English: The size of the board's estate is massive. It covers three district hospitals, 22 other community and acute hospitals, 19 medical centres and 121 GP practices. And, as I've known when I've driven up there, it's in a geographically pretty diverse area and it can take literally hours to get from one side to the other. However, we should also remind ourselves that, while recognising the challenges that an organisation of this size faces, the health board has been in special measures for nearly two and a half years now - since June 2015. This was a decision taken by the Welsh Government, and today I'm calling on the Welsh Government to provide a comprehensive update on where this health board's status currently stands. For the sake of its staff and the patients as well as the public of north Wales, we must know how close we are to seeing the board move out of special measures and what tangible improvements there are since special measures were imposed 29 months ago. This is important because, despite being in the highest form of Welsh Government control, Betsi Cadwaladr still trails behind Wales's other six health boards on a number of major performance indicators. As well as having the highest projected budget deficit, waiting times for routine treatments have spiralled, with the number of patients waiting longer than 52 weeks for routine surgery rising by a staggering 2,550 per cent to stand at 2,491 individuals in September 2017. Given that more than an extra £10 million has been spent on keeping the health board in special measures and that its budget overspend is set to reach £50 million, I am concerned that we still haven't seen that coherent plan for improvement from the Government, from the Cabinet Secretary and from his team. Other contributors will look more closely at some of the key issues that affect Betsi. They are local AMs who, with their families and friends, make use of the health service that the trust offers on a regular basis, and they see at their regular surgeries the problems that patients using the local health service face. However, I would like to highlight one key issue that I feel drives this message home: 100-day plans were put in place to deliver urgent improvements, but more than two years on since the improvement framework was instigated, there remain serious concerns about the health board's ability to manage its finances and to deliver safe, sustainable and timely services to the people of north Wales. This is coupled with the fact that, since being placed in special measures, Welsh Government Ministers have held more than 90 meetings or discussions with the health board, in addition to those held with Welsh Government officials, yet the boards de-escalation out of special measures seems to be lacking a coherent overarching strategic direction. And it's not just Betsi Cadwaladr, obviously, that's under this cloud. I surely do not need to remind Members that three other boards are working under the targeted intervention level of Government support - those of Cardiff and Vale, Abertawe Bro Morgannwg and Hywel Dda health boards. So, we talk about special measures and targeted interventions, but what do these terms actually mean for the people on the ground? Special measures should refer to a range of actions that can be taken to improve health boards in exceptional circumstances, i.e. as a last resort, and it happens when a health board or a trust is not making the improvements expected and there are concerns that the leadership and management require external support. Targeted intervention sits one level below special measures and means that the Welsh Government may take actions that include arranging mentoring for individual board or executive team members and appointing experienced individuals with the necessary clinical and/or governance skills onto the board for a finite period. The Welsh Government's NHS Wales escalation and intervention arrangements document, produced in 2014, outlines the ways that interventions can be de-escalated. So, will the Cabinet Secretary please inform the