English: Thank you, Deputy Presiding Officer, and thank you to Huw Davies for another opportunity to speak today in the Chamber, but in particular for using today's short debate to highlight the importance of accessing high- quality primary care services. Our local healthcare services account for more than 90 per cent of people's contact with the healthcare system here in Wales. Of all the points that were made today, it's been really interesting that so much of it has focused on the hospital-based part of that system and yet the great majority - as I said, over 90 per cent - of people's interaction takes place in our local healthcare service. And I certainly want our local healthcare service in Wales not just to be based on the principles of prudent healthcare as a mainstay of a sustainable health and care system that is generally able to respond to the changing needs of our population, but I share what you say as well: I want every single community across our country to have not just high-quality healthcare locally, but actually to have good access to it, to have really great care and to understand what that looks like. And in many parts of the country, that will look different to the system that has served us well up to this point in time, because I recognise the stress and the pressures that we frequently discuss in this place over the future of our local healthcare service, and in particular GPs as significant, if you like, leading parts of our local healthcare system, because we recognise that local healthcare is changing, and it needs to. There are so many drivers that we frequently rehearse in this Chamber and otherwise, but we want it to deliver more care closer to home, with a more preventative approach: so, the idea of treating illness, moving beyond that to actually how you prevent ill health, and having a much wider team of people. That's why our national primary care plan sets out key actions to improve local health, and that includes developing a more integrated, multi-professional workforce that collaborates at a very local level to meet people's needs at, or close to, home, and recognises that much more care could and should take place in people's own homes. I'm really pleased that you mentioned in your own contribution the reality that we want to keep people out of hospital. There's much more that we could and should do. I think that, sometimes, this sounds like a bit of a platitude, saying, 'This is the course we want to do', and then we go back, as politicians, to talking about hospitals again. If we can't get this right, as we discussed in the parliamentary review, there's a really difficult future ahead for the whole service. And, increasingly, though, we are seeing health boards collaborating with GP practices and other local service providers. Some of this is already happening, with pharmacists, community-based nurses, therapists, dentists, optometrists, mental health teams, social workers, third sector workers and others, through the 64 primary care clusters we've created. That's to optimise the best use of our available resources and people's time and expertise and the money we've directly provided to each of those clusters to spend on local priorities. Because I recognise that there are significant parts of Wales where they're struggling to recruit and retain GPs. We talked about that earlier, in the Health and Social Care Committee's report - not just the measures we're taking on - [Inaudible.] - and others, but cluster working is a really important part of what we want to do to keep great local healthcare. That should lead, and is already leading, to greater collaboration