English: Thank you, Llywydd. I have listened to the rationale for laying the amendments tabled in this group, both at Stage 2 and again today. In relation to amendment 39, which, for reasons that I'll explain again, I don't agree with, the purpose and the effect is quite clear: any failure by an NHS body to comply with the duty of candour procedure regulations, or with the provisions is sections 5 to 10 in the Bill, must be dealt with under NHS Wales's escalation and intervention arrangements. Now, there is a recognition that there are those arrangements in place already. But there's a technical point, though, about the fact that the escalation and intervention arrangements and their use in primary legislation means there's a mixture of legislative and non-legislative measures available to the Welsh Ministers. However, those very much, as I say, work within a wider governance and accountability framework within the NHS at individual body and system level, through quality and safety committees, on health boards and trusts, quality and delivery meetings, and joint executive meetings. Those are all opportunities for scrutiny and appropriate and timely action and learning. Should serious concerns emerge from those mechanisms, they would, where needed, inform any discussions and potential action under our existing escalation and intervention arrangements. However, it is my expectation that every opportunity should be taken to address concerns as they emerge and that a body should take immediate corrective action. I don't believe it's necessary to include a provision on the face of the Bill that essentially says failures by an NHS body to comply with the duty must be dealt with under the measures that already exist. I've listened again to the intended purpose and effect of amendments 73 and 74 and their requirement for Welsh Ministers to set out the procedure in regulations that NHS bodies must follow if they fail to follow the duty of candour procedure or comply with the reporting and other arrangements set out in sections 5 to 10 of the Bill. So, that means there would be a procedure for failure to comply with the procedure, and a duty to make statements and issue a report where the NHS has failed to comply with their reporting requirements. Now, that sounds really quite bureaucratic to me and adds unnecessary layers of complexity to the operation of the duty, which is not desirable. I also have real concerns about how this would work, or rather wouldn't work, in practice. The requirement in subsection (4) of amendment 73 for Welsh Ministers to make a statement on serious breaches of the duty of candour procedure could result in information that enables patients to be identified being disclosed. The definition of a serious breach is not clear, and it's certainly not defined in the amendment. Requiring Welsh Ministers to report on the number of the breaches of the duty of candour that are reported to them is, again, unnecessary. In terms of monitoring compliance with the duty, I expect regular updates to be provided in public safety and quality committee meetings so independent members, as a first port of call, can seek assurance that the duty is being discharged and learning being taken forward. Now, that will be discussed at quality and delivery group meetings between Welsh Government, individual bodies, joint executive team meetings, and of course between the chief executive of NHS Wales and the chief executives of boards and trusts, as well as my appraisals with chairs and vice-chairs. The Welsh Government will also monitor