English: I'm very grateful to take part in this debate on the committee report. And the first thing, actually, I'd like to do is pay an enormous tribute to all of the district nurses and community nurses out there in Wales. I speak from personal experience when I say that, after the arrival of No. 1 daughter, it was the district nurse that helped me keep my sanity, because I certainly had no idea what I was supposed to do once I arrived home. They are the unsung heroes, and, in fact, our report describes them as 'the invisible service'. And I think it's worth us all remembering that there's no accurate picture, at national level, of the number and skill mix of nursing teams, nor the numbers in our teams, the acuity levels of the patients that they're having to deal with. And this, of course, impacts on workforce planning, on recruitment and retention. And I think that the Chair of the committee has very, very clearly laid out, actually, the stress levels that district and community nurses face, and how this is driving people out of a profession that we so desperately need, particularly, Minister, if you are going to carry on a direction of travel that we all support, which is about treating people at home, in the community, in their homes, rather than sending them off to hospitals or to other facilities. And I do find - . And I want to particularly speak to recommendations 6, 7 and 8. Six is about data, 7 and 8 are about training and recruitment. Because I find that the availability of data on nursing services is beyond poor. I recognise that health boards understand that, but not knowing for sure how many nurses in the community are district nurses, or not knowing how many district nurses are nurse practitioners, must seriously hamper the planning and delivery of services. And acknowledging that there are significant challenges in terms of data and the future development of the ICT infrastructure is a step forward. But I have to point out that this is a step that the Welsh Government and the health boards have been standing on for years. So, I'd like to know when will we see the roll-out of the Welsh community care information system. It's only in one health board, and that's Powys, at the moment. And I just want to read out a couple of little highlighted segments from this report. This is what the people who work in our community services have to cope with - and you think about all the technology that we're surrounded with here to help us do our job - 'We have mobile phones without access to diary or email though colleagues in local authority have both and a functioning electronic system for health records.' But district nurses, community nurses, don't. 'We have very little IT to support integration and CRT working. District Nurses are on paper; some therapy staff are on therapy manager; social care colleagues on WCCIS.' 'Most of the team have blackberry's, years old, that don't work sufficiently We have no computerised system for documentation - it's all paper.' And one of the concerns I have - and it runs, actually, across a wide variety of the health service - is I very often write to you, Minister, to ask for data on a range of topics, and you come back, in your written answer, and you say, 'No data held centrally'. Okay, I get that. I will then do an FOI on every single health board, following your answer, and guess what they come back and say? 