English: Can I thank the committee for the report and for the debate today? I have to say that there are a lot of good recommendations and analysis within this, focusing particularly on the issues of discharge and how we deal with this. I think it's also recognition that this is exceptionally challenging, extremely complex and that there isn't a simple switch to solve this. There is a range of things that we need to do. Minister, I just want to reflect in my opening remarks on the fact that the NHS, the staff within the NHS, from the clinicians and the nurses to the people who clean the operating theatres and prepare them and the porters, are performing miracles every day, and I get told that by my constituents as well. So, whilst there is immense pressure, probably unprecedented pressure, on the system and it isn't, as you were saying, simply in winter any more, it's every single day through every single year, the demands are rising on what we expect of the NHS as well as the challenges that it's facing post pandemic and the cost pressures on it, it is performing miracles, and I know that. Both my parents passed away in the last few years, and the treatment they had and the care they had over the years, in acute settings and actually when they finally went into hospital and didn't come back out, was simply incredible, and I challenge anywhere in the world to give them the care that they had and the compassion and the treatment that they had. What this report focuses on is something that I reflected on after I recently visited the hospital that Sarah and I share, the Princess of Wales Hospital. I met and spoke in detail and at great length with the emergency services staff in A&E and wider. I reflected with them that I've always known that that A&E unit has been from time to time commended for the best-practice approach that it has in the way that it deals with patients, identifies the problem coming off the ambulance and gets them into the hospital, and so on. It's been an innovator over many years. And they're still doing what they believe to be best practice, but the simple fact is - . Their analysis was interesting, because they feel that they are now caught in a situation where they cannot provide the standard of care that they need to, and it's not to do with what you see at the front end of the hospital, it's what you see at the back end; it is discharge. They saw as symptoms the fact that you have ambulances queueing; they saw as symptoms the fact that you have people stuck too long in emergency services, sitting in chairs when they should be in beds, lying in beds when they should be in a ward, and so on, and when they get to that ward, being stuck in that ward too long and not being able to actually leave the hospital because of problems with discharge. They're seeing people, as has been remarked in this debate already, who are turning up - these are not people who are turning up for futile, silly reasons within emergency services; they are typically much older, they're typically much iller by the time they present. So, it's not people you can turn away. Luke was there with me at this visit; we heard this face-to-face from front-line staff there. They're unable to get them onto the wards, unable to move them out of emergency services, unable, then, to move them from the hospital into good wraparound care in their homes - despite, by the way, what Jenny was referring to as really good practice within Cwm Taf and within the Bridgend area about that wraparound care and nursing service that we provide; despite a brilliant - I'd say the best in Wales - Care and Repair service who have got a backlog as long as your arm. So, every part of the thing we rely on for discharge back to home is creaking. Meanwhile, as Sarah was rightly saying, we are significantly under capacity in the Bridgend area in terms of step-down care. So, I would say to you, Minister, around the issue I raised on the floor yesterday about the old Maesteg Community Hospital - much loved, much valued - here's an