English: Now, whilst both I and the Deputy Minister for Mental Health and Well-being are challenging the health board to increase the pace of change in relation to mental health services - and both of us have brought this up with the health board on several occasions - I do recognise the impact that this level of scrutiny over so many years will have on staff morale. At the outset, I want to say on record that I recognise the efforts of all the staff at the health board and appreciate the work that they do. In 2013, Robin Holden was commissioned by Betsi Cadwaladr health board to undertake a review of the Hergest psychiatric unit following complaints by staff, and I am familiar with the content of the report, and I must say it does make uncomfortable reading. Now, the call for the publication of the full, unredacted version of the Holden report is a matter for the health board, and some will be aware that there is currently a live case with the Information Commissioner's Office. It's therefore not appropriate for me to comment on this particular aspect in the debate. What I can say is that I expect the health board to fulfil its statutory obligations to both the people of north Wales, in terms of openness and transparency, and also, importantly, to its staff, by protecting the anonymity of people who raise concerns. The health board must also, of course, ensure it meets its legal obligation around data protection. It's always important to note that, following the review, a summary report was published by the health board in 2015, which included the recommendations made by Robin Holden. The executive medical director and executive director of nursing and midwifery subsequently commissioned a piece of work to ensure that the Holden report's recommendations have been implemented, and this work was submitted for executive scrutiny and was reported to the health board's quality, safety and experience committee in January 2021. Now, this provided assurance that action was taken and remains in place against each of the recommendations of the report, and my focus now is on ensuring the health board continues to act on those recommendations. Now, as we're all aware, the Holden report was one of a number of independent reviews commissioned by the health board in response to concerns about the quality of mental health care in north Wales in recent years, and which led to its placement in special measures in 2016. Now, since that time, much has happened, and the health board made progress against the milestones set out in the special measures framework, particularly including improved governance and quality, and improvements in mental health services. However, I am clear that there is still a long way to go, and that's why the health board remains in targeted intervention. We must remember that targeted intervention is a high level of intervention with ongoing scrutiny by Welsh Government that recognises that the health board remains on an improvement journey. A new chief executive has been appointed to steer the health board on its improvement journey, and it's clear that there is much greater oversight and scrutiny of mental health services now at board level. In mental health, a part of the organisation that was subject to continuous staff changes, I'm pleased to say, has now been stabilised, and that stability at a management level has started to increase confidence in the service to deliver. Improvements to organisational and governance structures have been put in place with a systematic way of identifying and reporting issues as they arrive. These same improvements also allow changes to be implemented more efficiently and effectively. Innovative working that used to be seen in isolated pockets is now being spread much wider, and there is clear evidence of much greater integration among services. For instance, child and adolescent mental health services that were previously run as three different and unconnected sub-regional services have been brought together, enabling best practices to be retained across the whole service and allowing a more integrated and cohesive service. And there's now much greater alignment between adult mental