English: Thank you, Presiding Officer. I formally table the amendments here in my name. I would like to, at the outset, Minister, say that these are by way of probing amendments. You do have the opportunity, by your response, to ensure that we don't have to spend time in voting from 21 to 34. These amendments have been retabled by us from Stage 2. They were previously tabled as a mix from Helen Mary Jones and from me, and they are in support of committee recommendation 4, because I think it is necessary to remember the Royal College of Nursing's comments on the Bill at Stage 1, saying that this Bill is an ideal opportunity for the Welsh Government to progress with the principles of the Nurse Staffing Levels (Wales) Act 2016 and to broaden its applicability. It's particularly relevant to section 25D of this Act, which is about making sure that local health boards and NHS trusts may undertake these provisions in order to enable them to comply with their duties under this Act. Now, surely this chimes with what the Minister also said at Stage 1, when he said that the duty of quality is more than just a cultural change, and I agree with him. To have a cultural change, all clinical staffing groups should be part of sufficient workforce planning. Amendment 33 outlines that the Welsh Government must take reasonable steps to ensure that there are a sufficient number of specific healthcare staff, including nurses, midwives and medical practitioners. As I noted at Stage 2, it was heartbreakingly clear in the case of Cwm Taf that a number of factors, including an insufficient level of midwives, caused the catastrophic collapse in the provision of safe care that we saw there. So, we believe it's the Welsh Government's duty to ensure that it's not repeated again, and we think that this Bill is a very good vehicle to do that through. There is no routine reporting of midwifery vacancies, and Healthcare Inspectorate Wales's national review of maternity services in Wales won't be published until later this summer. So, without this key data on an ongoing basis, rather than a one-off review, we're not aware of whether there are enough maternity staff in every health board in Wales. The first part of amendment 34, a duty to ensure appropriate staffing, is intended to hold the Welsh Government to the same standards and expectations as an NHS body. It does require the Minister to demonstrate what action has been taken to achieve this. Now, let me be clear, with the cases that we're now seeing of COVID-19 appearing in Wales, and noting the potential pressures on staffing that a full outbreak will have, now is the time to monitor pressures within the health system, so that we know whether our health boards are able to deliver those safe levels of care. The second part of our amendment, the duty to have a real-time staffing assessment in place, will ensure that staffing levels are regularly monitored so that NHS bodies and Ministers actually respond to issues as they happen in real time, instead of only responding to agreed procedures from months or years before. As I noted at Stage 2, there are already issues with safe nursing levels, as the Royal College of Nursing is still concerned that neither the Welsh Government nor NHS Wales publish national figures for nursing vacancies using an agreed definition of what constitutes a vacancy. And annual data published by the Welsh Government on nursing levels does not adequately reflect patient need or service development, including comorbidities and an ageing population. The third and final part of the amendment, the duty to have a risk escalation process in place, will give every single member of staff a clear mechanism to raise concerns if they are working in settings where they feel the levels of available staffing are not conducive to safety. At Stage 2, it was noted by the Minister that he would not support these amendments - so, I understand that at the moment - as the Bill would not be the appropriate mechanism