English: Thank you, Deputy Presiding Officer. Last October, I shared with the previous Assembly my plans to extend the major health delivery plans until March 2020. The cancer, heart disease, diabetes, end-of-life care, critically ill and stroke delivery plans have been reviewed and are in the process of being refreshed. The respiratory and neurological conditions plans will be reviewed in 2017. The liver disease delivery plan is due to end in 2020. I am going to launch the second mental health delivery plan on 10 October on World Mental Health Day. This Government has invested £10 million annually - that's £1 million for each of the delivery plans - and the impact of this investment is reported in annual reports for each major health condition. There is a lot to be proud of. Since their introduction, each delivery plan has helped to improve the care and treatment of people with a major health condition. There have been significant improvements in patient outcomes including, for example, a steady decline in the rate of people in Wales dying from cardiovascular disease and diabetes-related diseases. Survival rates for many major health conditions such as stroke and heart disease are improving, as are survival rates for people being treated in critical care units in Wales. Each delivery group has had a focus on prevention and support, with an emphasis on co-production with the third sector in particular. The diabetes implementation group has developed patient resources to educate and support people living with diabetes, covering subjects such as the importance of retinal screening, foot care and hypoglycaemia. The stroke implementation group is piloting an approach with primary and community care to identify those at risk of atrial fibrillation and ensure that the appropriate treatment is in place. This should reduce the number of people having strokes, as well as supporting people to understand and manage their own risk. The results from the pilot indicate that, if rolled out, this approach could result in a 10 per cent reduction in the number of strokes across Wales. Ensuring services are working well and efficiently for the benefit of patients is a key aspect of each delivery plan. Working in partnership, the heart disease, stroke and diabetes implementation groups are introducing a national programme for cardiovascular risk assessment. This is focusing upon patients with the highest risk of cardiovascular disease in the most deprived areas in Wales, and aims to identify undiagnosed cardiovascular disease and to support people to reduce their own risk factors for developing the condition. Developing effective rehabilitation services has been a national priority for both the neurological conditions and stroke implementation groups. As a result, both groups have jointly provided £1.2 million to support community neuro-rehabilitation services. In addition, staff at Cardiff and Vale University Local Health Board ran a pilot seven-day patient-centred, integrated rehabilitation service for stroke. The results have shown a reduction in the average length of stay for patients from 58 days down to 24 days. The new service has continued and has been expanded. The learning from this service will be shared with other health boards at a national stroke learning event. Making sure patients receive fast diagnosis improves the support and treatment that services can provide, and there are many excellent examples of progress in this area, including the new community cardiology service funded by the heart disease implementation group, now in operation across all health boards. The service provides a direct access one-stop cardiology community clinic and has introduced community cardiology services to provide basic diagnostics and assessment closer to home in primary care or in a community hospital setting. Supported by Macmillan Cancer Support and the cancer delivery plan, a programme of investment in primary care oncology has commenced. Lead GPs and nurses have been identified in each health board area to support primary care clusters to improve diagnosis, referral and post-treatment support. In September last year, the end-of-life care implementation board introduced an advance care plan, which details a patient's wishes and preferences for future care. To date, for example, more than 900 members of staff have received training on care decisions in Betsi Cadwaladr University Local Health Board alone. In response to its local priorities required to deliver the critically ill delivery plan, Cardiff and Vale university health board opened a post-anaesthetic care unit in January last year, providing ring-fenced critical care capacity for high-risk, post-operative elective patients. The new unit has already