English: Cabinet Secretary, I welcome the involvement of the standing committees in the way that the scrutiny of the Welsh Government budget is conducted, although it has to be said that following the money has proven, as ever, a challenge, as moneys have been moving around budget allocations, and have, in some instances, made direct year-on-year comparisons extremely difficult. I do want to make it clear that I understand the budget is finite, and I also note the funding allocated to the NHS has increased in real terms by 0.5 per cent on the previous year. However, at the current run rate and scale of practice, this is merely enough to keep the operation going. My concerns revolve around how the money within the health service MEG is deployed, and whether that deployment enables positive outcomes in line with the Welsh Government's programme for government. I have three specific areas I wish to raise with you. My first concern lies with general practice. You'll be aware that the Cabinet Secretary for health is putting an enormous emphasis on dealing with ill health at a community level - it reflects what Mike Hedges has just been saying - in order to prevent referrals to secondary care, where the costs tend to rise exponentially. This also ties in to the findings highlighted in the interim report from the parliamentary review of health and social care, which are a good indication of the likely recommendations they're going to make. The benefits of using doctors, nurses, physiotherapists, occupational therapists, chronic condition nurses and mental health specialists in a community setting are not merely financial. We know that it is beneficial for the patient to be seen locally, treated locally and followed up locally, yet by any measure the Welsh Government budget is not putting enough resources into supporting primary care. The lowest percentage share of the NHS budget in any home nation is borne by Welsh GPs. In 2015-16, general practice received only 7.24 per cent of NHS spend, but they are expected to do the bulk of the heavy lifting in terms of the prevention of ill health and the management of co-morbidity. The Welsh Government must also recognise that many GP surgeries have inadequate facilities and find it very difficult to offer a plethora of clinics and services in conditions that are either archaic or simply too small for the demand that they face. In my own constituency, I have surgeries saying that they cannot offer some of the vital preventative care clinics that are required because they simply do not have the room and the staff. The Welsh health estate needs financial support to bring it into line with modern-day requirements, and this is a point that the Health, Social Care and Sport Committee picked up on in our scrutiny of the budget. So, Cabinet Secretary, could you please tell us how GPs are going to be able to offer such transformational services with such a small share of NHS resource? That brings me to my second area of concern. We've all made a political commitment to enable the parliamentary review to take a long hard look at what needs to be done to transform our NHS into one that's capable of facing the challenges of the future, but I don't see how the costs of this are allowed for in the budget going forward. In fact, reviewing evidence from both the Cabinet Secretary for health and you, it was very clear that the 0.5 per cent increase provides barely enough to keep the wheels turning, so how can you expect health boards and GP practices to transform the way that they work without clear funding streams to enable and support that transformational programme? Recommendations 