between GP practices - they didn't always talk to each other, frankly; so, it's between the practices, not just within them - as they identify new ways of organising themselves and making effective use of their available resources. Our national programme of Pacesetters has been really interesting in helping to identify more sustainable ways of working and providing services, like the federation of GP practices that is moving to the same place in the Bridgend locality, and the social enterprise in southern Powys, the Red Kite social enterprise. And that's been so interesting, because that's drawn together GP practices that previously did not talk to each other, and they were not friends of each other, and, now, they wouldn't have it any other way. They've got a different way of working with each other, the way that people actually access the service, and they've just taken on board a GP service in Presteigne - where the previous GP practice was handing back its contract, they've taken that on. So, there is an appetite amongst the profession to work differently, because more practices are seeing the advantages of coming together to provide a better environment to work in for staff in the service, but also a better platform to deliver great local healthcare with and for the public. I think this is where it comes back to how the national programmes can look at the challenges that you raise, because a significant part of the concern that is being taken up at the national Pacesetter programme is access. It's a common concern about the ability either to get an appointment or to get a convenient and local appointment. Much of what you say is about access to local care. From that model, that new way of working with Pacesetters, much of it focuses on how you have a triage system, whether it's on the phone or online or whether it's nurse or GP-led, but a way to actually try and direct people to the right part of care. That could be going to see a GP; that could be having advice you can deal with at home; it could be going to the pharmacy; it could be coming in to see a physiotherapist or a different healthcare professional. And what we've seen in significant parts of that is that it actually speeds up access to see a healthcare professional, and it actually helps people to get directed to the right part of the service, so GPs don't get overloaded with people they don't need to see and, potentially, they don't get to see people that they really could and should see, and I know this is an issue that the Member opposite has recognised in his own working practice well, about how you make the very best use of GP time. Now, more anticipatory care, to be designed to keep people at home rather than being admitted to hospital, and that's where we've seen the development of the virtual ward-type models around the country as well - . Now, the other part I just wanted to focus on before I go from the national to the local is the common element service in the way of pharmacy, because, again, you mentioned the point about could pharmacy be an option for people to get a service more locally. Actually, Cwm Taf have been really go-ahead on this in the way they've gone out after the Choose Pharmacy service. So, we currently have over 350 pharmacies in the country offering the service; 75 of them are in Cwm Taf. One of the pilots was in the Cwm Taf area, in Aberdare, and it was really interesting how the local GP practice recognised that it had helped them to manage the numbers of people coming through the door, and not just the numbers, but the appropriateness of people coming through the door as well. And people actually trusted their