English: Thank you, Deputy Presiding Officer. Betsi Cadwaladr University Health Board was placed into special measures in June 2015. The significant concerns at the time centred on leadership and governance, maternity services, mental health, re-connecting with the public and primary care out-of-hours services. Progress has been made in each of these areas. Maternity services and primary care out-of-hours services have both been de-escalated and are no longer special measures concerns. The health board has met a number of the expectations set out in the special measures improvement framework to be achieved by April this year. There have been improvements in governance and quality processes, board leadership, mental health services, engagement and partnership working, and achieving sustainable hours in general practice. David Jenkins, the independent adviser to the board, has provided assurance that board oversight and scrutiny of delivery and performance has improved markedly. He also reports the board is now setting clear expectations and providing constructive challenge. The chair has brought new impetus with more active and constructive participation in partnership working arrangements. Quality improvement has been a key driver for the health board under the clinical leadership of the executive director of nursing and midwifery. Concerns-related data is now available at ward level following the roll-out of the harms dashboard and harm summits to promote shared learning. There's also been significant improvements in infection rates, including a reduction of more than 50 per cent in MRSA rates. I've been pleased to see that recent Healthcare Inspectorate Wales reports on mental health, together with feedback from Emrys Elias, the independent adviser on mental health services, have provided independent assurance that improvements have been made to the quality of care provided, the commitment of staff, and access for patients. Like all health boards, Betsi Cadwaladr University Health Board is collaborating with partners through local primary care clusters to transform local services. The health board is achieving positive results with fewer GP practice resignations, managed GP practices moving back to general medical services contracts, and all trainee GP posts in north Wales filled for the first time. The special measures oversight has, however, identified other concerns across the whole system to deliver the progress needed in finance, planning and waiting-time performance. The health board has not met the expectations set out in the framework in these areas. The health board faces a significant financial challenge, but also opportunities to improve on its financial position. This has been supported by local assessments of financial opportunity and benchmarking. In 2013, a Deloitte's benchmarking exercise identified potential efficiency savings ranging from between £85 million to £125 million. A further internal benchmarking exercise in 2017 estimated an even higher level of potential saving. It is simply not acceptable that little or no progress has been made in pursuing these opportunities. To make the required progress, I have agreed support that PricewaterhouseCoopers works alongside the health board during the first quarter of this year to improve its planning and approach to deliver sustainable financial improvement. This will help to ensure it has a more robust plan for 2019-20 and a basis for sustainable financial planning for the future. I also recognise the need for additional high calibre turnaround expertise and officials are already working with the chair of the health board to take forward the Public Accounts Committee's recommendations in this area. The future success of the health board beyond special measures in delivering