1 and 2 of the health committee report are very clear on this. The third area I would like to briefly raise with you is the mental health ring fence, which will increase by some £20 million in 2018-19. However, despite being ring-fenced since 2008, the ways in which health boards have interpreted the ring fence are a cause for concern, with precious funding being absorbed by carrying out routine treatments. For example, if somebody with a mental health issue needs a new hip operation, it comes out of the mental health budget, and I cannot see the logic or fairness in that. So, Cabinet Secretary, I wonder whether you have any plans to review all of the ring-fenced areas of the Welsh Government budget to see if they are still absolutely applicable and doing what they were intended to do in the first place. Finally, Cabinet Secretary, a general point in regard to health board deficits. All of the foregoing is impossible if these health board deficits continue. In answers to written questions you've said there's no bailout for health boards, and yet the reality is that we need to look at how those health boards are funded because I'm not, and I want to make this crystal clear, I'm not asking for any more money for the NHS out of that Welsh Government budget, but what I am questioning is the deployment of the current funds, including the 0.5 per cent increase, and whether or not we have to make, or you have to make and your colleagues have to make, some tough decisions about where we have to move money from temporarily in order to effect that transformational change. Otherwise, we will not have a health service that can keep those wheels on and keep going for the people of Wales in the future.
Welsh: Ysgrifennydd y Cabinet, rwy'n croesawu cyfraniad y Pwyllgorau Sefydlog yn y ffordd y creffir ar gyllideb Llywodraeth Cymru, er mae'n rhain dweud bod olrhain yr arian wedi profi, fel erioed, yn her, oherwydd mae arian wedi bod yn symud o'r naill ddyraniad cyllideb i'r llall, ac, mewn rhai achosion, wedi gwneud cymariaethau uniongyrchol flwyddyn ar ôl blwyddyn yn eithriadol o anodd. Hoffwn ei gwneud hi'n glir fy mod yn deall bod y gyllideb yn gyfyngedig, ac rwyf hefyd yn sylwi bod y cyllid a ddyrennir i'r GIG wedi cynyddu mewn 0.5 y cant mewn termau real o'i gymharu â'r flwyddyn flaenorol. Fodd bynnag, ar ystod a graddfa bresennol y gwasanaeth, dim ond digon yw hyn i'w chynnal. Mae fy mhryderon ynglŷn â sut y defnyddir yr arian o fewn Prif Grŵp Gwariant y gwasanaeth iechyd, ac a yw'r defnydd hwnnw yn arwain at ganlyniadau cadarnhaol yn unol â rhaglen lywodraethu Llywodraeth Cymru. Mae gennyf dri maes penodol yr hoffwn i ddwyn i'ch sylw. Mae a wnelo fy mhryder cyntaf â meddygfeydd teulu. Byddwch yn ymwybodol bod yr Ysgrifennydd Cabinet dros Iechyd yn rhoi pwyslais enfawr ar ymdrin ag iechyd gwael ar lefel gymunedol - mae'n adlewyrchu'r hyn mae Mike Hedges newydd fod yn ei ddweud - er mwyn atal cyfeiriadau i ofal eilaidd, lle mae costau yn tueddu i godi fwyfwy. Mae hyn hefyd yn gysylltiedig â'r canfyddiadau a amlygwyd yn yr adroddiad interim sy'n deillio o'r arolwg seneddol o iechyd a gofal cymdeithasol, sy'n arwydd da o'r argymhellion tebygol y byddant yn eu gwneud. Mae manteision defnyddio meddygon, nyrsys, ffisiotherapyddion, therapyddion galwedigaethol, nyrsys cyflyrau cronig ac arbenigwyr iechyd meddwl yn y gymuned yn fwy na rhai ariannol. Rydym yn gwybod ei bod hi'n fuddiol i'r claf gael ei gweld yn lleol, ei drin yn lleol a bod y dilyniant yn lleol, ac eto nid yw cyllideb Llywodraeth Cymru ar unrhyw gyfrif yn rhoi digon o adnoddau i gefnogi gofal sylfaenol. Meddygon Teulu Cymru sy'n cael y canran