English: Thank you, Presiding Officer. I formally move amendment 35, tabled in my name. Members, I want teeth, not for me but for the NHS, and amendment 35 is tabled in support of committee recommendation 6, which asks the Minister to make a specific provision for the consequences of non-compliance with the duty of quality. I've re-tabled this from Stage 2 because, actually, I think it's vitally important that if we have legislation, it must have checks and balances built within it and the whole point of this is to give the Government, give the whole system, those very, very important teeth. It's not intended to have a detrimental impact on the financial position of health boards, trusts or special authorities, but it could be dealt with through the NHS escalation and intervention arrangements by the health Minister. During evidence sessions and the committee's consultation, it was clear that many stakeholders wanted to introduce consequences for the non-compliance in relation to both the duties of quality and candour. The British Medical Association noted that this needed to be addressed, stating, 'Unless some form of sanction or corrective action is triggered, we believe that the proposed duty would run the risk of lacking effectiveness, and at worst would become a mere box-ticking exercise.' The Royal College of Nursing noted that there 'has to be a consequence to doing it or not doing it, otherwise there's no incentive to do it, in a sense, at the most basic level.' Minister, your response at Stage 2 didn't give me any reassurance in the slightest. You said, again, in your commentary from Stage 1, that there were existing mechanisms, including escalation measures, that would underpin the failure to adhere to that duty of quality. Furthermore, you went on to say that these arrangements were part of wider governance and accountability within the NHS, and you believe that it provided opportunities for scrutiny and appropriate, timely action and learning. Well, I'm sorry, Minister, but I don't believe we are using these mechanisms and I don't believe they've provided opportunities for timely action and learning. I don't see health boards acting really quickly or learning their lessons. So, for example, we're still dealing with the fallout from some of our worst situations: Tawel Fan, where Betsi Cadwaladr is still in special measures four and a half years later, meaning that special measures and direct Government intervention haven't had much effect on the board's governance arrangements. An independent review of its psychological therapy services - you know, mental health services - highlighted that it is still failing in many areas. So, you would have thought that, after Tawel Fan, they would have actually looked at that quality in that element of the health services. I don't really want to dwell too much on Cwm Taf Morgannwg's maternity services, but we've got to say it here. This is the truth: despite numerous reports between 2010 and 2018 stating that the board's maternity services at Prince Charles Hospital and Royal Glamorgan Hospital were in trouble, including a damning internal report by a consultant midwife, who said there were systemic failings, they were ignored by senior management. So, where's that duty to secure quality in health services? This is a direct mirror of what we've seen at Betsi. So, Minister, members of the governing party, I really want you to think about this. This could be a really useful piece of legislation to drive quality, to drive candour through the NHS, but it has to have some teeth, and this whole amendment is about giving those teeth to the whole Act in order to ensure that we do get that real compliance. We can't afford for our NHS to carry on in a way where we cannot hold people to account and actually make sure that there are improvements. Duty to secure quality, non-compliance, give us teeth.