for enacting a change of this magnitude, and that applying any principles of the nurse staffing levels Act to all other clinical staffing groups in Wales without the same degree of consideration and scrutiny would be inappropriate and inconsistent. Yet, as we have so often said before with Welsh Government legislation, the Bill's provisions on the duty of quality are overly broad. It therefore risks becoming an aim rather than a duty, without specific mechanisms for health boards to undertake the necessary action to ensure it is upheld and monitored routinely. I do also, Minister, dispute your concerns about the financial considerations, as having appropriate staffing levels in place will cost NHS bodies and Welsh Government less money in the long term due to less sickness and stress-related illnesses, as well as improved mental health for all staff. The amendments also recognise that the onus is not solely placed on NHS bodies, and that Welsh Government have a role to play in the long-term secure future of staffing levels for NHS bodies. I do note the points that you raised in Stage 2 in your letter to the Chair of the Health, Social Care and Sport Committee on 26 February, in which you said that Schedule 3 to the Bill amends subsection 47 of the Health and Social Care (Community Health and Standards) Act 2003 to require NHS bodies to take into account the healthcare standards. However, as will be outlined in my amendments in group 7, these standards have not been updated since 2015. Since then we've had a rapidly ageing population, as well as advances in technology that mean they are fast becoming obsolete. Therefore, I would be grateful if the Minister could outline a timeline on the refreshed standards, as well as placing on record his commitment to a clear mechanism to review these standards regularly. Minister, should you be prepared to answer these questions on the health and care standards, as well as commit to supporting amendments 36 and 37, I would be prepared to withdraw these amendments.
Welsh: Diolch yn fawr, Llywydd. Rwy'n cyflwyno'r gwelliannau'n ffurfiol yma yn fy enw i. Hoffwn, ar y dechrau, Gweinidog, ddweud bod y rhain yn welliannau treiddgar. Mae gennych y cyfle, drwy eich ymateb, i sicrhau nad oes raid inni dreulio amser yn pleidleisio o 21 i 34. Ailgyflwynwyd y gwelliannau hyn gennym ni o Gyfnod 2. Fe'u cyflwynwyd yn flaenorol fel cymysgedd gan Helen Mary Jones a mi, ac maen nhw'n cefnogi argymhelliad 4 y Pwyllgor, oherwydd credaf fod angen cofio sylwadau'r Coleg Nyrsio Brenhinol ar y Mesur yng Nghyfnod 1, a oedd yn nodi bod y Mesur hwn yn gyfle delfrydol i Lywodraeth Cymru fwrw ymlaen ag egwyddorion Deddf Lefelau Staff Nyrsio (Cymru) 2016 ac ehangu ei chymhwysedd. Mae'n arbennig o berthnasol i adran 25D o'r Ddeddf hon, sy'n ymwneud â sicrhau y gall byrddau iechyd lleol ac ymddiriedolaethau'r GIG ymgymryd â'r darpariaethau hyn i'w galluogi i gydymffurfio â'u dyletswyddau o dan y Ddeddf hon. Nawr, does bosib bod hyn yn cyd-fynd â'r hyn a ddywedodd y Gweinidog yng Nghyfnod 1 hefyd, sef bod y ddyletswydd ansawdd yn fwy na newid diwylliannol, ac rwy'n cytuno ag ef. I gael newid diwylliannol, dylai pob grŵp o staff clinigol fod yn rhan o gynllunio'r gweithlu'n ddigonol. Mae gwelliant 33 yn amlinellu bod yn rhaid i Lywodraeth Cymru gymryd camau rhesymol i sicrhau bod nifer digonol o staff gofal iechyd penodol, gan gynnwys nyrsys, bydwragedd ac ymarferwyr meddygol. Fel y nodais yng Nghyfnod 2, roedd yn dorcalonnus o eglur yn achos Cwm Taf fod nifer o ffactorau, gan gynnwys lefel annigonol o fydwragedd, wedi achosi'r methiant trychinebus yn y ddarpariaeth o ofal diogel a welsom yno. Felly, credwn mai dyletswydd Llywodraeth Cymru yw sicrhau na fydd hyn yn digwydd eto, ac rydym yn credu bod y Bil hwn yn gyfrwng da iawn i wneud hynny. Ni cheir adroddiadau rheolaidd am swyddi gwag ar gyfer bydwragedd, ac ni fydd adolygiad cenedlaethol Arolygiaeth Gofal Iechyd Cymru o wasanaethau mamolaeth yng Nghymru yn cael ei gyhoeddi tan yn