English: Diolch, Llywydd. I formally move the amendments tabled in my name. These amendments consider the Minister's concerns at Stage 2 about the implications of extending safe staffing levels to all clinical staff. This is despite the Chair of the Health, Social Care and Sport Committee stating that, in the committee's view, 'it is impossible to separate out the issue of quality from the provision of appropriate staffing levels - they are inextricably linked.' And we still firmly believe that is the case. The Minister has instead relied on the health and care standards on workforce levels, and, at Stage 3, the Minister promised to update them. To that end, amendments 36 and 37 are intended to place that promise on the face of the Bill. Amendment 36 places a duty on Welsh Ministers to carry out a detailed review of the standards at least once every term, meaning that we will have an opportunity to, first of all, analyse how effective the standards are at ensuring safe staffing levels. I cannot impress upon the Minister enough how important it is that we have this commitment across all clinical staff since the Mid Staffs report's findings. Indeed, the Royal College of Physicians UK said that, in 2018, more than one in five of their census respondents reported that gaps in trainee rotas occurred so frequently as to cause significant problems in patient safety. It is therefore essential that workforce planning is undertaken across the board. As such, health boards need to ensure workforce levels are planned and accounted for, and not to just rely on safe staffing for nurses. Secondly, we need to be fully aware of evolving changes to NHS pressures in population age, which will increase incidences of comorbidity and complex conditions. And we also have to recognise the technological advances, which may have a further impact on staffing levels. It cannot therefore be left for five years between updates and reviews to this important document. Amendment 37 ensures that Ministers must have regard to the views of stakeholders when updating and reviewing these standards. I do note, Minister, and you've already mentioned it tonight, that you've invited the British Medical Association Cymru and the Royal College of Nursing Wales to reviewing and updating the health care standards in the first instance. However, we believe this should be an ongoing duty, so that healthcare professionals are taken seriously throughout the review process. It is extremely heartening, Llywydd, to see such a wide range of Welsh healthcare representatives bodies, including BMA Cymru, RCN Wales, the Royal College of GPs Wales, the Association of Medical Research Charities Wales, the RCP Wales, the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons, and the Royal College of Midwives Wales, calling on the National Assembly to support amendments that ensure the duty of quality in the Bill is underpinned by guidance that includes reference to workforce planning, and that health and care standards are appropriately and regularly reviewed, and that reporting by NHS bodies of the steps taken to comply with the duty of quality includes workforce planning. I therefore urge all Members to support these amendments.
Welsh: Diolch, Llywydd. Cynigiaf yn ffurfiol y gwelliannau a gyflwynwyd yn fy enw i. Mae'r gwelliannau hyn yn ystyried pryderon y Gweinidog yng Nghyfnod 2 am oblygiadau ymestyn lefelau staffio diogel i'r holl staff clinigol. Mae hyn er gwaethaf y ffaith bod Cadeirydd y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon wedi datgan, ym marn y pwyllgor, 'mae'n amhosibl gwahanu materion sy'n ymwneud ag ansawdd oddi wrth ddarparu lefelau staffio priodol - mae cysylltiad annatod rhyngddynt.' Ac rydym yn dal i gredu'n gryf bod hyn yn wir. Yn hytrach, mae'r Gweinidog wedi dibynnu ar y safonau iechyd a gofal ar lefelau'r gweithlu ac, yng Nghyfnod 3, addawodd y Gweinidog eu diweddaru nhw. I'r perwyl hwnnw, bwriedir i welliannau 36 a 37 roi'r addewid hwnnw ar wyneb y Bil. Mae gwelliant 36 yn gosod dyletswydd ar Weinidogion Cymru i gynnal adolygiad manwl o'r safonau o leiaf unwaith bob tymor, sy'n golygu y cawn gyfle, yn gyntaf, i ddadansoddi pa mor effeithiol yw'r safonau o ran sicrhau lefelau staffio diogel. Ni allaf bwysleisio digon i'r Gweinidog pa mor bwysig yw bod gennym yr ymrwymiad hwn ar draws yr holl staff clinigol ers canfyddiadau adroddiad Canolbarth Swydd Stafford. Yn wir, dywedodd Coleg Brenhinol Ffisigwyr y DU fod mwy nag un o bob pump o ymatebwyr eu cyfrifiad wedi dweud, yn 2018, bod bylchau mewn rotâu hyfforddeion yn digwydd mor aml fel eu bod yn achosi problemau sylweddol o ran diogelwch cleifion. Felly, mae'n hanfodol bod gwaith cynllunio'r gweithlu yn cael ei wneud yn gyffredinol. Fel y cyfryw, mae angen i fyrddau iechyd sicrhau bod lefelau'r gweithlu yn cael eu cynllunio a'u cyfrif, ac nad ydynt yn dibynnu'n unig ar staffio diogel ar gyfer nyrsys. Yn ail, mae angen inni fod yn gwbl ymwybodol o newidiadau sy'n esblygu i bwysau'r GIG o ran oedran y boblogaeth, a fydd yn cynyddu achosion o gydafiachedd a chyflyrau cymhleth. Ac mae'n rhaid inni hefyd gydnabod y datblygiadau technolegol, a allai gael effaith bellach ar lefelau staffio. Felly ni ellir gadael pum mlynedd rhwng diweddariadau ac adolygiadau i'r ddogfen bwysig hon. Mae gwelliant 37 yn sicrhau bod yn rhaid i Weinidogion roi sylw i farn rhanddeiliaid wrth ddiweddaru ac adolygu'r safonau hyn. Rwy'n nodi, Gweinidog, ac rydych eisoes wedi sôn amdano heno, eich bod wedi gwahodd Cymdeithas Feddygol Prydain Cymru a Choleg Nyrsio Brenhinol Cymru i adolygu a diweddaru'r safonau gofal iechyd yn y lle cyntaf. Fodd bynnag, credwn y dylai hyn fod yn ddyletswydd barhaus, fel bod gweithwyr gofal iechyd proffesiynol yn cael eu hystyried o ddifrif drwy gydol y broses adolygu. Mae'n galondid mawr, Llywydd, gweld ystod mor eang o gyrff sy'n cynrychioli gofal iechyd yng Nghymru, gan gynnwys Cymdeithas Feddygol Prydain Cymru, Coleg Nyrsio Brenhinol Cymru, Coleg Meddygon Teulu Brenhinol Cymru, Cymdeithas Elusennau Ymchwil Feddygol Cymru, Coleg Ffisigwyr Brenhinol Cymru, Coleg Llawfeddygon Brenhinol Caeredin, Coleg Llawfeddygon Brenhinol, a Choleg Bydwragedd Brenhinol Cymru, yn galw ar y Cynulliad Cenedlaethol i gefnogi gwelliannau sy'n sicrhau bod dyletswydd ansawdd yn y Mesur wedi'i seilio ar ganllawiau sy'n cynnwys cyfeiriad at gynllunio'r gweithlu, a bod safonau iechyd a gofal yn cael eu hadolygu'n briodol ac yn rheolaidd, a bod rhoi gwybod i gyrff y GIG am y camau a gymerir i gydymffurfio â'r ddyletswydd ansawdd yn cynnwys cynllunio'r gweithlu. Rwyf felly'n annog pob Aelod i gefnogi'r gwelliannau hyn.