health services in the health board and those in place to support children and young people. There's also a much stronger strategic overview of the three regional areas, which is so important in a large geographical area such as Betsi Cadwaladr. The 'I CAN' initiative is another good example of innovative improvements to mental health services, providing easy access to support and offering an alternative to admission to hospital. The health board has now relaunched its 'Together for Mental Health' strategy for north Wales, which is resulting in much stronger partnership working with local authority and third sector partners across the region - so, essential to support the preventative and early intervention part of mental health. In line with the targeted intervention framework issued to the health board in February, the board has signed off the four maturity matrices and baseline assessment for mental health at its board meeting on 20 May. Now, the matrices are very detailed, and I intend them to be dynamic documents that are regularly reviewed and updated, and they focus on areas for improvement. They are owned by the health board, developed with the staff on the ground who've shown real insights into the difficulties they face and the challenge ahead of them. So, there are many key deliverables, and I'm happy to write to Members who request for me to set those out. Now, I'm pleased to say that officials are meeting regularly with the health board to review progress against the matrices, and I welcome the transparency and openness being demonstrated by the health board as part of this process. The board has also been very realistic, and in its own assessment has recognised that there's much work to do. And whilst I recognise that the baseline scores are low, they reflect an honest appraisal of the position the health board is in. It's important to note that these scores are not reflective of the whole area, but of those areas that are in targeted intervention. They set a strong baseline against which we can track progress through the four maturity matrices. Recovery and transformation will take time, but we've consistently made it clear to the health board that being able to evidence service improvements is the key to progressing across the matrices with a view to further de-escalation. And just last week, there was a mental health round-table discussion, chaired by the NHS Wales chief executive, which also included the chair and chief executive of the health board and senior mental health service leads. The purpose of the round-table, which also included Audit Wales, HIW and Welsh Government officials, was to open a frank and open discussion of the LHB's previous position, to assess the current situation and to provide assurances that the right mechanisms are now in place to secure improvements to mental health services in north Wales. And I'm reassured that there was wide agreement, following that meeting, about the openness and transparency being shown by the health board. But I also want to acknowledge the recent and tragic incidents at the health board, and I can assure Members that these incidents have been formally reported, as part of the NHS Wales national incident reporting policy, and are being investigated. I expect the health board to undertake a timely review to ensure immediate safety issues are identified and actioned, and to reduce the risk to patient harm. Processes should support a just culture for organisations and staff to feel supported to identify, report and learn from patient safety incidences. The Welsh Government continues to monitor and, importantly, to support the health board. There are regular meetings linked to the formal targeted intervention process between officials and the health board, as well as regular performance and quality and safety discussions. These are rooted in robust challenge, but we'll also consider what further support we can offer as a Government. It's clear that there is a real desire to deliver change and secure improvement, and we all owe it to the people of north Wales to support the health board to deliver for them. Diolch, Llywydd.
