English: I'd like to thank the committee clerks and all those who gave evidence to our committee during our inquiry into primary care clusters. Primary care clusters have the potential to transform the care delivered in our communities, but whilst we saw some excellent examples of successful clusters, there is a large variation in performance. Many GPs expressed their disappointment at the clusters. Some were highly critical. One GP described their cluster as 'amateur'. Whilst there is widespread support for the principles behind the clusters, it is broadly felt that they're not living up to the expectations. Many witnesses pointed to the fact that development was being held up by local health boards. Cluster development funding is controlled by local health boards, and many of the clusters found they were unable to use the moneys in the most effective way, due to overly bureaucratic rules and regulations. We heard that around 90 per cent of the funding was being used to pay for staffing costs. We also heard, time and time again, that the local health board's role in allocating development moneys added unnecessary delays in getting the funding to the clusters. The Welsh NHS Confederation told us that the need to spend moneys by year end made it difficult to redesign a service, recruit, train and make real change, due to the inflexibility and insufficient lead time. As a committee, we felt that funding should go directly to the clusters, and that it should be allocated on a three-year basis to avoid short-term planning decisions, which often do not offer the best value for money. I'm disappointed that the Cabinet Secretary has rejected recommendation 11, and I urge him to reconsider. It became apparent to me, over the course of this inquiry, that it wasn't just the funding issues: health boards were hindering the ability of the clusters to deliver real change. The British Medical Association called for greater autonomy for clusters, and that they should be at arm's length from local health boards. I'm therefore pleased that the Cabinet Secretary has accepted recommendations 2 and 3, which recommend new governance structures and delegation of decision making to clusters. Of course, the clusters are only effective when they have consistent and clear leadership. The BMA told us that where clusters are successful, it's largely due to specific individuals who have shown proactive leadership despite the constraints of their clinical responsibilities. The committee feels that all relevant professionals need the time and space to be meaningfully involved. We recommend that there be a refreshed model and that guidance be published, setting out core membership to ensure that clusters involve the right people and have the best possible leadership team. I'm pleased that the Welsh Government have accepted this. The Cabinet Secretary has indicated that a workshop will take place next month to draw together proposed governance arrangements. The BMA has requested that the date of this workshop be moved to allow GPs to attend. I would be grateful if the Cabinet Secretary could inform us if that is possible. All of us here want primary care clusters to succeed. As highlighted by the parliamentary review, the future of care will focus more on primary rather than secondary care, so it is important that we improve health and care provision in our local communities. Clusters have an important role to play in delivering those improvements and change. Our committee have made 16 suggestions for improving the role and operation of primary care clusters, and I urge the Welsh Government to reconsider and accept all of our recommendations. Thank you. Diolch yn fawr.
