English: I'm very pleased, as a member of this committee, to have a chance to speak in support of this report, and I'd like to put on record my thanks to all those who came to give evidence before us, and to the clerking teams that support us so ably. Medical recruitment and workforce planning are two of the most important issues affecting our NHS going forward, and we need to ensure that we find the right balance to ensure that the future - or future Assembly Members, actually, here, are not going to have to try to solve this problem in the future. This report ties in very closely with the cross-party parliamentary review into health and social care, which we discussed yesterday and which is still an ongoing piece of work, but when I was sitting in that committee there were two specific elements that really struck me most forcefully, and those are the two I would like to concentrate my contribution on. The first is the whole issue of workforce planning. I think that we have to recognise that we cannot rely on our NHS to be a medical-based model, run solely by doctors and nurses, because, with the best will in the world, we simply cannot fill the gaps that we have. We need to be far more effective at bringing in and incorporating and integrating, as valuable members with equal presence within the NHS, allied healthcare professionals of all types. We need to bring in the third sector. We need to embrace care home operators more into the NHS, because otherwise we simply will not get the people, and the people within to stay within the NHS that we need. We've got to just broaden our base and not simply concentrate on the very obvious gaps that we see within some surgical specialities, some GP practices and within some elements of nursing. When we looked at the workforce planning, which we only did a very small part of, because it is so complicated, it really struck me that we simply don't spend enough time on that. If we plan today for what might happen in five years' time, then we've got a sporting chance of actually putting in place the people that we need in five years' time. So, we know that some health boards, for example, are going to see a dramatic drop-off in key areas because staff are ageing; they're going to retire, and there's going to be a gap. If we constantly rely on filling that gap as we get to that crisis, we're never, ever going to get ahead of ourselves. So, I would like to talk to recommendation 10, and I would like to urge the Welsh Government - . Because, although you accepted it, you talk about identifying priority areas for investment, you talk about talking to medical and dental commissioning and non-medical commissioning proposals. But have you talked about other organisations such as allied health workers, and have you talked to other engaged bodies such as local authorities? Because, of course, for us to do workforce planning in the NHS, we need to know that we have the social workers, which is a local authority function, for example. I just feel that the impression I came away with, as a committee member, was that this was a very, very big task, there wasn't cohesion, there wasn't a coherent strategy at all, there wasn't a real idea of capacity building at lower levels for the future, and there simply just wasn't enough forward planning. I would like to have reassurance that somebody somewhere is really getting to grips with this issue. The other point that I would like to discuss and concentrate some of my remarks on is how we get more Welsh students to study in Wales and remain in Wales. I notice that the Government has partially accepted our recommendations, and I know that Dai Lloyd has already commented on this, but I was quite disappointed in one of your responses. Actually, it was the response to recommendation 2, Cabinet Secretary - but it does speak to all of these recommendations - when you said that admission criteria is ultimately a matter for medical schools, and elsewhere there's a marginal implication that there's not an awful lot that the Welsh Government can do because these medical schools are universities within their own right. I simply don't agree with you. You do have the leverage. For example, widening access, as an element of funding, could be used to lever in more Welsh-domiciled students. Using part of our Welsh baccalaureate as a criteria for being able to take a medical degree could be another lever. There are levers at your disposal, and I think, to be frank, that just sort of stepping back and saying, 'Well, you know, it is up to Swansea; it is up to Cardiff how they do it. They are independent universities; they can say what the criteria for eligibility are' is actually letting you and us and them off the hook. I think we've got to be far more robust. You do have the power; you simply need to be creative and exercise it.