opportunity here, curiously, that could be one of the roles that Maesteg hospital actually provides going forward. But we need to find even more capacity within the Bridgend area. There are definitely issues we need to tackle on breaking down the funding things that still remain after all these years between local authorities and health boards. We've sat with them - I've sat with them - and said to them, 'We know what the problem is here with lack of capacity in being able to move patients out. Put your heads together, put your funding together and decide how you're going to do it, and move on.' I know they are trying to do it, Minister, but I guess that challenge is replicated across the whole of Wales. The point on social care levels of pay is a point that's really well made, and we've recognised this for a long time. It's good that we've moved to the real living wage in the health service and so on and so forth, and we've tried to professionalise the social care system and so on, but I would simply say that the solution to this is not to see what more we can actually say to that Minister sitting there - take away from the health service in some area to give to social care workers here or whatever. I want Welsh Ministers to do whatever they can, but this needs to be a UK-wide uplift. This needs to be right across the UK, because we know that what the UK Government gives in terms of social care settlements, in terms of that uplift, we can replicate here. I've gone over time. There are significant issues, with staff trying to do their absolute utmost to deliver best practice and compassionate care, but what I would say is that they said to us, 'We're at the point now where we worry when we come in, because we're trying to do our jobs and we can't do it.' The problem is not at the front door, it's at the back door. How do we resolve that, Minister? How fast can we get to resolving that?
Welsh: A gaf fi ddiolch i'r pwyllgor am yr adroddiad ac am y ddadl heddiw? Rhaid imi ddweud bod llawer o argymhellion a dadansoddiadau da o'i fewn, gan ganolbwyntio'n enwedig ar faterion rhyddhau cleifion a sut yr ymdriniwn â hynny. Rwy'n credu ei fod hefyd yn cydnabod bod hyn yn eithriadol o heriol, yn hynod gymhleth ac nad oes un newid syml a all ddatrys hyn. Mae angen inni wneud amrywiaeth o bethau. Weinidog, yn fy sylwadau agoriadol rwyf am fyfyrio ar y ffaith bod y GIG, y staff o fewn y GIG, o'r clinigwyr a'r nyrsys i'r bobl sy'n glanhau'r theatrau llawdriniaethau ac yn eu paratoi a'r porthorion, yn gwneud gwyrthiau bob dydd, ac rwy'n cael gwybod hynny gan fy etholwyr hefyd. Felly, er bod pwysau aruthrol, pwysau digynsail mae'n debyg, ar y system ac nad yn y gaeaf yn unig, fel yr oeddech chi'n ei ddweud, y mae'n digwydd mwyach, ond bob diwrnod o'r flwyddyn, a bod y gofynion yn cynyddu ynghylch yr hyn yr ydym yn ei ddisgwyl gan y GIG yn ogystal â'r heriau y mae'n eu hwynebu wedi'r pandemig a'r pwysau costau arno, mae'n perfformio gwyrthiau, ac rwy'n gwybod hynny. Bu farw fy nau riant yn ystod y blynyddoedd diwethaf, ac roedd y driniaeth a gawsant a'r gofal a gawsant dros y blynyddoedd, mewn lleoliadau acíwt a phan aethant i mewn i'r ysbyty ar y diwedd heb ddod yn ôl allan, yn gwbl anhygoel, ac rwy'n herio unrhyw le yn y byd i roi'r gofal a gawsant a'r tosturi a'r driniaeth a gawsant. Mae'r adroddiad hwn yn canolbwyntio ar rywbeth y bûm yn myfyrio arno ar ôl i mi ymweld â'r ysbyty y mae Sarah a minnau yn ei rannu, Ysbyty Tywysoges Cymru, yn ddiweddar. Fe wneuthum gyfarfod a siarad yn fanwl ac yn hir iawn gyda staff y gwasanaethau brys yn yr adran damweiniau ac achosion brys ac yn ehangach. Soniais fy mod bob amser wedi gwybod bod yr uned damweiniau ac achosion brys honno wedi cael ei chanmol o bryd i'w gilydd am y dull ymarfer gorau sydd ganddi o ymdrin â chleifion, drwy nodi'r broblem wrth ddod oddi ar yr ambiwlans a'u cael i mewn i'r ysbyty, ac yn y blaen. Mae wedi bod yn arloeswr dros nifer o flynyddoedd. Ac maent yn dal i wneud yr hyn y credant sy'n ymarfer gorau, ond y ffaith syml amdani yw - . Roedd eu