on ambulance capacity caused by ambulance patient handover delays that so many people have talked about this afternoon. And that is compounded by increasing demand on services as well as workforce, and resource constraints due to the continued impact of the pandemic. So, we do need a genuinely system-wide response to address these system-wide challenges which, by their very nature, can't be viewed in isolation or solved by any single part of the system. So, we need cohesive actions to take place at local, regional and national level, and despite significant investment and accelerated recruitment to the Welsh ambulance services, staff resourcing has continued to be significantly impacted, as some have pointed out, by staff absence, and that's through a combination of staff sickness, which grew by 10 per cent [ Correction: to 10 per cent] FootnoteLink in June 2021, self-isolation - they are affected of course by COVID as well - shielding, annual leave - which was delayed, of course, for so many staff as a result of the emergency response to the pandemic. We've got to accept the fact that a lot of these people are reaching burnout and they need a break. Welsh ambulance staff have been working to their limit, and often going beyond what could be reasonably expected of them over the course of the pandemic. And of course, that is impacting on staff morale and well-being. There's also been a reduced uptake of overtime, which has prompted the trust to consider options to incentivise overtime in order to make it more appealing to staff to fill gaps, and increase capacity over the forthcoming months. Now, practical requirements, including the need to don personal protective equipment and deep cleaning of equipment and vehicles for each ambulance response. Don't forget, we're working in a COVID environment; it changes what they do usually to something more difficult and more sophisticated. And that also impacts therefore on ambulance availability and responsiveness at times of peak demand. Now, these capacity-limiting factors have been accentuated by difficulties in timely discharge of patients from hospital, which, again, so many Members alluded to, and this reduces available hospital beds and causes delays for the transfer of patients from ambulance crews to the emergency department staff. Despite all of these challenges, almost 60 per cent of immediately life-threatened patients received a response within eight minutes in July. Almost a third of these patients received a response within five minutes. Now, over recent weeks there have been a number of occasions when the Welsh ambulance service trust has experienced pressures that have forced it to escalate, through its demand management plan, to a level at which it has not been possible to send an ambulance for certain categories of calls. Now, the demand management plan enables the trust to dynamically react to situations where the demand for services is greater than the available resources, and it's designed to optimise the safety and outcomes of all patients, and to prioritise those patients in the greatest need of an immediate response based on the resources available. Now, I don't think it would be appropriate for the Welsh Government to declare an emergency in the Welsh ambulance service, but of course we accept there is a problem here that needs to be resolved. The trust is taking actions to transition from the recovery phase of its COVID-19 effort back to the response phase, the monitoring position, in response to the current and anticipated pressures. Now, this places the trust on a similar footing to when we were at the height of the pandemic, so I'm underlining the point that the problem now is as great as it was at the point of the greatest risk in terms of the pandemic. That gives a stark perspective on the level of the pressure the service continues to experience. The Welsh ambulance service has been considering a number of options to supplement existing capacity, including exploring options with a number of national agencies. So, the