English: Thank you very much, Dirprwy Lywydd. Thank you to my fellow members of the committee, and thank you to the researchers and the clerking team. This is a very important report. We're getting to the heart of issues that are holding our health service back at the moment. We're talking about patient flow through the health service. If there isn't that easy flow through the system, you have a problem. We'll start at the back door of the hospital, when a patient is ready to leave the general hospital after receiving treatment. I've sat in huddles in Ysbyty Gwynedd twice - the morning meetings where staff come together to assess where they are at the beginning of another busy day - one of the statistics discussed is how many patients are ready to leave on a medical basis, medically fit for discharge. It's striking to find that 80 or more beds in the hospital are being used by patients who don't need to be there. The same is true in general hospitals across Wales. That means a problem at the front door: cancelling treatments because there aren't beds available, perhaps, and longer waiting lists then; it means that patients arriving through the emergency department can't move from the emergency department to the ward if needed, because the ward is full. The emergency department is full, which means that an ambulance can't unload a patient; they're queuing outside the hospital; they can't respond to calls. It's a vicious cycle, isn't it, and through our work as a committee, of course, we tried to understand why this block is happening at the back door, this delay in discharging patients - why that is happening. Now, the focus in recent years has turned to care services. There are robust recommendations in this report to this end: how to ensure that the NHS and social services departments in local authorities work better together to integrate health and care; how to ensure that integration funding is spent effectively; and how to support care staff, to pay them properly, and to support them so that we can recruit. I won't go into the details of that; they are comprehensive recommendations in the report. The Welsh Government, as we've heard from the Chair, agrees to the vast majority of the recommendations. It's a matter for us to hold the Government to account and to scrutinise progress. There are five of the recommendations that are only being accepted in principle, and I want to turn to one of those, namely recommendation 8: 'The Welsh Government should set out how it will work with health boards and other partners to increase the availability of more appropriate step-up/step-down facilities across Wales'. The lack of that step-down provision is a huge problem. The capacity isn't there. It has become increasingly clear to me that we can't depend on the care sector to provide that capacity and that, indeed, it's not fair for us to ask them to provide that capacity. And I'm afraid that what we're seeing here is the result of decades of poor policy. I've seen figures that suggest we had around 20,000 hospital beds in Wales at the end of the 1980s. There are very specific statistics by 1997, where there were just under 16,000. Just over 10,000 beds, that's how many we have now. What we've seen is a purposeful deliberate programme of closing community hospitals, closing beds, decreasing capacity. And now, are we genuinely meant to be surprised that there is a capacity problem, that there's a poor flow of patients through the system? The Government is turning to the care services, and says that that sector needs to be accepting patients more quickly. I'm afraid, as I've said, that we are asking them to do something that is impossible to do. Does that take away from the recommendations of the committee? No, it doesn't, not at all. We need to strengthen the care sector, we do need to fund it properly and we need to support care workers. But by closing all of those beds, Labour and Conservative Governments, here and in Westminster, were helping to create the problem that we have today. People are living longer. More people need treatment. And no matter how much we would wish, entirely correctly by the way, for people to receive care at home, to go home as soon as possible after receiving treatment and so on, it's common sense that there are still more people who will need just that little bit of additional care after having hospital treatment - exactly the kind of treatment that can be provided in a community hospitals. So, I'd like to hear from the Minister a commitment to a new programme of creating that capacity. She'll say that there's no funding available, I'm sure, but we're talking here about beds that are so much cheaper than beds in general hospitals. We're talking about taking the pressure away from that expensive end of the NHS. Let's create a programme that will generate that capacity, rather than just asking for care services to do what I think is impossible.
