English: I'm grateful for the opportunity to contribute to today's debate. We have excellent ambulance services here in the UK. I have a lot to speak, but I don't have time. Ambulance response times are an indicator of system failure, and that our staff, who are exceptionally capable, are now being let down by a health and care system that is badly configured, where patient care is being compromised by long waits to be connected, long waits in our ambulances outside the hospital, and long waits in the A&E department to be assessed. Much of this is sadly not new, and the fact that we are here yet again debating ambulance response times tells us that the Government has not resolved the problem. COVID-19 has slowed us down, and it has shown us our weaknesses in how we structure and plan our health and care system. I will focus my contribution to those actions that the Government could consider, addressing some areas that would affect our ambulance provisions, specifically (1) improvements to out-of-hours services and operations of A&E departments; (2) measures to lower the rate of bed occupancy; and (3) ambulance staff recruitment. Firstly, we know that out-of-hours services can be effective, but they are hampered by not being able to access on-site diagnostic tests. Instead of referring a patient further up the line to establish the nature of the problem, why can't the Government examine the resources available at out-of-hours to improve their effectiveness? Addressing this capacity outside of A&E departments would be beneficial. Equally, the operation of A&E departments requires attention, and so too do waiting times. We need additional space, more trained casualty doctors, and observation wards. Well-trained accident and emergency consultants should be in charge on the floor and the number of doctors has to be increased to eliminate the inhuman waiting times in the departments. It will also allow an effective ambulance service. There are also concerns about 'hospital by night', which, in many hospitals, has created a lot of problems, both for junior staff in the delivery of healthcare and to the people in emergencies. The service is delivered by medical staff who may have no experience in that field. If this service must be continued, then it should be delivered directly by the consultants of different specialities in the A&E department. Otherwise, in the interests of the delivery of patient care, it should be stopped immediately. In addressing the problem of capacity in A&E, it is time that the Government considers how the NHS responds to flu. We have this debate every year - winter pressures and what to do about it. In my view, those with flu should never have to be dealt with in an A&E department; they should have a separate door to the medical department to go to. It is like a road traffic accident; when the road is blocked, the police find a diversion. At the time when cases of flu return, the A&E department should not have to cope with this extra surge in patients because the plan should have been made knowing that this was going to happen - it always does in winter. I would like to ask the Minister what assessment can she offer of the likely number of people requiring hospitalisation this year because of flu, and the anticipated impact on the ambulance services. I hope she will address this point, because I want assurance that the Government has a plan. Deputy Presiding Officer, this brings me to my second point, and that is the difficulty in helping people to leave hospital when they are fit to do so, and how we can free up beds, which will have a positive effect on the ambulance service. We know that around 100 patients are in hospital waiting to be discharged because of the brittle state of the care sector, as said by the Minister. Many people waiting to be discharged will need residential or nursing care -
