English: Earlier today, we met with people who gave evidence to the original inquiry over in the Pierhead at lunchtime, and that was in order to seek their views on the report's findings and the Welsh Government's response to it. I would like to take this opportunity to thank all those who took part in that. Moving on to the conclusions and recommendations, our report covers a wide range of issues, including whether clusters are reducing demands on GPs, the benefits of multidisciplinary team working, and the level and allocation of funding. We have made a series of 16 recommendations to the Welsh Government and we hope they will contribute towards delivering the major step change we believe is needed in the development and direction of primary care clusters if they are to relieve pressure on GPs and Welsh hospitals. Our first set of recommendations - 1, 2, 3 and 4 - relate to the pace and nature of cluster development. There is significant variation in the maturity of the 64 clusters and their stages of development. Whilst variation is not in itself a negative, the committee wants to be assured that this is as a result of responding to local needs, rather than because of a lack of consistency in the pace of development. We heard differing views about the purpose of clusters and believe this adds to the variation in how they are developing. Whilst some are very effective at bringing key delivery partners and stakeholders together, in other areas they appear to be primarily seen as a vehicle to apply for funds. According to some respondents there is a large degree of reliance on the energy and enthusiasm of individual GPs, GP practices or cluster leads, and that this is not a sustainable long-term model. We also heard that not all the right stakeholders are involved and that some clusters still have a focus on general medical practice. We agree with the Welsh Government that primary care services should have a strong focus on local planning and delivery of services to meet the identified health needs of the population. Therefore we support the view that clusters need autonomy. However, this must be positioned within a much more defined and structured governance framework. There is a need for a clearer view on the future shape, accountability, powers and structure of clusters. Without this, there is a danger of a variety of ad hoc local approaches that will not deliver sustainable change. I therefore welcome the Cabinet Secretary's acceptance, wholly or in principle, of recommendations 1 to 4. Turning now to whether clusters are delivering the Welsh Government's ambitions for primary care - these are recommendations 5, 6 and 7. We fully support the Welsh Government's aim for clusters to play a significant role in planning the transfer of services and resources out of hospitals and into their local communities. This will not happen without an increased impetus and focus on how secondary care professionals can be meaningfully involved in cluster working, and how clusters can engage in the very big challenges around reducing unscheduled care. The Welsh Government must set out a clear plan as to how this aspect of cluster work will be taken forward. We also heard about the need to change patient expectations in terms of the appropriateness of seeing a range of primary care professionals rather than seeing the GP. Examples were given of patients insisting on an appointment with a GP, despite there being other staff such as a practice nurse who it may have been more appropriate for them to see. We therefore support the need for a national campaign, building on the existing Choose Well strategy, to increase patient understanding and support for the increased multidisciplinary team approach. We