English: Thank you very much, Llywydd. With just over 49 per cent of the whole Assembly budget falling in the health sector - some £7.3 billion of a budget of £15 billion - then, naturally, members of the health committee scrutinised the budget very enthusiastically in terms of all the funds spent in this sector under the new system that we've already discussed. May I thank my fellow Members for their work and the clerks and researchers for their support? There was a substantial evidence-gathering process from June onwards - in-year financial scrutiny with the Cabinet Secretary, and then, through September and October, written and oral evidence from all health boards in Wales. In October, we took evidence from the WLGA and the ADSS, who appeared in committee, and, in November, we took additional evidence from the Cabinet Secretary for Health and Social Services and the Minister for Children and Social Care - they all appeared before the committee. A number of themes emerged: transformative change is the main theme. Transformation of the service is central to the long-term success of a financially viable NHS, alongside funding to lever this change. If this does not happen, we will remain in a position where additional sums of Welsh Government funding are being used to maintain current delivery models, without any transformative change. The Cabinet Secretary told us about the additional investment of a further £450 million in the Welsh NHS over the next two years. These allocations to the NHS must be used to lever long-term change. The committee's recommendation is that the Welsh Government should ensure, following the publication of the parliamentary review of health and social care in January of next year, that it fully costs plans to take forward transformational change in terms of health and social care. Additional funding for the NHS must be premised on delivering change. The Welsh Government should identify ways in which transformation and transition funding is prioritised and made available for NHS organisations from within existing budgets. Turning now to health board finances, we know that the largest proportion of the Welsh Government's funding for the NHS in Wales goes directly to the health boards, and the committee sought to examine the current financial position in detail. This year, we have focused specifically on health boards. We note that the ambitions of the National Health Service Finance (Wales) Act 2014 have not been fully realised by all NHS bodies. It's very disappointing that four of the seven local health boards have noted a deficit in at least one of the past three years, and it's a cause of concern specifically that the Betsi Cadwaladr health board and the Hywel Dda health board have reported a deficit each year from 2014 onwards. The Welsh Government should therefore review the current methodology of setting health board budgets and publish its findings. We know that the Health Foundation has said that the health service in Wales is facing the most financially challenging period in its history and, therefore, seeking savings of some £700 million, as has already been mentioned. The Welsh Government should develop an all-Wales efficiency programme in order to ensure that local best practice is rolled out across all services throughout Wales. Funding for social care is crucially important and we should ensure that sustainable, quality social care should be provided. We mentioned in our recommendation that we need a whole-systems approach in terms of health and social care. That must be planned year on year so that additional funding is available for social care and so it is sufficient to reflect increasing demands. Losing social care will mean damage to the health service as a whole. Turning to sport, the committee was surprised to see the most recent change to the Welsh Government portfolios. I have no time to go into the detail, but just to note that it moved from one portfolio to another. As has already been mentioned, we should prioritise capital investment for primary care in the community and ensure that we enhance capacity in terms of buildings in the community in order for multidisciplinary work to take place and new models of care. The Welsh Government should also undertake a further review of the mental health ring-fenced funds to assess whether it has led to effective and appropriate expenditure on mental health and ensured improved outcomes for patients. The Welsh Government should also look at the way the UK Government funds prisoner health, because we don't receive half enough funds for that. To conclude, we need to take into account the substantial amount of money spent by NHS Wales on agency staff, and the Welsh Government should commission a review of all the anomalies and perverse incentives across agency and bank arrangements. Therefore, I'd like to think that the most detailed scrutiny ever on the health budget is going to bring about the necessary changes in expenditure of that budget to improve health and social care services for the people of Wales. Thank you very much.