pharmacist. They had a private room to go and see them, they're registered healthcare professionals, and it's been enabled and empowered by access to a version of the GP records. There's something about the safety. And, interestingly, Cwm Taf have told me that they think that the Choose Pharmacy service has helped to eliminate handwriting mistakes in scripts to be delivered as well, so there's actually a significant benefit from a safety point of view as well. Now, in March, that service will be available to at least 400 - certainly more than half - of the pharmacies in Wales, and we want to see genuine national coverage of this service. It's National Eye Care Week, but I won't go on to talk about optometry because I do want to address directly the points you made about the local issue. And this comes on the back of an issue that other parts of the country recognise: population growth - current and planned population growth - that we know is going to happen, and you referred to Llanharan and Brynna being areas that are well connected from a transport point of view. The challenge is how we design so that services reflect what we currently have and will have, as opposed to waiting for those services to be overloaded. And there's something about the future of those services as well, and recognising that we want to work with independent contractors. So, we'd like to work with the current independent contractors to provide really good, high-quality care. And I do recognise what you say about the fact that this practice has invested in Pencoed. So, they haven't been afraid to invest, and invested in one of those sites. And I also reflect on and recognise the comments that the CHC made on the potential that, if they can't get somewhere where they think local residents want them to be, they may want to ask Cwm Taf to see if one of their other providers would want to come and open a list in the Llanharan and Brynna area. I think that means there's a greater imperative to want to have a local conversation where - [Inaudible.] - there's a different alternative. That's where I go back to the point to address the concern or the question that you raised about the offer of investment, and it partly deals with Suzy Davies's concern about ABM as well, because my understanding is that the Abertawe Bro Morgannwg University Local Health Board did offer some investment for services to stay in the Llanharan and Brynna area. I don't know why that hasn't been taken up, but I am happy to ask if that previous offer from the Abertawe Bro Morgannwg health board area can still be on the table as part of an open conversation. The final point, which I guess is your main ask from me, is whether I am prepared to use my good offices, to use one of those phrases, to try and engineer a conversation with relevant stakeholders. And I think it's really important that you mentioned the local authority, because, to be fair to Rhondda Cynon Taf local authority, in other parts of their footprint they've been really helpful about making use of not just their ability to access capital in a different way, but also look at the estate that they have as well, to see if there's an opportunity to try and re-engineer primary care with them as a partner - not just deliver what we currently have, but come up with a different way of doing it. I'll happily take an intervention if I'm allowed, and then I'm going to finish.
