English: I'm a member of the committee, so I was very pleased to take part in this inquiry, and my view, I think in line with that of the committee and most of those who gave evidence to us, is that the principle of clusters is a very good one, that the principle of interdisciplinary work is excellent. But I think we all felt that there's a lot more work to do to make the clusters more effective, and there are a lot of issues that need to be ironed out. The highlight of the inquiry for me was the focus group in Carmarthen, ably facilitated by Angela Burns, where we were able to hear first-hand about the issues that concerned the participants there and the frustrations that they experienced in the cluster groups. Of course, the Chair mentioned in his contribution the lunchtime meeting we had with the professionals here today before this report, and in that meeting at lunchtime, I was so struck by the enthusiasm of the participants there for doing a good job in the health service and really making a great commitment. I think that came over really strongly today, and I think they all were, in principle, in support of the clusters, but they were very keen to raise the very practical ways that the clusters could be improved and the ways that we could move forward. Obviously, one of those key issues is funding, and Members who've spoken before me have raised the issues about funding, but I think there is definitely some tension between the local health boards and the funding to the cluster groups. I think it was also mentioned in the report, and I think the BMA stated that they were aware of significant delays in the release of these funds. And there is a case, as well, for the cluster development money to be allocated directly to the clusters rather than to the health boards. So, along with the issue of the annual funding, I hope that the Cabinet Secretary will look at these issues, because there is this great enthusiasm, and I think that we need to make it as easy as possible for the clusters to develop. The multidisciplinary working is so much to be welcomed, and one of the very interesting discussions in the Carmarthen focus group was how the patients are not able to see the GP in the way that they used to, and for some of the elderly patients who were used to seeing a GP and used to seeing always the same GP, it's quite a break in culture to see the nurse instead, or to see another allied professional more appropriate for their needs. I think, obviously, being able to see someone who is most appropriate for their needs is the key thing of multidisciplinary work. I think that as patients gradually get used to this way of operating, it will be a very effective way to operate, and the patient will see the most relevant person. I think there is, also, the opportunity, because I think patients do like continuity, they do like to see the same person, that there's no reason that can't be an allied health professional who sees them on a regular basis. That could be the same person. I wanted to just mention quickly my experience in the constituency. Certainly, in this inquiry, fears about shortages of GPs and the difficulties of replacing GPs have cropped up all over the place, and we have had a difficult experience in Cardiff North where one of the local GP surgeries actually closed down. What happened was the existing partners of Llwynbedw practice in Birchgrove and Cathedral View in Llandaff North gave notice of their intention of terminating the general medical services contract, giving six months' notice. The health board were unable to secure another group of GPs to take over the practice, and no single practice came forward to take it over. So, both the buildings belonged to the GPs - the existing GPs. One of those is being sold. But this has had a very upsetting effect on many of my constituents who've contacted me, because it has resulted in the disruption of the pattern of healthcare that they were used to receiving. I attended a meeting of the cluster group in Cardiff North, and I know that the GPs in that cluster group felt that it should have been possible to stop this disruption for patients, and there should have been some way of ensuring that these - many elderly - patients weren't left bereft, because they were no longer able to go to the surgery they'd been to for many years. And it has resulted in a much heavier case load for other GP surgeries. So, I think that the cluster groups are an excellent way forward that does give the opportunity for expertise to be shared, to bring in the allied professionals, and in this meeting at lunch time today, I was sitting next to the only nurse who is the lead in a cluster group. There's only one in Wales who leads a cluster group, but we hope that is a pattern that may happen in many other place.