Welsh: Rwy'n ddiolchgar am y cyfle i gyfrannu at y ddadl heddiw. Mae gennym wasanaethau ambiwlans rhagorol yma yn y DU. Mae gennyf lawer i'w ddweud, ond nid oes gennyf amser. Mae amseroedd ymateb ambiwlansys yn arwydd o fethiant y system, ac mae ein staff, sy'n eithriadol o alluog, bellach yn cael eu siomi gan system iechyd a gofal sydd wedi'i chyflunio'n wael, lle mae gofal cleifion yn cael ei beryglu gan amseroedd aros hir i gael eu cysylltu, amseroedd aros hir yn ein hambiwlansys y tu allan i'r ysbyty, ac amseroedd aros hir yn yr adran ddamweiniau ac achosion brys i gael eu hasesu. Yn anffodus, nid yw llawer o hyn yn newydd, ac mae'r ffaith ein bod yma eto'n trafod amseroedd ymateb ambiwlansys yn dweud wrthym nad yw'r Llywodraeth wedi datrys y broblem. Mae COVID-19 wedi ein harafu, ac mae wedi dangos ein gwendidau o ran y modd y strwythurwn ac y cynlluniwn ein system iechyd a gofal. Rwyf am ganolbwyntio fy nghyfraniad ar y camau y gallai'r Llywodraeth eu hystyried, gan fynd i'r afael â rhai meysydd a fyddai'n effeithio ar ein darpariaethau ambiwlans, yn benodol (1) gwelliannau i wasanaethau y tu allan i oriau a gweithrediadau adrannau damweiniau ac achosion brys; (2) mesurau i ostwng cyfradd y gwelyau sy'n cael eu defnyddio; a (3) recriwtio staff ambiwlans. Yn gyntaf, gwyddom y gall gwasanaethau y tu allan i oriau fod yn effeithiol, ond cânt eu llesteirio gan yr anallu i gael profion diagnostig ar y safle. Yn hytrach na chyfeirio claf ymhellach i fyny'r llinell i sefydlu natur y broblem, pam na all y Llywodraeth archwilio'r adnoddau sydd ar gael y tu allan i oriau i wella eu heffeithiolrwydd? Byddai mynd i'r afael â'r capasiti hwn y tu allan i adrannau damweiniau ac achosion brys yn fuddiol. Yn yr un modd, mae angen rhoi sylw i weithrediad adrannau damweiniau ac achosion brys, ac felly hefyd i amseroedd aros. Mae arnom angen gofod ychwanegol, mwy o feddygon argyfwng hyfforddedig, a wardiau arsylwi. Dylai meddygon ymgynghorol damweiniau ac achosion brys sydd wedi'u hyfforddi'n dda fod wrth y llyw yn yr adran ac mae'n rhaid cynyddu nifer y meddygon er mwyn cael gwared ar yr amseroedd aros annynol yn yr adrannau. Bydd hyn hefyd yn caniatáu gwasanaeth ambiwlans effeithiol. Ceir pryderon hefyd am 'ysbytai liw nos', sydd, mewn llawer o ysbytai, wedi creu llawer o broblemau, i staff iau wrth ddarparu gofal iechyd ac i'r bobl sy'n dioddef argyfwng. Darperir y gwasanaeth gan staff meddygol nad oes ganddynt unrhyw brofiad yn y maes hwnnw o bosibl. Os oes rhaid parhau'r gwasanaeth hwn, dylai meddygon ymgynghorol y gwahanol feysydd arbenigol ei ddarparu'n uniongyrchol yn yr adran ddamweiniau ac achosion brys. Fel arall, er mwyn darparu gofal i gleifion, dylid rhoi'r gorau iddo ar unwaith. Wrth fynd i'r afael â phroblem capasiti mewn adrannau damweiniau ac achosion brys, mae'n bryd i'r Llywodraeth ystyried sut y mae'r GIG yn ymateb i'r ffliw. Rydym yn cael y ddadl hon bob blwyddyn - pwysau'r gaeaf a beth y dylid ei wneud yn ei gylch. Yn fy marn i, ni ddylai pobl sydd â'r ffliw fyth orfod cael eu trin mewn adran ddamweiniau ac achosion brys; dylent gael drws ar wahân i fynd i adran feddygol. Mae fel damwain ffordd; pan fydd y ffordd wedi'i chau, daw'r heddlu o hyd i ddargyfeiriad. Ar yr adeg pan fydd achosion o'r ffliw'n dychwelyd, ni ddylai'r adran ddamweiniau ac achosion brys orfod ymdopi â'r cynnydd ychwanegol hwn yn nifer y cleifion oherwydd dylid bod wedi llunio'r cynllun gan wybod bod hyn yn mynd i ddigwydd - mae bob amser yn digwydd yn y gaeaf. Hoffwn ofyn i'r Gweinidog pa asesiad y gall ei gynnig o'r nifer debygol o bobl y bydd angen iddynt fynd i'r ysbyty eleni oherwydd y ffliw, a'r effaith a ragwelir ar y gwasanaethau ambiwlans. Rwy'n gobeithio yr aiff i'r afael â'r pwynt hwn, oherwydd rwyf eisiau sicrwydd fod gan y Llywodraeth gynllun. Ddirprwy Lywydd, daw hyn â mi at fy ail bwynt, sef yr anhawster wrth helpu pobl i adael yr ysbyty pan fyddant yn barod i wneud hynny, a sut y gallwn ryddhau gwelyau, rhywbeth a fydd yn cael effaith gadarnhaol ar y gwasanaeth ambiwlans. Gwyddom fod tua 100 o gleifion yn yr ysbyty yn aros i gael eu rhyddhau oherwydd cyflwr bregus y sector gofal, fel y dywedodd y Gweinidog. Bydd llawer o bobl sy'n aros i gael eu rhyddhau angen gofal preswyl neu ofal nyrsio -