English: I very much enjoyed being part of this committee and I'd like to thank everyone who came as witnesses before it. They were very detailed, they were very knowledgeable and, in the main, they were incredibly passionate about the different areas that they represented. I'd also like to thank the clerking team and the staff for turning around and marshalling us all so well. The report, I think, speaks for itself. There's an awful amount of detail in the report, and when you read the Record of Proceedings there is even more detail there. But, for me, coming to this in a brand-new way - it's the first time I've sat on the health and social care committee - there were two main areas that really came forward - two big issues. The first issue is that whilst the pressure on the NHS remains constant 365 days of the year, there's no doubt about it that in the winter it changes shape. We know that it changes shape, and every winter we know that it's going to change shape because it's a different type of patient that mainly gets admitted, it's a different type of patient that needs the ambulance service and a different type of patient that needs the social care services. Therefore, it should not be beyond the wit of us all here - but particularly the Welsh Government, as it is your responsibility, Cabinet Secretary - to ensure that the health boards really reflect not so much the pressure but that change in pressure, so that we make sure that we do have good collaboration in place and good integration in place, and that we make sure that we have specific types of bed, because we know, for example, that we're going to have an awful lot more young children and we're going to have an awful lot more elderly people; that we think about things like co-location and we think about how we can make people's journey through A&E and through clinical decisions units into hospital and back out of hospital much more quick and efficient. No-one's taking away from the fact that that pressure is there all of the time, but we know that as winter turns - and winter turns year after year - that pressure will change shape. We had, as the Chair has already referred to, a committee report in 2013 that raised these very issues, and we're not learning the lessons. So, my first question to you, Cabinet Secretary, would be to really emphasise to you about the fact that we need to be ahead of the game and understand that pressure is not always the same, no matter how we describe it. The second area that really came up for me in this committee was the whole story around integration and collaboration. In your Government response to the committee report, you state, Cabinet Secretary, that 'Health boards are expected to routinely engage with social care and independent sectors as part of the development of their IMTPs'. I walked away from that committee with a very sure feeling that general practitioners did not feel that they'd been really consulted with and involved in the collaborative delivery of winter pressures and healthcare plans for the winter period, and I also walked away from that committee feeling that the care sector hadn't been, really, overly involved. And that's why I was very disappointed to see your comments on recommendation 6 and your refusal to actually accept that recommendation, because I think that market oversight, Cabinet Secretary, is absolutely vital, and I would like clarification of the timings and the depth of the work that's going to be undertaken by CSSIW and the national commissioning board, because there's no doubt that the market in social care is extremely fragile at present. There are a great number of barriers to the further growth of the social care market: there are dwindling care home beds, there is ageing building stock, and regulations and financial constraints are kicking in. If we're going to accept your response to recommendation 1, which is you believe that we need to go ahead and do more integration, more collaboration, build these IMTPs, which look at the whole sector - all the way from primary care, when somebody might first walk out of their door with an issue, all the way through to going in to hospital and then perhaps back out into a care home - we've got to involve all of those elements in those IMTPs. I did not have any sense - no true sense - that any of the health boards that we interviewed or the witnesses that we saw believed that that pan-sector collaboration had really been successfully undertaken. I think that, unless we can ensure we have a robust social care sector ahead of us, then with the best will in the world, with all the planning with GPs, with any planning in hospitals, if we cannot take people who are well out of hospital and put them into a social care setting, then we're going to end up with this constant jamming of our beds in our hospitals, and that brings all those other problems all the way through to the very front door of the hospital and then the back door of GP surgeries. So, those are my two points, Cabinet Secretary, and I really would urge you to look at a way of getting to grips with the state of the market in social care, ensuring collaboration and integration, and accepting that pressure is always there, but pressure looks different at different times of the year. Thank you very much indeed.