welcome the Cabinet Secretary's acceptance, wholly or in principle, of recommendations 5, 6 and 7. Recommendations 8, 9 and 10 focus on issues related to staffing. There are obvious and substantial benefits to the multidisciplinary team approach on which the cluster model is based. However some of the associated practical difficulties are substantial and, in our view, potentially pose the most significant challenge to the future of cluster working. These include: the recruitment and retention of GPs and a wide range of other professionals involved in primary care; the question of who employs cluster staff and the associated issues of pensions and indemnity, perhaps the most significant barrier to effective cluster working; the potential for GPs to spend time dealing with HR and management issues rather than on delivering clinical care; that the clinical supervision of the MDT is becoming diluted as staff are placed outside traditional management models and physical locations; the negative impact of annual funding allocations impacting on the ability to recruit and retain staff; and associated governance issues. We also heard about the need for properly planned and co-ordinated workforce training and skills development for staff. It is therefore disappointing that the Cabinet Secretary has rejected our call to put in place a national lead to co-ordinate training and development needs within clusters and I would welcome further explanation from the Cabinet Secretary of his reasons for this. Cluster funding was welcomed by all of those involved in cluster working, whether nationally or locally. We made three recommendations, 11, 12 and 13, in relation to funding, all of which were based on the evidence we received and were not calling for any additional funding. It is therefore disappointing that the Cabinet Secretary has chosen to disregard these important points. The NHS needs timely and effective infrastructure to support the change to cluster working. This includes both the primary care estate and ICT infrastructure - recommendations 14 and 15. The evidence we heard suggests that progress in this area has been minimal and that the estate, in its broadest sense, remains a significant issue for the primary care sector. I welcome the Cabinet Secretary's recent announcement of £68 million to deliver 19 new integrated health and care centres across Wales by 2021, as these will be key to relieving pressure on GPs and hospitals by keeping vital health services closer to home in people's communities. I also look forward to hearing the Cabinet Secretary's response to the findings of the parliamentary review of health and social care in relation to ICT infrastructure. Our final recommendation, recommendation 16, relates to the need for a much clearer and robust mechanism for evaluating cluster work. Whilst in general we heard some positive feedback about the perceived impact of cluster initiatives, there was very limited quantifiable and measurable evidence to back up these perceptions. Concerns were expressed about whether it is possible to demonstrate the impact of clusters, and about whether there are mechanisms in place to ensure the robust evaluation of what they do, and the extent to which they are improving patient outcomes. Evaluation and monitoring were seen as vital not only in assessing progress, but also in ensuring that successful cluster work was shared with others and rolled out where appropriate. It is therefore disappointing that the Cabinet Secretary has rejected recommendation 16. I look forward to the debate this afternoon. Thank you.