ddiweddarach yn yr haf. Felly, heb y data allweddol hyn ar sail barhaus, yn hytrach nag adolygiad untro, ni wyddom a oes digon o staff mamolaeth ym mhob Bwrdd Iechyd yng Nghymru. Bwriad rhan gyntaf gwelliant 34, sef y ddyletswydd i sicrhau lefelau staffio priodol, yw mynnu bod Llywodraeth Cymru yn cadw at yr un safonau a disgwyliadau â chorff y GIG. Mae'n ei gwneud yn ofynnol i'r Gweinidog ddangos pa gamau a gymerwyd i gyflawni hyn. Nawr, gadewch imi fod yn glir, gyda'r achosion a welwn bellach o COVID-19 yn ymddangos yng Nghymru, a chan nodi'r pwysau posibl ar staffio os bydd yr haint yn lledu, dyma'r amser i fonitro pwysau o fewn y system iechyd, fel ein bod yn gwybod a all ein byrddau iechyd lleol ddarparu'r lefelau gofal diogel hynny. Bydd ail ran ein gwelliant ni, y ddyletswydd i gael asesiad staffio amser real ar waith, yn sicrhau y caiff lefelau staffio eu monitro'n rheolaidd fel bod cyrff y GIG a'r Gweinidogion yn ymateb i faterion wrth iddyn nhw ddigwydd ar y pryd, yn hytrach na dim ond ymateb i weithdrefnau y cytunwyd arnyn nhw fisoedd neu flynyddoedd ynghynt. Fel y nodais yng Nghyfnod 2, mae materion eisoes yn codi o ran lefelau diogel nyrsio, gan fod y Coleg Nyrsio Brenhinol yn dal i bryderu nad yw Llywodraeth Cymru na GIG Cymru yn cyhoeddi ffigurau cenedlaethol ar gyfer swyddi nyrsio gwag gan ddefnyddio diffiniad y cytunwyd arno o'r hyn yw swydd wag. Ac nid yw data blynyddol a gyhoeddir gan Lywodraeth Cymru ar lefelau nyrsio yn adlewyrchu'n ddigonol anghenion cleifion na'r broses o ddatblygu gwasanaethau, gan gynnwys cydafiacheddau a phoblogaeth sy'n heneiddio. Bydd trydedd ran a rhan olaf y gwelliant, y ddyletswydd i roi proses uwchgyfeirio risg ar waith, yn rhoi i bob aelod staff fecanwaith clir ar gyfer codi pryderon os ydynt yn gweithio mewn lleoliadau lle teimlant nad yw'r lefelau staffio sydd ar gael yn ddiogel. Yng Nghyfnod 2, nododd y Gweinidog na fyddai'n cefnogi'r gwelliannau hyn - felly, rwy'n deall ar hyn o bryd - oherwydd nid y Mesur fyddai'r dull priodol o wneud newid o'r maint hwn, a byddai cymhwyso unrhyw egwyddorion o ddeddf lefelau staff nyrsio i bob grŵp staffio clinigol arall yng Nghymru, heb fod yr un faint o ystyriaeth a chraffu, yn amhriodol ac anghyson. Eto, fel yr ydym wedi dweud mor aml o'r blaen am ddeddfwriaeth Llywodraeth Cymru, mae darpariaethau'r Bil ar ddyletswydd ansawdd yn rhy eang. Felly mae perygl iddo fod yn nod yn hytrach na dyletswydd, heb fecanweithiau penodol i fyrddau iechyd ymgymryd â'r camau angenrheidiol i sicrhau y caiff ei gynnal a'i fonitro fel mater o drefn. Rwyf hefyd, Gweinidog, yn amau eich pryderon ynghylch yr ystyriaethau ariannol. Bydd cael lefelau staffio priodol ar waith yn costio llai o arian i gyrff y GIG a Llywodraeth Cymru yn y tymor hir oherwydd salwch ac afiechydon sy'n ymwneud â straen, yn ogystal â gwell iechyd meddwl i'r holl staff. Mae'r gwelliannau hefyd yn cydnabod nad yw'r pwyslais ar gyrff y GIG yn unig, a bod gan Lywodraeth Cymru ran i'w chwarae yn nyfodol hirdymor lefelau staffio cyrff y GIG. Rwy'n nodi'r pwyntiau a godwyd gennych yng Nghyfnod 2 yn eich llythyr at Gadeirydd y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon ar 26 Chwefror. Dywedasoch fod Atodlen 3 i'r Mesur yn diwygio is-adran 47 Deddf Iechyd a Gofal Cymdeithasol (Iechyd Cymunedol a Safonau) 2003 i'w gwneud yn ofynnol i gyrff y GIG ystyried y safonau gofal iechyd. Fodd bynnag, fel yr amlinellir yn fy ngwelliannau yng ngrŵp 7, nid yw'r safonau hyn wedi'u diweddaru ers 2015. Ers hynny rydym wedi cael poblogaeth sy'n heneiddio'n gyflym, yn ogystal â datblygiadau mewn technoleg sy'n golygu eu bod bellach ar eu hôl hi. Felly, byddwn yn ddiolchgar pe gallai'r Gweinidog amlinellu amserlen ar gyfer y safonau diwygiedig, yn ogystal â rhoi ar glawr ei ymrwymiad i fecanwaith clir i adolygu'r safonau hyn yn rheolaidd. Gweinidog, pe baech yn barod i ateb y cwestiynau hyn am y safonau iechyd a gofal, yn ogystal ag ymrwymo i gefnogi gwelliannau 36 a 37, byddwn yn fodlon tynnu'r gwelliannau hyn yn ôl.