English: The thing that was left in my head after this inquiry was the term 'the invisible service', and that's already been mentioned by others - the extent to which the work that these nurses do largely goes unseen unless it is not done or unless it goes wrong - and also the evidence that they gave about the level of responsibility of a nurse on her or his own in a family home, in a nursing home, perhaps, where they don't have the whole support network of nursing staff that's available to nursing staff who are working in hospital settings. Now, like many others, I'm sure, I was very glad to see the Minister accept nine out of the 10 recommendations, until I read in detail what he was saying in response to those recommendations. And I'm afraid that what he was telling us was that much of what we were asking for, what the nursing staff were asking for, was already happening. Well, as Dai Lloyd has said, it's difficult sometimes when you have conflicting evidence, but, when I have nurses before me and I have senior managers before me, I am inclined to believe the front-line staff, who may know better what's going on on the ground. I was particularly concerned that the Minister's response only highlights additional resourcing, or possible additional resourcing, for one of the recommendations that he accepts. Because if we are to meet his aspiration - an aspiration, I think, shared across this Chamber and across Wales - of moving more services into the community, we will have to have a larger, better supported, better resourced workforce, and that doesn't come for nothing. I want to turn briefly to the recommendation that the Minister decided to reject, and that is recommendation 4, which is that the Welsh Government should produce and publish a strategy for extending the Nurse Staffing Levels (Wales) Act 2016 to all settings, including community and district nursing. Now, while I appreciate it's more difficult to do that - . It's relatively straightforward to know how many nurses at what level of skill are needed to support a particular set of patients in a particular ward because it's relatively easy to work out what their level of need is - the patients' level of need. And it's been difficult to do that, and this, of course, feeds into the points that Angela Burns has already made about the issues with information. But if we are serious about treating community services with the same level of respect as we treat services that are provided in hospitals, if we are serious about providing community nursing staff with the same level of respect and the same level of support, then surely we must move to make those assessments, to work out the acuity, the sickness, of the patients that they're dealing with and the skills that they need and the time that they need, and, therefore, the level of community and district nursing that is safe for that particular population. And it is beyond me to understand why the Minister does not agree. I would have been perfectly happy to see him say that this will take a longer time, perhaps, than we as a committee were asking for, but simply to suggest that it's not necessary is a real matter of concern. I want to highlight one particular aspect that I think the Minister may be taking moves towards addressing, and that is issues around terms and conditions for nurses employed by GP practices rather than directly by the health boards. It's very clear to me that the terms and conditions for some of those nurses have not kept pace with the terms of those nurses who are directly employed. A particular concern that's been raised with me by individual nurses in my own region is that they often don't have time for learning. Now we know that's a problem across the whole sector, but, if you're perhaps one nurse on your own, employed by a rural GP practice, it can be incredibly difficult for you to be released to increase your skills. I think the work the Minister highlighted the other day in terms of making sure that GP practices are reporting what levels of staffing they've got now may help with that, but I think it's really, really important that we protect the terms and conditions of that very important group of nursing staff. I think there's an element of agreement about the issues that face us. The question now has to be how quickly and how effectively we can move to address those issues. It's a word I find myself using again and again, and not one that I particularly want to use, but I'm afraid that there are elements of the Government's response to this report that do appear complacent to me and, more seriously, appear complacent to the nursing workforce. Our nursing workforce staff deserve better than that. Our community nursing workforce deserve better than that from us all, and, very importantly, so do their patients. I am sure that we all agree with the Minister that we need to grow our community services, but unless we properly resource and respect our community nursing workforce we won't be able to do that.