Welsh: Rwy'n aelod o'r pwyllgor, felly roeddwn yn falch iawn o gymryd rhan yn yr ymchwiliad hwn, ac yn fy marn i, yn unol â barn y pwyllgor rwy'n credu, a'r rhan fwyaf o'r rhai a roddodd dystiolaeth i ni, mae'r egwyddor o glystyrau yn un da iawn, ac mae egwyddor gwaith rhyngddisgyblaethol yn rhagorol. Ond credaf ein bod i gyd yn teimlo bod llawer mwy o waith i'w wneud i sicrhau bod y clystyrau'n fwy effeithiol, a cheir llawer o faterion sydd angen eu datrys. Uchafbwynt yr ymchwiliad i mi oedd y grŵp ffocws yng Nghaerfyrddin, a drefnwyd yn fedrus gan Angela Burns, lle y cawsom gyfle i glywed yn uniongyrchol am y materion a oedd o bwys i'r cyfranogwyr yno a'r rhwystredigaethau a'u hwynebodd yn y grwpiau clwstwr. Wrth gwrs, soniodd y Cadeirydd yn ei gyfraniad am y cyfarfod amser cinio a gawsom gyda'r gweithwyr proffesiynol yma heddiw cyn yr adroddiad hwn, ac yn y cyfarfod hwnnw, fe'm trawyd yn fawr gan frwdfrydedd y cyfranogwyr tuag at wneud gwaith da yn y gwasanaeth iechyd ac i wneud ymrwymiad mawr. Credaf fod hynny wedi'i gyfleu yn wirioneddol gryf heddiw, a chredaf eu bod i gyd, mewn egwyddor, yn cefnogi'r clystyrau, ond roeddent yn awyddus iawn i nodi'r ffyrdd ymarferol iawn y gellid gwella'r clystyrau a'r ffyrdd y gallem symud ymlaen. Yn amlwg, un o'r materion allweddol hynny yw cyllid, ac mae Aelodau a siaradodd yn gynt wedi nodi materion yn ymwneud ag ariannu, ond credaf yn bendant fod rhywfaint o densiwn rhwng y byrddau iechyd lleol a'r cyllid i'r grwpiau clwstwr. Rwy'n credu bod hynny wedi cael sylw yn yr adroddiad hefyd, a chredaf fod Cymdeithas Feddygol Prydain wedi dweud eu bod yn ymwybodol o oedi sylweddol cyn rhyddhau'r cronfeydd hyn. Ac mae yna achos hefyd dros ddyrannu'r arian datblygu clwstwr yn uniongyrchol i'r clystyrau yn hytrach nag i'r byrddau iechyd. Felly, yn ogystal â mater y cyllid blynyddol, rwy'n gobeithio y bydd Ysgrifennydd y Cabinet yn edrych ar y materion hyn, gan fod y brwdfrydedd yn fawr, ac rwy'n credu bod angen inni ei wneud mor hawdd ag sy'n bosibl i'r clystyrau ddatblygu. Mae'r gwaith amlddisgyblaethol i'w groesawu'n fawr, ac un o'r trafodaethau diddorol iawn yn y grŵp ffocws yng Nghaerfyrddin oedd sut nad oedd y cleifion yn gallu gweld y meddyg teulu yn y ffordd yr arferent allu gwneud, ac i rai cleifion oedrannus a oedd wedi arfer gweld meddyg teulu ac a oedd wedi arfer gweld yr un meddyg teulu bob tro, mae'n newid go fawr yn ddiwylliannol i weld y nyrs yn lle hynny, neu i weld gweithiwr proffesiynol arall perthynol i iechyd sy'n fwy priodol ar gyfer eu hanghenion. Yn amlwg, rwy'n credu mai gallu gweld yr unigolyn mwyaf priodol ar gyfer eu hanghenion yw'r peth allweddol o ran gwaith amlddisgyblaethol. Wrth i gleifion arfer yn raddol â'r ffordd hon o weithredu, credaf y bydd yn ffordd effeithiol iawn o weithredu, a bydd y claf yn gweld y person mwyaf perthnasol. Mae cyfle yma hefyd, rwy'n credu, oherwydd mae cleifion yn hoffi parhad, ac maent yn hoffi gweld yr un person, ac nid oes unrhyw reswm na all hynny olygu gweithiwr proffesiynol perthynol i iechyd sy'n eu gweld yn rheolaidd. Gallai olygu'r un person. Roeddwn am sôn yn gyflym am fy mhrofiad yn yr etholaeth. Yn sicr, yn yr ymchwiliad hwn, mae ofnau ynghylch prinder meddygon teulu ac anawsterau i ddod o hyd i feddygon teulu yn lle rhai sy'n gadael wedi codi eu pen ym mhobman, ac rydym wedi cael profiad anodd yng Ngogledd Caerdydd lle caeodd un o'r meddygfeydd lleol mewn gwirionedd. Yr hyn a ddigwyddodd oedd bod partneriaid presennol practis Llwynbedw yn Birchgrove a Cathedral View yng Ngogledd Llandaf wedi hysbysu ynglŷn â'u bwriad i derfynu'r contract gwasanaethau meddygol cyffredinol, gan roi chwe mis o rybudd. Roedd y bwrdd iechyd yn methu sicrhau grŵp arall o feddygon teulu i gymryd y practis, ac ni chynigiodd practis unigol ei gymryd. Felly, roedd y ddau adeilad yn eiddo i'r meddygon teulu - y meddygon teulu presennol. Mae un o'r rheini'n cael ei werthu. Ond mae hyn wedi cael effaith ddigalon iawn ar lawer o fy etholwyr sydd wedi cysylltu â mi, gan ei fod wedi arwain at darfu ar batrwm y gofal iechyd roeddent wedi arfer ei dderbyn. Mynychais gyfarfod grŵp clwstwr yng Ngogledd Caerdydd, a gwn fod y meddygon teulu yn y grŵp clwstwr hwnnw'n teimlo y dylai fod wedi bod yn bosibl atal yr aflonyddu hwn ar gleifion, a dylai fod rhyw ffordd o sicrhau na châi'r cleifion hyn - gyda llawer ohonynt yn oedrannus - eu hamddifadu am na allent fynd i'r feddygfa y buont yn ei mynychu dros lawer o flynyddoedd. Ac mae wedi arwain at lwyth achosion trymach o lawer i feddygfeydd eraill. Felly, rwy'n credu bod y grwpiau clwstwr yn ffordd ragorol ymlaen sy'n rhoi cyfle i rannu arbenigedd, er mwyn cyflwyno'r gweithwyr proffesiynol perthynol i iechyd, ac yn y cyfarfod amser cinio heddiw, roeddwn yn eistedd wrth ymyl yr unig nyrs sy'n arwain grŵp clwstwr. Un nyrs yng Nghymru sy'n arwain grŵp clwstwr, ond gobeithiwn y bydd hwnnw'n batrwm a allai ddigwydd mewn sawl man arall.