Welsh: Mwynheais fod yn rhan o'r pwyllgor hwn yn fawr a hoffwn ddiolch i bawb a ddaeth o'i flaen fel tystion. Roeddent yn fanwl iawn, roeddent yn wybodus iawn ac ar y cyfan, roeddent yn frwdfrydig iawn ynglŷn â'r gwahanol feysydd yr oeddent yn eu cynrychioli. Hoffwn hefyd ddiolch i'r tîm clercio a'r staff am gael cystal trefn arnom. Rwy'n meddwl bod yr adroddiad yn siarad drosto'i hun. Mae yna gryn dipyn o fanylder yn yr adroddiad, a phan fyddwch yn darllen Cofnod y Trafodion, ceir mwy byth o fanylion yno. Ond i mi, yn dod at hyn mewn modd newydd sbon - dyma'r tro cyntaf i mi eistedd ar y pwyllgor iechyd a gofal cymdeithasol - roedd yna ddau brif faes yn amlygu eu hunain - dau fater mawr. Yn gyntaf, er bod y pwysau ar y GIG yn parhau'n gyson 365 diwrnod y flwyddyn, nid oes amheuaeth ei fod yn newid ei ffurf yn y gaeaf. Rydym yn gwybod ei fod yn newid ei ffurf, a phob gaeaf gwyddom ei fod yn mynd i newid ei ffurf am mai math gwahanol o glaf sy'n cael eu derbyn yn bennaf, math gwahanol o glaf sydd angen y gwasanaeth ambiwlans a math gwahanol o glaf sydd angen y gwasanaethau gofal cymdeithasol. Felly, ni ddylai fod y tu hwnt i allu pawb ohonom yma - ond yn enwedig Llywodraeth Cymru, gan mai eich cyfrifoldeb chi ydyw, Ysgrifennydd y Cabinet - i sicrhau bod y byrddau iechyd yn adlewyrchu nid yn gymaint y pwysau, ond y newid yn y pwysau, fel ein bod yn sicrhau cydweithio da ac integreiddio da, a'n bod yn gwneud yn siŵr ein bod yn cael mathau penodol o welyau, oherwydd fe wyddom, er enghraifft, ein bod yn mynd i gael llawer iawn mwy o blant ifanc ac rydym yn mynd i gael llawer iawn mwy o bobl oedrannus; ein bod yn meddwl am bethau fel cydleoli a'n bod yn meddwl sut y gallwn wneud taith pobl drwy'r adrannau damweiniau ac achosion brys a thrwy unedau penderfyniadau clinigol i'r ysbyty ac yn ôl allan o'r ysbyty yn llawer cyflymach a mwy effeithlon. Nid oes neb yn bychanu'r ffaith fod y pwysau yno bob amser, ond rydym yn gwybod wrth i'r gaeaf ddod - a daw'n aeaf bob blwyddyn - y bydd ffurf y pwysau'n newid. Fel y dywedodd y Cadeirydd eisoes, cawsom adroddiad pwyllgor yn 2013 a gyfeiriai at yr union faterion hyn, ac nid ydym yn dysgu'r gwersi. Felly, mae fy nghwestiwn cyntaf i chi, Ysgrifennydd y Cabinet, o ddifrif yn pwysleisio'r ffaith fod angen i ni fod ar flaen y gad a deall nad yw'r pwysau bob amser yr un fath, ni waeth sut y byddwn yn ei ddisgrifio. Yr ail faes a ddaeth yn amlwg iawn i mi yn y pwyllgor hwn oedd yr holl stori sy'n ymwneud ag integreiddio a chydweithio. Yn ymateb y Llywodraeth i adroddiad y pwyllgor, rydych yn dweud, Ysgrifennydd y Cabinet, fod 'disgwyl i fyrddau iechyd ymgysylltu'n rheolaidd â'r sector gofal cymdeithasol a'r sector annibynnol wrth ddatblygu eu Cynlluniau Tymor Canolig Integredig'. Cerddais o'r pwyllgor hwnnw gyda theimlad sicr iawn nad oedd meddygon teulu yn teimlo bod unrhyw un wedi ymgynghori â hwy go iawn na'u bod wedi bod yn rhan o'r broses gydweithredol o gyflawni cynlluniau pwysau'r gaeaf a gofal iechyd ar gyfer y gaeaf, a cherddais o'r pwyllgor hwnnw hefyd yn teimlo nad oedd y sector gofal wedi cael rhan hynod o fawr yn y gwaith mewn gwirionedd. A dyna pam fy mod yn siomedig iawn o weld eich sylwadau ar argymhelliad 6 a'ch gwrthodiad i dderbyn yr argymhelliad hwnnw mewn gwirionedd, oherwydd credaf fod trosolwg o'r farchnad, Ysgrifennydd y Cabinet, yn hollol hanfodol, a hoffwn gael eglurhad o'r amseriadau a thrylwyredd y gwaith sy'n mynd i gael ei wneud gan Arolygiaeth Gofal a Gwaith Cymdeithasol Cymru a'r bwrdd comisiynu cenedlaethol, gan nad oes unrhyw amheuaeth fod y farchnad ym maes gofal cymdeithasol yn eithriadol o fregus ar hyn o bryd. Mae yna nifer fawr o rwystrau i dwf pellach y farchnad gofal cymdeithasol: ceir llai a llai o welyau cartrefi gofal, mae'r stoc adeiladau'n heneiddio, a rheoliadau a chyfyngiadau ariannol yn dechrau cael effaith. Os ydym yn mynd i dderbyn eich ymateb i argymhelliad 1, sef eich bod yn credu bod angen i ni fwrw ymlaen a gwneud mwy o integreiddio, mwy o gydweithio, adeiladu'r Cynlluniau Tymor Canolig Integredig hyn sy'n edrych ar y sector cyfan - yr holl ffordd o ofal sylfaenol, pan fyddai rhywun yn cerdded allan drwy'r drws am y tro cyntaf gyda phroblem, yr holl ffordd i'r ysbyty ac yna efallai yn ôl i gartref gofal - rhaid i ni gynnwys pob un o'r elfennau hynny yn y Cynlluniau Tymor Canolig Integredig hyn. Ni chefais unrhyw deimlad - unrhyw wir deimlad - fod unrhyw un o'r byrddau iechyd a gyfwelwyd gennym neu'r tystion a welsom yn credu bod y cydweithio hwnnw rhwng yr holl sectorau wedi'i gyflawni'n llwyddiannus mewn gwirionedd. Oni bai ein bod yn gallu sicrhau bod gennym sector gofal cymdeithasol cadarn o'n blaenau, gyda'r ewyllys gorau yn y byd, gyda'r holl gynllunio gyda meddygon teulu, gydag unrhyw gynllunio mewn ysbytai, os na allwn fynd â phobl sy'n iach allan o'r ysbyty a'u rhoi mewn lleoliad gofal cymdeithasol, credaf ein bod yn mynd i wynebu'r goralw cyson am welyau yn ein hysbytai, ac mae hynny'n dod â'r holl broblemau eraill hynny yn ei sgil yr holl ffordd at ddrws blaen yr ysbyty ac yna'n ôl drwy ddrws cefn y meddygfeydd. Felly, dyna fy nau bwynt, Ysgrifennydd y Cabinet, a buaswn yn eich annog yn wir i edrych ar ffordd o fynd i'r afael â chyflwr y farchnad mewn gofal cymdeithasol, gan sicrhau cydweithio ac integreiddio, a derbyn bod y pwysau yno bob amser, ond bod pwysau'n edrych yn wahanol ar wahanol adegau o'r flwyddyn. Diolch yn fawr iawn yn wir.