English: May I express my gratitude to the Conservatives for bringing this motion forward today? This is not, as Angela Burns has said, a situation that any of us would wish to find ourselves in, and this impacts, of course, very directly on a great many of my constituents in the west of the Betsi Cadwaladr area. I'm really concerned that we get from this Minister a lot of complacency, a lot of 'everything's going to be all right'. I've been looking back through the six-monthly reports - they are full of assertion and they are not very full of evidence. And I just want to highlight a number - very briefly - of issues that are publicly evidenced. Waiting times have not improved since special measures were introduced and have only shown improvements in early 2018, when it was highlighted as an issue in Plenary again. The A&E system still consistently performs worse than the Welsh average, and the performance of two poorly-performing hospitals drag down the performance of a good one. Cancer waiting times show that, at the start of special measures, Betsi was actually performing better than the Welsh average and now performs worse than the Welsh average and there's been a 5 per cent decrease in the number of GPs in the Betsi Cadwaladr area over time, though I do accept what the Minister said yesterday about there being alternative services directly employed by the local health board being put in place to address some of those issues. Now, the Minister appears to be expressing some scepticism about this, but I'm basing this on publicly available figures, and if he's got other publicly available figures that tell us something else - other not publicly available figures - I urge him to put those in the public domain so we can see where this so-called progress is coming from and who is delivering it. After four years, we need to have from this Minister some real understanding about why he thinks delivering change in Betsi Cadwaladr has been so difficult. Why is it so intransigent? What is going wrong there? Now, if I was to hear from the Minister today, 'These are the issues that I'm facing', 'These are the things that I cannot shift', 'These are the things that we need to build political consensus, perhaps, to deliver and change', then I would be the first person in his corner, because Jack Sargeant, of course, is quite right when he says that nobody wants to play any kind of political game with the NHS, but the reality, of course, Deputy Presiding Officer, is that issues surrounding the NHS are highly political: how the NHS is funded, how it is managed, is highly political, and here, in Wales, we have established - we legislated in 2009 for a system that made the system accountable to the Minister. I remember the then Welsh Minister, Edwina Hart, saying that the decisions about health in Wales needed to be made by the people that the people can sack. Now, at that time, the Conservative spokesperson, Jonathan Morgan, was of the view that we should continue to have a more hands-off approach. That was not the decision that this place made. It's a perfectly respectable position; not one that I shared at the time. So, the Minister is clearly totally accountable for this, and he needs to explain to us why things have not moved on. Now, of course there's been some improvement; if you'd have left the system entirely alone for four years and done absolutely nothing there would have been some good people in some good places who would have been able to achieve some positive change. And, of course, as others have said, and we must acknowledge this, across that system - and I hear this weekly from constituents - there are really good people on the front line who are working their socks off. There are also some really good front-line managers who are doing innovative things, for example, co-operating with social services in Gwynedd. But, at the top of the health board, there is obviously something seriously wrong, and I believe that there is a cultural problem. I wonder how invested the senior leaders