English: I have previously described how 'A Healthier Wales' sets out our commitment to enable health and social care services to meet population need - as I've said before, the first time we have ever had a joint health and social care plan with ownership between health, local government and the third sector. A transformation programme will bring pace and purpose to how we invest in people and how we build staff capacity, and we know that improving system capacity to plan effectively and efficiently is essential. We're delivering on a key priority to work with health and social care organisations and partners to simplify the planning and delivery of our services. Our amendment recognises the comprehensive work of our staff within the NHS, within local government, and wider partners, to plan and build capacity around and within NHS Wales to meet demand for services throughout the year. We, of course, heard some of this, in relation to specific planning for winter, in the earlier comments of David Melding. We've been open about the challenges felt by out-of-hours primary care, critical care and emergency ambulance services, and we also know that, despite this pressure, the vast majority who require these services continue to receive timely access and high standards of care - once again, thanks to our compassionate and dedicated staff. As an example, the latest available figures show people categorised as 'immediately life threatened' in our red category of emergency ambulance calls receive a response in just over five minutes on average, and Dawn Bowden was right to point out that our model for emergency ambulance services is being copied in Scotland and England. We've been clear about how we're targeting national support for these services, with a clear understanding of demand and how best to manage it. That will help us to deliver sustainable out-of-hours primary care as well as critical care services. I've recently announced an additional £5 million to be made available this year for critical care, which will help us to create the capacity that is required over winter and to create a foundation for sustainable improvement. We have commissioned an independent review of ambulance services and the amber category to understand whether improvements can be made to the management of patients and, of course, we'll have a statement on that next month and an opportunity for Members to consider that in advance. There is significant work under way in all three areas to focus on the need to recognise and understand pressures and plan to meet them. Our plan is to help support front-line staff to deliver those high-performing services, focusing on experience, outcome and value. As to developing a national plan to address pressures on services, 'A Healthier Wales' describes our commitment to delivering a whole-system approach, where all services are delivered seamlessly and wrapped around the needs of the individual. It is imperative that we do not consider services in isolation. We should resist the regular calls in this place and in others to create new and piecemeal specific plans, but concentrate on delivering action that we have set out and agreed in our long-term plan. On bed numbers - a point was made at various points in the debate - we actually have a lower occupancy rate than in England and more beds, proportionately, than the system in England. Now, specifically on critical care, I made reference to the £5 million this year to help support a permanent increase in the number of critical care beds, and that does underline our commitment to strengthening critical care and we recognise that that is necessary, not only for the winter, but in the longer term. That follows my recent announcement of £15 million of recurrent funding from the next financial year for these essential services. On our emergency ambulance services, we already have a national plan. The Welsh ambulance service trust has an approved plan up to 2021, based on commissioning intentions that are set out by the chief ambulance commissioner. Members will, no doubt, be interested to know that the collaborative commissioning arrangements that we have in Wales have recently been copied in England. We know there are more paramedics working in Wales than ever before, and, since 2014, the number of paramedic training places has more than doubled - not by accident, but by deliberate choices made by Welsh Labour leadership. On primary care out-of-hour services, there's been a significant and collective focus on this area over the past year. As part of our broader plan, work is under way to develop a new model of out-of-hours primary care, modelled on seamless integration with other services through the 111 service. And I'm pleased to hear both in this debate and in recent weeks recognition of the successful impact that the 111 service has had where it's been rolled out. I'd caution Members who would demand an immediate roll-out of that service across the country. Part of the success has been to understand the demand of each area and to build capacity in primary care support and to make sure that we have the right staff in the right place to deliver the quality of service.
