English: Thank you, Presiding Officer. First of all, Cabinet Secretary, I'd like to thank you for the technical briefing you offered this morning from your officials. It was very helpful. It's a big report, there's an awful lot in it and it makes for interesting reading, much of it welcome, some of it concerning. Four areas particularly leapt out at me in terms of sheer statistics that caused me concern. The first is that, over the past two years, over 7,000 people waited over three hours outside a hospital to be transferred in, and over 15,000 people waited over three hours for an ambulance wherever they were when the incident they were involved in happened. There's been a rise in the amount of hours it takes from handover to clear, which is obviously an area we need to look at, and, of course, a very concerning one is the rise in sickness of ambulance staff and trying to discern why: is it down to stress? What are the issues here? Of those four areas themselves, two are indicators of where we're not performing well, and two are indicators of where there might be logjams in the system. The report as a whole makes some very interesting recommendations, but it does repeatedly reference placing clinicians in settings such as control rooms, nursing homes, police services as a means of improving management of the service and assessing the situation. In terms of implementation, how sure are you that you have the capacity to already put those clinicians in place? Are we aware of how many roles will be needed and where they are? Because it's all very well for this report to say, 'We could do so much better if we have people over there, over there and over there', there's a great devolution from the Welsh ambulance service, and it may well be right - I'm not certainly not arguing that - but what I am concerned about is that it's all very well saying, 'Let's put these clinicians in the control room'; 'Let's put more people here, there and everywhere', but we know the staff shortages we have. So, I'd be interested to know what you've done to assess that particular issue. And, again, with reducing the long waits of patients such as non-injury fallers - it tends to be our older population - this, again, is looking for social care workers and district nurses. So, how are they going to be better incorporated into the care pathways for these individuals? How are you planning to build that capacity? I do welcome the bespoke plans with the local health boards, but the implementation of these plans is highly dependent on those health boards. We know that ambulance services have received additional capital investment in this year's budget, but in order to drive forward change, how will you, how will health boards, be supported to put in place these improvements? Will they be asked by you to demonstrate how they will do that in their integrated medium-term plans, because if you don't monitor this, it could very easily get lost in the mix? With regard to improving the service, we did initially expect this review to be made public in September, and it is now the first week of November. One quote from the review says, 'In order to avoid the combination of factors that were seen last winter, the ambulance service and the wider NHS must ensure it takes every opportunity to maximise the availability and efficiency of resources in order that the patients of Wales receive the highest quality and timely ambulance response.' So, how, then, are LHBs going to be able to implement this ready for this winter and Christmas period? Were they privy to this review before us here in the Assembly? Have they been able to put in place resilience plans prior to the winter? Presiding Officer, I just have one last question. At the back of this review is a list of the protocol cards that are used by call centre staff, and I was really surprised to see that there is not a sepsis protocol card. As you know, sepsis kills more people each year than bowel, prostate and breast cancer combined. And there are key indicators. I know it is a chameleon, but the key indicators of chills and shivering, confusion and slurred speech, severe muscle pain, fast breathing and very high or low temperatures are real indicators that someone might be having a sepsis episode. We know if we can rescue people early, they've got more chance of a proper, full recovery. No protocol card. Would you please undertake to just have a look at that and see if it would be appropriate to put a protocol card and add it to the 19 other protocol cards that the ambulance service currently work to?