Welsh: Y peth a arhosodd yn fy mhen ar ôl yr ymchwiliad hwn oedd y term 'gwasanaeth anweledig', ac mae hynny eisoes wedi cael ei grybwyll gan eraill - y ffaith nad yw'r gwaith y mae'r nyrsys hyn yn ei wneud yn cael ei weld, i raddau helaeth, oni bai eu bod yn peidio â'i wneud neu oni bai fod rhywbeth yn mynd o'i le - a hefyd y dystiolaeth a roesant am lefel cyfrifoldeb nyrs ar ei phen ei hun mewn cartref teuluol, mewn cartref nyrsio, efallai, lle nad oes ganddynt rwydwaith o gymorth gan staff nyrsio sydd ar gael i staff nyrsio sy'n gweithio mewn ysbytai. Nawr, fel llawer o bobl eraill, rwy'n siŵr, roeddwn yn falch iawn o weld y Gweinidog yn derbyn naw o'r 10 argymhelliad, nes i mi ddarllen yn fanwl yr hyn a ddywedodd mewn ymateb i'r argymhellion hynny. Ac rwy'n ofni mai'r hyn a ddywedodd wrthym oedd fod llawer o'r hyn y gofynnem amdano, yr hyn y gofynnai'r staff nyrsio amdano, eisoes yn digwydd. Wel, fel y dywedodd Dai Lloyd, mae'n anodd weithiau pan fydd gennych dystiolaeth sy'n gwrthdaro, ond pan fo gennyf nyrsys o fy mlaen a phan fo gennyf uwch reolwyr o fy mlaen, rwy'n dueddol o gredu'r staff rheng flaen, sy'n gwybod yn well beth sy'n digwydd ar lawr gwlad. Roeddwn yn pryderu'n benodol nad yw ymateb y Gweinidog ond yn tynnu sylw at adnoddau ychwanegol, neu adnoddau ychwanegol posibl, ar gyfer un o'r argymhellion y mae'n eu derbyn. Oherwydd os ydym am wireddu ei ddyhead - dyhead, rwy'n credu, a rennir ar draws y Siambr hon a ledled Cymru - i weld mwy o wasanaethau'n cael eu symud i'r gymuned, bydd yn rhaid inni gael gweithlu mwy, gyda mwy o gefnogaeth, gyda gwell adnoddau, ac ni chawn hynny yn rhad ac am ddim. Hoffwn droi'n fyr at yr argymhelliad y penderfynodd y Gweinidog ei wrthod, sef argymhelliad 4, sy'n dweud y dylai Llywodraeth Cymru gynhyrchu a chyhoeddi strategaeth ar gyfer ymestyn Deddf Lefelau Staff Nyrsio (Cymru) 2016 i gynnwys pob lleoliad, gan gynnwys gwasanaethau nyrsio cymunedol a nyrsio ardal. Nawr, er fy mod yn derbyn ei bod yn anos gwneud hynny - . Mae'n gymharol hawdd canfod faint o nyrsys, gyda pha lefel o sgiliau, sydd eu hangen i gefnogi set benodol o gleifion mewn ward benodol oherwydd ei bod yn gymharol hawdd canfod beth yw lefel eu hangen - lefel angen y cleifion. Ac mae wedi bod yn anodd gwneud hynny, ac mae hyn, wrth gwrs, yn bwydo i mewn i'r pwyntiau y mae Angela Burns eisoes wedi'u gwneud am y problemau gyda gwybodaeth. Ond os ydym o ddifrif ynglŷn â thrin gwasanaethau cymunedol gyda'r un parch ag y byddwn yn trin gwasanaethau a ddarperir mewn ysbytai, os ydym o ddifrif ynglŷn â darparu'r un lefel o barch a'r un lefel o gymorth i staff nyrsio cymunedol, does bosibl nad oes rhaid inni wneud yr asesiadau hynny, canfod aciwtedd a salwch y cleifion y maent yn ymdrin â hwy a'r sgiliau y maent eu hangen a'r amser y maent ei angen, ac felly, nifer y nyrsys cymunedol a'r nyrsys ardal sy'n ddiogel ar gyfer y boblogaeth benodol honno. Ac ni allaf ddeall pam nad yw'r Gweinidog yn cytuno. Buaswn wedi bod yn berffaith hapus i'w weld yn dweud y byddai hyn yn cymryd mwy o amser, efallai, nag y gofynnem amdano fel pwyllgor, ond mae awgrymu nad yw'n angenrheidiol yn peri pryder gwirioneddol. Hoffwn dynnu sylw at un agwedd benodol y credaf efallai fod y Gweinidog yn rhoi camau ar waith i fynd i'r afael â hi, sef materion yn ymwneud â thelerau ac amodau ar gyfer nyrsys a gyflogir gan bractisau meddygon teulu yn hytrach nag yn uniongyrchol gan y byrddau iechyd. Mae'n amlwg iawn i mi fod y telerau a'r amodau i rai o'r nyrsys hynny yn llusgo ar ôl telerau nyrsys a gyflogir yn uniongyrchol. Un pryder penodol a godwyd gyda mi gan nyrsys unigol yn fy rhanbarth yw nad oes ganddynt amser ar gyfer dysgu yn aml. Nawr, rydym yn gwybod bod honno'n broblem ar draws y sector cyfan, ond os ydych yn nyrs ar eich pen eich hun, efallai, wedi'ch cyflogi gan bractis meddyg teulu gwledig, gall fod yn anhygoel o anodd i chi gael eich rhyddhau i wella eich sgiliau. Rwy'n credu y gallai'r gwaith a amlygwyd gan y Gweinidog y diwrnod o'r blaen o ran gwneud yn siŵr fod practisau meddygon teulu yn adrodd ar y lefelau staffio sydd ganddynt helpu gyda hynny, ond rwy'n credu ei bod yn wirioneddol bwysig ein bod yn diogelu telerau ac amodau'r grŵp pwysig hwnnw o staff nyrsio. Rwy'n credu bod yna elfen o gytundeb ynglŷn â'r materion sy'n ein hwynebu. Y cwestiwn yn awr yw pa mor gyflym a pha mor effeithiol y gallwn fynd i'r afael â'r materion hynny. Mae'n air rwy'n ei ddefnyddio dro ar ôl tro, ac nid yw'n un rwyf eisiau ei ddefnyddio fel y cyfryw, ond ofnaf fod elfennau o ymateb y Llywodraeth i'r adroddiad hwn sy'n ymddangos yn hunanfodlon ac yn fwy difrifol, maent yn ymddangos yn hunanfodlon i'r gweithlu nyrsio. Mae staff ein gweithlu nyrsio yn haeddu gwell na hynny. Mae ein gweithlu nyrsio cymunedol yn haeddu gwell na hynny gan bawb ohonom, ac yn bwysig iawn, mae eu cleifion yn haeddu gwell na hynny hefyd. Rwy'n siŵr ein bod i gyd yn cytuno â'r Gweinidog fod angen inni ddatblygu ein gwasanaethau cymunedol, ond oni bai ein bod yn rhoi adnoddau a pharch priodol i'n gweithlu nyrsio cymunedol, ni fyddwn yn gallu gwneud hynny.