Assembly about the de-escalation criteria for Betsi Cadwaladr, whether it has been met and, if not, when it is due to be met? I ask this question in light of a response that I received to a written question on 23 November, asking about the Cabinet Secretary's confidence that Welsh health boards are demonstrating improved financial performance. The Cabinet Secretary responded with: 'I am disappointed that Betsi Cadwaladr University Health Board is not yet demonstrating the necessary action to deliver their control total. My officials have commissioned an independent financial governance review of the Health Board which is currently being undertaken.' Cabinet Secretary, can you clarify for me exactly what is meant by 'control total'? What worries me is that you have here a health board that is under special measures yet needs to have further intervention to tackle financial problems. Surely, after all the time and money that this health board has had pumped into it during its time in special measures, it is a dereliction of duty to only now realise that an independent financial governance review is necessary. It strikes me that a financial audit should have been done at the start of this process, Cabinet Secretary, not 30 months into it. How much worse do things need to be before this situation gets the focused attention it so desperately needs? Surely this will only delay the health board emerging from special measures. And this is critical, because, whilst that health board is in special measures, its reputation is tarnished, its staff are demoralised, it's finding it difficult to recruit people, and there are a whole range of ripple effects that being under that special measures process has. I have absolutely no problem at all with you as the Cabinet Secretary, with you as the Welsh Government, looking at something and saying, 'This is not performing well enough - we have to improve it; we will put it into special measures.' I completely get it. But what I don't think anybody else gets is what those special measures mean, because, after almost 30 months, we should have seen some level of improvement, and that level of improvement is not there. I would lay against the Welsh Government that, actually, you have this problem throughout the whole of your public service delivery, because we have seen education, we have seen councils, being put into special measures, under ministerial advisory review boards, under targeted interventions, and I do not think there's a coherence as to what special measures mean. I have highlighted that there should be clear routes in and out of special measures, clear ways to de-escalate, and such a lack of clarity leads to real confusion for people in Wales, and, in this instance, for the people of north Wales. I think that you are paying lip service to intervention; I think there needs to be a common approach across departments, a clear and definable understanding as to what constitutes the top intervention in a health board. I think special measures should be the final option; it should mean boots on the ground, a thorough review of all aspects of a health board - not, you know, reviewing aspects when you're half way in, or, in this case, 30 months in - and we should have a clear way of how those health boards, and this particular health board, can move themselves back out. And I ask you to listen to our debate today, listen to the comments my colleagues are going to make, as they are there, on the front line, and actually come up with a clear and coherent plan that all of us can understand. Special measures are no good if it merely means 90 chats with you and your officials. It's got to be tangible, and if that health board is struggling to such an extent that you're now having to commission a financial governance review, you really have to put experienced soldiers onto that front line, because we ain't gonna win the battle for good health and good levels of healthcare in north Wales otherwise.
