English: Minister, I'd like to thank you for your statement today on the amber review, which I think is showing positive improvements. We have looked at this before, over the last months. I do have some questions and, of course, we're never going to be able to discuss the amber review without touching upon what happens to people who suffer from a stroke. Now, you've mentioned already that you are working with the various organisations and the ambulance service to consider that, but I think my concern is this: I remember so clearly a meeting that was arranged by Welsh Government with the Welsh ambulance service and with opposition spokespeople, about three years ago, to discuss, when the changes were first made to red, to amber and to the green criteria. And all the talk was about clinical pathways, and how incredibly important that, if somebody was to suffer a stroke, they wouldn't need to go into the red category because they would be able to follow a clinical pathway that would bring them straight to the door or to the bed where they needed to be in order to survive a stroke - and not just to survive it, but to survive it well, which is a very important point, I think, to make. Yet, when I talk to ambulance staff and to the ambulance service, they say that these clinical pathways are, in reality, still not in existence. Staff constantly tell me that they take somebody in the end, they still go through the emergency department or the critical admissions unit, and that they've still not developed the pathways to get them to the right place quickly enough. So, I just wanted to ask you to perhaps give a little bit more explanation about this review, about how it's going to be interpreted. And will you be giving credence to the Stroke Association, who are now asking for Wales to build on the approach taken by NHS England, where a new system will track you from the first call to the 999 to receiving the appropriate treatment, and give that a target? Because I think if we're never going to put, or you are never going to put, people who suffer a stroke into that red category, there has to be some fallback position that protects them, because I made the point earlier - and I'm going to say it again, because I think it's vital - it's not just good enough to survive, but we have to survive well. And, of course, it's not just stroke that has clinical pathways; there are a number of very clear areas where people who are on an amber response can go through a clinical pathway straight to where they need to be, rather than clogging up our already under pressure EDs. Do you have any view on when these clinical pathways will finally come to fruition - they were talked about three years ago - and how they're going to be identified? And trust me, Minister, I have put some freedom of information requests in to health boards, in to the Welsh ambulance service and some ordinary questions in to you to try to get to the bottom of this, and nobody, but nobody, can bottom it out. So, I think that information just isn't out there, and I would like your reassurance that you are able to do something about this, to make sure there's consistency and a quality of access to service in all areas of Wales for amber review people going through clinical pathways. Your statement touches very, very briefly on the fact that we are going to be doing a mapping exercise to look at resources and to look at other issues to basically futureproof, if you like, the Welsh ambulance service going forward. I was really surprised that you didn't really talk much about the staff in this, because, of course, whether it's red, amber or green, we need the staff to be there to do the job and staff sickness is one of the biggest pressures on the NHS trust. Six months ago you voiced your expectation for the NHS trust to work with partners to take immediate action to address this, and yet the latest figures show another 1 per cent increase in sickness absence, far outstripping