English: We have deep concerns around whether the NHS and social care services will be able to achieve this, given the demand and cost pressures identified and the continuing failure of the majority of health boards to break even. We welcome the £100 million being made available through the transformation fund for pathfinder projects, but we have sought assurance that the use and impact of this fund will be effectively monitored, particularly in terms of it being used to support projects that are genuinely transformative and scalable, and that mental health is given parity with physical health. We have serious concern about the level of funding for primary care. Given the policy focus on shifting care out of hospitals, we would have expected to see a significant increase in the level of spend on primary care, but the evidence that we have seen shows that this is not happening. We believe that this illustrates the challenges facing health boards in achieving service transformation given the ongoing pressures that they face in the acute sector, for example. Given that the direction of travel for services, as set out in 'A Healthier Wales' is towards delivery of services to be undertaken in primary and community healthcare, we are very concerned that the proposed funding for primary care will not be sufficient to support this objective. Turning to the financial position of the health board, as part of last year's budget scrutiny, we sought to examine in detail the financial position of LHBs in Wales. We reported our disappointment at the time that the ambitions of the National Health Service Finance (Wales) Act 2014 had not been fully realised by all NHS bodies and that four of the seven LHBs reported a deficit in at least one of the preceding three years. A particular concern was that Betsi Cadwaladr and Hywel Dda both reported a deficit in each of the years between 2014-15 and 2016-17. We note that progress has been made by particular health boards. However, we are disappointed by the continuing inability of a number of health boards to manage their finances and we seek to understand the reasons behind the enduring difficulties in some health boards. We believe it is of crucial importance to understand the extent to which this may be due to management issues at individual health board level, or how much may be due to their funding allocations. Turning to mental health, the Welsh Government's detailed draft budget proposals for 2019-20 highlight that mental health is the largest single area of NHS expenditure. The Welsh Government will spend £675 million on mental health services in 2019-20, and an extra £20 million is being provided in this draft budget for mental health services as part of the Welsh Government's two-year budget agreement with Plaid Cymru. We know that health boards are already spending more on mental health than the ring-fenced allocation. However, we are mindful of the growing demand for mental health services and we're persuaded by the Welsh NHS Confederation's suggestion that the level of need for mental health services may be significantly greater than the current levels of spend. Turning to the health workforce briefly, while systems and services provide a focus for change, it is the workforce that represents the largest asset in delivering care and in delivering the changes needed. We raised concerns with the Cabinet Secretary about the levels of sickness absence within the health workforce, particularly within the ambulance service. We also asked the Cabinet Secretary whether he recognised the disparity in terms of working conditions and pay, and a lack of parity of esteem between social care and healthcare staff. We believe that there's clear disparity between health care and social care sector workers, as has been raised regularly with us by stakeholders, and this is a significant barrier to successful service integration. We are in the closing seconds.