trust has already contracted St John Ambulance Cymru to support additional support over the busy winter months, and the trust has also been working with military planners as part of the MACA, or the military aid to the civil authorities process, which the First Minister explained in the Chamber yesterday. The Welsh Government received the MACA from the trust earlier today, and both the First Minister and I have now agreed that that should now be passed on as a formal request. We haven't been waiting for things to happen. In fact, in July, I called an extraordinary meeting of the emergency ambulance services committee, because we saw that there might be a problem. I requested the development of a delivery plan. I think somebody was asking for a delivery plan; we've got one and that sets out a range of time-bound actions to be delivered between now and the end of March 2022. The key actions in that plan - as Janet-Finch Saunders, I think, wanted me to tell her what was in the delivery plan - were: improved forecasting to better understand and plan for actual demand and match resourcing accordingly; continued implementation of recommendations from independent demand and capacity review; ensuring we're able to control the demand on our services whilst ensuring patients are safe and receive the care they need in the place that they need it; health board clinicians directly managing ambulance patients and redirecting them to clinically safe alternatives; and using ambulance staff to safely cohort multiple patients, allowing ambulances to return to community response.
Welsh: Credaf ei bod yn bwysig inni ddeall bod ymddiriedolaeth gwasanaeth ambiwlans Cymru wedi nodi cynnydd sylweddol mewn galwadau o rhwng tua 20 a 30 y cant o'i gymharu â'r adeg hon y llynedd, a chredaf ei bod yn werth nodi bod 18 y cant o alwadau ambiwlans 999 yn gysylltiedig â COVID. Felly, nid yw'n ymwneud â'r pwysau yn y system yn unig - mae COVID yn dal i fod yn broblem fawr yma. Ac mae'n werth nodi hefyd nad yw hon yn broblem sy'n unigryw i Gymru. Rydym wedi gweld cyhoeddiadau diweddar yn Lloegr, yn yr Alban, ac mae angen archwilio'r holl ffyrdd posibl o gael cymorth i gynnal darpariaeth ddiogel o wasanaethau gofal ac iechyd. Nawr, mae'r heriau hyn o ran llif cleifion drwy'r system gyfan yn amlygu eu hunain mewn gwahanol ffyrdd ar draws pob rhan o'r system. Pryder arbennig yw'r effaith sylweddol ar gapasiti ambiwlans a achosir gan oedi wrth drosglwyddo cleifion ambiwlans fel y soniodd cynifer o bobl y prynhawn yma. A chaiff hynny ei ddwysáu gan y galw cynyddol am wasanaethau yn ogystal â gweithlu, a chyfyngiadau ar adnoddau oherwydd effaith barhaus y pandemig. Felly, mae arnom angen ymateb go iawn ar draws y system i fynd i'r afael â'r heriau hyn ar draws y system na ellir, yn ôl eu natur, eu hystyried ar eu pen eu hunain neu eu datrys gan unrhyw ran unigol o'r system. Felly, mae angen camau cydlynol ar lefel leol, ranbarthol a chenedlaethol, ac er gwaethaf buddsoddiad sylweddol a recriwtio cyflymach i wasanaethau ambiwlans Cymru, fel y nododd rhai, mae adnoddau staff wedi parhau i gael eu heffeithio'n sylweddol gan absenoldeb staff, a hynny drwy gyfuniad o salwch staff, a welodd gynnydd o 10 y cant [ Cywiriad: i 10 y cant] FootnoteLink ym mis Mehefin 2021, lefelau hunanynysu - yr effeithir arnynt gan COVID hefyd wrth gwrs - gwarchod, gwyliau blynyddol - a ohiriwyd, wrth gwrs, i gynifer o staff o ganlyniad i'r ymateb brys i'r pandemig. Mae'n rhaid inni dderbyn bod llawer o'r bobl hyn wedi'u gorweithio ac mae angen seibiant arnynt. Mae staff ambiwlans Cymru wedi bod yn gweithio hyd eithaf eu gallu, ac yn aml wedi mynd y tu hwnt i'r hyn y gellid ei ddisgwyl yn rhesymol ganddynt yn ystod y pandemig. Ac wrth gwrs, mae hynny'n effeithio ar forâl a lles staff. Bu llai o ddefnydd o oramser hefyd, sydd wedi ysgogi'r ymddiriedolaeth i ystyried opsiynau i gymell goramser er mwyn ei gwneud yn fwy deniadol i staff lenwi bylchau, a chynyddu capasiti dros y misoedd nesaf. Nawr, gofynion ymarferol, gan gynnwys yr angen i wisgo cyfarpar diogelu