Welsh: Diolch i chi, Llywydd. Yn gyntaf oll, Ysgrifennydd y Cabinet, hoffwn ddiolch i chi am y sesiwn briffio technegol gan eich swyddogion a gynigiwyd gennych y bore yma. Roedd yn ddefnyddiol iawn. Mae'n adroddiad mawr, mae llawer iawn ynddo ac mae'n ddeunydd darllen diddorol, llawer ohono i'w groesawu, rhywfaint ohono yn peri pryder. Roedd pedwar maes yn arbennig yn tynnu fy sylw o ran ystadegau pur a oedd yn peri pryder imi. Y cyntaf yw, dros y ddwy flynedd diwethaf, arhosodd dros 7,000 o bobl dros dair awr y tu allan i ysbyty yn disgwyl cael eu trosglwyddo i mewn i'r ysbyty, ac arhosodd dros 15,000 o bobl dros dair awr am ambiwlans ym mha le bynnag yr oeddent ar adeg y digwyddiad. Bu cynnydd yn yr oriau rhwng trosglwyddo a chlirio, sy'n amlwg yn faes y mae angen i ni edrych arno, ac, wrth gwrs, un maes sy'n peri pryder mawr yw'r cynnydd mewn achosion o salwch ymhlith staff ambiwlans a cheisio dirnad pam: Ai straen sy'n gyfrifol? Beth yw'r problemau yn y fan yma? O'r pedwar maes hynny eu hunain, mae dau yn dangos pryd nad ydym yn perfformio'n dda, ac mae dau yn dangos ble y gallai fod tagfeydd yn y system. Mae'r adroddiad yn ei gyfanrwydd yn gwneud rhai argymhellion diddorol iawn, ond mae'n cyfeirio dro ar ôl tro at osod clinigwyr mewn lleoliadau megis ystafelloedd rheoli, cartrefi nyrsio, gwasanaethau heddlu fel ffordd o wella rheolaeth y gwasanaeth ac asesu'r sefyllfa. O ran gweithredu, pa mor sicr ydych chi bod gennych chi'r nifer angenrheidiol i osod y clinigwyr hynny yn y lleoliadau? A ydym ni'n ymwybodol o faint o swyddi y bydd eu hangen a ble y maen nhw? Oherwydd mae'n ddigon hawdd i'r adroddiad hwn ddweud, 'Gallwn ni wneud yn well o lawer petai gennym ni bobl yn y fan acw, yn y fan acw ac yn y fan acw'. ceir datganoli mawr o wasanaeth ambiwlans Cymru, a gallai hynny fod yn iawn - yn sicr nid wyf yn dadlau hynny - ond yr hyn sy'n peri pryder i mi yw ei bod yn hawdd dweud, 'Gadewch i ni roi'r clinigwyr hyn yn yr ystafell reoli'; 'Gadewch i ni roi mwy o bobl yn y fan yma, y fan acw ac ym mhob man', ond rydym ni'n gwybod bod staff yn brin. Felly, byddai diddordeb gennyf mewn cael gwybod beth yr ydych chi wedi ei wneud i asesu'r mater penodol hwnnw. Ac, unwaith eto, ynghylch lleihau amseroedd aros cleifion megis cleifion sy'n cael codwm heb ddioddef anaf - sy'n tueddu i fod ein poblogaeth hŷn - unwaith eto, mae hyn, yn gofyn am nyrsys ardal a gweithwyr gofal cymdeithasol. Felly, sut bydden nhw'n cael eu hymgorffori'n well yn llwybrau gofal yr unigolion hyn? Sut ydych chi'n bwriadu cynyddu'r capasiti hwnnw? Rwyf yn croesawu'r cynlluniau pwrpasol gyda'r byrddau iechyd lleol, ond mae gweithredu'r cynlluniau hyn yn ddibynnol iawn ar y byrddau iechyd hynny. Fe wyddom ni fod gwasanaethau ambiwlans wedi cael buddsoddiad cyfalaf ychwanegol yng nghyllideb eleni, ond er mwyn sbarduno newid, sut y byddwch, sut y bydd byrddau iechyd yn cael eu cefnogi i roi'r gwelliannau hyn ar waith? A fyddwch chi'n gofyn iddyn nhw ddangos sut y byddant yn gwneud hynny yn eu cynlluniau tymor canolig integredig, oherwydd os na fyddwch yn monitro hyn, gallai yn hawdd iawn fynd ar goll yn y gymysgfa? O ran gwella'r gwasanaeth, ar y dechrau roeddem ni'n disgwyl i'r adolygiad hwn gael ei gyhoeddi ym mis Medi, ac erbyn hyn mae'n wythnos gyntaf mis Tachwedd. Dywed un dyfyniad o'r adolygiad, Er mwyn osgoi'r cyfuniad o ffactorau a welwyd yn ystod y gaeaf diwethaf, mae'n rhaid i'r gwasanaeth ambiwlans a'r GIG ehangach sicrhau ei fod yn achub ar bob cyfle i sicrhau bod mwy o adnoddau ar gael a'u bod yn cynyddu eu heffeithlonrwydd er mwyn i gleifion o Gymru gael ymateb ambiwlansys o fewn amser priodol ac o'r safon uchaf. Felly, sut mae byrddau iechyd lleol yn mynd i gael hyn yn barod i'w weithredu ar gyfer y gaeaf hwn a chyfnod y Nadolig? A oedden nhw'n gwybod am yr adolygiad hwn cyn i ni gael gwybod amdano yma yn y Cynulliad? A ydyn nhw wedi sefydlu cynlluniau cydnerthedd cyn y gaeaf? Llywydd, mae gennyf i un cwestiwn arall. Yng nghefn yr adolygiad hwn ceir rhestr o gardiau protocol a ddefnyddir gan staff y ganolfan alwadau, ac yr oeddwn i'n synnu gweld nad oes cerdyn protocol ar gyfer sepsis. Fel y gwyddoch, mae sepsis yn lladd mwy o bobl bob blwyddyn na chanser y coluddyn, canser y brostad a chanser y fron gyda'i gilydd. A cheir dangosyddion allweddol. Fe wn i ei fod yn debyg i gameleon, ond mae arwyddion o oerfel a chryndod, dryswch a lleferydd aneglur, poen difrifol yn y cyhyrau, anadlu cyflym a thymheredd uchel iawn neu isel iawn yn ddangosyddion clir fod rhywun efallai'n dioddef o sepsis. Fe wyddwn os gallwn achub pobl yn gynnar, y bydd ganddyn nhw fwy o siawns o adferiad llwyr a llawn. Dim cerdyn protocol. A wnewch chi addo edrych os gwelwch yn dda ar hynny a gweld os byddai'n briodol i gynnwys cerdyn protocol a'i ychwanegu at y 19 o gardiau protocol eraill y mae'r gwasanaeth ambiwlans yn gweithio yn unol â nhw ar hyn o bryd?