timely, high-quality services within the resources available will depend upon its ability to develop a sustainable clinical strategy. A clear strategy is necessary to underpin the board's wider vision of providing care closer to home with an increased focus on improved population health and well-being. This is also the clear view of the Wales Audit Office. Without an appropriate clinical strategy, the board will struggle to sustainably address its poor performance in planned and unscheduled care. It is also likely to remain overly reliant on locum and agency staff in trying to maintain services with associated service quality and cost implications. Whilst the clinical services strategy is developed, I will be providing more focused support to deliver progress in waiting times, specifically in orthopaedics, urology, endoscopy and child and adolescent mental health services. To secure sustainable improvements in orthopaedic services, I have asked the NHS chief executive to intervene to ensure progress is made. Support will be provided to invest in community musculoskeletal services, expansion in the number of orthopaedic consultants with a further six posts, and to finalise the capital design and procurement process for the capital schemes across the three main hospitals. The additional recurrent funding that I announced last July has supported increased capacity, capability and resilience across the three main hospitals. I expect the 90-day improvement cycles in unscheduled care to maintain improvements in patient flow and to start to demonstrate a sustained positive impact on other unscheduled care targets. I expect to see significant action and progress on the outstanding concerns so that people in north Wales are assured the focus remains on making the improvements necessary beyond special measures.
Welsh: Diolch yn fawr, Dirprwy Lywydd. Rhoddwyd Bwrdd Iechyd Prifysgol Betsi Cadwaladr mewn mesurau arbennig ym mis Mehefin 2015. Roedd y pryderon sylweddol ar y pryd yn ymwneud ag arwain a llywodraethu, gwasanaethau mamolaeth, iechyd meddwl, ailgysylltu â'r gwasanaethau cyhoeddus a gofal sylfaenol y tu allan i oriau. Gwnaed cynnydd ym mhob un o'r meysydd hyn. Cafodd gwasanaethau mamolaeth a gwasanaethau gofal sylfaenol y tu allan i oriau eu his-gyfeirio ac nid ydyn nhw bellach yn destun mesurau arbennig. Mae'r bwrdd iechyd wedi bodloni nifer o'r disgwyliadau a nodwyd yn y fframwaith gwella mesurau arbennig sydd i'w gyflawni erbyn mis Ebrill eleni. Bu gwelliannau o ran prosesau llywodraethu ac ansawdd, arweinyddiaeth y bwrdd, gwasanaethau iechyd meddwl, ymgysylltu a gweithio mewn partneriaeth, a sicrhau oriau cynaliadwy mewn ymarfer cyffredinol. Mae David Jenkins, yr ymgynghorydd annibynnol i'r bwrdd, wedi rhoi sicrwydd bod gwaith y bwrdd yn goruchwylio ac yn craffu ar y ddarpariaeth a'r perfformiad wedi gwella'n sylweddol. Dywed hefyd fod y bwrdd bellach yn gosod disgwyliadau clir ac yn herio'n adeiladol. Mae'r cadeirydd wedi dod â chymhelliant newydd gyda chyfranogiad mwy gweithredol ac adeiladol mewn trefniadau gweithio mewn partneriaeth. Mae gwella ansawdd wedi bod yn sbardun allweddol i'r bwrdd iechyd dan arweiniad clinigol y cyfarwyddwr gweithredol nyrsio a bydwreigiaeth. Mae data sy'n ymwneud â phryderon bellach ar gael ar gyfer wardiau unigol yn dilyn cyflwyno'r dangosfwrdd niwed ac uwchgynadleddau niwed i hybu dysgu a rennir. Bu gwelliannau sylweddol hefyd yng nghyfraddau heintiau, gan gynnwys gostyngiad o fwy na 50 y cant mewn cyfraddau MRSA. Roeddwn yn falch o weld bod adroddiadau diweddar gan Arolygiaeth Gofal Iechyd Cymru ar iechyd meddwl, ynghyd ag adborth gan Emrys Elias, y cynghorydd annibynnol ar wasanaethau iechyd meddwl, wedi rhoi sicrwydd annibynnol bod gwelliannau wedi'u gwneud i ansawdd y gofal a ddarperir, i ymrwymiad y staff, ac i fynediad