in that health board are in delivering change. Now, it does worry me that six of the people leading that health board - not on the board side, but professionally - don't even live in this country, never mind in the area that they serve. Now, obviously, you wouldn't want to start discriminating against people on the basis of where they live, but, when you have such a high percentage of your management team whose families, whose children, whose neighbours are not directly affected by the decisions that they make, I think, potentially, you've got a problem. We used to, in the public sector in Wales, very often appoint senior leaders - I'm thinking particularly of chief executives of local authorities - on the basis that, 'We welcome you from wherever you come, but we expect you to come here, we expect you to live here, we expect you to invest in this community'. And Betsi is full of senior leaders who have not done that. When I raised the question yesterday with the Minister about whether he believed the senior leadership understood the communities they were serving, I was profoundly disappointed that he dismissed that as a concern. But it seems to my constituents and the constituents of other colleagues that the decisions are being made by people who don't understand the nature of the communities, who don't understand the geography, and maybe that is something that is at the root of all of this. I see my time is up, Deputy Presiding Officer, and I'll bring my remarks to a close. But I'd associate myself with what's already been said about the need to have performance standards for managers, to have core competencies, to have a register of NHS managers, off which they can be kicked, as doctors and nurses can, if they don't perform, because I believe this is a cultural problem across our NHS. The Minister has got to take some responsibility for this. If he wants our help, he can certainly have it, but, as it is, he dismisses our concern and it's not good enough.
Welsh: A gaf fi fynegi fy niolch i'r Ceidwadwyr am gyflwyno'r cynnig hwn heddiw? Nid yw hon, fel y dywedodd Angela Burns, yn sefyllfa y byddai unrhyw un ohonom yn dymuno bod ynddi ein hunain, ac mae'n effeithio, wrth gwrs, yn uniongyrchol iawn ar lawer iawn o fy etholwyr yng ngorllewin ardal Betsi Cadwaladr. Rwy'n pryderu'n fawr ein bod yn cael llawer o hunanfodlonrwydd gan y Gweinidog hwn, a llawer o 'bydd popeth yn iawn'. Rwyf wedi bod yn edrych yn ôl drwy'r adroddiadau chwe misol - maent yn llawn o haeriadau ac nid ydynt yn llawn iawn o dystiolaeth. Ac rwyf am dynnu sylw - yn fyr iawn - at nifer o'r materion y ceir tystiolaeth gyhoeddus yn eu cylch. Nid yw amseroedd aros wedi gwella ers cyflwyno mesurau arbennig ac nid ydynt ond wedi dangos gwelliannau ar ddechrau 2018, pan gafodd sylw fel problem yn y Cyfarfod Llawn unwaith eto. Mae'r system damweiniau ac achosion brys yn gyson yn perfformio'n waeth na chyfartaledd Cymru o hyd, ac mae perfformiad dau ysbyty sy'n perfformio'n wael yn tynnu oddi ar berfformiad ysbyty da. Mae amseroedd aros canser yn dangos, ar ddechrau mesurau arbennig, fod bwrdd iechyd Betsi Cadwaladr mewn gwirionedd yn perfformio'n well na chyfartaledd Cymru a'i fod bellach yn perfformio'n waeth na chyfartaledd Cymru a bod gostyngiad o 5 y cant yn nifer y meddygon teulu yn ardal Betsi Cadwaladr dros amser, er fy mod yn derbyn yr hyn a ddywedodd y Gweinidog ddoe ynghylch rhoi gwasanaethau amgen a gyflogir yn uniongyrchol gan y bwrdd iechyd lleol ar waith i fynd i'r afael â rhai o'r problemau hynny. Nawr, ymddengys bod y Gweinidog yn mynegi rhywfaint o amheuaeth ynglŷn â hyn, ond rwy'n seilio hyn ar ffigurau sydd ar gael i'r cyhoedd, ac os oes ganddo ffigurau eraill sydd ar gael i'r cyhoedd sy'n dweud rhywbeth arall wrthym - ffigurau eraill nad ydynt ar gael ar gyfer y cyhoedd - rwy'n ei annog i'w datgelu'n gyhoeddus er mwyn inni allu gweld ble mae'r cynnydd honedig a phwy sy'n ei gyflawni. Ar ôl pedair blynedd, mae angen inni weld bod y Gweinidog hwn yn deall yn iawn pam ei fod yn credu bod sicrhau newid