'No data held centrally. No data recorded. This data isn't known; it's not cut, sliced and diced in this way.' If we don't have this essential data, how can we do workforce planning and management, how can we really target recruitment and retention? Are we not setting up Health Education and Improvement Wales to fail, because, if we can't access the data, and the Minister's obviously not got the data, I don't suppose for one moment HEIW have got the data either. I would also like to know who will be evaluating the success of the Malinko software pilot at Cwm Taf. I'd be interested to know who's going to be evaluating it, when you expect the evaluation to happen. Because, as I understand it, if it does all that it says it does, then it would be a very good thing to roll out across all of our health boards. But I would like it independently evaluated, given Cwm Taf's current situation. And my last and final point that I want to make, which is slightly in this report but it is an adjunct to it - we all know that primary care is based on the multidisciplinary team model. However, it is hampered at times by lines of reporting, and that does apply to district and community nurses, because, of course, most of them report back to health boards, rather than clusters or GP practices. Now, I've had a couple of cases where we've had seriously ill constituents - terminal cancer, GP has gone out, they need the support of a district nurse. But because there hasn't been a 13-page form filled in, their doctor, who says, 'This person must be nursed and looked at by a district nurse in their home', hasn't been able to do it, because they've got to go back to the health board and then follow a very convoluted way of being able to provide that service. So, can we just look at that and tightening it up? Because they're an integral part of the primary care team, and they need to be under the auspices of those who lead the primary care function.
Welsh: Rwy'n ddiolchgar iawn i gael cymryd rhan yn y ddadl hon ar adroddiad y pwyllgor. A'r peth cyntaf, mewn gwirionedd, yr hoffwn ei wneud yw talu teyrnged enfawr i'r holl nyrsys ardal a nyrsys cymunedol sydd yng Nghymru. Rwy'n siarad o brofiad personol pan ddywedaf, ar ôl genedigaeth fy merch gyntaf, mai'r nyrs ardal a helpodd fi i gadw fy mhwyll, oherwydd, yn sicr, nid oedd gennyf syniad beth oeddwn i fod i'w wneud ar ôl i mi gyrraedd adref. Maent yn arwyr nad ydynt yn cael digon o glod, ac mewn gwirionedd, mae ein hadroddiad yn eu disgrifio fel 'y gwasanaeth anweledig'. Ac rwy'n credu ei bod yn werth i bawb ohonom gofio nad oes darlun cywir, ar lefel genedlaethol, o nifer a chymysgedd sgiliau timau nyrsio, y niferoedd yn ein timau na lefelau aciwtedd y cleifion y maent yn gorfod ymdrin â hwy. Ac mae hyn, wrth gwrs, yn effeithio ar gynllunio'r gweithlu, ar recriwtio a chadw staff. A chredaf fod Cadeirydd y pwyllgor wedi nodi'n glir iawn y lefelau straen y mae nyrsys ardal a nyrsys cymunedol yn eu hwynebu, a sut y mae hyn yn gwneud i bobl adael proffesiwn rydym ei angen yn daer, yn enwedig, Weinidog, os ydych yn bwriadu parhau â chyfeiriad teithio rydym i gyd yn ei gefnogi, sef trin pobl gartref, yn y gymuned, yn eu cartrefi, yn hytrach na'u hanfon i ysbytai neu gyfleusterau eraill. Ac rwy'n canfod - . Ac rwyf eisiau siarad yn benodol am argymhellion 6, 7 ac 8. Mae 6 yn ymwneud â data, a 7 ac 8 yn ymwneud â hyfforddiant a recriwtio. Oherwydd gwelaf fod argaeledd data am wasanaethau nyrsio yn wael tu hwnt. Rwy'n cydnabod bod byrddau iechyd yn deall hynny, ond mae'n rhaid bod peidio â gwybod yn sicr faint o nyrsys yn y gymuned sy'n nyrsys ardal, neu beidio â gwybod faint o nyrsys ardal sy'n ymarferwyr nyrsio, yn rhwystro'r gwaith o gynllunio a darparu gwasanaethau yn ddifrifol. Ac mae cydnabod bod heriau sylweddol o ran data a datblygu'r seilwaith TGCh yn y dyfodol yn gam ymlaen. Ond mae'n rhaid i mi nodi bod hwn yn gam y mae Llywodraeth Cymru a'r byrddau iechyd