Welsh: Diolch, Dirprwy Lywydd, a diolch i Huw Davies am gyfle arall i siarad heddiw yn y Siambr, ond yn arbennig am ddefnyddio'r ddadl fer heddiw i dynnu sylw at bwysigrwydd sicrhau mynediad at wasanaethau gofal sylfaenol o ansawdd uchel. Yn ein gwasanaethau gofal iechyd lleol y bydd mwy na 90 y cant o gysylltiad pobl â'r system gofal iechyd yma yng Nghymru yn digwydd. O'r holl bwyntiau a wnaed heddiw, mae wedi bod yn ddiddorol iawn fod cymaint ohonynt wedi canolbwyntio ar y rhan ysbyty o'r system honno ac eto mae mwyafrif helaeth - dros 90 y cant, fel y dywedais - o gysylltiad pobl â'r system yn digwydd yn ein gwasanaeth gofal iechyd lleol. Ac rwy'n sicr yn awyddus i'n gwasanaeth gofal iechyd lleol yng Nghymru, nid yn unig i fod yn seiliedig ar egwyddorion gofal iechyd darbodus fel prif gynheiliad system iechyd a gofal gynaliadwy sy'n gallu ymateb yn gyffredinol i anghenion newidiol ein poblogaeth, ond hefyd rwy'n rhannu'r hyn a ddywedwch: rwyf am i bob cymuned unigol ar draws ein gwlad gael gofal iechyd, sydd nid yn unig o ansawdd uchel yn lleol, ond eu bod yn cael mynediad da ato mewn gwirionedd, yn cael gofal gwirioneddol wych ac yn deall sut beth yw hynny. Ac mewn sawl rhan o'r wlad, bydd hynny'n edrych yn wahanol i'r system sydd wedi ein gwasanaethu'n dda hyd yn hyn, oherwydd rwy'n cydnabod y straen a'r pwysau yr ydym yn aml yn eu trafod yn y lle hwn ynglŷn â dyfodol ein gwasanaeth gofal iechyd lleol, a meddygon teulu yn arbennig fel rhannau arwyddocaol, arweiniol, os mynnwch, o'n system gofal iechyd lleol, gan ein bod yn cydnabod bod gofal iechyd lleol yn newid, ac mae angen iddo newid. Mae yna gymaint o ysgogwyr y soniwn amdanynt dro ar ôl tro yn y Siambr hon ac fel arall, ond rydym am i'r system ddarparu mwy o ofal yn nes at adref, gydag ymagwedd fwy ataliol: felly, y syniad o drin salwch, symud y tu hwnt i hynny at sut yr ydych yn atal salwch, a chael tîm ehangach o lawer o bobl. Dyna pam y mae ein cynllun gofal sylfaenol cenedlaethol yn nodi camau gweithredu allweddol ar gyfer gwella iechyd lleol, ac mae hynny'n cynnwys datblygu gweithlu mwy integredig, amlbroffesiynol sy'n cydweithio ar lefel leol iawn i ddiwallu anghenion pobl yn y cartref, neu'n agos at adref, ac sy'n cydnabod y gallai ac y dylai llawer mwy o ofal ddigwydd yng nghartrefi pobl eu hunain. Rwy'n falch iawn eich bod wedi sôn yn eich cyfraniad am y realiti ein bod am gadw pobl allan o'r ysbyty. Mae yna lawer mwy y gallem ac y dylem ei wneud. Weithiau, credaf fod hyn yn swnio fel ystrydeb braidd, pan ddywedwn, 'Dyma'r llwybr yr ydym am ei ddilyn', ac yna awn yn ôl, fel gwleidyddion, i siarad am ysbytai eto. Os na allwn wneud hyn yn iawn, fel y trafodasom yn yr adolygiad seneddol, mae yna ddyfodol anodd iawn o'n blaenau i'r gwasanaeth cyfan. Ac yn gynyddol, er hynny, rydym yn gweld byrddau iechyd yn cydweithio gyda phractisau meddygon teulu a darparwyr gwasanaethau lleol eraill. Mae rhywfaint o hyn yn digwydd yn barod, gyda fferyllwyr, nyrsys yn y gymuned, therapyddion, deintyddion, optometryddion, timau iechyd meddwl, gweithwyr cymdeithasol, gweithwyr trydydd sector ac eraill, drwy 64 o glystyrau gofal sylfaenol a grëwyd gennym. Dyna wneud y defnydd gorau o'r adnoddau sydd ar gael inni ac amser ac arbenigedd pobl a'r arian yr ydym wedi ei ddarparu yn uniongyrchol i bob un o'r clystyrau hynny ei wario ar flaenoriaethau lleol. Oherwydd rwy'n cydnabod bod rhannau sylweddol o Gymru lle maent yn cael trafferth recriwtio a chadw meddygon teulu. Buom yn siarad am hynny'n gynharach, yn adroddiad y Pwyllgor Iechyd a Gofal Cymdeithasol - nid yn unig y camau rydym yn eu cymryd ar - [Anghlywadwy.] - ac eraill, ond mae gwaith clwstwr yn rhan bwysig iawn o'r hyn yr ydym am ei wneud i gynnal gofal iechyd lleol gwych. Dylai hynny arwain, ac mae eisoes yn arwain, at fwy o gydweithredu rhwng practisau meddygon teulu - nid oeddent bob amser yn siarad â'i gilydd, a dweud y