Welsh: Rwyf eisoes wedi disgrifio sut y mae 'Cymru Iachach' yn nodi ein hymrwymiad i alluogi gwasanaethau iechyd a gofal cymdeithasol i fodloni anghenion y boblogaeth - fel y dywedais o'r blaen, y tro cyntaf erioed inni gael cynllun iechyd a gofal cymdeithasol sy'n eiddo i'r sector iechyd, llywodraeth leol a'r trydydd sector. Bydd rhaglen drawsnewid yn sicrhau cyflymder a diben i'r modd rydym yn buddsoddi mewn pobl a'r modd yr adeiladwn y capasiti staff, ac rydym yn gwybod bod gwella gallu'r system i gynllunio'n effeithiol ac yn effeithlon yn hanfodol. Rydym yn cyflawni ar flaenoriaeth allweddol i weithio gyda sefydliadau iechyd a gofal cymdeithasol a phartneriaid er mwyn symleiddio'r gwaith o gynllunio a darparu ein gwasanaethau. Mae ein gwelliant yn cydnabod gwaith cynhwysfawr ein staff yn y GIG, mewn llywodraeth leol, a chan bartneriaid ehangach, ar gynllunio ac adeiladu capasiti o amgylch ac o fewn GIG Cymru i ateb y galw am wasanaethau drwy gydol y flwyddyn. Wrth gwrs, fe glywsom rywfaint o hyn mewn perthynas â chynlluniau penodol ar gyfer y gaeaf, yn sylwadau cynharach David Melding. Rydym wedi bod yn agored ynglŷn â'r heriau a deimlir gan y gwasanaethau gofal sylfaenol y tu allan i oriau, gofal critigol ac ambiwlans brys, a gwyddom hefyd, er gwaethaf y pwysau, fod y mwyafrif helaeth sydd angen y gwasanaethau hyn yn parhau i gael mynediad amserol a gofal o safon uchel - unwaith eto, diolch i'n staff tosturiol ac ymroddedig. Er enghraifft, dengys y ffigurau diweddaraf sydd ar gael fod pobl sydd wedi'u categoreiddio fel rhai y mae eu bywyd mewn perygl yn ein categori coch o alwadau brys am ambiwlans yn cael ymateb o fewn ychydig dros bum munud ar gyfartaledd, ac roedd Dawn Bowden yn iawn i nodi bod ein model ar gyfer gwasanaethau ambiwlans brys yn cael ei efelychu yn Lloegr a'r Alban. Rydym wedi bod yn glir ynglŷn â'r modd y targedwn gymorth cenedlaethol ar gyfer y gwasanaethau hyn, gyda dealltwriaeth eglur o'r galw a'r ffordd orau i'w reoli. Bydd hynny'n ein helpu i ddarparu gofal sylfaenol y tu allan i oriau sy'n gynaliadwy yn ogystal â gwasanaethau gofal critigol. Yn ddiweddar cyhoeddais £5 miliwn ychwanegol i fod ar gael eleni ar gyfer gofal critigol, a bydd yn ein helpu i greu'r capasiti sydd ei angen dros y gaeaf ac i greu sylfaen ar gyfer gwelliant cynaliadwy. Rydym wedi comisiynu adolygiad annibynnol o wasanaethau ambiwlans a'r categori oren i ddeall a ellir gwella trefniadau rheoli cleifion ac wrth gwrs, bydd gennym ddatganiad ar hynny y mis nesaf a chyfle i'r Aelodau ystyried hynny ymlaen llaw. Mae gwaith sylweddol ar y gweill ym mhob un o'r tri maes i ganolbwyntio ar yr angen i gydnabod a deall y pwysau a chynllunio i'w ddiwallu. Ein cynllun yw helpu i gynorthwyo staff rheng flaen i ddarparu gwasanaethau perfformiad uchel, gan ganolbwyntio ar brofiad, canlyniad a gwerth. O ran datblygu cynllun cenedlaethol i ymdrin â phwysau ar wasanaethau, mae 'Cymru Iachach' yn disgrifio ein hymrwymiad i ddarparu dull system gyfan, lle mae'r holl wasanaethau'n cael eu darparu'n ddi-dor a'u lapio o amgylch anghenion yr unigolyn. Mae'n hanfodol nad ydym yn ystyried gwasanaethau ar eu pen eu hunain. Dylem wrthsefyll y galwadau rheolaidd yn y lle hwn ac mewn mannau eraill i greu cynlluniau penodol newydd a thameidiog, a chanolbwyntio yn lle hynny ar gyflawni'r camau gweithredu a nodwyd gennym ac y cytunwyd arnynt yn ein cynllun hirdymor. Ar niferoedd gwelyau - gwnaed pwynt ar amrywiol adegau yn y ddadl - mae gennym gyfradd defnydd is nag yn Lloegr a mwy o welyau yn gyfrannol na'r system yn Lloegr. Nawr, yn benodol ar ofal critigol, rwyf wedi cyfeirio at y £5 miliwn eleni i helpu i gefnogi cynnydd parhaol yn nifer y gwelyau gofal critigol, ac mae hynny'n tanlinellu ein hymrwymiad i gryfhau gofal critigol ac rydym yn cydnabod bod hynny'n angenrheidiol, nid yn unig ar gyfer y gaeaf, ond yn y tymor hwy. Mae hynny'n dilyn fy nghyhoeddiad diweddar o £15 miliwn o gyllid rheolaidd o'r flwyddyn ariannol nesaf ar gyfer y gwasanaethau hanfodol hyn. Ar ein gwasanaethau ambiwlans brys, mae gennym gynllun cenedlaethol eisoes. Mae gan ymddiriedolaeth gwasanaeth ambiwlans Cymru gynllun a gymeradwywyd hyd at 2021 yn seiliedig ar y bwriadau a nodwyd gan brif gomisiynydd y gwasanaeth ambiwlans. Heb amheuaeth, bydd yr Aelodau'n falch o wybod bod y trefniadau comisiynu cydweithredol sydd gennym yng Nghymru wedi'u copïo yn Lloegr yn ddiweddar. Gwyddom fod mwy o barafeddygon yn gweithio yng Nghymru nag erioed o'r blaen, ac ers 2014 mae nifer y lleoedd hyfforddiant parafeddygol wedi mwy na dyblu ers 2014 - nid drwy ddamwain, ond drwy ddewisiadau bwriadol a wnaed gan arweinyddiaeth Llafur Cymru. Ar wasanaethau gofal sylfaenol y tu allan i oriau, cafwyd ffocws sylweddol a chyfunol ar y maes hwn dros y flwyddyn ddiwethaf. Fel rhan o'n cynllun ehangach, mae gwaith yn mynd rhagddo ar ddatblygu model newydd o ofal sylfaenol y tu allan i oriau, wedi'i fodelu ar integreiddio di-dor â gwasanaethau eraill drwy'r gwasanaeth 111. Ac rwy'n falch o glywed cydnabyddiaeth yn y ddadl hon ac yn ystod yr wythnosau diwethaf i effaith lwyddiannus y gwasanaeth 111 lle cafodd ei gyflwyno. Buaswn yn rhybuddio Aelodau a fyddai'n galw am gyflwyno'r gwasanaeth hwnnw ar unwaith ledled y wlad. Rhan o'r llwyddiant oedd deall y galw ym mhob ardal ac adeiladu capasiti mewn cymorth gofal sylfaenol a gwneud yn siŵr fod gennym y staff cywir yn y lle cywir i ddarparu gwasanaeth o ansawdd.