English: Minister, thank you very much for your statement today. The first point I would like to concur with you on is to show appreciation to the staff who help maintain our NHS services during the winter, when, I think we all recognise, there do seem to be extraordinary pressures, and I would like to pay my tribute to them as well. This is a pretty upbeat statement, and I'm quite sure it reflects extremely your hopes for us dealing with the winter pressures, but I have to tell you, Minister, it does not reflect the evidence that we've been hearing throughout our committee sessions. So, a couple of key points I'd like to ask you about: you talk about having a range of positive actions planned to improve further resilience. Have you been utterly satisfied that the health boards have put this in place? Because when we've talked to GPs and we've talked to various A&E clinicians, the royal colleges, et cetera, they are less convinced that there has been a fully integrated discussion about how we can handle winter pressures. So, I'd like to be assured that you are reassured that our health boards have really got this taped, because, as I say, it does not reflect what we've been hearing. I'm interested to understand, Cabinet Secretary, where the staff are coming from, where these extra beds are coming from. You talk about more beds in hospitals perhaps being opened up for the winter pressures, you talk about community beds, but there's been a real slide in the number of beds in both hospitals and within the community, and I would like to understand how that is going to be rectified in such a short space of time, given that winter is just about here. An example I would give you is that there's been a 30 per cent decline in the number of district nurses. So, how are we going to be able to keep people in the community and out of hospital, being looked after by GPs and being looked after by other services? You talk about an overall downward trend in delayed transfers of care, but, Minister, every month, there are about 450 people waiting in hospitals for social care packages to be put into place so that they can escape a hospital confine and continue with their lives. How do you square that number we've already got in July, August, September, October - and that's before we get into winter pressures - when, as you've acknowledged yourself, the case mix changes quite dramatically and we have far more older, more frail, and more vulnerable people and, of course, a lot more young children entering into hospital with acute needs? Could you please, perhaps, explain how we're going to be able to catch up with that shortfall, given that there's also a social worker shortage? Because everything in your statement sounds absolutely great, but we all know that we are struggling to get enough staff into the health system, and I just can't quite see how they suddenly managed to pull the rabbit out of the hat and this is going to work brilliantly well for the next three or four months. May I also ask you if you have tasked the health boards with looking at developing more the idea of having acute clinicians in charge of specific departments such as orthopaedics, such as paediatrics, able to divert people from A&E to take the pressure off? Because the evidence appears to show that we can divert about 30 per cent of people away from A&E into GP out-of-hours - but, again, all of these services only function if they have the social workers on call, if they have the physiotherapists, if they've got the mental health workers to support. So, great statement, very positive and upbeat, I appreciate you've had the discussions with the health boards, but I really find it hard to swallow that there's been this massive change in the hospital regimes and the community services that we have available, with the shortages of staff we have, that's going to enable us to cruise through the winter in a way that I fear the health boards may hope that they can do. After all, we've been here every single year, talking about winter pressures. Experience is beginning to outweigh hope on this, and we do want to come up with some solutions that are utterly sustainable for the future. Thank you.