NHS board absences. So, how quickly would you expect to see changes to the management of staff absences? How quickly would you expect to see support going in for the ambulance workforce to translate into a lowering of the absence rate? Will you outline the barriers to quickly addressing the reasons behind such high rates of staff absence at the trust? And will you be able to give us an indication of when you might be able to come back to us with positive news on this particular issue? Finally, I know it's not entirely within just the remit of the amber review, but we can't talk about how we deliver good-quality red care, amber care and green care from the Welsh ambulance service without actually touching upon the waiting times that we see in our emergency departments. Ambulance crews are still reporting significant delays in hospital handovers. I would like to know, Minister, what strategy are you employing to ensure that health boards and the trust are carrying out the immediate action that you expected six months ago. We're already told that we're losing thousands and thousands and thousands of staff hours to ambulance handover. Tonight, ITV Wales will be broadcasting a report that the Welsh ambulance service is losing the equivalent of 15 full ambulance shifts a day outside emergency departments, and that crews have clocked up 65,000 hours in 2018 just waiting to offload patients in hospitals, and we hear stories of patients who are on amber call finally getting to the hospital, being taken in for treatment and then being popped back into the ambulance because there's nowhere else for them to go. So, I'll be really interested to know what you're going to be able to do to actually try to compress that time. You talk in your statement about that fact that you feel that it's getting better, but I'm afraid the statistics simply do not bear out that assertion that well.
Welsh: Gweinidog, hoffwn ddiolch ichi am eich datganiad heddiw am yr adolygiad oren, sy'n dangos gwelliannau cadarnhaol yn fy marn i. Rydym wedi edrych ar hyn o'r blaen, dros y misoedd diwethaf. Mae gennyf rai cwestiynau ac, wrth gwrs, nid ydym ni byth yn mynd i allu trafod yr adroddiad oren heb grybwyll yr hyn sy'n digwydd i bobl sy'n dioddef strôc. Nawr, rydych chi eisoes wedi sôn eich bod yn gweithio gyda'r gwahanol sefydliadau a'r gwasanaeth ambiwlans i ystyried hynny, ond rwy'n credu mai fy mhryder i yw hyn: rwy'n cofio'n glir cyfarfod a drefnwyd gan Lywodraeth Cymru gyda gwasanaeth ambiwlans Cymru a gyda llefaryddion y gwrthbleidiau, tua thair blynedd yn ôl, i drafod, pryd y gwnaed y newidiadau i'r meini prawf coch, oren a gwyrdd gyntaf. Ac roedd yr holl sôn am lwybrau clinigol, a pha mor anhygoel o bwysig oedd hi, pe byddai rhywun yn cael strôc, na fyddai angen iddo fynd i'r categori coch oherwydd y byddai'n gallu dilyn llwybr clinigol a fyddai'n dod ag ef yn syth at y drws neu at y gwely lle'r oedd angen iddo fod er mwyn goroesi strôc - ac nid dim ond i'w oroesi, ond i'w oroesi'n dda, sy'n bwynt pwysig iawn, rwy'n credu, i'w wneud. Eto i gyd, pan fyddaf yn siarad â staff ambiwlans a'r gwasanaeth ambiwlans, maen nhw'n dweud nad yw'r llwybrau clinigol hyn yn bodoli o hyd, mewn gwirionedd. Mae staff yn dweud wrthyf o hyd eu bod yn mynd â rhywun yn y pen draw, eu bod yn dal i fynd drwy'r adran achosion brys neu'r uned derbyniadau critigol, a'u bod yn dal heb ddatblygu'r llwybrau i'w cael i'r lle iawn yn ddigon cyflym. Felly, roeddwn i eisiau gofyn ichi efallai roi ychydig mwy o esboniad am yr adolygiad hwn, ynglŷn â sut y bydd yn cael ei ddehongli. Ac a fyddwch chi'n rhoi eich ffydd yn y Gymdeithas Strôc, sydd bellach yn gofyn i Gymru ddatblygu'r dull a ddefnyddir gan y GIG yn Lloegr, lle bydd system newydd yn eich tracio chi o'r alwad gyntaf i'r gwasanaeth 999 i gael y driniaeth briodol, a gosod targed i hynny? Oherwydd, rwy'n credu, os nad ydym ni byth yn mynd i roi pobl sy'n dioddef strôc yn y categori coch hwnnw, neu os nad ydych chi byth yn mynd