Welsh: Mae gennym bryderon dwfn o ran a fydd y gwasanaeth iechyd a'r gwasanaethau gofal cymdeithasol yn gallu cyflawni hyn o ystyried y pwysau o ran galw a chostau a nodwyd a methiant parhaus mwyafrif y byrddau iechyd i fantoli'r cyfrifon. Rydym ni'n croesawu'r £100 miliwn sydd ar gael drwy'r gronfa trawsnewid ar gyfer y prosiectau braenaru, ond rydym ni wedi gofyn am sicrwydd y bydd y defnydd o'r gronfa hon a'i heffaith yn cael eu monitro'n effeithiol, yn enwedig o ran defnyddio'r gronfa i gefnogi prosiectau sy'n wirioneddol drawsnewidiol ac mae'n bosibl eu cynyddu mewn maint, a bod ceisiadau iechyd meddwl ac iechyd corfforol yn cael yr un ystyriaeth. Mae gennym bryder difrifol ynghylch lefel y cyllid ar gyfer gofal sylfaenol. O ystyried y ffocws polisi ar symud gofal allan o ysbytai, byddem wedi disgwyl gweld cynnydd sylweddol yn lefel y gwariant ar ofal sylfaenol, ac mae'r dystiolaeth a ddaeth i law yn dangos nad yw hyn yn digwydd. Credwn fod hyn yn dangos yr heriau sy'n wynebu byrddau iechyd wrth drawsnewid gwasanaethau, o ystyried y pwysau parhaus y maent yn ei wynebu yn y sector acíwt. O gofio mai'r bwriad a nodwyd yn 'Cymru Iachach' yw cynnig gwasanaethau ym maes gofal iechyd sylfaenol a chymunedol, rydym ni'n bryderus iawn na fydd yr arian arfaethedig ar gyfer gofal sylfaenol yn ddigonol i gefnogi'r amcan hwn. Gan droi at y sefyllfa ariannol y bwrdd iechyd, fel rhan o graffu ar y gyllideb y llynedd, gwnaethom geisio archwilio'n fanwl sefyllfa ariannol y byrddau iechyd lleol yng Nghymru. Ar y pryd, gwnaethom nodi ein siom nad oedd holl gyrff y gwasanaeth iechyd wedi llwyr wireddu uchelgeisiau Deddf Cyllid y Gwasanaeth Iechyd Gwladol (Cymru) 2014, a bod pedwar o'r saith o fyrddau iechyd lleol wedi adrodd diffyg yn o leiaf un o'r tair blynedd blaenorol. Achos penodol o bryder oedd bod Betsi Cadwaladr a Hywel Dda wedi adrodd diffyg ym mhob un o'r blynyddoedd o 2014-15 i 2016-17. Nodwn fod cynnydd wedi'i wneud gan fyrddau iechyd penodol. Fodd bynnag, cawsom ein siomi gan fethiant parhaus nifer o fyrddau iechyd i reoli eu cyllidebau, ac rydym ni am geisio deall y rhesymau y tu ôl i'r anawsterau parhaol mewn rhai byrddau iechyd. Credwn ei bod yn hynod bwysig deall i ba raddau y gallai hyn fod o ganlyniad i faterion rheoli ar lefel bwrdd iechyd unigol, neu i ba raddau y mae eu dyraniadau cyllid yn gyfrifol am hyn. Wrth droi at iechyd meddwl, mae cynigion manwl cyllideb ddrafft Llywodraeth Cymru ar gyfer 2019-20 yn pwysleisio mai iechyd meddwl yw'r maes unigol mwyaf o wariant gan y gwasanaeth iechyd. Bydd Llywodraeth Cymru yn gwario £675 miliwn ar wasanaethau iechyd meddwl yn 2019-20, ac mae £20 miliwn ychwanegol yn cael ei ddarparu yn y gyllideb ddrafft hon ar gyfer gwasanaethau iechyd meddwl fel rhan o'r cytundeb ar y cyllid dros ddwy flynedd rhwng Llywodraeth Cymru a Phlaid Cymru. Gwyddom fod byrddau iechyd eisoes yn gwario mwy ar iechyd meddwl na'r dyraniad a neilltuwyd. Fodd bynnag, rydym ni'n ymwybodol o'r galw cynyddol am wasanaethau iechyd meddwl, ac rydym wedi ein hargyhoeddi gan awgrym conffederasiwn gwasanaeth iechyd Cymru y gall lefel y galw wasanaethau iechyd meddwl fod yn sylweddol uwch na'r lefelau gwariant presennol. Gan droi at y gweithlu iechyd yn fyr, er bod systemau a gwasanaethau yn cynnig ffocws ar gyfer newid, y gweithlu yw'r ased mwyaf wrth roi gofal a gwneud y newidiadau sydd eu hangen. Fe wnaethom godi pryderon efo Ysgrifennydd y Cabinet ynghylch lefelau absenoldeb oherwydd salwch yn y gweithlu iechyd, yn enwedig o fewn y gwasanaeth ambiwlans. Hefyd, gwnaethom ofyn i Ysgrifennydd y Cabinet a oedd e'n cydnabod gwahaniaethau o ran amodau gwaith a chyflog, a diffyg parch cydradd at staff gofal cymdeithasol a staff gofal iechyd. Credwn fod anghysondeb amlwg rhwng gweithwyr gofal iechyd a gweithwyr yn y sector gofal cymdeithasol, fel y mae rhanddeiliaid wedi dweud wrthym yn rheolaidd, ac mae hyn yn rhwystr sylweddol rhag cydlynu gwasanaethau yn llwyddiannus. Rydym ni yn yr eiliadau olaf.