English: Thank you, acting Deputy Presiding Officer. I want to thank the committee for their inquiry and report into community and district nursing services in Wales. I'm pleased to say that the recommendations do broadly reflect Welsh Government policy, as articulated in our 'A Healthier Wales' vision of more care being delivered closer to home. We know that, as part of a multidisciplinary approach to delivering this aim, registered nurses will continue to play a pivotal role. The majority of the recommendations relate directly to the community workforce in terms of planning, recruitment and training. Significant work has already been undertaken to increase the nursing workforce here in Wales with positive results. However, we are never complacent and recognise that there are challenges around the recruitment and retention of nurses in a number of settings. That is why I have again increased health education funding by 13 per cent for the next year, compared to the one that we are in. We went through the figures yesterday on the significant increases in nurse education and training here in Wales over the last six years. With the establishment of Health Education and Improvement Wales, we are now in a better position - a better position than ever - to ensure a national strategic approach to understanding our workforce and producing a sustainable supply of nursing staff for the future. The Welsh Government director of workforce and organisational development is liaising closely with Health Inspectorate Wales, as they develop their future workforce strategy, and that will ensure that recommendations 1 to 3 and 6 to 8 factor into that work. I recognise, of course, the crucial role that technology plays in community nursing, which was referred to by a number of Members in the debate. That is why the Welsh Government is working with all health boards in supporting investment in modern devices. I meet district nurses in my own constituency and around the country and they do describe some of the frustrations that some Members have referred to. It's again part of the challenge I regularly describe about catching up with what normal life is now like and our ability to do things on mobile devices. This does include the work that I've described within the Government - the prioritisation of mobile devices for community nurses and others who are not based in a hospital setting. We committed in 'A Healthier Wales' to significantly increase investment in digital as a key enabler of change, and that is supported by an increasing emphasis on common national standards across digital devices and applications. Members will recall that I endorsed the chief nursing officer principles for district nursing in 2017. These are an essential step in the preparation for the further roll-out of the Nurse Staffing Levels (Wales) Act 2016. The intelligence provided from that, and the monitoring that my officials from the chief nurse's office regularly undertake, are an important step, and I understand that progress is being made on the ground. In terms of further work on what the model should look like, we are undertaking an evaluation of the neighbourhood district nursing model. Subject to that being a successful evaluation, I will then consider options for commencing the roll-out of that right across Wales over the next financial year as part of our response to the forthcoming budget round. I am sorry that I couldn't accept all of the committee's recommendations, and I understand that Members have referred in particular to the one that I didn't. That was specifically recommendation 4, which relates to the extension of the Nurse Staffing Levels (Wales) Act. Section 25A of the Nurse Staffing Levels (Wales) Act already applies to all settings where nursing care is either provided or commissioned. This duty sets out the overarching responsibility of health boards to ensure that there are sufficient nurses to care for patients sensitively, and health boards are