English: I'm pleased to able to make a contribution as a member of the Petitions Committee and Plaid Cymru's spokesperson on health. I'm going to talk about the principles of downgrading and losing emergency services. This petition, of course, which we're discussing today, is a reflection, once again, of the concern that arises regularly when we talk of reorganising hospital services, and particularly the recommendations that have been causing concerns in this part of Wales for many years. Concerns are often ignored by politicians who say, 'Well, we have to go through a process of change. We have accept this.' And perhaps we will hear rhetorical references today to the parliamentary review of healthcare in Wales in the future, but before you go and search yourselves, I can tell you that there is no reference in that report to anything that is akin to the reorganisation being recommended here for the Hywel Dda area. Believe you me, it is important that we do listen to the petitioners and the protesters, because I think that people do have a right to crucial services within a reasonable distance of their homes, and an emergency department in a hospital, surely, is essential. I've called in the past for the development for frameworks within the health service noting which services should be provided at what level, that is, some services within your community or close to your community - your GP, for example, pharmacists, and so on. We should note that there are some specialist services that we have to travel for, and I would include in that - I've been convinced of this - the emergency trauma services, specialist trauma services. And I will note here that it reflects very poorly on historical decisions taken that patients in north Wales have to travel to Stoke for some of these trauma services, rather than investment having being made in developing those services to serve north Wales in Wales. But you can't develop those services easily now. But, looking at emergency services generally, I looked at a recent report published in Health Services and Delivery Research, which was a study comparing outputs between areas that have seen A&E services centralised and other areas. And that study doesn't demonstrate any benefit of centralisation. Some good news for you: in centralising, there was no great increase in the number of deaths, but that was because mitigating steps had been taken. And, yes, there was an increase in the risk of death following centralisation, but, generally speaking, things weren't much worse as a result of centralisation, if you can take some comfort from that. But, there was evidence of pressure on the ambulance service as a result of the centralisation of services, and it's worth noting too that the areas looked at as part of that study were less rural than this particular part of west Wales. I also think that it could be useful to look at the findings of the Sheffield University study, which looked in 2007 at 10,500 emergency cases and found that 10 km further in distance from an A&E department corresponded to a 1 per cent increase in mortality. And the figure was worse, then, for people with respiratory conditions. So, distance from A&E does have an impact on outputs and outcomes. So, there are risk factors inherent in these proposed change, and people, therefore, have a right to be concerned. And, of course, we don't have the details that we need at the moment to make a full evaluation of what is being proposed. There is no recommendation on out-of-hours care; no significant increase in social care; no plans to invest in the ambulance service, and so on and so forth. Rather, what we have is the bait of a new hospital, and I can tell you that everyone that I've spoken to is very suspicious as to whether that can be delivered: £350 million in investment - all of the capital expenditure in a single year in Wales. What we need to do, of course, is to improve those elements of the service that will make a real difference to people: we need to strengthen primary care; we need to invest more in medical training; we need to tackle recruitment problems, and so on, and retain staff in that way. To conclude, removing crucial services from large areas of Wales is not going to improve our health service, I'm afraid, and I'm very grateful to the petitioners for ensuring one of the highest numbers of signatures on a petition to be considered by our committee, because you represent not only the people of the Hywel Dda area, but people the length and breadth of Wales who treasure their local health service.