i gleifion. Fel pob bwrdd iechyd, mae Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn cydweithio â phartneriaid drwy glystyrau gofal sylfaenol lleol i weddnewid gwasanaethau lleol. Mae'r bwrdd iechyd yn gwneud yn dda gyda llai o ymddiswyddiadau mewn practisau meddygon teulu, practisau meddygon teulu a reolir yn dychwelyd at gontractau gwasanaethau meddygol cyffredinol, ac mae pob swydd dan hyfforddiant i feddygon teulu yn y gogledd yn llawn am y tro cyntaf. Canfuwyd o'r trosolwg mesurau arbennig, fodd bynnag, bod pryderon eraill drwy'r system gyfan o ran cyflawni'r cynnydd sydd ei angen ym maes cyllid, cynllunio a pherfformiad amser aros. Nid yw'r bwrdd iechyd wedi bodloni'r disgwyliadau a nodir yn y fframwaith yn y meysydd hyn. Mae'r bwrdd iechyd yn wynebu her ariannol sylweddol, ond mae cyfleoedd hefyd i wella ei sefyllfa ariannol. Cefnogwyd hyn gan asesiadau lleol o gyfleoedd ariannol a meincnodi. Yn 2013, canfuwyd o waith meincnodi gan Deloitte bod modd gwneud arbedion effeithlonrwydd o rhwng £85,000,000 a £125,000,000. Amcangyfrifwyd o waith meincnodi mewnol pellach yn 2017 ei bod hi'n bosib arbed mwy fyth. Nid yw'n dderbyniol o gwbl na wnaed fawr ddim cynnydd, os o gwbl, o ran manteisio ar y cyfleoedd hyn. Er mwyn gwneud y cynnydd gofynnol, rwyf wedi cytuno i roi cymorth i PricewaterhouseCoopers weithio gyda'r bwrdd iechyd yn ystod chwarter cyntaf eleni i wella'r ffordd y mae'n cynllunio ac yn gweithio i sicrhau gwelliant ariannol cynaliadwy. Bydd hyn yn helpu i sicrhau bod gan y bwrdd gynllun mwy cadarn ar gyfer 2019-20 a sail ar gyfer cynllunio ariannol cynaliadwy ar gyfer y dyfodol. Rwyf hefyd yn cydnabod yr angen am arbenigedd ychwanegol o ran newid, a hynny o safon uchel, ac mae swyddogion eisoes yn gweithio gyda chadeirydd y bwrdd iechyd i fwrw ymlaen ag argymhellion y Pwyllgor Cyfrifon Cyhoeddus yn y maes hwn. Bydd llwyddiant y bwrdd iechyd yn y dyfodol y tu hwnt i fesurau arbennig wrth ddarparu gwasanaethau amserol o ansawdd uchel o fewn yr adnoddau sydd ar gael yn dibynnu ar ei allu i ddatblygu strategaeth glinigol gynaliadwy. Mae angen strategaeth glir i ategu gweledigaeth ehangach y bwrdd i ddarparu gofal yn agosach at y cartref gan ganolbwyntio mwy ar wella iechyd a lles y boblogaeth. Dyma hefyd yw barn glir Swyddfa Archwilio Cymru. Heb strategaeth glinigol briodol, bydd y bwrdd yn ei chael hi'n anodd mynd i'r afael yn gynaliadwy â'i berfformiad gwael o ran gofal wedi'i gynllunio a heb ei drefnu. Mae hefyd yn debygol o barhau'n orddibynnol ar staff locwm ac asiantaeth wrth geisio cynnal gwasanaethau, ac mae ansawdd gwasanaeth cysylltiedig a goblygiadau cost yn gysylltiedig â hynny. Wrth i'r strategaeth gwasanaethau clinigol gael ei datblygu, byddaf yn darparu cymorth mwy penodol er mwyn sicrhau cynnydd mewn amseroedd aros, yn enwedig ym maes orthopedeg, wroleg, endosgopi a gwasanaethau iechyd meddwl i blant a'r glasoed. Er mwyn sicrhau gwelliannau cynaliadwy mewn gwasanaethau orthopedig, rwyf wedi gofyn i brif weithredwr y GIG ymyrryd er mwyn sicrhau y gwneir cynnydd. Rhoddir cymorth i fuddsoddi mewn gwasanaethau cyhyrysgerbydol cymunedol, i gynyddu nifer yr ymgynghorwyr orthopedig gyda chwe swydd arall, ac i gwblhau'r broses ddylunio a chaffael cyfalaf ar gyfer y cynlluniau cyfalaf yn y tri phrif ysbyty. Mae'r arian rheolaidd ychwanegol a gyhoeddais fis Gorffennaf diwethaf wedi cefnogi mwy o gapasiti, gallu a chydnerthedd yn y tri phrif ysbyty. Disgwyliaf i'r cylchoedd gwella 90 diwrnod mewn gofal heb ei drefnu barhau i wella llif cleifion a dechrau dangos effaith gadarnhaol barhaus ar dargedau eraill gofal heb ei drefnu. Disgwyliaf weld gweithredu a chynnydd sylweddol o ran y pryderon sy'n weddill er mwyn sicrhau pobl yn y gogledd bod y pwyslais yn parhau ar wneud y gwelliannau y mae eu hangen y tu hwnt i fesurau arbennig.