English: Diolch, Lywydd. I'm pleased to have the opportunity to open this debate today. Of course, since tabling this motion, the issue of winter pressures has hit the headlines in both Wales and England. And, to be truthful, I would expect there are concerns across all home nations. We are seeking an update report from you, Cabinet Secretary, on how you think the Welsh health service is coping and how you have evidenced the views that you might have. I'm very conscious that, year after year, health boards promise that they are ready for winter pressures, yet, year after year, we have a situation where people are struggling to give and receive the correct and safe levels of service. As I said yesterday, having a public debate in response to very public concerns - and you only have to look at the front page of today's 'Western Mail' to understand the pressures staff feel they are having to operate under - . Having that public debate in no way casts a negative light on staff within the NHS. This winter, as in previous winters, many of them have gone over and above the call of duty. They have stood in for colleagues struck down with flu, they have dealt with worried parents of frightened young children suffering from bronchiolitis, a winter perennial, and they have held the line with our more elderly and vulnerable members of society for whom winter can be such a trial. I would like to thank all the excellent staff who work in our hospitals, surgeries, nursing homes and ambulances. You are all a credit to your profession, and the fact that we are debating this issue is by no means a reflection on your abilities or dedication to your jobs. You're all working under immense pressure and, having been a reluctant but regular user of the NHS in recent years, I cannot speak highly enough of the work that you do. Cabinet Secretary, the Royal College of Physicians were among a great many organisations, including the Royal College of General Practitioners, the Royal College of Emergency Medicine, the Royal College of Paediatrics and Child Health, the Royal College of Nursing - and I could go on with the list - who essentially raised the same concerns about readiness, about staffing levels, numbers of beds available, training and funding during written and oral evidence to the health committee. The Royal College of Physicians stated that: The challenges facing health boards as they prepare for winter are complex. They reflect wider pressures on the NHS and social care.' And they went on to say that: Health boards are operating in an under-funded, under-doctored and overstretched context.' Given the reports that we are receiving in our constituencies, the stories emerging in the media and concerns being raised by a multitude of healthcare professionals, I ask you, Cabinet Secretary, for an honest appraisal of how you feel that the Welsh NHS has, under your watch, performed so far this winter. How is it coping, and do you feel that it is in a healthy enough position to see out the rest of the winter season? The British Medical Association, in evidence it gave to committee and in further briefings, states that too many hospital beds have closed over the last decade and the lack of investment and capacity in social care is increasingly impacting on the provision of healthcare, particularly during times of peak demand.' Yet, in evidence you gave on 17 November, you said: we don't think that there is evidence that year-round capacity is overstretched in terms of our numbers. We're always looking, though, at whether we have got the right level of bed capacity as part of the system.' Do you still stand by these views, even though the BMA seemed to think differently? Now, I do agree that many of these organisations say that the NHS is under this pressure year-round, however, the shape of that pressure changes in the winter, with far more of the individuals at either end of the spectrum being at risk - either the very young or the very elderly. Society has changed and Wales has now got an increasingly ageing and therefore more frail population, and this means there are more complex needs and an increase in the amount of visits to accident and emergency departments. Wales has the highest rate of long-term limiting illness in the UK. In the nine years between 2001-02 and 2010-11, the number of people with chronic or long-term conditions increased from 105,000 to 142,000, therefore placing more pressure on services. And, finally, the college of paediatrics and child health have highlighted the increased demand on services by children and young people, and they go on to highlight that they feel the number of high dependency and intensive care unit beds are insufficient. Cabinet Secretary, yesterday, I asked you a number of questions during the urgent question, and there are a few I would like further clarification on. You accept that bed numbers have reduced, but said that beds are ring-fenced over winter months in case of extra demand. Can you tell me whether you feel that there are now enough beds available in the Welsh NHS and, more specifically, are they available in the correct locations - community and secondary? It is all very well having bed space for patients, but if they're not located where we need them the most then they are wasted. Yesterday, I raised the issue of frail and elderly assessment units, which could be set up in A&Es during times of peak demand. Similar units are already deployed in hospitals in other parts of the UK. Could I get on record a commitment to consider this approach, which may help to alleviate the direct pressures on the front-facing parts of our health service and get patients treated more efficiently, a point made yesterday by the college of emergency medicine?
Welsh: Diolch, Lywydd. Rwy'n falch o gael y cyfle i agor y ddadl hon heddiw. Wrth gwrs, ers cyflwyno'r cynnig hwn, mae pwysau'r gaeaf wedi cyrraedd y penawdau yng Nghymru ac yn Lloegr. Ac i fod yn onest, buaswn yn disgwyl bod yna bryderon ar draws y pedair gwlad. Gofynnwn am y newyddion diweddaraf gennych, Ysgrifennydd y Cabinet, ynglŷn â sut rydych yn meddwl y mae'r gwasanaeth iechyd yng Nghymru yn ymdopi a pha dystiolaeth sydd gennych i gefnogi'ch safbwyntiau. Flwyddyn ar ôl blwyddyn, rwy'n ymwybodol iawn fod byrddau iechyd yn addo eu bod yn barod ar gyfer pwysau'r gaeaf, ac eto, flwyddyn ar ôl blwyddyn, mae gennym sefyllfa lle y caiff pobl anhawster i roi a chael y lefelau cywir a diogel o wasanaeth. Fel y dywedais ddoe, mae cael trafodaeth gyhoeddus mewn ymateb i bryderon cyhoeddus iawn - ac nid oes ond angen i chi edrych ar dudalen flaen y 'Western Mail' heddiw i ddeall y pwysau y mae staff yn teimlo bod yn rhaid iddynt weithredu oddi tano - . Nid yw cael y ddadl gyhoeddus honno yn taflu goleuni negyddol mewn unrhyw fodd ar staff yn y GIG. Y gaeaf hwn, fel mewn gaeafau blaenorol, mae llawer ohonynt wedi mynd y tu hwnt i'r hyn y mae dyletswydd yn galw amdano. Maent wedi camu i'r adwy pan fo cydweithwyr yn dioddef o ffliw, maent wedi ymdrin â rhieni pryderus plant ifanc ofnus sy'n dioddef o bronciolitis, haint sy'n digwydd bob gaeaf, ac maent wedi cynnal ein haelodau mwy oedrannus ac agored i niwed o'r gymdeithas y mae'r gaeaf yn gallu bod mor anodd iddynt. Hoffwn ddiolch i'r holl staff rhagorol sy'n gweithio yn ein hysbytai, ein meddygfeydd, ein cartrefi nyrsio a'n hambiwlansys. Rydych i gyd yn glod i'ch proffesiwn, ac nid yw'r ffaith ein bod yn trafod y mater hwn yn adlewyrchiad ar eich gallu na'ch ymroddiad i'ch swyddi mewn unrhyw fodd. Rydych i gyd yn gweithio o dan bwysau aruthrol ac ar ôl bod yn ddefnyddiwr GIG amharod ond rheolaidd dros y blynyddoedd diwethaf, ni allaf ganmol digon ar y gwaith a wnewch. Ysgrifennydd y Cabinet, roedd Coleg Brenhinol y Meddygon ymhlith llawer iawn o sefydliadau, gan gynnwys Coleg Brenhinol yr Ymarferwyr Cyffredinol, Coleg Brenhinol Meddygaeth