Welsh: Diolch yn fawr, Llywydd. Cynigiaf welliant 35, a gyflwynwyd yn fy enw i, yn ffurfiol. Aelodau, rwyf eisiau dannedd, nid i mi ond i'r GIG, ac mae gwelliant 35 wedi'i gyflwyno i gefnogi argymhelliad 6 gan y Pwyllgor, sy'n gofyn i'r Gweinidog wneud darpariaeth benodol ar gyfer goblygiadau peidio â chydymffurfio â'r ddyletswydd ansawdd. Rwyf wedi ail-gyflwyno hwn o Gyfnod 2 oherwydd, mewn gwirionedd, credaf ei bod yn hanfodol bwysig, os oes gennym ddeddfwriaeth, bod yn rhaid iddi gael rhwystrau a gwrthbwysau yn rhan ohoni a holl bwynt hyn yw rhoi'r dannedd hynny sy'n bwysig iawn i'r Llywodraeth, i'r holl system. Nid yw'n fwriad iddo gael effaith andwyol ar sefyllfa ariannol byrddau iechyd, ymddiriedolaethau neu awdurdodau arbennig, ond gellid ymdrin ag ef drwy drefniadau uwchgyfeirio ac ymyrryd y GIG gan y Gweinidog iechyd. Yn ystod y sesiynau tystiolaeth ac ymgynghoriad y pwyllgor, roedd yn amlwg bod llawer o randdeiliaid eisiau cyflwyno goblygiadau ar gyfer diffyg cydymffurfio mewn cysylltiad â'r dyletswyddau ansawdd a gonestrwydd. Nododd Cymdeithas Feddygol Prydain fod angen mynd i'r afael â hyn, gan nodi: Oni bai bod rhyw fath o sancsiwn neu gamau cywiro'n cael eu sbarduno, credwn y byddai perygl i'r ddyletswydd arfaethedig ddiffygio o ran effeithiolrwydd, ac y byddai ar ei gwaethaf yn troi'n ymarfer ticio blychau yn unig. Nododd y Coleg Nyrsio Brenhinol fod yn rhaid bod goblygiadau o'i wneud neu o beidio â'i wneud, neu fel arall nid oes cymhelliad i'w wneud, ar ryw ystyr, ar y lefel fwyaf sylfaenol. Gweinidog, ni wnaeth eich ymateb yng Nghyfnod 2 roi unrhyw sicrwydd imi o gwbl. Fe wnaethoch ddweud, unwaith eto, yn eich sylwadau o Gyfnod 1, fod dulliau ar gael eisoes, gan gynnwys mesurau uwchgyfeirio, a fyddai'n tanategu'r methiant i lynu at y ddyletswydd ansawdd honno. Hefyd, aethoch ymlaen i ddweud bod y trefniadau hyn yn rhan o lywodraethu ac atebolrwydd ehangach o fewn y GIG, a'ch bod yn credu eu bod yn cynnig cyfleoedd ar gyfer craffu a gweithredu a dysgu priodol ac amserol. Wel, mae'n ddrwg gennyf, Gweinidog, nid wyf yn credu ein bod yn defnyddio'r dulliau hyn ac nid wyf yn credu eu bod wedi darparu cyfleoedd ar gyfer gweithredu a dysgu amserol. Nid wyf yn gweld byrddau iechyd yn gweithredu'n gyflym iawn nac yn dysgu eu gwersi. Felly, er enghraifft, rydym ni'n dal i ymdrin â chanlyniadau rhai o'n sefyllfaoedd gwaethaf: Tawel Fan, lle mae Betsi Cadwaladr yn dal i fod mewn mesurau arbennig bedair blynedd a hanner yn ddiweddarach, sy'n golygu nad yw mesurau arbennig ac ymyrraeth uniongyrchol gan y Llywodraeth wedi cael llawer o effaith ar drefniadau llywodraethu'r bwrdd. Mewn adolygiad annibynnol o'i wasanaethau therapi seicolegol - hynny yw, gwasanaethau iechyd meddwl - tynnwyd sylw at y ffaith ei fod yn dal i fethu mewn nifer o feysydd. Felly, byddech wedi disgwyl, ar ôl Tawel Fan, y bydden nhw wedi edrych ar yr ansawdd hwnnw yn yr elfen honno o'r gwasanaethau iechyd. Nid wyf eisiau rhoi gormod o bwys ar wasanaethau mamolaeth Cwm Taf Morgannwg, ond mae'n rhaid inni ei ddweud yma. Dyma'r gwir: er gwaethaf adroddiadau niferus rhwng 2010 a 2018 yn datgan bod gwasanaethau mamolaeth y bwrdd yn Ysbyty'r Tywysog Siarl ac Ysbyty Brenhinol Morgannwg mewn trafferthion, gan gynnwys adroddiad mewnol damniol gan fydwraig ymgynghorol, a ddywedodd fod methiannau systemig, fe'u hanwybyddwyd gan yr uwch reolwyr. Felly, ble mae'r ddyletswydd honno i sicrhau ansawdd mewn gwasanaethau iechyd? Mae hyn yn adlewyrchu'n union yr hyn a welsom yn Betsi. Felly, Gweinidog, Aelodau'r blaid lywodraethol, rwyf eisiau ichi feddwl am hyn. Gallai hwn fod yn ddarn defnyddiol iawn o ddeddfwriaeth i sbarduno ansawdd, i sbarduno gonestrwydd drwy'r GIG, ond mae'n rhaid iddo gael rhywfaint o ddannedd, ac mae'r gwelliant cyfan hwn yn ymwneud â rhoi'r dannedd hynny i'r Ddeddf gyfan er mwyn sicrhau ein bod yn cael y gydymffurfiaeth wirioneddol honno. Ni allwn fforddio i'n GIG ni barhau mewn modd fel na allwn ddwyn pobl i gyfrif a gwneud yn siŵr bod yna welliannau mewn gwirionedd. Dyletswydd i sicrhau ansawdd, diffyg cydymffurfio, rhowch ddannedd inni.