Welsh: Nawr, er fy mod i a'r Dirprwy Weinidog Iechyd Meddwl a Llesiant yn herio'r bwrdd iechyd i gynyddu cyflymder newid mewn perthynas â gwasanaethau iechyd meddwl - ac mae'r ddwy ohonom wedi codi hyn gyda'r bwrdd iechyd ar sawl achlysur - rwy'n cydnabod yr effaith y bydd y lefel hon o graffu dros gynifer o flynyddoedd yn ei chael ar forâl staff. I ddechrau, hoffwn gofnodi fy mod yn cydnabod ymdrechion holl staff y bwrdd iechyd ac yn gwerthfawrogi'r gwaith a wnânt. Yn 2013, comisiynwyd Robin Holden gan fwrdd iechyd Betsi Cadwaladr i gynnal adolygiad o uned seiciatrig Hergest yn dilyn cwynion gan staff, ac rwy'n gyfarwydd â chynnwys yr adroddiad, a rhaid imi ddweud ei fod yn ddeunydd darllen anghyfforddus. Nawr, mater i'r bwrdd iechyd yw'r alwad am gyhoeddi'r fersiwn lawn heb ei golygu o adroddiad Holden, a bydd rhai'n ymwybodol fod achos ar y gweill ar hyn o bryd gyda Swyddfa'r Comisiynydd Gwybodaeth. Felly, nid yw'n briodol i mi wneud sylwadau ar yr agwedd benodol hon yn y ddadl. Yr hyn y gallaf ei ddweud yw fy mod yn disgwyl i'r bwrdd iechyd gyflawni ei rwymedigaethau statudol i bobl gogledd Cymru, o ran bod yn agored a thryloyw, a hefyd, yn bwysig, i'w staff, drwy ddiogelu cyfrinachedd pobl sy'n lleisio pryderon. Wrth gwrs, rhaid i'r bwrdd iechyd sicrhau hefyd ei fod yn cyflawni ei rwymedigaeth gyfreithiol mewn perthynas â diogelu data. Mae bob amser yn bwysig nodi, yn dilyn yr adolygiad, fod adroddiad cryno wedi'i gyhoeddi gan y bwrdd iechyd yn 2015, a oedd yn cynnwys yr argymhellion a wnaed gan Robin Holden. Yn dilyn hynny, comisiynodd y cyfarwyddwr meddygol gweithredol a'r cyfarwyddwr gweithredol nyrsio a bydwreigiaeth waith i sicrhau bod argymhellion adroddiad Holden wedi'u gweithredu, ac fe'i cyflwynwyd ar gyfer craffu gweithredol ac i bwyllgor ansawdd, diogelwch a phrofiad y bwrdd iechyd ym mis Ionawr 2021. Nawr, rhoddodd hyn sicrwydd fod camau wedi'u cymryd ac yn parhau i fod ar waith yn erbyn pob un o argymhellion yr adroddiad, ac mae fy ffocws yn awr ar sicrhau bod y bwrdd iechyd yn parhau i weithredu ar yr argymhellion hynny. Nawr, fel y gwyddom i gyd, roedd adroddiad Holden yn un o nifer o adolygiadau annibynnol a gomisiynwyd gan y bwrdd iechyd mewn ymateb i bryderon am ansawdd gofal iechyd meddwl yng ngogledd Cymru yn ystod y blynyddoedd diwethaf, ac a arweiniodd at ei osod dan fesurau arbennig yn 2016. Nawr, ers hynny, mae llawer wedi digwydd, a gwnaeth y bwrdd iechyd gynnydd yn erbyn y cerrig milltir a nodir yn y fframwaith mesurau arbennig, gan gynnwys yn benodol gwella llywodraethu ac ansawdd, a gwelliannau i wasanaethau iechyd meddwl. Fodd bynnag, rwy'n glir fod llawer i'w wneud o hyd, a dyna pam y mae'r bwrdd iechyd yn parhau i fod yn destun ymyrraeth wedi'i thargedu. Rhaid inni gofio bod ymyrraeth wedi'i thargedu yn lefel uchel o ymyrraeth gyda gwaith craffu parhaus gan Lywodraeth Cymru sy'n cydnabod bod y bwrdd iechyd yn parhau i fod ar daith wella. Penodwyd prif weithredwr newydd i lywio'r bwrdd iechyd ar ei daith wella, ac mae'n amlwg fod llawer mwy o drosolwg a chraffu ar wasanaethau iechyd meddwl ar lefel y bwrdd erbyn hyn. Mewn iechyd meddwl, mae rhan o'r sefydliad a welodd newid staff parhaus wedi'i sefydlogi bellach, rwy'n falch o ddweud, ac mae'r sefydlogrwydd hwn ar lefel reoli wedi dechrau cynyddu hyder yn y gwasanaeth ynglŷn â chyflawni. Mae gwelliannau i strwythurau sefydliadol a strwythurau llywodraethu wedi'u rhoi ar waith gyda ffordd systematig o nodi ac adrodd ar broblemau wrth iddynt ddigwydd. Mae'r un gwelliannau hefyd yn caniatáu i newidiadau gael eu gweithredu'n fwy effeithlon ac effeithiol. Mae gwaith arloesol a arferai gael ei weld mewn pocedi ynysig bellach yn cael ei ledaenu'n llawer ehangach, ac mae tystiolaeth glir o lawer mwy o integreiddio rhwng gwasanaethau. Er enghraifft, mae gwasanaethau iechyd meddwl plant a'r glasoed a oedd gynt yn cael eu rhedeg fel tri gwasanaeth is-ranbarthol gwahanol a digyswllt wedi'u dwyn ynghyd, gan ei gwneud yn bosibl cynnal arferion gorau ar draws y gwasanaeth cyfan a chaniatáu gwasanaeth mwy integredig a chydlynol. Ac erbyn hyn mae llawer mwy o aliniad rhwng gwasanaethau iechyd meddwl oedolion yn y bwrdd iechyd a'r rhai sydd ar waith i gefnogi plant a phobl ifanc. Mae trosolwg strategol