delivered improved patient outcomes and revolutionised the delivery of critical care for elective surgery patients. For example, it's reduced cancellations due to emergency pressures, it's supported a further reduction in length of stay, and it's reduced delayed transfers of care. To actively self-manage, individuals need confidence and skills to manage their health on a daily basis and implementation groups have worked with health boards to improve services and patient experience. The diabetes implementation group has developed an all-Wales structured education programme for 11 to 16-year-olds with diabetes, called SEREN. For each of the delivery plans, the patient experience and their voice are represented by the appropriate support groups. The neurological conditions and stroke implementation group are working together to develop a patient-reported experience measure and a patient-reported outcome measure for stroke and neurological conditions. This is a really significant piece of work that has not been attempted in other parts of the UK before. Both measures should be available for national roll-out by March 2018. The cancer implementation group has established a three-year quality and governance cycle for peer review. All of the main cancer services have been reviewed and are now being re-reviewed, starting with lung cancer during 2016. Findings have already demonstrated measurable change, including the funding of clinical nurse specialists and other clinical staff, and the development of clinical policies and protocols to minimise unnecessary variation in standards of care across health boards. This model has been adapted by a number of implementation groups, such as those for the critically ill, heart disease and diabetes. As I hope Members can see, from each delivery plan and implementation group, there has been a profound and positive impact. I expect the refreshed delivery plans to continue to do so, and I would like to thank the implementation groups for the progress that they have made against the current plans, and I look forward to further achievements over the coming years right across Wales.
Welsh: Diolch, Ddirprwy Lywydd. Fis Hydref diwethaf, rhannais â'r Cynulliad blaenorol fy nghynlluniau i ymestyn y cynlluniau cyflawni ar gyfer iechyd difrifol tan fis Mawrth 2020. Mae'r cynlluniau cyflawni ar gyfer canser, clefyd y galon, diabetes, gofal diwedd bywyd, y rhai difrifol wael a strôc wedi cael eu hadolygu ac maent wrthi'n cael eu hadnewyddu. Bydd y cynlluniau ar gyfer cyflyrau anadlol a niwrolegol yn cael eu hadolygu yn 2017. Mae'r cynllun cyflawni ar gyfer clefyd yr afu/iau yn dod i ben yn 2020. Byddaf yn lansio'r ail gynllun cyflawni ar gyfer iechyd meddwl ar 10 Hydref ar Ddiwrnod Iechyd Meddwl y Byd. Mae'r Llywodraeth hon wedi buddsoddi £10 miliwn yn flynyddol - sef £1 filiwn ar gyfer pob un o'r cynlluniau cyflawni - ac mae effaith y buddsoddiad hwn yn cael ei hadrodd mewn adroddiadau blynyddol ar bob cyflwr iechyd difrifol. Mae gennym lawer i fod yn falch ohono. Ers eu cyflwyno, mae pob cynllun cyflawni wedi helpu i wella'r gofal a'r driniaeth i bobl sydd â chyflwr iechyd difrifol. Bu gwelliannau sylweddol yn y canlyniadau i gleifion, gan gynnwys, er enghraifft, ostyngiad cyson yng nghyfradd y bobl yng Nghymru sy'n marw o glefyd cardiofasgwlaidd a chlefydau sy'n gysylltiedig â diabetes. Mae'r cyfraddau goroesi ar gyfer llawer o gyflyrau iechyd difrifol fel strôc a chlefyd y galon yn gwella, fel y mae'r cyfraddau goroesi ar gyfer pobl sy'n cael eu trin mewn unedau gofal critigol yng Nghymru. Mae pob grŵp cyflawni wedi canolbwyntio ar atal a chymorth, gyda phwyslais ar gyd-gynhyrchu â'r trydydd sector yn benodol. Mae'r grŵp gweithredu ar gyfer diabetes wedi datblygu adnoddau i gleifion sy'n addysgu a chefnogi pobl sy'n byw gyda diabetes. Mae'r adnoddau hyn yn cynnwys pynciau fel pwysigrwydd sgrinio'r retina, gofal traed a hypoglycemia. Mae'r grŵp gweithredu ar gyfer strôc yn treialu dull o weithredu gyda gofal sylfaenol a chymunedol sy'n nodi'r rhai sydd mewn perygl o ffibriliad atrïaidd a sicrhau bod y driniaeth briodol yn ei lle. Dylai hyn leihau nifer y bobl sy'n cael strôc, yn ogystal â chefnogi pobl i ddeall a rheoli eu risg eu hunain. Dengys y canlyniadau o'r cynllun peilot y gallai'r dull hwn, o'i roi ar waith, arwain at ostyngiad o 10 y cant yn nifer y bobl sy'n cael strôc ledled Cymru. Mae sicrhau bod gwasanaethau'n gweithio'n dda ac yn effeithlon er budd y claf yn un o'r agweddau allweddol ar bob cynllun cyflawni. Gan weithio mewn partneriaeth, mae'r grwpiau gweithredu ar gyfer clefyd y galon, strôc a diabetes yn cyflwyno rhaglen genedlaethol i asesu risg cardiofasgwlaidd. Mae hyn yn canolbwyntio ar gleifion sydd â'r risg uchaf o glefyd cardiofasgwlaidd yn yr ardaloedd