the content of those reports alongside other sources of information to help us try and get at the application of the duty with, for example, consideration of serious incident reports. The reports will also be considered by Health Inspectorate Wales as part of their wider reviews of services. Where concerns come to light through these mechanisms, they would undoubtedly inform the tripartite discussions and any subsequent advice to Ministers on escalation and intervention. But I do need to return back to a point that was made both at Stage 2 and in the previous two contributions: the key intention of the duty is to promote an ethos of learning and improving and the promotion of an open and honest culture to be owned at an organisational level. When comments are made about how there's already been an act of dishonesty or lying if the duty is breached, I don't think that sets the right tone at all. It would be possible for an oversight or a mistake to lead to a breach of the duty, not an act of deliberate dishonesty, necessarily. And that runs wholly against our aim to foster that open culture, where people can hold their hand up when something goes wrong, rather than looking to say, 'How can I explain this away or avoid responsibility?' The approach that is being urged on us in these amendments is, in my view, entirely the wrong approach to take. And in any event, the powers to intervene already exist. I don't believe that these overly bureaucratic amendments would facilitate the creation of the open and honest ethos that we're aiming to create. More concerning, though, is that they really could drive a much more punitive culture and a fear of reporting. I ask Members to reject the amendments in this group.
Welsh: Diolch, Llywydd. Rwyf wedi gwrando ar y rhesymeg dros osod y gwelliannau a gyflwynwyd yn y grŵp hwn, yng Nghyfnod 2 ac eto heddiw. O ran gwelliant 39, nad ydw i, am resymau y byddaf yn eu hegluro eto, yn cytuno ag ef, mae'r diben a'r effaith yn ddigon clir: mae unrhyw fethiant gan un o gyrff y GIG i gydymffurfio â rheoliadau dyletswydd gonestrwydd, neu â'r darpariaethau yn adrannau 5 i 10 yn y Bil, yn gorfod cael eu trin o dan drefniadau uwchgyfeirio ac ymyrryd GIG Cymru. Yn awr, cydnabyddir bod y trefniadau hynny eisoes ar waith. Ond mae pwynt technegol, fodd bynnag, ynglŷn â'r ffaith bod y trefniadau uwchgyfeirio ac ymyrryd a'r defnydd a wneir ohonyn nhw mewn deddfwriaeth sylfaenol yn golygu bod cymysgedd o fesurau deddfwriaethol ac anneddfwriaethol ar gael i Weinidogion Cymru. Fodd bynnag, mae'r rheini, fel y dywedaf, yn gweithio o fewn fframwaith llywodraethu ac atebolrwydd ehangach o fewn y GIG ar lefel corff a system unigol, drwy bwyllgorau ansawdd a diogelwch, ar fyrddau ac ymddiriedolaethau iechyd, cyfarfodydd ansawdd a chyflawni, a chyd-gyfarfodydd gweithredol. Mae'r rheini i gyd yn gyfleoedd ar gyfer craffu a gweithredu a dysgu priodol ac amserol. Pe bai pryderon difrifol yn deillio o'r mecanweithiau hynny, bydden nhw, lle bo angen, yn llywio unrhyw drafodaethau a chamau gweithredu posib o dan ein trefniadau uwchgyfeirio ac ymyrryd presennol. Fodd bynnag, rwy'n disgwyl y dylid manteisio ar bob cyfle i fynd i'r afael â phryderon wrth iddyn nhw godi ac y dylai corff gymryd camau unioni ar unwaith. Dydw i ddim yn credu bod angen cynnwys darpariaeth ar wyneb y Bil sydd yn ei hanfod yn dweud bod yn rhaid ymdrin â methiannau gan gorff y GIG i gydymffurfio â'r ddyletswydd o dan y mesurau sydd eisoes yn bodoli. Rwyf wedi gwrando eto ar bwrpas ac effaith arfaethedig gwelliannau 73 a 74 a'u gofyniad i Weinidogion Cymru