llawer cryfach hefyd ar y tair ardal ranbarthol, sydd mor bwysig mewn ardal ddaearyddol fawr fel Betsi Cadwaladr. Mae menter 'Mi FEDRAF' yn enghraifft dda arall o welliannau arloesol i wasanaethau iechyd meddwl, sy'n darparu mynediad hawdd at gymorth a chynnig dewis arall yn lle mynd i'r ysbyty. Mae'r bwrdd iechyd bellach wedi ail-lansio ei strategaeth 'Law yn Llaw at Iechyd Meddwl' ar gyfer gogledd Cymru, sy'n arwain at weithio mewn partneriaeth llawer cryfach gyda phartneriaid awdurdodau lleol a thrydydd sector ar draws y rhanbarth - felly, yn hanfodol i gefnogi elfen ataliol ac ymyrraeth gynnar iechyd meddwl. Yn unol â'r fframwaith ymyrraeth wedi'i thargedu a roddwyd i'r bwrdd iechyd ym mis Chwefror, mae'r bwrdd wedi cymeradwyo'r pedwar matrics aeddfedrwydd ac asesu llinell sylfaen ar gyfer iechyd meddwl yn ei gyfarfod bwrdd ar 20 Mai. Nawr, mae'r matricsau'n fanwl iawn, ac rwy'n bwriadu iddynt fod yn ddogfennau deinamig sy'n cael eu hadolygu a'u diweddaru'n rheolaidd, ac maent yn canolbwyntio ar feysydd i'w gwella. Y bwrdd iechyd sy'n berchen arnynt, ac fe'u datblygwyd gyda'r staff ar lawr gwlad sydd wedi dangos crebwyll gwirioneddol ynghylch yr anawsterau y maent yn eu hwynebu a'r her sydd o'u blaenau. Felly, ceir llawer o gyflawniadau allweddol, ac rwy'n hapus i ysgrifennu at Aelodau sy'n gofyn i mi nodi'r rheini. Nawr, rwy'n falch o ddweud bod swyddogion yn cyfarfod yn rheolaidd â'r bwrdd iechyd i adolygu cynnydd yn erbyn y matricsau, ac rwy'n croesawu'r tryloywder a'r agwedd agored a ddangosir gan y bwrdd iechyd fel rhan o'r broses hon. Mae'r bwrdd hefyd wedi bod yn realistig iawn, ac yn ei asesiad ei hun mae wedi cydnabod bod llawer o waith i'w wneud. Ac er fy mod yn cydnabod bod y sgoriau llinell sylfaen yn isel, maent yn adlewyrchu arfarniad gonest o'r sefyllfa y mae'r bwrdd iechyd ynddi. Mae'n bwysig nodi nad yw'r sgoriau hyn yn adlewyrchu'r maes cyfan, ond yn hytrach, y meysydd sy'n destun ymyrraeth wedi'i thargedu. Maent yn gosod llinell sylfaen gref y gallwn olrhain cynnydd yn ei herbyn drwy'r pedwar matrics aeddfedrwydd. Bydd adfer a thrawsnewid yn cymryd amser, ond rydym wedi'i gwneud yn glir yn gyson i'r bwrdd iechyd mai gallu dangos tystiolaeth o welliannau i wasanaethau yw'r allwedd i symud ymlaen ar draws y matricsau gyda golwg ar isgyfeirio pellach. A'r wythnos diwethaf, cafwyd trafodaeth bord gron ar iechyd meddwl dan gadeiryddiaeth prif weithredwr GIG Cymru, a oedd hefyd yn cynnwys cadeirydd a phrif weithredwr y bwrdd iechyd ac uwch-arweinwyr y gwasanaeth iechyd meddwl. Diben y ford gron, a oedd hefyd yn cynnwys swyddogion Archwilio Cymru, AGIC a Llywodraeth Cymru, oedd agor trafodaeth onest ac agored ar sefyllfa flaenorol y bwrdd iechyd lleol, asesu'r sefyllfa bresennol a gwneud yn siŵr fod y mecanweithiau cywir bellach ar waith i sicrhau gwelliannau i wasanaethau iechyd meddwl yng ngogledd Cymru. Ac rwy'n dawel fy meddwl bod yna gytundeb eang, yn dilyn y cyfarfod hwnnw, ynglŷn â natur agored a thryloyw y bwrdd iechyd. Ond rwyf hefyd am gydnabod y digwyddiadau trasig yn ddiweddar yn y bwrdd iechyd, a gallaf sicrhau'r Aelodau fod y digwyddiadau hyn wedi'u cofnodi'n ffurfiol fel rhan o bolisi cofnodi digwyddiadau cenedlaethol GIG Cymru, ac maent yn destun ymchwiliad. Rwy'n disgwyl i'r bwrdd iechyd gynnal adolygiad amserol i sicrhau bod materion diogelwch uniongyrchol yn cael eu nodi a bod camau'n cael eu rhoi ar waith yn eu cylch, ac i leihau'r risg o niwed i gleifion. Dylai prosesau gefnogi diwylliant cyfiawn i sefydliadau a staff allu teimlo eu bod yn cael eu cefnogi i nodi, adrodd a dysgu o ddigwyddiadau diogelwch cleifion. Mae Llywodraeth Cymru yn parhau i fonitro, ac yn bwysig, i gefnogi'r bwrdd iechyd. Cynhelir cyfarfodydd rheolaidd sy'n gysylltiedig â phroses ffurfiol yr ymyrraeth wedi'i thargedu rhwng swyddogion a'r bwrdd iechyd, yn ogystal â thrafodaethau rheolaidd ar berfformiad ac ansawdd a diogelwch. Mae'r rhain wedi'u gwreiddio mewn her gadarn, ond byddwn hefyd yn ystyried pa gymorth pellach y gallwn ei gynnig fel Llywodraeth. Mae'n amlwg fod yna wir awydd i gyflawni newid a sicrhau gwelliant, a'n dyletswydd i bobl gogledd Cymru yw cefnogi'r bwrdd iechyd i gyflawni ar eu rhan. Diolch, Lywydd.