Welsh: Yn gynharach heddiw, cawsom gyfarfod efo pobl a roddodd dystiolaeth i'r ymchwiliad gwreiddiol, draw yn y Pierhead amser cinio, a hynny er mwyn cael eu barn ar ganfyddiadau'r adroddiad a hefyd ar ymateb Llywodraeth Cymru i'n hadroddiad ni. Dyma fanteisio ar y cyfle hwn i ddiolch unwaith eto i bawb a gymerodd ran yn ein hadolygiad. Rwy'n symud ymlaen at y casgliadau a'n hargymhellion ni. Mae ein hadroddiad yn ymdrin ag ystod eang o faterion, gan gynnwys a yw'r clystyrau wedi lleihau'r galw ar feddygon teulu, y manteision o weithio fel tîm amlddisgyblaethol, a lefel y cyllid a'i ddyraniad. Mae gennym gyfanswm o 16 o argymhellion i Lywodraeth Cymru, a'r gobaith yw y bydd y rhain yn cyfrannu tuag at sicrhau'r newid mawr sydd ei angen, yn ein barn ni, o ran datblygiad a chyfeiriad clystyrau gofal sylfaenol, os ydyn nhw i ysgafnhau'r pwysau sydd ar feddygon teulu ac ysbytai Cymru. Mae'r set gyntaf o argymhellion - argymhellion 1, 2, 3 a 4 - yn ymwneud â chyflymder a natur datblygiad clwstwr. Mae amrywiad sylweddol yn y 64 o glystyrau o ran eu haeddfedrwydd a ble maen nhw arni yn eu datblygiad. Er nad yw amrywiad ynddo'i hun yn beth negyddol, mae'r pwyllgor am gael sicrwydd bod yr amrywiad hwn o ganlyniad i ymateb i anghenion lleol, yn hytrach na diffyg cysondeb yng nghyflymder y datblygiad. Clywsom wahaniaeth barn ynghylch diben y clystyrau a chredwn fod hyn yn ychwanegu at yr amrywiad yn y ffordd y maen nhw'n datblygu. Er bod rhai yn effeithiol iawn o ran dod â rhanddeiliaid a phartneriaid cyflenwi allweddol ynghyd, mewn ardaloedd eraill, ymddengys iddynt gael eu hystyried yn gyfrwng ar gyfer gwneud cais am arian yn bennaf. Dywedodd rhai o'r ymatebwyr fod datblygiad rhai clystyrau yn dibynnu i raddau helaeth ar egni a brwdfrydedd meddygon teulu, practisau meddygon teulu, neu arweinwyr clwstwr unigol, ac nad yw'r model hwn yn un cynaliadwy yn y tymor hir. Hefyd, clywsom nad yw'r holl randdeiliaid cywir yn cymryd rhan, a bod rhai clystyrau'n dal i ganolbwyntio ar bractis meddygol cyffredinol. Rydym yn cytuno efo Llywodraeth Cymru y dylai gwasanaethau gofal sylfaenol ganolbwyntio'n gryf ar gynllunio a chyflwyno gwasanaethau lleol i ddiwallu anghenion iechyd y boblogaeth. Felly, rydym yn cefnogi'r farn bod angen annibyniaeth ar glystyrau. Fodd bynnag, rhaid gosod hyn o fewn fframwaith llywodraethu llawer mwy diffiniedig a strwythuredig. Mae angen golwg gliriach ar ffurf, atebolrwydd, pwerau a strwythur y clystyrau yn y dyfodol. Heb hyn, y perygl yw y bydd amrywiaeth o drefniadau ad hoc lleol ac, oherwydd hynny, na fydd newid cynaliadwy yn digwydd. Felly, rwy'n croesawu'r ffaith bod Ysgrifennydd y Cabinet wedi derbyn, yn llwyr neu mewn egwyddor, argymhellion 1 i 4. Rwy'n troi nawr at y cwestiwn a yw clystyrau'n gwireddu uchelgeisiau Llywodraeth Cymru ar gyfer gofal sylfaenol, sef argymhellion 5, 6 a 7. Rydym yn cefnogi'n llawn nod Llywodraeth Cymru i glystyrau chwarae rhan arwyddocaol wrth gynllunio'r gwaith o drosglwyddo gwasanaethau ac adnoddau allan o ysbytai i'w cymunedau lleol. Ni fydd hyn yn digwydd heb ffocws ac ysgogiad cynyddol o ran sut y gall gweithwyr gofal eilaidd ymwneud yn ystyrlon â gwaith clwstwr a sut y gall clystyrau ymgymryd â'r heriau mawr o ran lleihau gofal heb ei drefnu. Rhaid i Lywodraeth Cymru nodi cynllun clir ynghylch sut y bydd yr agwedd hon ar waith clwstwr yn cael ei datblygu. Clywsom hefyd am yr angen i newid disgwyliadau cleifion o ran priodoldeb gweld ystod o weithwyr proffesiynol gofal sylfaenol, yn hytrach na gweld y meddyg teulu bob tro. Rhoddwyd enghreifftiau o gleifion sy'n mynnu gweld meddyg teulu er gwaethaf y ffaith bod aelodau eraill o staff ar gael, fel nyrsys practis, ac y gallai fod wedi bod yn fwy priodol iddynt eu gweld nhw yn lle. Felly, rydym ni yn cefnogi'r angen am ymgyrch genedlaethol a fydd yn adeiladu ar y strategaeth Dewis Doeth bresennol i wella dealltwriaeth y