gwir; felly, mae'n digwydd rhwng practisau, nid yn unig o'u mewn - wrth iddynt nodi ffyrdd newydd o drefnu eu hunain a gwneud defnydd effeithiol o'r adnoddau sydd ar gael iddynt. Mae ein rhaglen genedlaethol ar gyfer pennu cyfeiriad wedi bod yn ddiddorol iawn yn helpu i nodi ffyrdd mwy cynaliadwy o weithio a darparu gwasanaethau, fel y ffederasiwn o bractisau meddyg teulu sy'n symud i'r un lle yn ardal Pen-y-bont ar Ogwr, a'r fenter gymdeithasol yn ne Powys, menter gymdeithasol Red Kite. Ac mae hynny wedi bod mor ddiddorol, gan ei fod wedi dod â phractisau meddygon teulu nad oedd yn siarad â'i gilydd o'r blaen at ei gilydd, ac nid oeddent yn arfer bod yn ffrindiau, ac erbyn hyn, ni fyddent am ei weld yn digwydd men unrhyw ffordd arall. Mae ganddynt ffordd wahanol o weithio gyda'i gilydd, y ffordd y mae pobl yn cael mynediad at y gwasanaeth, ac maent newydd fabwysiadu gwasanaeth meddyg teulu yn Llanandras - lle roedd y practis meddyg teulu blaenorol yn rhoi ei gontract yn ôl, ac maent wedi mabwysiadu hwnnw. Felly, mae yna awydd yn y proffesiwn i weithio'n wahanol, gan fod mwy o feddygfeydd yn gweld manteision dod at ei gilydd i ddarparu amgylchedd gwell i weithio ynddo ar gyfer staff yn y gwasanaeth, ond llwyfan gwell hefyd i ddarparu gofal iechyd lleol gwych gyda'r cyhoedd, ac ar eu cyfer. Rwy'n credu mai dyma ble y daw'n ôl at sut y gall y rhaglenni cenedlaethol edrych ar yr heriau y soniwch amdanynt, gan mai rhan sylweddol o'r pryder sy'n cael sylw yn y rhaglen genedlaethol ar gyfer pennu cyfeiriad yw mynediad. Mae'n bryder cyffredin ynglŷn â'r gallu naill ai i gael apwyntiad neu i gael apwyntiad cyfleus a lleol. Mae llawer o'r hyn a ddywedwch yn ymwneud â mynediad at ofal lleol. O'r model hwnnw, y ffordd newydd o weithio drwy bennu cyfeiriad, mae llawer ohono'n canolbwyntio ar sut y mae gennych system frysbennu, naill ai ar y ffôn neu ar-lein neu dan arweiniad nyrs neu feddyg teulu, ond mae'n ffordd o geisio cyfeirio pobl at y rhan gywir o ofal. Gallai hynny olygu mynd i weld meddyg teulu; a gallai olygu cael cyngor y gallwch ymdopi ag ef gartref; gallai olygu mynd i'r fferyllfa; gallai olygu dod i mewn i weld ffisiotherapydd neu weithiwr gofal iechyd proffesiynol gwahanol. A'r hyn a welsom mewn rhannau sylweddol o hynny yw ei fod mewn gwirionedd yn cyflymu mynediad ar gyfer gweld gweithiwr gofal iechyd proffesiynol, ac mewn gwirionedd mae'n helpu pobl i gael eu cyfeirio at y rhan gywir o'r gwasanaeth, felly nid yw meddygon teulu'n cael eu gorlwytho â phobl nad oes angen iddynt eu gweld ac o bosibl, yn methu gweld y bobl y gallant ac y dylent eu gweld mewn gwirionedd, a gwn fod hwn yn fater y mae'r Aelod gyferbyn wedi ei weld yn ei ymarfer ei hun, ynglŷn â'r ffordd yr ydych yn gwneud y defnydd gorau o amser meddyg teulu. Nawr, mwy o ofal rhagflaenorol, i'w gynllunio i gadw pobl yn eu cartrefi yn hytrach na chael eu derbyn i'r ysbyty, a dyna ble rydym wedi gweld modelau ward rithwir yn cael eu datblygu o gwmpas y wlad hefyd - . Nawr, y rhan arall yr oeddwn am ganolbwyntio arni cyn i mi fynd o'r cenedlaethol i'r lleol yw'r gwasanaeth elfen gyffredin mewn perthynas â fferylliaeth, oherwydd unwaith eto, fe sonioch am y pwynt ynglŷn â sut y gallai fferylliaeth fod yn opsiwn i bobl gael gwasanaeth mwy lleol. A dweud y gwir, mae Cwm Taf wedi bod yn wirioneddol flaengar ar hyn yn y ffordd y maent wedi mynd ar ôl y gwasanaeth Dewis Fferyllfa. Felly, mae gennym dros 350 o fferyllfeydd yn y wlad ar hyn o bryd sy'n cynnig y gwasanaeth; mae 75 ohonynt yng Nghwm Taf. Roedd un o'r cynlluniau peilot yn ardal Cwm Taf, yn Aberdâr, ac roedd yn wirioneddol ddiddorol gweld sut oedd y practis meddyg teulu lleol yn cydnabod ei fod