dadansoddiad yn ddiddorol, oherwydd teimlant eu bod bellach wedi cael eu dal mewn sefyllfa lle na allant ddarparu gofal o'r safon sydd ei hangen, ac nid yw'n ymwneud â'r hyn a welwch ym mhen blaen yr ysbyty, ond yn hytrach yr hyn a welwch yn y cefn; sef rhyddhau cleifion. Roeddent yn gweld y ffaith bod gennych ambiwlansys yn ciwio fel symptomau; roeddent yn gweld y ffaith bod gennych bobl gorfod aros yn rhy hir mewn adrannau gwasanaethau brys fel symptomau, yn eistedd mewn cadeiriau pan ddylent fod mewn gwelyau, yn gorwedd mewn gwelyau pan ddylent fod ar ward, ac yn y blaen, a phan fyddant yn cyrraedd y ward, yn gorfod aros ar y ward honno'n rhy hir a methu gadael yr ysbyty oherwydd problemau gyda rhyddhau. Maent yn gweld pobl, fel sydd wedi cael ei nodi yn y ddadl hon yn barod, yn dod yno - nid pobl sy'n dod yno am resymau ofer, gwirion o fewn y gwasanaethau brys yw'r rhain; maent fel arfer yn llawer hŷn, maent fel arfer yn llawer salach erbyn iddynt gyrraedd. Felly, nid pobl y gallwch eu troi ymaith. Roedd Luke yno gyda mi ar yr ymweliad hwn; clywsom hyn wyneb yn wyneb gan staff rheng flaen yno. Ni allant eu cael ar y wardiau, ni allant eu symud allan o'r gwasanaethau brys, ac ni allant eu symud wedyn o'r ysbyty i ofal cofleidiol da yn eu cartrefi - er gwaethaf, gyda llaw, yr hyn yr oedd Jenny yn cyfeirio atynt fel arferion da iawn yng Nghwm Taf ac yn ardal Pen-y-bont ar Ogwr gyda'r gofal cofleidiol a gwasanaeth nyrsio a ddarparerir; er gwaethaf gwasanaeth Gofal a Thrwsio gwych - byddwn i'n dweud y gorau yng Nghymru - sydd ag ôl-groniad mor hir â'ch braich. Felly, mae pob rhan o'r peth y dibynnwn arno ar gyfer rhyddhau cleifion adref yn gwegian. Yn y cyfamser, fel yr oedd Sarah yn gywir i ddweud, rydym o dan y capasiti yn sylweddol yn ardal Pen-y-bont ar Ogwr gyda gofal cam-i-lawr. Felly, rwyf am ddweud wrthych, Weinidog, ynghylch y mater a godais ar y llawr ddoe am hen Ysbyty Cymunedol Maesteg - annwyl iawn, a gwerthfawr iawn - dyma gyfle yma, yn rhyfedd iawn, y gallai honno fod yn un o'r rolau y mae ysbyty Maesteg yn eu darparu yn y dyfodol. Ond mae angen inni ddod o hyd i fwy o gapasiti eto yn ardal Pen-y-bont ar Ogwr. Yn bendant mae yna faterion sy'n galw am ein sylw er mwyn chwalu'r pethau cyllido sy'n dal i aros ar ôl yr holl flynyddoedd rhwng awdurdodau lleol a byrddau iechyd. Rydym wedi eistedd gyda hwy - rwyf fi wedi eistedd gyda hwy - ac wedi dweud wrthynt, 'Rydym yn gwybod beth yw'r broblem yma gyda diffyg capasiti i allu symud cleifion allan. Rhowch eich pennau at ei gilydd, rhowch eich cyllid at ei gilydd a phenderfynwch sut yr ydych am ei wneud, a symudwch ymlaen.' Rwy'n gwybod eu bod yn ceisio ei wneud, Weinidog, ond rwy'n dyfalu bod yr her honno'n cael ei hailadrodd ar draws Cymru gyfan. Mae'r pwynt ar lefelau cyflog gofal cymdeithasol yn bwynt sydd wedi'i wneud yn dda iawn, ac rydym wedi cydnabod hyn ers amser maith. Mae'n dda ein bod wedi symud i'r cyflog byw go iawn yn y gwasanaeth iechyd ac yn y blaen, a'n bod wedi ceisio proffesiynoli'r system gofal cymdeithasol ac yn y blaen, ond yn syml, byddwn yn dweud nad yr ateb i hyn yw gweld beth arall y gallwn ei ddweud wrth y Gweinidog sy'n eistedd yno mewn gwirionedd - cymryd gan y gwasanaeth iechyd mewn rhyw faes i'w roi i weithwyr gofal cymdeithasol yma neu beth bynnag. Rwyf am i Weinidogion Cymru wneud beth bynnag a allant, ond mae angen i hyn fod yn gynnydd i'r DU gyfan. Mae angen i hyn ddigwydd ar draws y DU, oherwydd fe wyddom, o ran yr hyn y mae Llywodraeth y DU yn ei roi yn setliad gofal cymdeithasol, o ran y cynnydd hwnnw, gallwn efelychu hynny yma. Mae fy amser wedi dod i ben. Ceir problemau sylweddol, gyda staff yn ceisio gwneud eu gorau glas i gyflawni arferion gorau a gofal tosturiol, ond yr hyn y byddwn i'n ei ddweud yw eu bod wedi dweud wrthym, 'Rydym ar y pwynt yn awr lle rydym yn poeni pan ddown i mewn, oherwydd rydym yn ceisio gwneud ein swyddi ac ni allwn eu gwneud.' Nid wrth y drws blaen y mae'r broblem, ond wrth y drws cefn. Sut y gallwn ddatrys hynny, Weinidog? Pa mor gyflym y gallwn ni ddatrys hynny?