claf a'r gefnogaeth ar gyfer y dull tîm amlddisgyblaethol cynyddol. Rydym ni'n croesawu'r ffaith fod Ysgrifennydd y Cabinet wedi derbyn, yn llwyr neu mewn egwyddor, argymhellion 5, 6 a 7. Mae argymhellion 8, 9 a 10 yn canolbwyntio ar faterion sy'n gysylltiedig â staffio. Mae manteision amlwg a sylweddol i'r dull tîm amlddisgyblaethol y mae'r clwstwr yn seiliedig arno. Fodd bynnag, mae rhai o'r anawsterau ymarferol cysylltiedig yn sylweddol ac, yn ein barn ni, nhw fydd yr her fwyaf arwyddocaol, o bosibl, i ddyfodol clystyrau. Mae'r rhain yn cynnwys: recriwtio a chadw meddygon teulu ac ystod eang o weithwyr proffesiynol eraill sy'n ymwneud â gofal sylfaenol; y cwestiwn ynghylch pwy sy'n cyflogi staff clwstwr a materion cysylltiedig fel pensiynau ac indemniad, efallai'r rhwystr mwyaf sylweddol i waith clwstwr effeithiol; y potensial i feddygon teulu dreulio amser yn ymdrin â materion adnoddau dynol a rheoli yn hytrach na darparu gofal clinigol; y ffaith bod goruchwyliaeth glinigol y tîm amlddisgyblaethol yn cael ei wanhau gan fod staff yn cael eu gosod y tu allan i fodelau rheoli traddodiadol a lleoliadau ffisegol; effaith negyddol dyraniadau cyllid blynyddol sy'n effeithio ar y gallu i recriwtio a chadw staff o safon; a hefyd materion llywodraethu cysylltiedig. Yn ogystal, clywsom fod angen mynd ati, o fewn y model clwstwr newydd hwn, i gynllunio a chydgysylltu'r ddarpariaeth ar gyfer datblygu sgiliau staff a hyfforddi'r gweithlu. Siom, felly, yw bod Ysgrifennydd y Cabinet wedi gwrthod ein galwad i gyflwyno arweinydd cenedlaethol i gydlynu anghenion hyfforddiant a datblygu yn y clystyrau. Fe fyddwn i'n croesawu esboniad gan Ysgrifennydd y Cabinet am ei resymau dros wneud hyn. Croesawyd cyllid clwstwr gan bawb sy'n ymwneud â gwaith clwstwr, yn genedlaethol ac yn lleol. Mae tri o'n hargymhellion, sef 11, 12 a 13, yn ymwneud â chyllid. Seiliwyd y tri ar y dystiolaeth a ddaeth i law ac nid ydyn nhw'n galw am gyllid ychwanegol. Mae'n siom, felly, fod Ysgrifennydd y Cabinet wedi dewis diystyru'r pwyntiau pwysig hyn. Mae angen seilwaith amserol ac effeithiol ar y gwasanaeth iechyd gwladol i gefnogi'r newid i waith clwstwr. Mae hyn yn cynnwys yr ystâd gofal sylfaenol a'r seilwaith IT - argymhellion 14 a 15. Mae'r dystiolaeth yn awgrymu mai ychydig o gynnydd a welwyd yn y maes hwn a bod yr ystâd, yn ei hystyr ehangaf, yn parhau i fod yn broblem sylweddol i'r sector gofal sylfaenol. Rwy'n croesawu'r ffaith bod Ysgrifennydd y Cabinet wedi cyhoeddi swm o £68 miliwn yn ddiweddar i gyflwyno 19 canolfan iechyd a gofal integredig newydd ledled Cymru erbyn 2021, gan y bydd y rhain yn allweddol i leddfu pwysau ar feddygon teulu ac ysbytai trwy gadw gwasanaethau iechyd hanfodol yn agosach at bobl yn eu cymunedau. Hefyd, rwy'n edrych ymlaen at glywed ymateb Ysgrifennydd y Cabinet i ganfyddiadau'r adolygiad seneddol o iechyd a gofal cymdeithasol mewn perthynas â seilwaith IT. Mae a wnelo ein hargymhelliad terfynol, argymhelliad 16, â'r angen am drefn gliriach a mwy cadarn ar gyfer gwerthuso gwaith clwstwr. Yn gyffredinol, clywsom adborth cadarnhaol am effaith ganfyddedig mentrau clwstwr, ond ychydig iawn o dystiolaeth fesuradwy oedd ar gael i ategu'r canfyddiadau hyn. Mynegwyd pryderon ynghylch a yw'n bosibl dangos effaith clystyrau, ac a oes mecanweithiau ar waith i sicrhau y gellid gwerthuso'n gadarn yr hyn maen nhw'n ei wneud, ac i ba raddau maen nhw'n gwella canlyniadau cleifion. Ystyriwyd bod gwerthuso a monitro yn hanfodol nid yn unig wrth asesu cynnydd, ond hefyd wrth sicrhau bod gwaith clwstwr llwyddiannus yn cael ei rannu ag eraill a'i gyflwyno lle bo'n briodol. Mae'n siomedig, felly, fod Ysgrifennydd y Cabinet wedi gwrthod argymhelliad 16. Edrychaf ymlaen at y ddadl y prynhawn yma. Diolch yn fawr.