lleiaf o gyllideb y GIG o unrhyw un o'r gwledydd cartref. Yn 2015-16, derbyniodd meddygfeydd teulu dim ond 7.24 y cant o wariant y GIG yn gwario, ond disgwylir iddyn nhw wneud y rhan fwyaf o'r gwaith caib a rhaw o ran atal iechyd gwael a rheoli cyflyrau lluosog. Mae'n rhaid i Lywodraeth Cymru hefyd gydnabod bod gan lawer o feddygfeydd gyfleusterau annigonol a'u bod yn ei chael hi'n anodd iawn cynnig llu o glinigau a gwasanaethau mewn amgylchiadau sydd naill ai'n hynafol neu yn rhy fach ar gyfer y galw sy'n eu hwynebu. Yn fy etholaeth fy hun, mae gennyf feddygfeydd sy'n dweud na allan nhw gynnig rhai o'r clinigau gofal ataliol hanfodol sydd eu hangen oherwydd does ganddyn nhw mo'r lle na'r staff. Mae Ystadau Iechyd Cymru angen cymorth ariannol fel ei fod yn cyfateb â gofynion cyfoes, ac mae hyn yn bwynt y sylwodd y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon arno wrth inni graffu ar y gyllideb. Felly, Ysgrifennydd y Cabinet, a allwch chi ddweud wrthym ni os gwelwch yn dda sut mae meddygon teulu yn mynd i allu cynnig gwasanaethau trawsnewidiol o'r fath gyda chyfran mor fach o adnoddau'r GIG? Daw hynny â mi at yr ail faes sy'n peri pryder imi. Rydym ni i gyd wedi gwneud ymrwymiad gwleidyddol i alluogi'r Arolwg Seneddol i ystyried yn ddwys beth sydd angen ei wneud i drawsnewid ein GIG yn un sy'n gallu wynebu heriau'r dyfodol, ond nid wyf yn gweld sut mae'r gyllideb yn darparu ar gyfer y costau hyn wrth symud ymlaen. Yn wir, wrth adolygu tystiolaeth gan Ysgrifennydd y Cabinet dros Iechyd a gennych chithau, roedd hi'n amlwg iawn bod y cynnydd o 0.5 y cant yn darparu prin ddigon i gadw'r olwynion yn troi, felly sut y gallwch chi ddisgwyl i fyrddau iechyd a meddygfeydd i drawsnewid y ffordd maen nhw'n gweithio heb ffrydiau ariannu clir i alluogi a chefnogi'r rhaglen drawsnewidiol honno? Mae argymhellion 1 a 2 adroddiad y Pwyllgor Iechyd yn glir iawn ynglŷn â hyn. Y trydydd maes yr hoffwn i gyfeirio ato'n fyr yw'r arian sydd wedi ei glustnodi ar gyfer iechyd meddwl, a fydd yn cynyddu tua £20 miliwn yn 2018-19. Fodd bynnag, er gwaethaf cael ei glustnodi ers 2008, mae'r ffyrdd y mae byrddau iechyd wedi dehongli'r clustnodi hwnnw yn destun pryder, gyda thriniaethau rheolaidd yn llyncu arian gwerthfawr. Er enghraifft, os oes rhywun â phroblem iechyd meddwl angen clun newydd, daw hynny allan o'r gyllideb iechyd meddwl, ac ni allaf weld y rhesymeg na'r tegwch yn hynny. Felly, Ysgrifennydd y Cabinet, tybed a oes gennych chi unrhyw gynlluniau i adolygu'r holl feysydd lle mae cyllideb Llywodraeth Cymru wedi ei glustnodi i weld a ydynt nhw'n dal yn gwbl berthnasol ac yn gwneud yr hyn yr oeddent i fod i'w wneud yn y lle cyntaf. Yn olaf, Ysgrifennydd y Cabinet, pwynt cyffredinol o ran diffygion ariannol byrddau iechyd. Mae pob un o'r uchod yn amhosibl os bydd y diffygion ariannol hyn yn y Byrddau Iechyd yn parhau. Mewn atebion i gwestiynau ysgrifenedig rydych wedi dweud nad oes unrhyw arian i achub croen byrddau iechyd, ac eto, y gwir amdani yw bod angen inni edrych ar sut mae'r byrddau iechyd hynny yn cael eu hariannu oherwydd nid wyf i, ac rwyf eisiau gwneud hyn yn gwbl glir, nid wy'n gofyn am fwy o arian ar gyfer y GIG o gyllideb Llywodraeth Cymru, ond yr hyn yr wyf yn ei gwestiynu'r yw defnyddio'r cyllid presennol, gan gynnwys y cynnydd o 0.5 y cant, a pha un ai a oes angen i ni wneud, neu a oes angen i chi wneud ac angen i'ch cyd-Aelodau wneud rhai penderfyniadau anodd ynghylch o ble mae angen inni symud arian dros dro er mwyn i'r newid trawsffurfiol hwnnw ddigwydd. Fel arall, ni fydd gennym ni wasanaeth iechyd sy'n gallu cadw dau ben llinyn ynghyd a pharhau i weithio ar gyfer pobl Cymru yn y dyfodol.