Welsh: Mae maint ystâd y bwrdd yn enfawr. Mae'n cynnwys tri ysbyty dosbarth, 22 o ysbytai cymunedol ac acíwt eraill, 19 o ganolfannau meddygol a 121 o bractisau meddygon teulu. Ac fel y gwn wrth yrru i fyny yno, mae mewn ardal ddaearyddol eithaf amrywiol a gall gymryd oriau yn llythrennol i fynd o un ochr i'r llall. Fodd bynnag, dylem hefyd atgoffa ein hunain, gan gydnabod yr heriau sy'n wynebu sefydliad o'r maint hwn, fod y bwrdd iechyd wedi bod o dan fesurau arbennig ers bron i ddwy flynedd a hanner bellach - ers mis Mehefin 2015. Penderfyniad a wnaed gan Lywodraeth Cymru oedd hwn, a heddiw rwy'n galw ar Lywodraeth Cymru i ddarparu diweddariad cynhwysfawr ar statws y bwrdd iechyd ar hyn o bryd. Er mwyn ei staff a'r cleifion yn ogystal â'r cyhoedd yng ngogledd Cymru, rhaid i ni wybod pa mor agos rydym i weld y bwrdd yn symud allan o fesurau arbennig a pha welliannau o bwys a gafwyd ers gosod mesurau arbennig 29 mis yn ôl. Mae hyn yn bwysig oherwydd, er ei fod o dan y ffurf uchaf o reolaeth gan Llywodraeth Cymru, mae bwrdd iechyd Betsi Cadwaladr ar ei hôl hi o gymharu â chwe bwrdd iechyd arall Cymru ar nifer o ddangosyddion perfformiad mawr. Yn ogystal â bod â'r diffyg rhagamcanol mwyaf yn y gyllideb, mae amseroedd aros am driniaethau cyffredin wedi ymestyn i'r entrychion, gyda nifer y cleifion sy'n aros yn hwy na 52 wythnos am lawdriniaethau cyffredin wedi codi 2,550 y cant, sy'n syfrdanol, ac roedd 2,491 o unigolion ar y rhestr honno ym mis Medi 2017. O gofio bod mwy na £10 miliwn yn ychwanegol wedi'i wario ar gadw'r bwrdd iechyd mewn mesurau arbennig a bod ei orwariant ar y gyllideb ar y ffordd i gyrraedd £50 miliwn, rwy'n bryderus ein bod yn dal heb weld cynllun cydlynol ar gyfer gwella gan y Llywodraeth, gan Ysgrifennydd y Cabinet a chan ei dîm. Bydd cyfranwyr eraill yn edrych yn fanylach ar rai o'r materion allweddol sy'n effeithio ar Betsi Cadwaladr. Maent yn ACau lleol sydd, gyda'u teuluoedd a'u ffrindiau, yn defnyddio'r gwasanaeth iechyd y mae'r ymddiriedolaeth yn ei gynnig yn rheolaidd, ac maent yn gweld yn eu meddygfeydd yn rheolaidd pa broblemau y mae cleifion sy'n defnyddio'r gwasanaeth iechyd lleol yn eu hwynebu. Fodd bynnag, hoffwn dynnu sylw at un mater allweddol y teimlaf ei fod yn crisialu'r neges hon: rhoddwyd cynlluniau 100 diwrnod ar waith er mwyn cyflawni gwelliannau ar frys, ond dros ddwy flynedd ers sefydlu'r fframwaith gwella, erys pryderon difrifol am allu'r bwrdd iechyd i reoli ei arian ac i ddarparu gwasanaethau diogel, cynaliadwy ac amserol i bobl gogledd Cymru. Yn ogystal â hyn mae Gweinidogion Llywodraeth Cymru wedi cynnal mwy na 90 o gyfarfodydd neu drafodaethau gyda'r bwrdd iechyd ers iddynt gael eu rhoi mewn mesurau arbennig, yn ogystal â chyfarfodydd a gynhaliwyd gyda swyddogion Llywodraeth Cymru, ac eto nid yw'n ymddangos bod cyfeiriad strategol trosfwaol cydlynus i ymdrechion y bwrdd i ddod allan o fesurau arbennig. Ac nid Betsi Cadwaladr yn unig sydd o dan y cwmwl hwn wrth gwrs. Yn sicr nid oes angen i mi atgoffa'r Aelodau fod tri bwrdd iechyd arall yn gweithio o dan y lefel ymyrraeth a dargedir o gymorth gan y Llywodraeth - sef byrddau iechyd Caerdydd a'r Fro, Abertawe Bro Morgannwg a Hywel Dda. Felly, soniwn am fesurau arbennig ac ymyriadau wedi'u targedu, ond beth y mae'r termau hyn yn ei olygu mewn gwirionedd i bobl ar lawr gwlad? Dylai mesurau arbennig gyfeirio at amrywiaeth o gamau gweithredu y gellir eu cymryd i wella byrddau iechyd mewn amgylchiadau eithriadol, h.y. fel dewis olaf, ac mae'n digwydd pan nad yw bwrdd iechyd neu ymddiriedolaeth yn gwneud y gwelliannau a ddisgwylir a cheir pryderon bod yr arweinyddiaeth a'r rheolwyr angen cymorth allanol. Daw ymyrraeth wedi'i thargedu un lefel yn is na'r mesurau arbennig ac mae'n golygu y gall Llywodraeth Cymru roi camau ar waith sy'n cynnwys trefnu mentora ar gyfer aelodau unigol o'r bwrdd neu'r tîm gweithredol a phenodi unigolion profiadol sydd â'r sgiliau clinigol a/neu sgiliau llywodraethu ar y bwrdd am gyfnod cyfyngedig. Mae dogfen trefniadau uwchgyfeirio ac ymyrryd GIG Cymru Llywodraeth Cymru, a gynhyrchwyd yn 2014, yn amlinellu'r ffyrdd y gellir isgyfeirio ymyriadau. Felly, a wnaiff Ysgrifennydd y Cabinet roi gwybod i'r Cynulliad beth