mwyaf difreintiedig yng Nghymru. Y nod yw dod o hyd i glefyd cardiofasgwlaidd sydd heb ei ganfod a chefnogi pobl i leihau eu ffactorau risg eu hunain o ddatblygu'r cyflwr. Bu datblygu gwasanaethau adsefydlu effeithiol yn flaenoriaeth genedlaethol i grwpiau cyflyrau niwrolegol a gweithredu ar gyfer strôc. O ganlyniad, mae'r ddau grŵp ar y cyd wedi darparu £1.2 miliwn i gefnogi gwasanaethau adsefydlu niwro yn y gymuned. Yn ogystal â hyn, fe wnaeth staff ym Mwrdd Iechyd Lleol Prifysgol Caerdydd a'r Fro gynnal gwasanaeth adsefydlu integredig peilot am saith diwrnod a oedd yn canolbwyntio ar gleifion strôc. Mae'r canlyniadau wedi dangos bod yr amser aros i gleifion mewn ysbyty wedi gostwng ar gyfartaledd o 58 i 24 diwrnod. Mae'r gwasanaeth newydd wedi parhau ac wedi cael ei ehangu. Bydd yr hyn a ddysgir o'r gwasanaeth hwn yn cael ei rannu â byrddau iechyd eraill mewn digwyddiad cenedlaethol i ddysgu am strôc. Mae sicrhau bod cleifion yn cael diagnosis cyflym yn gwella'r cymorth a'r driniaeth y gall gwasanaethau eu darparu. Gwelwyd llawer o enghreifftiau ardderchog o gynnydd yn y mae hwn, gan gynnwys y gwasanaeth cardioleg cymunedol newydd a ariennir gan y grŵp gweithredu ar gyfer clefyd y galon, sydd bellach yn weithredol ar draws yr holl fyrddau iechyd. Mae'r gwasanaeth yn cynnig clinig cardioleg cymunedol sydd â mynediad uniongyrchol un stop, a chafodd gwasanaethau cardioleg cymunedol eu cyflwyno i ddarparu diagnosteg ac asesiad yn nes at gartref y claf mewn gofal sylfaenol neu mewn ysbyty cymunedol. Gyda chefnogaeth Cymorth Canser Macmillan a'r cynllun cyflawni ar gyfer canser, mae rhaglen o fuddsoddi mewn oncoleg gofal sylfaenol wedi dechrau. Nodwyd meddygon teulu a nyrsys arweiniol ym mhob ardal bwrdd iechyd i gefnogi clystyrau gofal sylfaenol i wella diagnosis, atgyfeirio a chefnogaeth ôl-driniaeth. Ym mis Medi y llynedd, cyflwynodd y bwrdd gweithredu ar gyfer gofal diwedd oes gynllun gofal ymlaen llaw, sy'n rhoi manylion am ddymuniadau a dewisiadau'r claf ar gyfer ei ofal yn y dyfodol. Hyd yn hyn, er enghraifft, mae mwy na 900 o aelodau o staff wedi cael hyfforddiant ar benderfyniadau gofal ym Mwrdd Iechyd Lleol Prifysgol Betsi Cadwaladr yn unig. Mewn ymateb i'w flaenoriaethau lleol y mae eu hangen i gyflawni'r cynllun cyflawni ar gyfer y rhai difrifol wael, agorodd bwrdd iechyd prifysgol Caerdydd a'r Fro uned gofal ôl-anaesthetig ym mis Ionawr y llynedd. Mae'r uned newydd hon yn darparu capasiti ar gyfer gofal critigol wedi'i neilltuo i gleifion risg uchel dewisol, ar ôl llawdriniaeth. Mae eisoes wedi darparu gwell canlyniadau i gleifion a chwyldroi'r modd y mae gofal critigol yn cael ei ddarparu i gleifion llawdriniaeth ddewisol. Er enghraifft, mae llai o achosion o ganslo llawdriniaethau oherwydd pwysau argyfwng, mae'n golygu lleihad pellach yn yr amser y mae'n rhaid i'r claf aros yn yr ysbyty, ac mae llai o oedi wrth drosglwyddo gofal. Er mwyn mynd ati i hunanreoli, mae angen hyder a sgiliau ar unigolion i reoli eu hiechyd yn ddyddiol ac mae grwpiau gweithredu wedi gweithio â'r byrddau iechyd i wella gwasanaethau a phrofiad y claf. Mae'r grŵp gweithredu ar gyfer diabetes wedi datblygu rhaglen addysg strwythuredig Cymru gyfan ar gyfer rhai 11 i 16 mlwydd oed sydd â diabetes, a elwir yn SEREN. Ar gyfer pob un o'r cynlluniau cyflawni, mae profiad y cleifion a'u llais yn cael eu cynrychioli gan y grwpiau cymorth priodol. Mae'r grŵp gweithredu ar gyfer cyflyrau niwrolegol a strôc yn cydweithio i ddatblygu mesurau profiad a chanlyniad a adroddir gan gleifion cyflyrau niwrolegol a strôc. Mae hwn yn waith hynod bwysig nad yw unrhyw rannau eraill o'r DU wedi mynd i'r afael ag ef o'r blaen. Dylai'r ddau fesur fod yn barod i'w cyflwyno'n genedlaethol erbyn mis Mawrth 2018. Mae'r grŵp gweithredu ar gyfer canser wedi sefydlu cylch safon a llywodraethu tair blynedd ar gyfer adolygiad gan gymheiriaid. Adolygwyd pob un o'r prif wasanaethau canser, ac maent bellach yn cael eu hail-adolygu, gan ddechrau gyda chanser yr ysgyfaint yn ystod 2016. Mae'r canfyddiadau eisoes wedi dangos newid mesuradwy, gan gynnwys ariannu arbenigwyr nyrsio clinigol a staff clinigol eraill, a datblygu polisïau a phrotocolau clinigol i leihau amrywiad diangen mewn safonau gofal ar draws byrddau iechyd. Addaswyd y model hwn gan nifer o grwpiau gweithredu, fel y rhai ar gyfer pobl ddifrifol wael, clefyd y galon a diabetes. Rwy'n gobeithio y gall yr Aelodau weld bod pob cynllun cyflawni a grŵp gweithredu wedi cael effaith sylweddol a chadarnhaol. Rwy'n disgwyl i'r cynlluniau cyflawni ar eu newydd wedd barhau i gael yr effaith honno, a hoffwn ddiolch i'r grwpiau gweithredu am y cynnydd y maent wedi'i wneud yn erbyn y cynlluniau presennol. Edrychaf ymlaen at gyflawniadau pellach dros y blynyddoedd sydd i ddod ar draws Cymru gyfan.