English: Thank you, Presiding Officer. First of all, I'd like to tell the Chamber that the health Minister is at a COBRA meeting about the coronavirus, so that's why I'm taking his place. At the outset, I'd like to reiterate my thanks to staff across NHS Wales, social care and all the other partners, who continue to work every day to provide care to the people of Wales. Their dedication to continuing to deliver high-quality services in the busiest, most difficult and pressured environments on record is extraordinary, and I know we all want to acknowledge that. In the Minister's written statement on unscheduled care pressures he said that over winter this year, more than any other, we've seen relentless demand across the whole system, and I think that relentless demand has been echoed across the whole of the UK. I'll start off with the ambulance service. Of course, we are disappointed that the Welsh ambulance service has been unable to achieve the national target for a second month, but it is important to remember that this is from a background of achievement over the previous 48 months, While the target was not achieved in percentage terms, more people received a response within the eight-minute target when compared to December 2018, and this is because of the increased numbers. The Minister has recently announced a number of actions to improve ambulance availability, and this will include the establishment of a ministerial ambulance availability taskforce. This approach will focus not only on ambulance responsiveness, but also on the need for wider, whole-system improvements to reflect and respond to the changing environment. This taskforce is expected to provide early views by the end of March 2020, and the Minister will keep Members updated on those developments. There have been additional factors outside of unscheduled care that have had a real impact upon performance. One such area is the UK Government tax and pension changes, and these continue to significantly affect the availability of medical staff to deliver on previously agreed scheduled care plans. Over the last three years, on planned care, we have seen significant improvements in the reduction of long waits, with a 20 per cent reduction from our high point, which was in 2015. However, because of the tax and pension changes, our latest information is that between April and December 2019 around 3,200 sessions have been lost, affecting nearly 27,000 patients in planned care. And we've also lost sessions in unscheduled care and GP out of hours for the same reasons. The Minister has called repeatedly on the UK Government to resolve this matter urgently. The problem is the direct result of UK Government tax rules, and the harm to our NHS is actually felt across the whole of the UK. We are very worried about losing the goodwill of a generation of staff. Long waiting times are not what we want, and we continue to invest money to support improvements. However, this is not unique to Wales, with other parts of the United Kingdom also being affected. The latest figures from NHS England show their worst performance in terms of A&E four-hour performance, the highest number of 12-hour waits, the lowest 18-week referral-to-treatment performance, and they haven't met their urgent cancer targets since December 2015. Performance in Scotland has also struggled, with A&E four-hour performance being 6 percentage points lower than it was compared to the same period last year, and the lowest it's been since December 2017. So, I'm making the point to say that this is something that is affecting the whole of the UK, and it is affected by a huge increase in demand. In the case of cancer performance, we continue to treat more patients within the target each year. In the 12 months ending in November 2019, nearly 8,200 people started definitive treatment on the urgent suspected cancer route, 3 per cent higher than the previous year, and 18 per cent more people started definitive treatment within target time than five years ago. The single cancer pathway will supersede the old measures in