committed to meeting that responsibility. Regarding the extension of section 25B, C and E of the Act to all settings, the honest truth is that it wouldn't be possible at this time to articulate a strategic vision with any detail that could be considered valuable and worthwhile. There are significant and fundamental differences to the various settings in which nurses provide care, and it is too early to begin to understand the complexity around the variability across all settings. A substantial piece of mapping will need to be undertaken by the all-Wales nurse staffing programme before a national strategy can be contemplated, but the programme manager has begun the early stages of that work. That's underscored by the reality of the work that is already ongoing that has underpinned the initial stage of roll-out, the pieces of work that are already in train at present, and, of course, the work that took place before my written statement today, where I confirmed that I had commenced the legislative process to extend the Act to paediatric inpatient wards, with the intention that the practical extension will be in place by April 2021. I will, of course, write to the committee setting out current progress across all nurse staffing programme workstreams. There's a final point that I think is worth mentioning in terms of the debate, and that is that the publication of the committee's report was in August. The Nursing and Midwifery Council, the professional regulator, then announced that it intended to conduct a full review of post-registration recordable qualifications, and has explicitly identified specialist practice qualifications. That could potentially have significant ramifications for community-based roles and the way in which they are defined. Such roles include, specifically, general practice nurses, community children's nurses and, especially, district nurses. I will, though, keep the Assembly - through the committee - appraised of the outcome of that review and the ways that that might affect the practical implementation of Welsh Government policy.
Welsh: Diolch, Ddirprwy Lywydd dros dro. Hoffwn ddiolch i'r pwyllgor am ei ymchwiliad a'i adroddiad ar wasanaethau nyrsio cymunedol a nyrsio ardal yng Nghymru. Rwy'n falch o ddweud bod yr argymhellion yn adlewyrchu polisi Llywodraeth Cymru yn fras o ddarparu mwy o ofal yn nes at adref, fel y'i nodwyd yn ein gweledigaeth 'Cymru Iachach'. Fel rhan o ddull amlddisgyblaethol o gyflawni'r nod hwn, gwyddom y bydd nyrsys cofrestredig yn parhau i chwarae rhan ganolog. Mae'r rhan fwyaf o'r argymhellion yn ymwneud yn uniongyrchol â'r gweithlu cymunedol o ran cynllunio, recriwtio a hyfforddi. Mae gwaith sylweddol wedi'i wneud eisoes ar gynyddu'r gweithlu nyrsio yma yng Nghymru gyda chanlyniadau cadarnhaol. Fodd bynnag, nid ydym byth yn hunanfodlon ac rydym yn cydnabod bod heriau'n gysylltiedig â recriwtio a chadw nyrsys mewn nifer o leoliadau. Dyna pam fy mod, unwaith eto, wedi cynyddu'r cyllid ar gyfer addysg iechyd 13 y cant ar gyfer y flwyddyn nesaf, o'i gymharu â'r flwyddyn hon. Aethom drwy'r ffigurau ddoe mewn perthynas â'r cynnydd sylweddol mewn addysg a hyfforddiant i nyrsys yma yng Nghymru dros y chwe blynedd diwethaf. Gyda sefydliad Addysg a Gwella Iechyd Cymru, rydym bellach mewn gwell sefyllfa - sefyllfa well nag erioed - i sicrhau dull strategol cenedlaethol o ddeall ein gweithlu a chynhyrchu cyflenwad cynaliadwy o staff nyrsio ar gyfer y dyfodol. Mae cyfarwyddwr gweithlu a datblygu sefydliadol Llywodraeth Cymru yn cydweithio'n agos ag Arolygiaeth Iechyd Cymru, wrth iddynt ddatblygu eu strategaeth ar gyfer y gweithlu yn y dyfodol, a bydd hynny'n sicrhau bod argymhellion 1 i 3 a 6 i 8 yn ffactor yn y gwaith hwnnw. Rwy'n cydnabod, wrth gwrs, y rôl hollbwysig y mae technoleg yn ei chwarae mewn nyrsio cymunedol, rhywbeth y cyfeiriwyd ato gan nifer o Aelodau yn y ddadl. Dyna pam fod Llywodraeth Cymru yn gweithio gyda phob bwrdd iechyd i gefnogi buddsoddiad mewn dyfeisiau modern. Rwy'n cyfarfod