wedi bod yn sefyll arno ers blynyddoedd. Felly, hoffwn wybod pryd y bydd system wybodaeth gofal cymunedol Cymru yn cael ei chyflwyno. Nid yw'r system ond ar waith mewn un bwrdd iechyd ar hyn o bryd, a Phowys yw hwnnw. Hoffwn ddarllen ychydig o ddarnau sydd wedi'u hamlygu yn yr adroddiad hwn. Dyma'r hyn y mae'n rhaid i'r bobl sy'n gweithio yn ein gwasanaethau cymunedol ymdopi ag ef - ac rydych yn meddwl am yr holl dechnoleg sy'n ein hamgylchynu yma i'n helpu i wneud ein gwaith - 'Mae gennym ni ffonau symudol heb fynediad at ddyddiadur nac e-bost, er bod cydweithwyr yn yr awdurdod lleol yn meddu ar system electronig weithredol ar gyfer cofnodion iechyd.' Ond nid oes gan nyrsys ardal, nyrsys cymunedol, fynediad at y pethau hyn. 'Ychydig iawn o TG sydd gennym i gefnogi integreiddio a gwaith Timau Adnoddau Cymunedol. Mae Nyrsys Ardal ar bapur; mae rhai staff therapi ar Therapy Manager; cydweithwyr gofal cymdeithasol ar WCCIS.' 'Mae gan y rhan fwyaf o'r tîm ddyfeisiau 'blackberry', ond tydyn nhw ddim yn gweithio'n ddigon da Does gennym ni ddim system gyfrifiadurol ar gyfer dogfennaeth - mae'n bapur i gyd.' Ac un o'r pryderon sydd gennyf - ac mae'n rhedeg ar draws amrywiaeth eang o'r gwasanaeth iechyd mewn gwirionedd - yw fy mod yn ysgrifennu atoch yn aml iawn, Weinidog, i ofyn am ddata ar amrywiaeth o bynciau, ac fe ddowch yn ôl ataf yn eich ateb ysgrifenedig, a dweud , 'Ni chedwir unrhyw ddata yn ganolog'. Iawn, rwy'n derbyn hynny. Byddaf yn cyflwyno cais rhyddid gwybodaeth wedyn ar bob bwrdd iechyd, yn dilyn eich ateb, a dyfalwch beth y maent yn ei ddweud? 'Ni chedwir unrhyw ddata yn ganolog. Nid oes unrhyw ddata wedi'i gofnodi. Nid yw'r data hwn yn hysbys; nid yw'n cael ei dorri a'i rannu yn y ffordd hon.' Os nad oes gennym y data hanfodol hwn, sut y gallwn ni reoli a chynllunio'r gweithlu, sut y gallwn fynd ati o ddifrif i dargedu recriwtio a chadw staff? Onid ydym yn sefydlu Addysg a Gwella Iechyd Cymru i fethu, oherwydd, os na allwn gael gafael ar y data, ac yn amlwg nid yw'r data gan y Gweinidog, nid wyf yn tybio am un eiliad fod y data gan Addysg a Gwella Iechyd Cymru chwaith. Hoffwn wybod hefyd pwy fydd yn gwerthuso llwyddiant cynllun peilot meddalwedd Malinko yng Nghwm Taf. Byddai diddordeb gennyf mewn gwybod pwy fydd yn ei werthuso, pryd rydych yn disgwyl i'r gwerthusiad ddigwydd. Oherwydd, yn ôl yr hyn a ddeallaf, os yw'n gwneud popeth y dywed y mae'n ei wneud, byddai'n beth da iawn i'w gyflwyno ar draws ein holl fyrddau iechyd. Ond hoffwn iddo gael ei werthuso'n annibynnol, o ystyried sefyllfa bresennol Cwm Taf. A'r pwynt olaf a therfynol yr hoffwn ei wneud, sydd yn yr adroddiad hwn i raddau ond sy'n ategiad iddo - mae pawb yn gwybod bod gofal sylfaenol yn seiliedig ar y model tîm amlddisgyblaethol. Fodd bynnag, mae'n cael ei lesteirio ar adegau gan linellau adrodd, ac mae hynny'n berthnasol i nyrsys ardal a nyrsys cymunedol, oherwydd, wrth gwrs, mae'r rhan fwyaf ohonynt yn adrodd yn ôl i fyrddau iechyd, yn hytrach na chlystyrau neu bractisau meddygon teulu. Nawr, rwyf wedi cael un neu ddau o achosion lle roedd gennym etholwyr difrifol wael - canser angheuol, mae'r meddyg teulu wedi mynd allan, mae angen cefnogaeth nyrs ardal arnynt. Ond gan nad oes ffurflen 13 tudalen wedi'i llenwi, nid yw eu meddyg, sy'n dweud, 'Rhaid i nyrs ardal nyrsio'r person hwn a gofalu amdano yn ei gartref', wedi gallu ei wneud, oherwydd bod yn rhaid iddynt ddychwelyd i'r bwrdd iechyd a dilyn llwybr troellog iawn er mwyn gallu darparu'r gwasanaeth hwnnw. Felly, a gawn ni edrych ar hynny a'i dynhau? Oherwydd maent yn rhan annatod o'r tîm gofal sylfaenol, ac mae angen iddynt fod o dan adain y rhai sy'n arwain y swyddogaeth gofal sylfaenol.