personol a glanhau offer a cherbydau yn ddwfn ar gyfer pob ymateb ambiwlans. Peidiwch ag anghofio, rydym yn gweithio mewn amgylchedd COVID; mae'n newid yr hyn a wnânt fel arfer yn rhywbeth anos a mwy soffistigedig. Ac mae hynny hefyd yn effeithio felly ar argaeledd ac ymatebolrwydd ambiwlansys ar yr adegau pan fydd y galw ar ei anterth. Nawr, gwaethygwyd y ffactorau hyn sy'n cyfyngu ar gapasiti gan anhawster i ryddhau cleifion o'r ysbyty yn amserol, mater a gafodd sylw, unwaith eto, gan gynifer o'r Aelodau, ac mae hyn yn lleihau nifer y gwelyau ysbyty sydd ar gael ac yn achosi oedi wrth drosglwyddo cleifion o ofal criwiau ambiwlans i ofal staff yr adran achosion brys. Er gwaethaf yr holl heriau hyn, ymatebwyd i bron 60 y cant o'r cleifion lle roedd bywyd yn y fantol o fewn wyth munud ym mis Gorffennaf. Cafodd bron i draean o'r cleifion hyn ymateb o fewn pum munud. Nawr, dros yr wythnosau diwethaf gwelwyd nifer o achlysuron pan fu ymddiriedolaeth gwasanaeth ambiwlans Cymru dan bwysau sydd wedi ei gorfodi i uwchgyfeirio, drwy ei chynllun rheoli galw, i lefel lle na fu'n bosibl anfon ambiwlans ar gyfer categorïau penodol o alwadau. Nawr, mae'r cynllun rheoli galw yn galluogi'r ymddiriedolaeth i ymateb yn ddeinamig i sefyllfaoedd lle mae'r galw am wasanaethau yn fwy na'r adnoddau sydd ar gael, ac mae wedi'i gynllunio i sicrhau'r diogelwch a'r canlyniadau gorau posibl i bob claf, ac i flaenoriaethu'r cleifion sydd fwyaf o angen ymateb ar unwaith yn seiliedig ar yr adnoddau sydd ar gael. Nawr, nid wyf yn credu y byddai'n briodol i Lywodraeth Cymru ddatgan argyfwng yng ngwasanaeth ambiwlans Cymru, ond wrth gwrs rydym yn derbyn bod problem yma sydd angen ei datrys. Mae'r ymddiriedolaeth yn rhoi camau ar waith i bontio o gyfnod adfer ei hymdrech COVID-19 yn ôl i'r cyfnod ymateb, y sefyllfa fonitro, mewn ymateb i'r pwysau presennol a'r pwysau disgwyliedig. Nawr, mae hyn yn rhoi'r ymddiriedaeth ar sail debyg i'r adeg pan oeddem ar anterth y pandemig, felly rwy'n tanlinellu'r pwynt fod y broblem yn awr yr un mor fawr â'r hyn ydoedd pan oedd y risg ar ei huchaf yn ystod y pandemig. Mae hynny'n rhoi persbectif llwm o lefel y pwysau y mae'r gwasanaeth yn parhau i'w brofi. Mae gwasanaeth ambiwlans Cymru wedi bod yn ystyried nifer o opsiynau i chwyddo'r capasiti presennol, gan gynnwys archwilio opsiynau gyda nifer o asiantaethau cenedlaethol. Felly, mae'r ymddiriedolaeth eisoes wedi contractio Ambiwlans Sant Ioan Cymru i gynorthwyo gyda chymorth ychwanegol dros fisoedd prysur y gaeaf, ac mae'r ymddiriedolaeth hefyd wedi bod yn gweithio gyda chynllunwyr milwrol fel rhan o broses MACA, neu gymorth milwrol i awdurdodau sifil, a eglurwyd gan y Prif Weinidog yn y Siambr ddoe. Derbyniodd Llywodraeth Cymru y MACA gan yr ymddiriedolaeth yn gynharach heddiw, ac mae'r Prif Weinidog a minnau bellach wedi cytuno y dylid trosglwyddo hynny yn awr fel cais ffurfiol. Nid ydym wedi bod yn aros i bethau ddigwydd. Yn wir, ym mis Gorffennaf, gelwais gyfarfod eithriadol o'r pwyllgor gwasanaethau ambiwlans brys oherwydd ein bod yn gweld y gallai fod problem. Gofynnais am ddatblygu cynllun cyflawni. Rwy'n credu bod rhywun wedi gofyn am gynllun cyflawni; mae gennym un ac mae'n nodi ystod o gamau gweithredu sy'n gyfyngedig i amser penodol i'w cyflawni rhwng nawr a diwedd mis Mawrth 2022. Roedd y camau allweddol yn y cynllun hwnnw - roedd Janet-Finch Saunders, rwy'n credu, am imi ddweud wrthi beth oedd yn y cynllun cyflawni - fel a ganlyn: gwell rhagolygon i ddeall a chynllunio'n well ar gyfer galw gwirioneddol a chynyddu adnoddau yn unol â hynny; parhau i weithredu argymhellion o'r adolygiad annibynnol o alw a chapasiti; sicrhau ein bod yn gallu rheoli'r galw am ein gwasanaethau tra'n sicrhau bod cleifion yn ddiogel ac yn derbyn y gofal sydd ei angen arnynt yn y lle y mae ei angen arnynt; clinigwyr byrddau iechyd i reoli cleifion ambiwlans yn uniongyrchol a'u hailgyfeirio at opsiynau amgen sy'n glinigol ddiogel; a defnyddio staff ambiwlans i garfanu cleifion lluosog yn ddiogel, gan alluogi ambiwlansys i ddychwelyd i ymateb cymunedol.