â nyrsys ardal yn fy etholaeth a ledled y wlad ac maent yn disgrifio rhai o'r rhwystredigaethau y mae rhai Aelodau wedi cyfeirio atynt. Unwaith eto, mae'n rhan o'r her rwy'n ei disgrifio'n rheolaidd am ddal i fyny â'r hyn sy'n fywyd normal bellach a'n gallu i wneud pethau ar ddyfeisiau symudol. Mae hyn yn cynnwys y gwaith a ddisgrifiais o fewn y Llywodraeth - blaenoriaethu dyfeisiau symudol ar gyfer nyrsys cymunedol ac eraill nad ydynt wedi'u lleoli mewn ysbyty. Gwnaethom ymrwymo yn 'Cymru Iachach' i gynyddu'r buddsoddiad mewn technoleg ddigidol yn sylweddol fel ffactor allweddol sy'n galluogi newid, ac ategir hynny gan bwyslais cynyddol ar safonau cenedlaethol cyffredin ar draws dyfeisiau a chymwysiadau digidol. Bydd yr Aelodau'n cofio fy mod wedi cymeradwyo egwyddorion y prif swyddog nyrsio ar gyfer nyrsio ardal yn 2017. Mae'r rhain yn gam hanfodol yn y paratoadau i gyflwyno Deddf Lefelau Staff Nyrsio (Cymru) 2016 ymhellach. Mae'r wybodaeth a ddarperir o hynny, a'r monitro y mae fy swyddogion o swyddfa'r prif nyrs yn ei wneud yn rheolaidd, yn gam pwysig, a deallaf fod cynnydd yn digwydd ar lawr gwlad. O ran gwaith pellach ar sut y dylai'r model edrych, rydym yn cynnal gwerthusiad o'r model nyrsio ardal seiliedig ar gymdogaeth. Yn amodol ar werthusiad llwyddiannus, byddaf wedyn yn ystyried opsiynau ar gyfer dechrau ei gyflwyno ledled Cymru yn ystod y flwyddyn ariannol nesaf fel rhan o'n hymateb i'r cylch cyllideb nesaf. Mae'n ddrwg gennyf na allwn dderbyn holl argymhellion y pwyllgor, a deallaf fod Aelodau wedi cyfeirio'n arbennig at yr un na wneuthum ei dderbyn. Argymhelliad 4 oedd hwnnw, sy'n ymwneud ag ymestyn Deddf Lefelau Staff Nyrsio (Cymru). Mae adran 25A o'r Ddeddf Lefelau Staff Nyrsio (Cymru) eisoes yn berthnasol i bob lleoliad lle mae gofal nyrsio naill ai'n cael ei ddarparu neu ei gomisiynu. Mae'r ddyletswydd hon yn nodi cyfrifoldeb trosfwaol byrddau iechyd i sicrhau bod digon o nyrsys i ofalu am gleifion mewn modd sensitif, ac mae byrddau iechyd yn ymrwymedig i gyflawni'r cyfrifoldeb hwnnw. O ran ymestyn adran 25B, C ac E o'r Ddeddf i gynnwys pob lleoliad, y gwir plaen yw na fyddai'n bosibl mynegi gweledigaeth strategol gydag unrhyw fanylder y gellid ei ystyried yn werthfawr ac yn fuddiol ar hyn o bryd. Mae gwahaniaethau sylweddol a sylfaenol i'r gwahanol leoliadau lle mae nyrsys yn darparu gofal, ac mae'n rhy gynnar i ddechrau deall y cymhlethdod sydd ynghlwm wrth yr amrywioldeb ar draws pob lleoliad. Bydd angen i raglen staff nyrsio Cymru wneud gwaith mapio sylweddol cyn y gellir ystyried strategaeth genedlaethol, ond mae rheolwr y rhaglen wedi dechrau ar gamau cynnar y gwaith hwnnw. Tanlinellir hynny gan realiti'r gwaith sydd eisoes yn mynd rhagddo ac sydd wedi bod yn sail i gam cyntaf y broses gyflwyno, y gwaith sydd eisoes ar y gweill ar hyn o bryd, ac wrth gwrs, y gwaith a wnaed cyn fy natganiad ysgrifenedig heddiw, lle roeddwn yn cadarnhau fy mod wedi dechrau'r broses ddeddfwriaethol i ymestyn y Ddeddf i gynnwys wardiau cleifion mewnol pediatrig, gyda'r nod o sicrhau y bydd yr estyniad ymarferol yn ei le erbyn Ebrill 2021. Wrth gwrs, byddaf yn ysgrifennu at y pwyllgor yn nodi'r cynnydd cyfredol ar draws holl ffrydiau gwaith y rhaglen staff nyrsio. Credaf fod yna bwynt terfynol sy'n werth ei grybwyll o ran y ddadl, sef y ffaith bod adroddiad y pwyllgor wedi cael ei gyhoeddi ym mis Awst. Yna, cyhoeddodd y Cyngor Nyrsio a Bydwreigiaeth, y rheoleiddiwr proffesiynol, ei fod yn bwriadu cynnal adolygiad llawn o gymwysterau cofnodadwy ar ôl cofrestru, ac mae wedi nodi cymwysterau ymarfer arbenigol yn benodol. Gallai hynny arwain at oblygiadau sylweddol o bosibl i rolau yn y gymuned a'r ffordd y cânt eu diffinio. Mae rolau o'r fath yn cynnwys, yn benodol, nyrsys practis, nyrsys cymunedol i blant, a nyrsys ardal yn enwedig. Fodd bynnag, byddaf yn sicrhau bod y Cynulliad - drwy'r pwyllgor - yn ymwybodol o ganlyniad yr adolygiad hwnnw a'r ffyrdd y gallai hynny effeithio ar weithrediad ymarferol polisi Llywodraeth Cymru.