Frys, Coleg Brenhinol Pediatreg ac Iechyd Plant, y Coleg Nyrsio Brenhinol - a gallwn barhau â'r rhestr - a oedd yn nodi'r un pryderon yn eu hanfod am barodrwydd, lefelau staffio, niferoedd y gwelyau sydd ar gael, hyfforddiant a chyllid yn ystod tystiolaeth ysgrifenedig a llafar i'r pwyllgor iechyd. Dywedodd Coleg Brenhinol y Meddygon: Mae'r heriau sy'n wynebu byrddau iechyd wrth iddynt baratoi ar gyfer y gaeaf yn gymhleth. Maent yn adlewyrchu pwysau ehangach ar y GIG a gofal cymdeithasol. Ac aethant ymlaen i ddweud: Mae byrddau iechyd yn gweithredu mewn cyd-destun sydd wedi'i danariannu a'i orymestyn, a lle na cheir digon o feddygon. O ystyried yr adroddiadau rydym yn eu cael yn ein hetholaethau, y straeon sy'n dod i'r amlwg yn y cyfryngau a'r pryderon sy'n cael eu mynegi gan lu o weithwyr gofal iechyd proffesiynol, rwy'n gofyn i chi, Ysgrifennydd y Cabinet, am werthusiad gonest o sut y teimlwch y mae'r GIG yng Nghymru wedi perfformio y gaeaf hwn hyd yn hyn o dan eich goruchwyliaeth chi. Sut y mae'n ymdopi, ac a ydych yn teimlo ei fod mewn sefyllfa ddigon iach i allu ymdopi dros weddill tymor y gaeaf? Mae Cymdeithas Feddygol Prydain, mewn tystiolaeth a roddodd i'r pwyllgor ac mewn sesiynau briffio pellach, yn nodi bod gormod o welyau ysbyty wedi'u cau dros y degawd diwethaf ac mae diffyg buddsoddiad a chapasiti mewn gofal cymdeithasol yn effeithio'n gynyddol ar y ddarpariaeth gofal iechyd, yn enwedig ar adegau brig. Eto i gyd, mewn tystiolaeth a roddwyd gennych ar 17 Tachwedd, fe ddywedoch: nid ydym yn credu bod yna dystiolaeth fod capasiti drwy gydol y flwyddyn wedi'i orymestyn o ran ein niferoedd. Fodd bynnag, rydym bob amser yn edrych i weld a oes gennym y lefel gywir o gapasiti gwelyau yn rhan o'r system. A ydych yn dal i arddel y safbwyntiau hyn, er bod Cymdeithas Feddygol Prydain i'w gweld yn meddwl fel arall? Nawr, rwy'n cytuno bod llawer o'r sefydliadau hyn yn dweud bod y GIG o dan bwysau o'r fath drwy gydol y flwyddyn, ond mae ffurf y pwysau'n newid yn y gaeaf, gyda llawer mwy o unigolion ar ddau ben y sbectrwm yn wynebu risg - naill ai'r ifanc iawn neu'r hen iawn. Mae cymdeithas wedi newid a bellach, mae gan Gymru boblogaeth gynyddol o bobl sy'n heneiddio ac sydd, felly, yn fwy bregus, a golyga hyn fod yna anghenion mwy cymhleth a chynnydd yn nifer yr ymweliadau ag adrannau damweiniau ac achosion brys. Gan Gymru y mae'r gyfradd uchaf o salwch cyfyngol hirdymor yn y DU. Yn y naw mlynedd rhwng 2001-02 a 2010-11, cynyddodd nifer y bobl â chyflyrau hirdymor neu gronig o 105,000 i 142,000, gan roi mwy o bwysau ar wasanaethau. Ac yn olaf, mae'r coleg pediatreg ac iechyd plant wedi tynnu sylw at y galw cynyddol gan blant a phobl ifanc am wasanaethau, ac maent yn mynd rhagddynt i dynnu sylw at y ffaith eu bod yn teimlo bod nifer y gwelyau dibyniaeth uchel ac unedau gofal dwys yn annigonol. Ysgrifennydd y Cabinet, ddoe gofynnais nifer o gwestiynau i chi yn ystod y cwestiwn brys, a hoffwn gael eglurhad pellach ar rai ohonynt. Rydych yn derbyn bod nifer y gwelyau wedi gostwng, ond rydych wedi dweud bod arian yn cael ei glustnodi ar gyfer gwelyau yn ystod misoedd y gaeaf rhag ofn y bydd galw ychwanegol. A allwch ddweud wrthyf a ydych yn teimlo bod yna bellach ddigon o welyau ar gael yn y GIG yng Nghymru ac yn fwy penodol, a ydynt ar gael yn y lleoliadau cywir - yn y gymuned ac mewn gofal eilaidd? Mae'n hawdd cael gwelyau gwag ar gyfer cleifion, ond os nad ydynt wedi'u lleoli lle rydym fwyaf o'u hangen, cânt eu gwastraffu. Ddoe, gofynnais ynglŷn ag unedau asesu pobl oedrannus a bregus, y gellid eu sefydlu mewn adrannau damweiniau ac achosion brys ar adegau brig. Defnyddir unedau tebyg eisoes mewn ysbytai mewn rhannau eraill o'r DU. A gaf fi ymrwymiad wedi'i gofnodi i ystyried y dull hwn o weithredu, a allai helpu i leddfu'r pwysau uniongyrchol ar reng flaen ein gwasanaeth iechyd a sicrhau bod cleifion yn cael eu trin yn fwy effeithlon, pwynt a wnaed ddoe gan y coleg meddygaeth frys?