yw'r meini prawf isgyfeirio ar gyfer Betsi Cadwaladr, a ydynt wedi eu bodloni, ac os nad ydynt, pa bryd y mae disgwyl iddynt gael eu bodloni? Gofynnaf y cwestiwn yn sgil ymateb a gefais i gwestiwn ysgrifenedig ar 23 Tachwedd, yn gofyn am hyder Ysgrifennydd y Cabinet fod byrddau iechyd Cymru yn dangos gwell perfformiad ariannol. Ymatebodd Ysgrifennydd y Cabinet: Rwy'n siomedig nad yw Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn dangos y camau gweithredu angenrheidiol hyd yma i gael cyfanswm rheolaeth. Mae fy swyddogion wedi comisiynu adolygiad annibynnol o drefniadau llywodraethu ariannol y Bwrdd Iechyd sydd ar waith ar hyn o bryd. Ysgrifennydd y Cabinet, a allwch egluro i mi beth yn union a olygir wrth 'gyfanswm rheolaeth'? Yr hyn sy'n fy mhoeni yw bod gennych fwrdd iechyd yma sydd o dan fesurau arbennig ac eto mae angen cael rhagor o ymyrraeth i fynd i'r afael â phroblemau ariannol. Yn sicr, ar ôl yr holl amser ac arian a fwydwyd i mewn i'r bwrdd iechyd hwn yn ystod ei amser o dan fesurau arbennig, esgeuluso dyletswydd yw methu sylweddoli tan yn awr fod angen cynnal adolygiad annibynnol o'r trefniadau llywodraethu ariannol. Mae'n ymddangos i mi y dylid bod wedi cynnal archwiliad ariannol ar ddechrau'r broses hon, Ysgrifennydd y Cabinet, nid 30 mis yn ddiweddarach. Faint yn waeth y mae angen i bethau fynd cyn i'r sefyllfa hon gael y sylw manwl y mae cymaint o'i angen? Yn sicr ni fydd hyn ond yn oedi'r broses o adael mesurau arbennig i'r bwrdd iechyd. Ac mae hyn yn hanfodol, oherwydd, tra bo'r bwrdd iechyd o dan fesurau arbennig, caiff ei enw da ei lychwino, mae ei staff yn digalonni, mae'n ei chael hi'n anodd recriwtio pobl, a cheir amrywiaeth eang o effeithiau o ganlyniad i fod o dan broses y mesurau arbennig. Nid oes gennyf broblem o gwbl gyda chi fel Ysgrifennydd y Cabinet, gyda chi fel Llywodraeth Cymru, yn edrych ar rywbeth a dweud, 'Nid yw'n perfformio'n ddigon da - rhaid i ni ei wella; fe'i gosodwn o dan fesurau arbennig.' Rwy'n derbyn hynny'n llwyr. Ond yr hyn nad wyf yn credu y bydd neb arall yn ei dderbyn yw beth y mae'r mesurau arbennig hynny'n ei olygu, oherwydd, ar ôl bron i 30 mis, dylem fod wedi gweld rhywfaint o welliant, ac nid yw'r lefel honno o welliant yno. Buaswn yn awgrymu wrth y Llywodraeth, mewn gwirionedd, fod y broblem hon yn eich wynebu drwy eich holl ddarpariaeth o wasanaethau cyhoeddus, oherwydd rydym wedi gweld addysg, rydym wedi gweld cynghorau, yn cael eu rhoi o dan fesurau arbennig, o dan fyrddau adolygu ar gyfer cynghori'r Gweinidog, o dan ymyriadau wedi'u targedu, ac nid wyf yn credu bod cydlyniad ynglŷn â'r hyn y mae mesurau arbennig yn ei olygu. Nodais y dylai fod llwybrau clir i mewn ac allan o fesurau arbennig, a ffyrdd clir o isgyfeirio, ac mae diffyg eglurder o'r fath yn arwain at ddryswch go iawn i bobl Cymru, ac yn yr achos hwn, i bobl gogledd Cymru. Credaf mai cefnogaeth arwynebol a rowch i ymyrraeth; credaf fod angen cael dull cyffredin o weithredu ar draws adrannau, a dealltwriaeth glir a diffiniadwy ynglŷn â beth yw'r ymyrraeth uchaf mewn bwrdd iechyd. Credaf y dylai mesurau arbennig fod yn opsiwn olaf; dylai olygu gwaith ar lawr gwlad, adolygiad trylwyr o bob agwedd ar y bwrdd iechyd - nid adolygu agweddau, wyddoch chi, pan fyddwch hanner ffordd drwodd, neu yn yr achos hwn, 30 mis yn ddiweddarach - a dylai fod gennym ffordd eglur i'r byrddau iechyd, a'r bwrdd iechyd penodol hwn, allu symud allan o fesurau arbennig. A gofynnaf i chi wrando ar ein dadl heddiw, gwrando ar y sylwadau y mae fy nghyd-Aelodau yn mynd i'w gwneud, gan eu bod ar y rheng flaen, ac yn gallu cynnig cynllun clir a chydlynol y gall pob un ohonom ei ddeall. Nid yw mesurau arbennig yn dda i ddim os yw'n golygu 90 o sgyrsiau â chi a'ch swyddogion a dim mwy na hynny. Mae'n rhaid iddo fod yn weladwy, ac os yw bwrdd iechyd yn cael trafferth i'r fath raddau fel eich bod bellach yn gorfod comisiynu adolygiad o'r trefniadau llywodraethu ariannol, rhaid i chi roi milwyr profiadol yn y rheng flaen, oherwydd fel arall nid ydym yn mynd i ennill y frwydr dros iechyd da a lefelau da o ofal iechyd yng ngogledd Cymru.