Welsh: Rwy'n falch iawn, fel aelod o'r pwyllgor hwn, i gael cyfle i siarad o blaid yr adroddiad hwn, a hoffwn gofnodi fy niolch i bawb a ddaeth i roi tystiolaeth ger ein bron, ac i'r timau clercio sy'n ein cefnogi mor fedrus. Mae recriwtio meddygol a chynllunio'r gweithlu yn ddau o'r materion pwysicaf sy'n effeithio ar ein GIG wrth wynebu'r dyfodol, ac mae angen i ni sicrhau ein bod yn dod o hyd i'r cydbwysedd iawn er mwyn sicrhau nad yw'r dyfodol hwnnw - neu Aelodau'r Cynulliad yma yn y dyfodol, mewn gwirionedd, yn mynd i orfod ceisio datrys y broblem hon yn y dyfodol. Mae'r adroddiad hwn yn cysylltu'n agos iawn â'r adolygiad seneddol trawsbleidiol i iechyd a gofal cymdeithasol a drafodwyd gennym ddoe ac sy'n dal i fod yn waith ar y gweill, ond pan oeddwn yn eistedd yn y pwyllgor hwnnw, roedd dwy elfen benodol a wnaeth fy nharo'n galed iawn, sef y ddau beth yr hoffwn ganolbwyntio fy nghyfraniad arnynt. Y cyntaf yw mater cynllunio'r gweithlu. Credaf fod yn rhaid i ni gydnabod na allwn ddibynnu ar ein GIG i fod yn fodel meddygol sy'n cael ei redeg yn llwyr gan feddygon a nyrsys, oherwydd, gyda'r ewyllys gorau yn y byd, ni allwn lenwi'r bylchau sydd gennym. Mae angen inni fod yn llawer mwy effeithiol wrth gyflwyno, ymgorffori ac integreiddio gweithwyr proffesiynol perthynol i iechyd o bob math fel aelodau gwerthfawr gyda phresenoldeb cyfartal o fewn y GIG. Mae angen inni ddod â'r trydydd sector i mewn. Mae angen inni gynnwys gweithredwyr cartrefi gofal yn well o fewn y GIG, oherwydd fel arall ni fyddwn yn cael y bobl sydd eu hangen arnom, a'r bobl o fewn y GIG i aros o fewn y GIG. Mae'n rhaid i ni ehangu ein sylfaen ac nid canolbwyntio'n unig ar y bylchau amlwg iawn a welwn mewn rhai arbenigeddau llawfeddygol, rhai practisau meddygon teulu ac mewn rhai elfennau o nyrsio. Pan oeddem yn edrych ar y gwaith o gynllunio'r gweithlu, gwaith nad ydym ond wedi gwneud rhan fach iawn ohono gan ei fod mor gymhleth, sylweddolais nad ydym yn treulio agos digon o amser ar wneud hynny. Os ydym yn cynllunio heddiw ar gyfer yr hyn a allai ddigwydd mewn pum mlynedd, yna mae gennym rywfaint o obaith o allu rhoi'r bobl sydd eu hangen arnom ymhen pum mlynedd yn eu lle. Felly, rydym yn gwybod bod rhai byrddau iechyd, er enghraifft, yn mynd i weld gostyngiad dramatig mewn meysydd allweddol am fod staff yn heneiddio; maent yn mynd i ymddeol, ac mae bwlch yn mynd i fodoli. Os ydym yn dibynnu o hyd ar lenwi'r bwlch wrth i ni nesu at yr argyfwng hwnnw, ni fyddwn byth, byth yn llwyddo i achub y blaen arnom ein hunain. Felly, hoffwn siarad am argymhelliad 10, a hoffwn annog Llywodraeth Cymru - . Oherwydd, er eich bod wedi ei dderbyn, rydych yn siarad am nodi meysydd blaenoriaeth ar gyfer buddsoddi, rydych yn siarad am gynigion comisiynu meddygol a deintyddol a chynigion comisiynu anfeddygol. Ond a ydych wedi siarad am sefydliadau eraill megis gweithwyr perthynol i iechyd, ac a ydych wedi siarad â chyrff cysylltiedig eraill megis awdurdodau lleol? Oherwydd, wrth gwrs, i ni allu cynllunio'r gweithlu yn y GIG, mae angen i ni wybod bod gennym y gweithwyr cymdeithasol, sy'n swyddogaeth awdurdod lleol, er enghraifft. Rwy'n teimlo mai'r argraff a gefais, fel aelod o'r pwyllgor, oedd bod hon yn dasg fawr iawn, nid oedd cydlyniant, nid oedd yna strategaeth gydlynol o gwbl, nid oedd yna syniad go iawn o feithrin gallu ar lefelau is ar gyfer y dyfodol, ac yn syml, nid oedd digon o flaengynllunio. Hoffwn gael sicrwydd fod rhywun yn rhywle yn mynd i'r afael â'r mater hwn o ddifrif. Y pwynt arall yr hoffwn ei drafod a chanolbwyntio rhai o fy sylwadau arno yw sut y gallwn gael rhagor o fyfyrwyr Cymru i astudio yng Nghymru ac i aros yng Nghymru. Sylwaf fod y Llywodraeth wedi derbyn ein hargymhellion yn rhannol, a gwn fod Dai Lloyd eisoes wedi gwneud sylwadau ar hyn, ond roeddwn yn eithaf siomedig ynglŷn ag un o'ch ymatebion. Yr ymateb i argymhelliad 2 oedd hwnnw mewn gwirionedd, Ysgrifennydd y Cabinet - ond mae'n ymwneud â phob un o'r argymhellion hyn - pan ddywedoch mai mater i ysgolion meddygol yn y pen draw yw meini prawf derbyn, ac mewn mannau eraill ceir goblygiad ymylol nad oes llawer iawn y gall Llywodraeth Cymru ei wneud oherwydd bod yr ysgolion meddygol hyn yn brifysgolion yn eu hawl eu hunain. Nid wyf yn cytuno â chi. Mae gennych ddylanwad yn hyn o beth. Er enghraifft, gellid defnyddio ehangu mynediad fel elfen o gyllid i ddenu mwy o fyfyrwyr sy'n hanu o Gymru. Gallai defnyddio rhan o fagloriaeth Cymru fel maen prawf i allu gwneud gradd feddygol fod yn ffordd arall o wneud hynny. Mae yna ddulliau ar gael at eich defnydd, ac rwy'n meddwl, a bod yn onest, fod camu'n ôl rywsut a dweud, 'Wel, wyddoch chi, mater i Abertawe yw hynny; mater i Gaerdydd yw sut y maent yn ei wneud. Maent yn brifysgolion annibynnol; gallant ddweud beth yw'r meini prawf cymhwysedd' yn eich gadael chi a ni a hwythau oddi ar y bachyn. Rwy'n credu bod yn rhaid inni fod yn llawer mwy cadarn. Mae gennych bŵer; mae angen i chi fod yn greadigol, ac arfer y pŵer hwnnw.