Welsh: Weinidog, diolch yn fawr iawn am eich datganiad heddiw. Y pwynt cyntaf yr hoffwn i gytuno â chi yn ei gylch yw dangos gwerthfawrogiad i'r aelodau staff sy'n helpu i gynnal ein gwasanaethau GIG yn ystod y gaeaf, pan geir, rwy'n credu ein bod ni i gyd yn cydnabod, pwysau eithriadol, a hoffwn dalu fy nheyrnged iddyn nhw hefyd. Mae hwn yn ddatganiad eithaf gobeithiol, ac rwy'n eithaf siŵr ei fod yn adlewyrchu yn eithriadol eich gobeithion o ran ein gallu ni i ymdrin â phwysau'r gaeaf, ond mae'n rhaid i mi ddweud wrthych chi, Weinidog, nid yw'n adlewyrchu'r dystiolaeth yr ydym wedi'i chlywed yn ystod ein sesiynau pwyllgor. Felly, un neu ddau o bwyntiau allweddol yr hoffwn eich holi chi yn eu cylch: rydych chi'n siarad am gael amrywiaeth o gamau cadarnhaol wedi'u cynllunio er mwyn cryfhau gwasanaethau ymhellach. A ydych chi wedi'ch llwyr fodloni fod y byrddau iechyd wedi gweithredu hyn? Oherwydd o fod yn siarad â meddygon teulu a siarad â nifer o glinigwyr o'r adrannau Damweiniau ac Achosion Brys, y colegau brenhinol, ac ati, rydym wedi sylwi eu bod yn llai argyhoeddedig y bu trafodaeth cwbl integredig ynglŷn â sut y gallwn ymdrin â phwysau'r gaeaf. Felly, hoffwn gael sicrwydd eich bod chi'n fodlon bod hyn dan reolaeth gan y byrddau iechyd, oherwydd, fel y dywedais, nid yw'n adlewyrchu'r hyn yr ydym wedi'i glywed. Rwy'n awyddus i ddeall, Ysgrifennydd y Cabinet, o le y daw'r aelodau staff, o le y daw'r gwelyau ychwanegol hyn. Rydych chi'n sôn y gallai fod yna ragor o welyau mewn ysbytai ar gael ar gyfer ymdopi â phwysau'r gaeaf, rydych chi'n sôn am welyau cymunedol, ond mae gostyngiad gwirioneddol wedi bod yn nifer y gwelyau mewn ysbytai ac o fewn y gymuned, a hoffwn ddeall sut y caiff hynny ei gywiro mewn cyfnod o amser mor fyr, o gofio bod y gaeaf bron â chyrraedd. Un enghraifft y byddwn i'n ei rhoi i chi yw y bu gostyngiad o 30 y cant yn nifer y nyrsys ardal. Felly, sut yr ydym ni am lwyddo i gadw pobl yn y gymuned ac allan o'r ysbyty, i gael gofal gan feddygon teulu a chan wasanaethau eraill? Gwnaethoch chi sôn am duedd gyffredinol o leihau'r oedi wrth drosglwyddo gofal, ond, Weinidog, bob mis, mae tua 450 o bobl yn aros mewn ysbytai i becynnau gofal cymdeithasol gael eu gweithredu fel y gallant adael yr ysbyty a pharhau â'u bywydau. Sut yr ydych chi'n cysoni'r rhif hwnnw sydd eisoes gennym ar gyfer mis Gorffennaf, mis Awst, mis Medi, mis Hydref - ac mae hynny cyn i bwysau'r gaeaf ein taro ni - pan fo'r cymysgedd o achosion yn newid yn sylweddol, fel yr ydych wedi cydnabod eich hun, a bod gennym ni lawer mwy o bobl hŷn, mwy o bobl bregus eu hiechyd, a mwy o bobl sy'n agored i niwed ac, wrth gwrs, llawer mwy o blant ifanc sy'n dod i'r ysbyty gydag anghenion difrifol? A wnewch chi, efallai, egluro sut yr ydym ni am lwyddo i ymdrin â'r diffyg hwnnw, o gofio bod prinder hefyd o weithiwr cymdeithasol? Oherwydd mae popeth yn eich datganiad yn swnio'n hollol wych, ond rydym i gyd yn gwybod ein bod yn cael trafferth i gael digon o aelodau staff i fod yn rhan o'r system iechyd, ac nid wyf yn deall yn iawn sut y maen nhw wedi llwyddo i ddatrys hynny'n sydyn a bod hyn am weithio'n hynod effeithiol dros y tri neu bedwar mis nesaf. A gaf fi hefyd ofyn i chi os ydych chi wedi gofyn i'r byrddau iechyd ystyried datblygu mwy ar y syniad o gael clinigwyr acíwt i fod yn gyfrifol am adrannau penodol megis yr adran orthopedeg, megis yr adran pediatreg, er mwyn gallu ailgyfeirio pobl o'r adrannau damweiniau ac achosion brys i leihau'r pwysau? Oherwydd mae'n ymddangos bod y dystiolaeth yn dangos ein bod yn gallu dargyfeirio tua 30 y cant o bobl i ffwrdd o'r adran damweiniau ac achosion brys at wasanaeth meddygon teulu y tu allan i oriau - ond, eto, nid yw'r gwasanaethau hyn yn gallu bod yn weithredol oni bai bod ganddyn nhw weithwyr cymdeithasol ar alwad, os oes ganddyn nhw'r ffisiotherapyddion, os oes ganddyn nhw'r gweithwyr iechyd meddwl i roi cefnogaeth. Felly, datganiad gwych, cadarnhaol a gobeithiol iawn, rwy'n gwerthfawrogi eich bod wedi cael y trafodaethau â'r byrddau iechyd, ond rwy'n ei chael hi'n anodd iawn derbyn bod newid sylweddol wedi bod yng nghyfundrefnau'r ysbytai a'r gwasanaethau cymunedol sydd ar gael i ni, o ystyried y prinder o ran aelodau staff sydd gennym, sydd am ganiatáu inni ymdopi'n dda yn ystod y gaeaf mewn ffordd rwy'n ofni efallai y bydd y byrddau iechyd yn gobeithio y gallant wneud. Wedi'r cyfan, rydym wedi bod yn yr un sefyllfa bob blwyddyn, yn siarad am bwysau'r gaeaf. Mae profiad yn dechrau mynd yn drech na gobaith yn hyn o beth, ac rydym ni'n awyddus i ddod o hyd i rai atebion sy'n gwbl gynaliadwy ar gyfer y dyfodol. Diolch.