due course with a more useful, accurate and honest measure. Unscheduled care pressures have also impacted on elective surgery. However, health boards mitigated the impact on elective care by deliberately reducing planned activity in the first two weeks of January to support the demand for urgent emergency admissions. Each patient is assessed based on their clinical need. If necessary, planned admissions may have to be postponed - and we know that they have been postponed - but care is provided at a later date. Any postponements are a last resort to ensure that patient safety is maintained and prioritised. And despite unscheduled care pressures, planned care activity continued across Wales in the early days of January 2020, with around 70 per cent of the planned activity undertaken while still meeting the emergency demand. Planning for winter 2019-20 began early in 2019, informed by the review of health and social care resilience over winter 2018-19. As Members have mentioned in the Chamber today, the Minister made £30 million available to health boards and local authorities - earlier in the year than ever before, at their request - to support plans for the winter. And for the first time, we chose to allocate a significant part of the funding to regional partnership boards. This was intended to ensure health boards and local authority partners work together with other partners to collaboratively plan services across the health and social care community. That does echo some of the comments made in the Chamber here today with Angela Burns talking about the artificial barrier between health and social care, and Jenny Rathbone also referring to many of the projects that are used to tackle that issue. I think this is a very important point: we do have to tackle this issue. Our transformation funds are intended to bring health and social care together and to try to treat the whole system in a more holistic way. The Minister also allocated an additional £10 million last week to add capacity across the system and to help relieve pressures on services to improve flow through hospitals and into social care. And as with the £30 million, this has been funded through RPBs to encourage joint working across health and social care. I have spoken to many of those people who are participating in the RPBs, and they tell me that the partnership working is developing and is becoming much stronger, and I think this is where we're going to see the transformation that we do need in our services. The winter plans agreed between health and social care partners acknowledge the importance of prevention and the need for effective partnership working. I think the investment through regional partnerships makes clear that we do see health and social care as genuine partners. Health Education and Improvement Wales and Social Care Wales were commissioned to produce a workforce strategy for health and social care in Wales. That strategy was signed off by both boards in December last year and submitted to Welsh Government, and we are now considering the strategy and its subsequent implementation. Health boards' recruitment remains an operational matter, and they've been clear on ensuring actions taken do not affect patient care or quality of service. Recruitment for nursing and medical staff continues as required to deliver safe services. The Welsh Government has invested over £0.5 billion extra in the NHS this year. We've seen the underlying NHS deficit reduced by 35 per cent between 2016-17 and 2018-19, and we expect there to be further improvements in this year, demonstrating better financial management. I have listened to all the comments that individual Members have made in this debate and have taken careful note of them. I can assure you that we want to be very clear that our force - the people who work in our health and social care force - are aware of our commitment and gratitude to them. Thank you.