Welsh: Diolch yn fawr iawn, Dirprwy Lywydd. Diolch i fy nghyd-aelodau o'r pwyllgor, a diolch i'r ymchwilwyr a'r tîm clercio. Mae hwn yn adroddiad pwysig iawn. Rydym ni'n cael at wraidd y materion sy'n dal ein gwasanaeth iechyd ni yn ôl ar hyn o bryd. Rydym ni'n sôn am lif cleifion drwy'r system iechyd. Os nad oes yna lif rhwydd drwy'r system, mae gennych chi broblem. Dechreuwn ni wrth ddrws cefn ysbyty, pan fo claf yn barod i adael yr ysbyty cyffredinol ar ôl derbyn triniaeth. Dwi wedi eistedd mewn huddles yn Ysbyty Gwynedd ddwywaith - y cyfarfodydd boreol lle mae staff yn dod at ei gilydd i asesu lle maen nhw arni ar ddechrau diwrnod prysur arall - un o'r ystadegau sy'n cael eu trafod ydy faint o gleifion sy'n barod i adael ar sail meddygol, medically fit for discharge. Mae'n drawiadol i ffeindio bod efallai 80 neu'n fwy o welyau yn yr ysbyty yn cael eu defnyddio gan gleifion sydd ddim angen bod yno. Ac mae'r un yn wir mewn ysbytai cyffredinol ar draws Cymru. Mae hynny'n golygu problem wrth y drws ffrynt: canslo triniaethau achos does yna ddim gwely ar gael, efallai, a rhestrau aros hirach wedyn; mae'n golygu bod cleifion sy'n cyrraedd drwy'r adran frys yn methu symud o'r adran frys i'r ward os oes angen - mae'r ward yn llawn. Mae'r adran frys yn llawn, sy'n golygu bod ambiwlans yn methu dadlwytho claf, yn ciwio tu allan i'r ysbyty, yn methu ag ateb galwadau. Mae o'n gylch dieflig, a thrwy ein gwaith ni fel pwyllgor, wrth gwrs, mi oeddem ni'n trio deall pam mae'r bloc yma wrth y drws cefn, yr oedi wrth ryddhau cleifion, yn digwydd. Mae'r sylw, yn gyffredinol, mewn blynyddoedd diweddar, wedi troi at wasanaethau gofal. Mae yna argymhellion cadarn yn yr adroddiad yma i'r perwyl yma: sut i sicrhau bod yr NHS ac adrannau gwasanaethau cymdeithasol cynghorau sir yn gweithio'n well efo'i gilydd i integreiddio iechyd a gofal; sut i sicrhau bod arian integreiddio yn cael ei wario'n effeithiol; a sut i gefnogi staff gofal, eu talu nhw'n iawn, a'u cefnogi nhw'n iawn fel ein bod ni'n gallu recriwtio. Gwnaf i ddim mynd i mewn i fanylion hynny; maen nhw'n argymhellion cynhwysfawr. Mae Llywodraeth Cymru, fel rydym ni wedi ei glywed gan y Cadeirydd, yn cytuno â'r mwyafrif helaeth ohonyn nhw. Mater i ni fydd dal y Llywodraeth i gyfrif a sgrwtineiddio cynnydd. Mae pump o'r argymhellion sydd ddim ond yn cael eu derbyn mewn egwyddor, a dwi am droi at un o'r rheini, sef argymhelliad 8: 'Dylai Llywodraeth Cymru nodi sut y bydd yn gweithio gyda byrddau iechyd a phartneriaid eraill i sicrhau bod mwy o gyfleusterau cam-i-fyny/cam-i-lawr mwy priodol ar gael ledled Cymru.' Mae diffyg darpariaeth cam i lawr yn broblem enfawr. Dydy'r capasiti ddim yno. Ac mae wedi dod yn fwy a mwy clir i fi na allwn ni ddibynnu ar y sector gofal i ddarparu'r capasiti yna ac, a dweud y gwir, nad ydy hi'n deg i ni ofyn iddyn nhw ei ddarparu fo. A dwi'n ofni mai beth rydym ni'n ei weld yn fan hyn ydy canlyniadau degawdau o bolisi gwael. Dwi wedi gweld ffigurau sy'n awgrymu bod gennym ni rhyw 20,000 o welyau ysbyty yng Nghymru ddiwedd y 1980au. Mae yna ystadegau pendant iawn erbyn 1997, pan oedd yna ychydig o dan 16,000. Dipyn dros 10,000 o welyau sydd gennym ni erbyn hyn. Beth rydym ni wedi'i weld ydy rhaglen bwrpasol o gau ysbytai cymunedol, cau gwelyau, lleihau capasiti. A rŵan, ydym ni wir i fod i synnu bod yna broblem capasiti, bod yna lif gwael o gleifion drwy'r system? Mae'r Llywodraeth yn troi at y gwasanaethau gofal, yn dweud bod angen i'r sector hwnnw fod yn derbyn cleifion ynghynt. Mae gen i ofn, fel dwi'n dweud, ein bod ni'n gofyn iddyn nhw wneud rhywbeth sy'n amhosib. Ydy hynny'n tynnu oddi ar argymhellion y pwyllgor? Nac ydy, dydy o ddim, ddim o gwbl. Mae eisiau cryfhau y sector gofal, mae eisiau ei gyllido fo yn iawn ac mae eisiau cefnogi gweithwyr gofal. Ond drwy gau yr holl welyau, mi oedd Llywodraethau Llafur a Cheidwadol, yn fan hyn ac yn San Steffan, yn helpu i greu y broblem sydd gennym ni heddiw. Mae pobl yn byw yn hirach. Mae mwy o bobl angen triniaeth. A dim ots faint rydym ni'n dymuno, yn hollol, hollol gywir gyda llaw, i bobl allu cael gofal gartref, i fynd gartref mor gyflym â phosibl ar ôl triniaeth ac ati, mae'n synnwyr cyffredin bod yna'n dal fwy o bobl sy'n mynd i fod angen jest ychydig bach o ofal ychwanegol ar ôl triniaeth ysbyty - yr union fath o ofal sy'n gallu cael ei gynnig mewn ysbyty cymunedol. Felly, mi hoffwn i glywed gan y Gweinidog ymrwymiad i raglen newydd o greu y capasiti yna. Mi ddywedith fod yna ddim arian at gael, dwi'n siŵr, ond rydym ni'n sôn yn y fan hyn am welyau sydd gymaint rhatach na gwelyau mewn ysbyty cyffredinol. Rydym ni'n sôn am dynnu'r pwysau oddi ar y pen drud o'r NHS. Gadewch inni weld rhaglen fydd yn creu y capasiti yna, yn hytrach na dim ond gofyn i wasanaethau gofal wneud yr hyn dwi'n ei gredu sy'n amhosib.