Welsh: Mae'n braf gallu siarad fel aelod o'r Pwyllgor Deisebau a llefarydd Plaid Cymru ar iechyd. Rydw i'n mynd i siarad am yr egwyddorion o israddio a cholli gwasanaethau brys. Mae'r ddeiseb yma, wrth gwrs, rydym ni'n ei thrafod heddiw yn adlewyrchiad eto fyth o'r consýrn sy'n codi'n gyson pan fyddwn yn sôn am ad-drefnu gwasanaethau ysbytai, ac yn benodol yr argymhellion sydd wedi bod yn achosi pryderon yn y rhan yma o Gymru bellach ers blynyddoedd. Mae pryderon yn cael eu hanwybyddu yn aml gan wleidyddion sydd yn dweud, 'O, mae'n rhaid inni fynd drwy broses o newid. Mae'n rhaid derbyn hyn.' Efallai y clywn ni gyfeiriadau rhethregol heddiw at yr adolygiad seneddol o ofal iechyd yng Nghymru yn y dyfodol, ond cyn ichi fynd i chwilio'ch hun, mi allaf i addo nad oes yna gyfeiriad yn yr adroddiad hwnnw at unrhyw beth tebyg i'r ad-drefnu sydd yn cael ei argymell yma ar gyfer ardal Hywel Dda. Credwch chi fi, mae'n bwysig ein bod ni yn gwrando ar y deisebwyr a'r protestwyr, achos rydw i'n meddwl bod hawl gan bobl i dderbyn gwasanaethau hanfodol o fewn pellter rhesymol i le maen nhw'n byw, ac mae adran frys ysbyty yn hanfodol, siawns. Rydw i wedi galw yn y gorffennol am ddatblygu fframweithiau o fewn y gwasanaeth iechyd yn nodi pa wasanaethau a ddylai gael eu darparu ar ba lefel, hynny ydy, rhai gwasanaethau o fewn eich cymunedau neu yn agos iawn at eich cymunedau - eich meddyg teulu chi, fferyllfeydd ac yn y blaen. Mae angen nodi bod rhai gwasanaethau arbenigol mae'n rhaid inni dderbyn bod yn rhaid teithio ymhellach i'w cael nhw, ac rydw i'n cynnwys yn hynny - rydw i wedi cael fy argyhoeddi - gwasanaethau brys trawma arbenigol. Mi wnaf i nodi yn fan hyn ei bod hi'n adlewyrchiad gwael iawn ar benderfyniadau hanesyddol fod cleifion yn y gogledd yn gorfod mynd i Stoke am y gwasanaethau trawma yma yn hytrach na bod buddsoddiad wedi cael ei wneud mewn datblygu gwasanaeth o'r math yna a allai gwasanaethu'r gogledd yng Nghymru. Nid ar chwarae bach, wrth gwrs, mae datblygu'r gwasanaethau hynny rŵan. Ond, o edrych ar wasanaethau brys yn gyffredinol, mi edrychais i ar adroddiad diweddar a gafodd ei gyhoeddi yn Health Services and Delivery Research - astudiaeth a oedd yn cymharu allbynnau rhwng ardaloedd sydd wedi gweld gwasanaethau A&E yn cael eu canoli ac ardaloedd eraill. Nid yw'r astudiaeth yna ddim yn gweld bod yna fudd wedi dod o ganoli. Newyddion da i chi: wrth ganoli, nid oedd cynnydd mawr yn cael ei weld mewn niferoedd marwolaethau, ond mi oedd hynny oherwydd bod camau lliniarol wedi cael eu cymryd. Oedd, mi oedd yna gynnydd yn y risg o farwolaethau o ganoli ond, yn gyffredinol, nid oedd pethau ddim llawer gwaeth ar ôl canoli, os ydych chi'n cymryd cysur o hynny. Ond, mi oedd yna dystiolaeth o bwysau ar y gwasanaeth ambiwlans o ganlyniad i ganoli, ac mae'n werth nodi hefyd fod yr ardaloedd yr edrychwyd arnyn nhw fel rhan o'r astudiaeth yna yn rhai llai gwledig na'r rhan arbennig yma o orllewin Cymru. Rydw i'n meddwl hefyd y gallai fod yn ddefnyddiol edrych ar ganfyddiadau astudiaeth Prifysgol Sheffield, yn ôl o 2007, a wnaeth astudio 10,500 o achosion brys a chanfod bod 10 km yn rhagor mewn pellter o adran frys yn cyfateb i 1 y cant o gynnydd mewn marwolaethau. Ac mi oedd y ffigwr yn waeth, wedyn, ar gyfer pobl a oedd â chyflyrau anadlu neu gyflyrau anadlol. Felly, mae pellter o adran frys yn gwneud gwahaniaeth i allbynnau. Felly, mae yna ffactorau risg ymhlith y newidiadau arfaethedig, ac mae gan bobl, felly, yr hawl i fod â chonsýrn. Ac, wrth gwrs, nid oes gennym ni ddim mo'r manylion rydym ni eu heisiau ar hyn o bryd i wneud gwerthusiad llawn o'r hyn sydd yn cael ei gynnig. Nid oes argymhelliad am ofal allan o oriau; dim cynnydd sylweddol mewn gwasanaethau gofal cymdeithasol; dim cynlluniau i fuddsoddi yn y gwasanaeth ambiwlans, ac yn y blaen. Yn hytrach, beth sydd gennym ni yw abwyd o ysbyty newydd sbon, ac rydw i'n addo i chi, o bawb rydw i wedi siarad efo nhw, maen nhw'n amheus iawn y caiff hynny ei ddelifro: £350 miliwn, o bosib, o fuddsoddiad - yr holl wariant cyfalaf mewn blwyddyn yng Nghymru. Beth rydym ni angen ei wneud, wrth gwrs, ydy gwella'r elfennau hynny o'r gwasanaeth sy'n mynd i wneud gwahaniaeth go iawn i bobl: cryfhau gofal sylfaenol, buddsoddi mwy mewn hyfforddiant meddygol, taclo problemau recriwtio ac ati, a chadw staff yn y ffordd yna. I gloi, nid yw tynnu gwasanaethau hanfodol o ardaloedd helaeth o Gymru am wella ein gwasanaeth iechyd ni, mae gen i ofn, ac rydw i'n ddiolchgar iawn i'r deisebwyr am sicrhau un o'r niferoedd uchaf erioed o enwau ar ddeiseb i gael ei hystyried gan ein pwyllgor ni, achos rydych chi'n cynrychioli nid yn unig y bobl yn ardal Hywel Dda, ond pobl ledled Cymru sy'n trysori eu gwasanaeth iechyd lleol nhw.