Welsh: Diolch yn fawr, Lywydd. Yn gyntaf, hoffwn ddweud wrth y Siambr fod y Gweinidog iechyd mewn cyfarfod COBRA am y coronafeirws, felly dyna pam rwy'n cymryd ei le. Ar y cychwyn, hoffwn ddiolch eto i staff ar draws GIG Cymru, gofal cymdeithasol a'r holl bartneriaid eraill, sy'n parhau i weithio bob dydd i ddarparu gofal i bobl Cymru. Mae eu hymroddiad i barhau i ddarparu gwasanaethau o ansawdd uchel yn yr amgylchedd prysuraf, mwyaf anodd a gofnodwyd erioed yn anhygoel, a gwn ein bod i gyd am gydnabod hynny. Yn natganiad ysgrifenedig y Gweinidog ar bwysau ar ofal heb ei drefnu, dywedodd fod y galw ar draws y system gyfan dros y gaeaf eleni wedi bod yn fwy nag a welwyd erioed, ac rwy'n credu bod y galw di-baid hwnnw wedi'i weld ar draws y DU i gyd. Fe ddechreuaf gyda'r gwasanaeth ambiwlans. Wrth gwrs, rydym yn siomedig na allodd gwasanaeth ambiwlans Cymru gyrraedd y targed cenedlaethol am yr ail fis, ond mae'n bwysig cofio bod hyn yn erbyn cefndir o gyflawniad dros y 48 mis blaenorol. Er na chyflawnwyd y targed o ran canrannau, cafodd mwy o bobl ymateb o fewn y targed wyth munud o'i gymharu â Rhagfyr 2018, a'r rheswm am hyn yw'r cynnydd yn y niferoedd. Yn ddiweddar, cyhoeddodd y Gweinidog nifer o gamau i wella argaeledd ambiwlansys, a bydd hyn yn cynnwys sefydlu tasglu gweinidogol ar argaeledd gwasanaeth ambiwlans. Bydd hwn yn canolbwyntio nid yn unig ar ymatebolrwydd y gwasanaeth ambiwlans, ond hefyd ar yr angen am welliannau ehangach i'r system gyfan er mwyn adlewyrchu'r amgylchedd newidiol ac ymateb iddo. Disgwylir i'r tasglu hwn ddarparu safbwyntiau cynnar erbyn diwedd mis Mawrth 2020, a bydd y Gweinidog yn rhoi'r wybodaeth ddiweddaraf i'r Aelodau am y datblygiadau hynny. Gwelwyd ffactorau ychwanegol y tu allan i ofal heb ei drefnu sydd wedi cael effaith wirioneddol ar berfformiad. Un maes o'r fath yw newidiadau i drethi a phensiynau Llywodraeth y DU, ac mae'r rhain yn parhau i effeithio'n sylweddol ar argaeledd staff meddygol i gyflawni cynlluniau gofal wedi'u trefnu a gytunwyd yn flaenorol. Dros y tair blynedd diwethaf, ar ofal wedi'i gynllunio, gwelsom welliannau sylweddol o ran lleihau amseroedd aros hir, gyda gostyngiad o 20 y cant o'n pwynt uchaf yn 2015. Fodd bynnag, oherwydd y newidiadau i drethi a phensiynau, ein gwybodaeth ddiweddaraf yw bod tua 3,200 o sesiynau wedi'u colli rhwng mis Ebrill a mis Rhagfyr 2019 gan effeithio ar bron 27,000 o gleifion mewn gofal wedi'i gynllunio. Ac rydym hefyd wedi colli sesiynau mewn gofal heb ei drefnu a meddygon teulu y tu allan i oriau am yr un rhesymau. Mae'r Gweinidog wedi galw dro ar ôl tro ar Lywodraeth y DU i ddatrys y mater hwn ar frys. Mae'r broblem yn ganlyniad uniongyrchol i reolau treth Llywodraeth y DU, a theimlir y niwed i'n GIG ar draws y DU yn ei gyfanrwydd. Rydym yn poeni'n fawr am golli ewyllys da cenhedlaeth o staff. Nid ydym eisiau amseroedd aros hir, ac rydym yn parhau i fuddsoddi arian i gefnogi gwelliannau. Fodd bynnag, nid yw hyn yn unigryw i Gymru, ac effeithir ar rannau eraill o'r Deyrnas Unedig hefyd. Mae'r ffigurau diweddaraf gan GIG Lloegr yn dangos eu perfformiad gwaethaf o ran perfformiad pedair awr adrannau damweiniau ac achosion brys, y nifer uchaf o rai'n aros am 12 awr, y perfformiad gwaethaf o ran amseroedd atgyfeirio i driniaeth o fewn 18 wythnos, ac nid ydynt wedi cyrraedd eu targedau canser brys ers mis Rhagfyr 2015. Mae perfformiad yr Alban wedi wynebu trafferthion hefyd, gyda pherfformiad damweiniau ac achosion brys pedair awr 6 phwynt canran yn is na'r hyn ydoedd o gymharu â'r un cyfnod y llynedd, a'r isaf a fu ers mis Rhagfyr 2017. Felly, rwy'n gwneud y pwynt er mwyn nodi bod hyn yn rhywbeth sy'n effeithio ar y DU gyfan, ac effeithir arno gan gynnydd enfawr yn y galw. Yn achos perfformiad canser, rydym yn parhau i drin mwy o gleifion o fewn y targed bob blwyddyn. Yn y 12 mis a ddaeth i ben ym mis Tachwedd 2019, dechreuodd bron i 8,200 o bobl ar driniaeth frys benodol yn sgil amheuaeth o ganser, 3 y cant yn uwch na'r flwyddyn flaenorol, a dechreuodd 18 y cant yn fwy o bobl na phum mlynedd yn ôl ar driniaeth benodol o fewn yr amser targed. Bydd y llwybr canser sengl yn pennu mesur mwy defnyddiol, cywir a gonest yn lle'r hen fesurau maes o law. Mae pwysau ar ofal heb ei drefnu hefyd wedi