ym mwrdd Betsi Cadwaladr wedi bod mor anodd. Pam y mae mor ddi-ildio? Beth sy'n mynd o'i le yno? Nawr, pe bawn yn clywed gan y Gweinidog heddiw, 'Dyma'r problemau rwy'n eu hwynebu', 'Dyma'r pethau na allaf eu newid', 'Dyma'r pethau sydd eu hangen arnom i sicrhau consensws gwleidyddol, efallai, er mwyn cyflawni a newid', fi fyddai'r person cyntaf i achub ei gam, gan fod Jack Sargeant, wrth gwrs, yn llygad ei le pan ddywed nad oes neb am chwarae unrhyw fath o gêm wleidyddol gyda'r GIG, ond y realiti, wrth gwrs, Ddirprwy Lywydd, yw bod materion sy'n ymwneud â'r GIG yn wleidyddol iawn: mae'r modd yr ariennir y GIG, y modd y caiff ei reoli, yn wleidyddol iawn, ac yma, yng Nghymru, rydym wedi sefydlu - deddfwyd yn 2009 ar gyfer system a oedd yn atebol i'r Gweinidog. Rwy'n cofio'r Gweinidog ar y pryd, Edwina Hart, yn dweud bod angen i'r penderfyniadau ynglŷn ag iechyd yng Nghymru gael eu gwneud gan y bobl y gall y bobl eu diswyddo. Nawr, ar y pryd, roedd llefarydd y Ceidwadwyr, Jonathan Morgan, o'r farn y dylem barhau i goleddu ymagwedd lai gweithredol. Nid dyna oedd y penderfyniad a wnaeth y lle hwn. Mae'n safbwynt cwbl barchus; nid un a rannwn ar y pryd. Felly, mae'r Gweinidog yn amlwg yn gwbl atebol am hyn, ac mae angen iddo egluro wrthym pam nad yw pethau wedi symud ymlaen. Nawr, wrth gwrs fod rhywfaint o welliant wedi bod; pe baech wedi gadael y system yn gyfan gwbl ar ei phen ei hun am bedair blynedd heb wneud unrhyw beth o gwbl byddai rhai pobl dda mewn rhai sefyllfaoedd da wedi gallu sicrhau rhywfaint o newid cadarnhaol. Ac wrth gwrs, fel y mae eraill wedi'i ddweud, a rhaid inni gydnabod hyn, ar draws y system honno - a chlywaf hyn bob wythnos gan etholwyr - mae pobl wirioneddol dda ar y rheng flaen sy'n gweithio'n galed iawn. Ceir rhai rheolwyr rheng flaen da iawn hefyd sy'n gwneud pethau arloesol, er enghraifft cydweithredu â gwasanaethau cymdeithasol yng Ngwynedd. Ond ar frig y bwrdd iechyd, mae'n amlwg fod rhywbeth mawr o'i le, ac rwy'n credu bod problem ddiwylliannol yn bodoli. Tybed faint o ymrwymiad sydd gan yr uwch arweinwyr yn y bwrdd iechyd hwnnw i sicrhau newid. Nawr, mae'n peri pryder i mi nad yw chwech o'r bobl sy'n arwain y bwrdd iechyd - nid ar ochr y bwrdd, ond yn broffesiynol - yn byw yn y wlad hon hyd yn oed, heb sôn am yr ardal y maent yn ei gwasanaethu. Nawr, yn amlwg, ni fyddech am ddechrau gwahaniaethu yn erbyn pobl ar sail ble maent yn byw, ond pan fo gennych ganran mor uchel o'ch tîm rheoli nad effeithir ar eu teuluoedd, ar eu plant, ar eu cymdogion yn uniongyrchol gan y penderfyniadau a wnânt, rwy'n credu ei bod hi'n bosibl fod gennych broblem. Yn y sector cyhoeddus yng Nghymru, yn aml iawn arferem benodi uwch arweinwyr - rwy'n meddwl yn arbennig am brif weithredwyr awdurdodau lleol - ar y sail, 'Rydym yn eich croesawu o ble bynnag y dewch, ond disgwyliwn i chi ddod yma, disgwyliwn i chi fyw yma, disgwyliwn i chi fuddsoddi yn y gymuned hon'. Ac mae Betsi Cadwaladr yn llawn o uwch arweinwyr nad ydynt wedi gwneud hynny. Pan ofynnais i'r Gweinidog ddoe a oedd yn credu bod yr uwch arweinwyr yn deall y cymunedau yr oeddent yn eu gwasanaethu, cefais fy siomi'n ddirfawr pan wfftiodd at hynny fel pryder. Ond mae'n ymddangos i fy etholwyr i ac etholwyr cyd-Aelodau eraill fod y penderfyniadau'n cael eu gwneud gan bobl nad ydynt yn deall natur y cymunedau, nad ydynt yn deall y ddaearyddiaeth, ac efallai fod hynny'n rhywbeth sydd wrth wraidd hyn oll. Rwy'n gweld bod fy amser ar ben, Ddirprwy Lywydd, ac rwyf am ddirwyn fy sylwadau i ben. Ond hoffwn gysylltu fy hun â'r hyn sydd eisoes wedi'i ddweud am yr angen i gael safonau perfformiad ar gyfer rheolwyr, i gael cymwyseddau craidd, i gael cofrestr ar gyfer rheolwyr y GIG y gellir eu tynnu oddi arni, fel y gellir ei wneud i feddygon a nyrsys os nad ydynt yn cyflawni, oherwydd rwy'n credu bod hon yn broblem ddiwylliannol ar draws ein GIG. Rhaid i'r Gweinidog ysgwyddo rhywfaint o gyfrifoldeb am hyn. Os oes arno eisiau ein help, gall ei gael yn sicr, ond fel y mae, mae'n diystyru ein pryder ac nid yw hynny'n ddigon da.