wedi eu helpu i reoli nifer y bobl sy'n dod drwy'r drws, ac nid y niferoedd yn unig, ond pa mor briodol oedd hi i bobl ddod drwy'r drws yn ogystal. Ac roedd pobl yn ymddiried yn eu fferyllydd. Roedd ganddynt ystafell breifat i fynd i'w gweld, maent yn weithwyr gofal iechyd proffesiynol cofrestredig, a chafodd hyn ei alluogi a'i rymuso drwy fynediad at fersiwn o'r cofnodion meddyg teulu. Mae yna rywbeth ynglŷn â'r diogelwch. Ac yn ddiddorol, mae Cwm Taf wedi dweud wrthyf eu bod yn credu bod y gwasanaeth Dewis Fferyllfa wedi helpu i ddileu camgymeriadau llawysgrifen yn y presgripsiynau sydd i'w darparu hefyd, felly mae yna fudd sylweddol o safbwynt diogelwch hefyd. Nawr, ym mis Mawrth, bydd y gwasanaeth hwnnw ar gael i o leiaf 400 - mwy na hanner yn sicr - y fferyllfeydd yng Nghymru, ac rydym am weld sylw cenedlaethol go iawn i'r gwasanaeth hwn. Mae'n Wythnos Genedlaethol Gofal Llygaid, ond nid wyf am fynd ymlaen i siarad am optometreg gan fy mod am roi sylw uniongyrchol i'r pwyntiau a wnaethoch am y mater lleol. A daw hyn yn sgil mater y mae rhannau eraill o'r wlad yn ei gydnabod: twf poblogaeth - twf cyfredol yn y boblogaeth a thwf a gynlluniwyd - y gwyddom ei fod yn mynd i ddigwydd, ac fe gyfeirioch at Lanharan a Brynna fel ardaloedd sydd wedi eu cysylltu'n dda o safbwynt trafnidiaeth. Yr her yw sut i gynllunio fel bod gwasanaethau'n adlewyrchu'r hyn sydd gennym ar hyn o bryd a'r hyn a fydd gennym, yn hytrach nag aros i'r gwasanaethau hynny gael eu gorlwytho. Ac mae rhywbeth ynglŷn â dyfodol y gwasanaethau hynny hefyd, a chydnabod ein bod am weithio gyda chontractwyr annibynnol. Felly, byddem yn hoffi gweithio gyda'r contractwyr annibynnol presennol i ddarparu gofal da iawn, o ansawdd uchel. Ac rwy'n cydnabod yr hyn a ddywedwch am y ffaith fod y practis hwn wedi buddsoddi ym Mhencoed. Felly, nid oedd arnynt ofn buddsoddi, ac maent wedi buddsoddi yn un o'r safleoedd hynny. Ac rwyf hefyd yn ystyried ac yn cydnabod y sylwadau a wnaeth y CIC ar y potensial, os na allant gael rhywle y credant fod trigolion lleol am iddynt fod, efallai y byddant eisiau gofyn i Gwm Taf weld a fyddai un o'u darparwyr eraill eisiau dod i agor rhestr yn ardal Llanharan a Brynna. Rwy'n credu bod hynny'n golygu bod yna fwy o reidrwydd i fod eisiau cael sgwrs leol lle - [Anghlywadwy.] - mae yna ddewis arall. Dyna ble rwy'n dychwelyd at y pwynt ynglŷn â mynd i'r afael â'r pryder neu'r cwestiwn a ofynnwyd gennych am y cynnig i fuddsoddi, ac mae'n ymwneud yn rhannol â phryder Suzy Davies am ABM yn ogystal, gan mai fy nealltwriaeth i yw bod Bwrdd Iechyd Lleol Prifysgol Abertawe Bro Morgannwg wedi cynnig rhywfaint o fuddsoddiad i wasanaethau aros yn ardal Llanharan a Brynna. Nid wyf yn gwybod pam na chymerwyd hwnnw, ond rwy'n hapus i ofyn a oes modd i'r cynnig blaenorol o ardal bwrdd iechyd Abertawe Bro Morgannwg ddal i fod ar y bwrdd fel rhan o sgwrs agored. Y pwynt olaf yw'r prif beth y gofynnwch amdano gennyf, rwy'n dyfalu, sef a wyf yn barod i ddefnyddio fy nylanwad, os caf ddefnyddio'r ymadrodd hwnnw, i geisio trefnu sgwrs gyda rhanddeiliaid perthnasol. Ac rwy'n meddwl ei bod yn bwysig iawn eich bod wedi sôn am yr awdurdod lleol, oherwydd, i fod yn deg ag awdurdod lleol Rhondda Cynon Taf, mewn rhannau eraill o'u gwaith maent wedi bod yn help mawr o ran gwneud defnydd nid yn unig o'u gallu i gael gafael ar gyfalaf mewn ffordd wahanol, ond hefyd i edrych ar yr ystâd sydd ganddynt yn ogystal, i weld a oes cyfle i geisio ailsaernïo gofal sylfaenol gyda hwy'n bartneriaid - ac nid cyflawni'r hyn sydd gennym ar hyn o bryd yn unig, ond dod o hyd i ffordd wahanol o'i wneud. Rwy'n hapus i dderbyn ymyriad os caf, ac yna fe fyddaf yn gorffen.