Welsh: Diolch yn fawr, Llywydd. Wrth gwrs, gyda ryw jest dros 49 y cant o holl gyllideb y Cynulliad yn disgyn yn y maes iechyd - rhyw £7.3 biliwn allan o gyllideb o £15 biliwn - yn naturiol, bu i aelodau'r pwyllgor iechyd fynd ati i graffu gyda brwdfrydedd heintus ar yr holl arian yna sydd yn cael ei wario yn y maes o dan y drefn newydd rydym ni wedi clywed amdani. A allaf i ddiolch i fy nghyd-Aelodau am eu gwaith a hefyd i'r clercod a'r ymchwilwyr am eu cefnogaeth? Cafwyd proses casglu tystiolaeth sylweddol o fis Mehefin ymlaen - craffu ariannol o dan adain Ysgrifennydd y Cabinet, ac wedyn, drwy fis Medi a'r Hydref, tystiolaeth ysgrifenedig a thystiolaeth lafar gan bob bwrdd iechyd yng Nghymru. Yn Hydref, cawsom Gymdeithas Llywodraeth Leol Cymru a Chymdeithas Cyfarwyddwyr Gwasanaethau Cymdeithasol o'n blaenau yn y pwyllgor, a hefyd, ym mis Tachwedd, tystiolaeth ychwanegol gan Ysgrifennydd y Cabinet dros Iechyd a Gwasanaethau Cymdeithasol a'r Gweinidog Gofal Cymdeithasol a Phlant hefyd o'n blaenau ni. Sawl prif thema: newid trawsffuriol ydy'r prif thema. Mae trawsnewid y gwasanaeth yn sylweddol yn ganolog i lwyddiant hirdymor gwasanaeth iechyd sy'n ariannol hyfyw, ochr yn ochr â chyllid i alluogi'r newid yma. Os na fydd hyn yn digwydd, byddwn yn parhau mewn sefyllfa lle mae symiau ychwanegol o arian Llywodraeth Cymru yn cael eu defnyddio ar gyfer cynnal y modelau cyflawni presennol yn unig, heb ddim newid trawsffurfiol. Dywedodd Ysgrifennydd y Cabinet wrthym am y buddsoddiad ychwanegol o ryw £450 miliwn yn y gwasanaeth iechyd yng Nghymru dros y ddwy flynedd nesaf. Rhaid defnyddio'r dyraniadau hyn i'r gwasanaeth iechyd er mwyn galluogi newid hirdymor. Argymhelliad y pwyllgor ydy y dylai Llywodraeth Cymru sicrhau, ar ôl cyhoeddi'r adolygiad seneddol o iechyd a gofal cymdeithasol ym mis Ionawr flwyddyn nesaf, ei bod yn prisio'n llawn gynlluniau i ddatblygu newid trawsffurfiol o ran iechyd a gofal cymdeithasol. Rhaid i gyllid ychwanegol ar gyfer y GIG fod yn seiliedig ar gyflawni newid. Dylai Llywodraeth Cymru ymhellach nodi ffyrdd y mae trawsnewid a chyllid ar gyfer trawsnewid yn cael ei flaenoriaethu ac ar gael i sefydliadau'r gwasanaeth iechyd o gyllidebau presennol. Yn troi at gyllid y byrddau iechyd, gwyddom fod y gyfran fwyaf o gyllid Llywodraeth Cymru ar gyfer gwasanaeth iechyd Cymru yn mynd yn uniongyrchol i fyrddau iechyd, a cheisiodd y pwyllgor edrych yn fanwl ar eu sefyllfa ariannol bresennol. Eleni, rydym wedi canolbwyntio'n benodol ar fyrddau iechyd. Rydym yn nodi nad yw uchelgeisiau Deddf Cyllid y Gwasanaeth Iechyd Gwladol (Cymru) 2014 wedi cael eu gwireddu'n llawn gan holl gyrff y gwasanaeth iechyd. Mae'n siomedig bod pedwar o'r saith bwrdd iechyd lleol wedi nodi diffyg yn un o leiaf o'r tair blynedd flaenorol. Mae'n destun pryder, yn benodol, bod bwrdd iechyd Betsi Cadwaladr a bwrdd iechyd Hywel Dda wedi nodi diffyg bob blwyddyn o 2014 ymlaen. Dylai Llywodraeth Cymru, felly, adolygu'r dull presennol o bennu cyllidebau byrddau iechyd a chyhoeddi ei chanfyddiadau. Gwyddom fod y Sefydliad Iechyd wedi dweud bod y gwasanaeth iechyd yng Nghymru yn wynebu'r cyfnod mwyaf ariannol heriol yn ei hanes ac felly yn edrych am arbedion o ryw £700 miliwn, fel sydd wedi cael ei sôn o'r blaen. Dylai Llywodraeth ddatblygu rhaglen effeithlonrwydd Cymru gyfan er mwyn sicrhau bod arferion da lleol yn cael eu troi yn newid ar draws yr holl wasanaethau ledled Cymru. Arian ar gyfer gofal cymdeithasol: yn hanfodol bwysig dylid darparu gofal cymdeithasol cynaliadwy ac o safon. Rydym ni'n sôn mewn argymhelliad bod angen dull gweithredu system gyfan o ran iechyd a gofal cymdeithasol. Rhaid iddi gynllunio i sicrhau bod arian ychwanegol ar gael flwyddyn ar ôl blwyddyn ar gyfer gofal cymdeithasol a'i fod yn ddigonol i fodloni gofynion cynyddol. Bydd colli gofal cymdeithasol yn golygu colli'r gwasanaeth iechyd yn gyfan gwbl. Troi at chwaraeon, roedd y pwyllgor yn synnu gweld y newid diweddaraf i bortffolios Llywodraeth Cymru - nid oes gyda fi amser i fynd i mewn i'r manylion, dim ond nodi bod hyn wedi symud o un portffolio i'r llall. Dylem ni, fel sydd wedi cael ei sôn eisoes, flaenoriaethu cyllid cyfalaf ar gyfer gofal sylfaenol yn y gymuned, a sicrhau ei bod yn gwella'r gallu yn nhermau adeiladau yn y gymuned ar gyfer gweithio'n amlddisgyblaethol ac yn hyrwyddo modelau gofal newydd. Dylai Llywodraeth Cymru hefyd gynnal adolygiad pellach o'r arian sydd wedi'i neilltuo ar gyfer iechyd meddwl, i asesu a yw wedi arwain at wariant effeithiol a phriodol ar iechyd meddwl ac ar sicrhau canlyniadau gwell i gleifion. Dylai Llywodraeth Cymru hefyd edrych ar y ffordd y mae Llywodraeth y Deyrnas Gyfunol yn ariannu iechyd carcharorion, achos nid ydym ni'n derbyn hanner digon o bres. Ac i orffen, felly, mae angen ystyried y swm sylweddol y mae gwasanaeth iechyd Cymru yn ei wario ar staff asiantaeth, a dylai Llywodraeth Cymru gomisiynu adolygiad o'r holl anghysonderau a'r cymhellion gwrthnysig ar draws y trefniadau asiantaeth. Felly, hoffwn feddwl bod y craffu mwyaf manwl erioed ar y gyllideb iechyd yn mynd i esgor ar y newidiadau angenrheidiol yn y gwariant ar y gyllideb yna er mwyn gwella gwasanaethau iechyd a gofal cymdeithasol i bobl Cymru. Diolch yn fawr.