Welsh: Hoffwn ddiolch i glercod y pwyllgor a'r rhai a roddodd dystiolaeth i'n pwyllgor yn ystod ein hymchwiliad i glystyrau gofal sylfaenol. Mae gan glystyrau gofal sylfaenol botensial i drawsnewid y gofal a ddarperir yn ein cymunedau, ond er i ni weld enghreifftiau ardderchog o glystyrau llwyddiannus, ceir amrywiadau mawr yn eu perfformiad. Mynegodd llawer o feddygon teulu eu siom yn y clystyrau. Roedd rhai'n feirniadol iawn. Disgrifiodd un meddyg teulu eu clwstwr fel 'amatur'. Er bod cefnogaeth eang i'r egwyddorion sy'n sail i'r clystyrau, teimlir yn gyffredinol nad ydynt yn cyflawni'r disgwyliadau. Nododd llawer o dystion y ffaith fod byrddau iechyd lleol yn rhwystro datblygiadau. Caiff cyllid datblygu clwstwr ei reoli gan fyrddau iechyd lleol, a chanfu llawer o'r clystyrau nad oeddent yn gallu defnyddio'r arian yn y ffordd fwyaf effeithiol, oherwydd rheoliadau a rheolau rhy fiwrocrataidd. Clywsom fod oddeutu 90 y cant o'r cyllid yn cael ei ddefnyddio i dalu costau staffio. Clywsom hefyd, dro ar ôl tro, fod rôl y bwrdd iechyd lleol yn dyrannu arian datblygu yn peri oedi ychwanegol diangen cyn cael y cyllid at y clystyrau. Dywedodd Conffederasiwn GIG Cymru wrthym fod yr angen i wario arian erbyn diwedd y flwyddyn yn ei gwneud yn anodd ailgynllunio gwasanaeth, recriwtio, hyfforddi a gwneud newid go iawn, oherwydd anhyblygrwydd a phrinder amser arwain. Fel pwyllgor, teimlem y dylai'r arian fynd yn uniongyrchol i'r clystyrau, ac y dylid ei ddyrannu ar sail tair blynedd er mwyn osgoi penderfyniadau cynllunio byrdymor, nad ydynt yn cynnig y gwerth gorau am arian yn aml. Rwy'n siomedig fod Ysgrifennydd y Cabinet wedi gwrthod argymhelliad 11, ac rwy'n ei annog i ailystyried. Daeth yn amlwg i mi, yn ystod yr ymchwiliad hwn, ei fod yn ymwneud â mwy na'r problemau ariannu: roedd byrddau iechyd yn llesteirio gallu'r clystyrau i gyflawni newid gwirioneddol. Galwodd Cymdeithas Feddygol Prydain am fwy o ymreolaeth i glystyrau, ac y dylent fod hyd braich oddi wrth y byrddau iechyd lleol. Rwy'n falch felly fod Ysgrifennydd y Cabinet wedi derbyn argymhellion 2 a 3, sy'n argymell strwythurau llywodraethu newydd a dirprwyo penderfyniadau i glystyrau. Wrth gwrs, nid yw'r clystyrau ond yn effeithiol pan fydd ganddynt arweinyddiaeth gyson a chlir. Lle mae clystyrau'n llwyddiannus, dywedodd Cymdeithas Feddygol Prydain wrthym fod hynny'n deillio'n bennaf o ganlyniad i unigolion penodol sydd wedi dangos arweiniad rhagweithiol er gwaethaf cyfyngiadau eu cyfrifoldebau clinigol. Mae'r pwyllgor yn teimlo bod angen amser a lle ar bob gweithiwr proffesiynol perthnasol i gymryd rhan yn ystyrlon. Rydym yn argymell y dylid cael model diwygiedig ac y dylid cyhoeddi'r canllawiau, gan nodi aelodaeth graidd er mwyn sicrhau bod clystyrau'n cynnwys y bobl gywir a bod ganddynt y tîm arweinyddiaeth gorau posibl. Rwy'n falch fod Llywodraeth Cymru wedi derbyn hyn. Mae Ysgrifennydd y Cabinet wedi nodi y cynhelir gweithdy y mis nesaf i ddwyn ynghyd y trefniadau llywodraethu arfaethedig. Mae Cymdeithas Feddygol Prydain wedi gofyn am newid dyddiad y gweithdy i alluogi meddygon teulu i'w fynychu. Buaswn yn ddiolchgar pe gallai Ysgrifennydd y Cabinet roi gwybod inni a yw hynny'n bosibl. Mae pob un ohonom yma eisiau i glystyrau gofal sylfaenol lwyddo. Fel yr amlygodd yr adolygiad seneddol, bydd dyfodol gofal yn canolbwyntio mwy ar ofal sylfaenol yn hytrach na gofal eilaidd, felly mae'n bwysig ein bod yn gwella darpariaeth iechyd a gofal yn ein cymunedau lleol. Mae gan glystyrau rôl bwysig i'w chwarae'n cyflawni'r gwelliannau a'r newid. Mae ein pwyllgor wedi gwneud 16 o awgrymiadau ar gyfer gwella rôl a gweithrediad clystyrau gofal sylfaenol, ac anogaf Lywodraeth Cymru i ailystyried a derbyn pob un o'n hargymhellion. Diolch. Diolch yn fawr.