nodi'r weithdrefn y mae'n rhaid i gyrff y GIG ei dilyn mewn rheoliadau os ydyn nhw'n methu â dilyn y weithdrefn dyletswydd gonestrwydd neu gydymffurfio â'r adroddiad a threfniadau eraill a nodir yn adrannau 5 i 10 o'r Bil. Felly, mae hynny'n golygu y byddai gweithdrefn ar gyfer methiant i gydymffurfio â'r weithdrefn, a dyletswydd i wneud datganiadau a chyhoeddi adroddiad lle mae'r GIG wedi methu â chydymffurfio â'u gofynion adrodd. Nawr, mae hynny'n swnio'n eithaf biwrocrataidd i mi ac mae'n ychwanegu haenau diangen o gymhlethdod at y gwaith o weithredu'r ddyletswydd, ac nid yw hynny'n ddymunol. Mae gennyf bryderon gwirioneddol hefyd ynghylch sut y byddai hyn yn gweithio, neu'n hytrach na fyddai'n gweithio, yn ymarferol. Gallai'r gofyniad yn is-adran (4) o welliant 73 i Weinidogion Cymru wneud datganiad ar achosion difrifol o dorri'r weithdrefn dyletswydd gonestrwydd arwain at ddatgelu gwybodaeth a fyddai'n gallu adnabod cleifion. Nid yw'r diffiniad o doriad difrifol yn glir, ac yn sicr nid yw wedi'i ddiffinio yn y gwelliant. Unwaith eto, nid oes angen ei gwneud yn ofynnol i Weinidogion Cymru gyflwyno adroddiad ar nifer yr achosion o dorri'r ddyletswydd gonestrwydd a gafodd eu hadrodd iddyn nhw. O ran monitro'r gwaith o gydymffurfio â'r ddyletswydd, disgwyliaf i ddiweddariadau rheolaidd gael eu darparu yng nghyfarfodydd y pwyllgor ansawdd a diogelwch cyhoeddus fel y gall aelodau annibynnol, yn y lle cyntaf, ofyn am sicrwydd bod y ddyletswydd yn cael ei chyflawni a bod dysgu'n cael ei ddatblygu. Nawr, caiff hynny ei drafod mewn cyfarfodydd o'r grŵp ansawdd a chyflawni rhwng Llywodraeth Cymru, cyrff unigol, cyfarfodydd tîm gweithredol ar y cyd, ac wrth gwrs rhwng prif weithredwr GIG Cymru a phrif weithredwyr byrddau ac ymddiriedolaethau, yn ogystal â'm harfarniadau gyda chadeiryddion ac is-gadeiryddion. Bydd Llywodraeth Cymru hefyd yn monitro cynnwys yr adroddiadau hynny ynghyd â ffynonellau eraill o wybodaeth i'n helpu ni i geisio cymhwyso'r ddyletswydd, er enghraifft, i ystyried adroddiadau difrifol am ddigwyddiadau. Bydd Arolygiaeth Iechyd Cymru hefyd yn ystyried yr adroddiadau fel rhan o'u hadolygiadau ehangach o wasanaethau. Pan ddaw pryderon i'r amlwg drwy'r mecanweithiau hyn, bydden nhw yn sicr yn llywio'r trafodaethau tairochrog ac unrhyw gyngor dilynol i Weinidogion ar uwchgyfeirio ac ymyrryd. Ond mae angen imi ddychwelyd at bwynt a wnaed yng Nghyfnod 2 ac yn y ddau gyfraniad blaenorol: prif fwriad y ddyletswydd yw hyrwyddo ethos o ddysgu a gwella a hyrwyddo diwylliant agored a gonest i fod yn eiddo i'r sefydliad ar lefel sefydliadol. Pan wneir sylwadau ynghylch sut mae gweithred o anonestrwydd neu ddweud celwydd eisoes wedi digwydd os yw'r ddyletswydd yn cael ei thorri, nid wyf yn credu bod hynny'n gosod y cywair cywir o gwbl. Byddai modd i amryfusedd neu gamgymeriad arwain at dorri'r ddyletswydd, nid gweithred o anonestrwydd bwriadol, o reidrwydd. Ac mae hynny'n mynd yn gwbl groes i'n nod ni o feithrin y diwylliant agored hwnnw, lle gall pobl godi eu llaw pan aiff rhywbeth o'i le, yn hytrach na cheisio dweud, 'Sut y galla i esbonio hyn neu osgoi cyfrifoldeb?' Yn fy marn i, mae'r dull sy'n cael ei annog yn y gwelliannau hyn yn un hollol anghywir. A sut bynnag, mae'r pwerau i ymyrryd eisoes yn bodoli. Dydw i ddim yn credu y byddai'r gwelliannau gor-fiwrocrataidd hyn yn hwyluso creu'r ethos agored a gonest yr ydym ni'n anelu at ei greu. Yr hyn sy'n peri mwy o bryder, er hynny, yw y gallen nhw mewn gwirionedd arwain at ddiwylliant llawer mwy cosbol ac ofn adrodd. Gofynnaf i'r Aelodau wrthod y gwelliannau yn y grŵp hwn.