i'w rhoi yn y categori hwnnw, mae'n rhaid bod yna sefyllfa wrth gefn sy'n eu diogelu, oherwydd fe wnes i'r pwynt yn gynharach - ac rwy'n mynd i'w ddweud eto, oherwydd rwy'n credu ei fod yn hanfodol - nid yw goroesi'n ddigon da, ond mae'n rhaid i ni ei oroesi'n dda. Ac, wrth gwrs, nid dim ond strôc sydd â llwybrau clinigol; mae nifer o feysydd clir iawn lle y gall pobl sydd ar ymateb oren fynd drwy lwybr clinigol yn syth i'r man lle y mae angen iddyn nhw fod, yn hytrach na thagu ein hadrannau brys sydd eisoes o dan bwysau. A oes gennych chi farn ynghylch pryd y bydd y llwybrau clinigol hyn yn dwyn ffrwyth o'r diwedd - cawsant eu trafod dair blynedd yn ôl - a sut y cânt eu nodi? A, choeliwch fi, Gweinidog, rwyf wedi cyflwyno rhai ceisiadau rhyddid gwybodaeth i fyrddau iechyd, i wasanaeth ambiwlans Cymru a rhai cwestiynau cyffredin i chi er mwyn ceisio mynd at wraidd y mater hwn, ac ni all neb, neb o gwbl, fynd at wraidd y mater. Felly, rwy'n credu nad yw'r wybodaeth ar gael, a hoffwn gael sicrwydd gennych y gallwch chi wneud rhywbeth ynghylch hyn, i sicrhau cysondeb ac ansawdd yn y gallu i gael gwasanaeth ym mhob rhan o Gymru ar gyfer pobl yr adolygiad oren sy'n mynd drwy lwybrau clinigol. Mae eich datganiad yn crybwyll yn fyr iawn, iawn y ffaith ein bod yn mynd i fod yn gwneud ymarfer mapio i edrych ar adnoddau ac i ystyried materion eraill er mwyn, yn y bôn, os mynnwch chi, ddiogelu gwasanaeth ambiwlans Cymru ar gyfer y dyfodol wrth symud ymlaen. Roeddwn i'n synnu'n fawr na wnaethoch chi sôn ryw lawer am y staff yn hyn o beth, oherwydd, wrth gwrs, boed yn goch, yn oren neu'n wyrdd, mae angen i'r staff fod yno i wneud y gwaith ac mae salwch staff yn un o'r pwysau mwyaf ar Ymddiriedolaeth y GIG. Chwe mis yn ôl gwnaethoch ddweud eich bod yn disgwyl i Ymddiriedolaeth y GIG weithio gyda phartneriaid i gymryd camau ar unwaith i fynd i'r afael â hyn, ac eto mae'r ffigurau diweddaraf yn dangos cynnydd o 1 y cant arall mewn absenoldeb oherwydd salwch, sy'n llawer mwy na nifer absenoldebau byrddau'r GIG. Felly, pa mor gyflym y byddech chi'n disgwyl gweld newidiadau o ran rheoli absenoldebau staff? Pa mor gyflym y byddech chi'n disgwyl gweld cymorth yn cael ei roi i'r gweithlu ambiwlans i'w ddefnyddio i ostwng y gyfradd absenoldeb? A wnewch chi amlinellu'r rhwystrau i ymdrin yn gyflym â'r rhesymau sydd y tu ôl i gyfraddau uchel o absenoldeb staff yn yr ymddiriedolaeth? Ac a fyddwch chi'n gallu rhoi syniad inni pryd y gallech chi ddod yn ôl atom ni â newyddion cadarnhaol am y mater penodol hwn? Yn olaf, gwn nad yw'n gyfan gwbl o fewn cylch gwaith yr adolygiad oren yn unig, ond ni allwn siarad am y ffordd yr ydym ni'n darparu gofal coch, gofal oren a gofal gwyrdd o ansawdd da gan wasanaeth ambiwlans Cymru heb grybwyll yr amseroedd aros a welwn yn ein hadrannau achosion brys. Mae criwiau ambiwlans yn dal i nodi oedi sylweddol o ran trosglwyddo cleifion i'r ysbyty. Hoffwn wybod, Gweinidog, pa strategaeth yr ydych chi'n ei defnyddio i sicrhau bod byrddau iechyd a'r ymddiriedolaeth yn gweithredu'r camau ar unwaith yr oeddech chi'n eu disgwyl chwe mis yn ôl. Rydym ni eisoes yn gwybod ein bod ni'n colli miloedd ar filoedd ar filoedd o oriau staff i'r broses o drosglwyddo cleifion o ambiwlansys. Heno, bydd ITV Cymru yn darlledu adroddiad bod gwasanaeth ambiwlans Cymru yn colli'r hyn sy'n cyfateb i 15 o shifftiau ambiwlans llawn y dydd y tu allan i adrannau achosion brys, a bod criwiau wedi treulio 65,000 o oriau yn 2018 yn aros i ollwng cleifion mewn ysbytai, ac rydym yn clywed hanesion am gleifion sydd ar alwad oren yn cyrraedd yr ysbyty o'r diwedd, yn cael eu derbyn i gael triniaeth ac yna'n cael eu rhoi yn ôl yn yr ambiwlans gan nad oes unman arall iddyn nhw fynd. Felly, byddai gennyf i ddiddordeb mawr mewn gwybod beth fyddech chi'n gallu ei wneud i geisio cywasgu'r amser hwnnw. Rydych chi'n sôn yn eich datganiad am y ffaith eich bod yn teimlo bod hyn yn gwella, ond mae arnaf ofn nad yw'r ystadegau'n cadarnhau'r haeriad hwnnw'n dda iawn.