effeithio ar lawdriniaeth ddewisol. Fodd bynnag, lliniarodd byrddau iechyd yr effaith ar ofal dewisol drwy leihau gweithgarwch wedi'i gynllunio yn fwriadol yn ystod pythefnos gyntaf mis Ionawr i gefnogi'r galw am dderbyniadau brys. Caiff pob claf ei asesu ar sail ei angen clinigol. Os oes angen, efallai y bydd yn rhaid gohirio derbyniadau wedi'u cynllunio - a gwyddom eu bod wedi'u gohirio - ond darperir gofal yn ddiweddarach. Mae unrhyw ohiriadau yn ddewis olaf er mwyn sicrhau bod diogelwch cleifion yn cael ei gynnal a'i flaenoriaethu. Ac er gwaethaf y pwysau ar ofal heb ei drefnu, parhaodd y gweithgarwch gofal wedi'i gynllunio ledled Cymru yn nyddiau cynnar mis Ionawr 2020, gydag oddeutu 70 y cant o'r gweithgarwch a gynlluniwyd wedi'i gyflawni gan ddal i ateb y galw brys. Dechreuodd y cynllunio ar gyfer gaeaf 2019-20 yn gynnar yn 2019, wedi'i lywio gan yr adolygiad o gadernid iechyd a gofal cymdeithasol dros aeaf 2018-19. Fel y crybwyllodd Aelodau yn y Siambr heddiw, rhyddhaodd y Gweinidog £30 miliwn i fyrddau iechyd ac awdurdodau lleol - yn gynharach yn y flwyddyn nag erioed o'r blaen, ar eu cais hwy - i gefnogi cynlluniau ar gyfer y gaeaf. Ac am y tro cyntaf, fe wnaethom ddewis dyrannu rhan sylweddol o'r cyllid i fyrddau partneriaeth rhanbarthol. Nod hyn oedd sicrhau bod byrddau iechyd a phartneriaid awdurdodau lleol yn cydweithio â phartneriaid eraill i gynllunio gwasanaethau ar y cyd ar draws y gymuned iechyd a gofal cymdeithasol. Mae hynny'n adleisio rhai o'r sylwadau a wnaethpwyd yn y Siambr yma heddiw gydag Angela Burns yn sôn am y rhwystr artiffisial rhwng iechyd a gofal cymdeithasol, a Jenny Rathbone hefyd yn cyfeirio at lawer o'r prosiectau a ddefnyddir i fynd i'r afael â'r broblem honno. Rwy'n credu bod hwn yn bwynt pwysig iawn: rhaid inni fynd i'r afael â'r broblem hon. Nod ein cronfeydd trawsnewid yw dod ag iechyd a gofal cymdeithasol at ei gilydd a cheisio trin y system gyfan mewn ffordd fwy cyfannol. Hefyd, dyrannodd y Gweinidog £10 miliwn ychwanegol yr wythnos diwethaf i ychwanegu capasiti ar draws y system ac i helpu i leddfu'r pwysau ar wasanaethau er mwyn gwella llif drwy ysbytai ac i mewn i ofal cymdeithasol. Ac fel gyda'r £30 miliwn, cafodd hyn ei ariannu drwy fyrddau partneriaeth rhanbarthol i annog cydweithio ar draws y maes iechyd a gofal cymdeithasol. Siaradais â llawer o'r bobl sy'n rhan o'r byrddau partneriaeth rhanbarthol, a dywedant wrthyf fod y gwaith partneriaeth yn datblygu a'i fod yn dod yn llawer cryfach, a chredaf mai dyma lle rydym yn mynd i weld y trawsnewid sydd ei angen arnom yn ein gwasanaethau. Mae cynlluniau'r gaeaf y cytunwyd arnynt rhwng partneriaid iechyd a gofal cymdeithasol yn cydnabod pwysigrwydd atal a'r angen am weithio mewn partneriaeth effeithiol. Rwy'n credu bod y buddsoddiad drwy bartneriaethau rhanbarthol yn egluro ein bod yn gweld iechyd a gofal cymdeithasol fel partneriaid go iawn. Comisiynwyd Addysg a Gwella Iechyd Cymru a Gofal Cymdeithasol Cymru i gynhyrchu strategaeth ar gyfer y gweithlu iechyd a gofal cymdeithasol yng Nghymru. Cafodd y strategaeth honno ei chymeradwyo gan y ddau fwrdd ym mis Rhagfyr y llynedd a'i chyflwyno i Lywodraeth Cymru, ac rydym yn awr yn ystyried y strategaeth a'r broses o'i gweithredu wedyn. Mae prosesau recriwtio byrddau iechyd yn parhau i fod yn fater gweithredol, ac maent wedi bod yn glir ynglŷn â sicrhau nad yw'r camau a gymerir yn effeithio ar ofal cleifion nac ar ansawdd y gwasanaeth. Mae recriwtio staff nyrsio a staff meddygol yn parhau fel y bo'r angen i ddarparu gwasanaethau diogel. Mae Llywodraeth Cymru wedi buddsoddi dros £0.5 biliwn ychwanegol yn y GIG eleni. Gwelsom ostyngiad o 35 y cant yn niffyg sylfaenol y GIG rhwng 2016-17 a 2018-19, ac rydym yn disgwyl gweld gwelliannau pellach yn y flwyddyn hon, gan arddangos gwell rheolaeth ariannol. Gwrandewais ar yr holl sylwadau gan Aelodau unigol yn y ddadl hon ac rwyf wedi'u nodi'n ofalus. Gallaf eich sicrhau ein bod eisiau dweud yn glir iawn fod ein grym - y bobl sy'n gweithio yn ein gweithlu iechyd a gofal cymdeithasol - yn ymwybodol o'n hymrwymiad a'n diolch iddynt. Diolch.