English: Can I commend Lee Waters's opening salvo in this debate and also commend him for being the prime mover in bringing this debate before us? I was going to concentrate on the performance, or otherwise, of Capita when it comes to that report from the National Audit Office in England about the outsourcing of the primary care support services, or NHS shared services partnerships, as we call them here in Wales. Now, general practice is an amazingly complex entity that is difficult for anyone who is not a GP to understand what's going on, and it's difficult for GPs to explain to anyone else how it works. So, here goes - but that was one of the problems with the Capita contract: they failed to understand the complexity of the whole issue, because GPs, by and large, are independent contractors who are basically contracted only with the NHS. So, GP practices, put simply, are paid by the NHS according to the number of patients they have, and basically what they tend to do to these patients, what services they provide for them, how many are immunised and stuff. They're agreed by various complicated quality outcome frameworks - QOF - guidelines, providing services with regard to chronic cancer, diabetes, heart disease. All that sort of service provision is counted minutely, patient by patient, totted up. It's amazingly complex, and it goes back to the local primary care support, or the NHS shared services partnership, who deal with that contractual obligation. So, they then give the individual general practice a fairly large dollop of money. From that money that arrives in the practice, the independent, contracted GPs then employ a practice manager to run the practice. They employ receptionists, they employ other salaried GPs and practice nurses and, after all that employment, then split the remainder as the so-called net salary for each GP practice principal. It is amazingly complex, and that is all handled by the primary care support services, dealing directly with individual practices. There are hundreds of GPs, all our patients are individually monitored, individual patient registrations, leaving and going - it's amazingly complex, but it doesn't stop with just GP practices. They perform the same detailed analysis for pharmacists, for opticians and for dentists. So, the business support, if you like, for primary care practice is amazingly complex. It has evolved over generations and the people in shared services partnerships, the business support of primary care in Wales, are amazingly experienced, have usually been there an awfully long time and they know the businesses inside out. That's general practice, that's pharmacy, that's optometry and dentistry - they all have their individual complexities. You cannot just package it together into a little package that's nice and simple to be outsourced and joined together with other similar practices, because all GP practices or pharmacists - they're individual entities with different people, different needs. So, it's amazingly complicated, every practice is different. Decades of experience then is swept away then, when in England it was decided to outsource that sort of business support element - outsourced to Capita, and as we've heard from Lee Waters, with predicable, disastrous results. I'm quoting from the report now, 'a long way below an acceptable standard.' Because if only a little bit of detail goes wrong, it upsets the smooth running of many practices or it can totally undermine, for a couple of days, the running of that individual practice, just by something going wrong. And, again, as the report says, both parties, NHS England and Capita, misjudged the scale and the nature of the risk in outsourcing primary care support services. Yes, they did, as does everybody who doesn't understand the immense complexity that is primary care in the United Kingdom. So, I say: keep the NHS in all its forms public. Private outsourcing of a complex public service only ends in tears. Support the motion.
Welsh: A gaf fi gymeradwyo anerchiad agoriadol Lee Waters yn y ddadl hon a'i gymeradwyo hefyd am fod yn bennaf gyfrifol am gyflwyno'r ddadl hon ger ein bron? Roeddwn yn mynd i ganolbwyntio ar gyflawniad, neu ddiffyg cyflawniad, Capita mewn perthynas â'r adroddiad hwnnw gan y Swyddfa Archwilio Genedlaethol yn Lloegr ynghylch prynu gwasanaethau cymorth gofal sylfaenol gan gyflenwyr allanol, neu bartneriaethau cydwasanaethau GIG, fel rydym yn eu galw yma yng Nghymru. Nawr, mae ymarfer cyffredinol yn endid hynod gymhleth sy'n anodd i unrhyw un nad yw'n feddyg teulu ddeall beth sy'n digwydd, ac mae'n anodd i feddygon teulu egluro i unrhyw un arall sut y mae'n gweithio. Felly, dyma ni - ond dyna oedd un o'r problemau gyda'r contract Capita: nid oeddent yn deall cymhlethdod yr holl beth, gan fod meddygon teulu, ar y cyfan, yn gontractwyr annibynnol sydd dan gontract gyda'r GIG yn unig yn y bôn. Felly, o'i roi'n syml, mae'r GIG yn talu i bractisau meddygon teulu yn ôl nifer y cleifion sydd ganddynt, ac yn y bôn, yr hyn y maent yn tueddu i'w wneud i'r cleifion hyn, pa wasanaethau y maent yn darparu ar eu cyfer, faint sy'n cael eu himiwneiddio a phethau. Cânt eu cytuno drwy amrywiaeth o ganllawiau fframweithiau ansawdd a chanlyniadau cymhleth, i ddarparu gwasanaethau ar gyfer canser cronig, diabetes, clefyd y galon. Caiff yr holl fath hwnnw o ddarpariaeth gwasanaeth ei gyfrifo'n fanwl, glaf wrth glaf. Mae'n hynod o gymhleth, ac mae'n mynd yn ôl at y cymorth gofal sylfaenol lleol, neu bartneriaeth cydwasanaethau'r GIG, sy'n ymdrin â'r rhwymedigaeth gytundebol honno. Felly, maent wedyn yn rhoi swm go fawr o arian i'r ymarfer cyffredinol unigol. O'r arian hwnnw sy'n cyrraedd y practis, mae'r meddygon teulu annibynnol dan gontract wedyn yn cyflogi rheolwr practis i redeg y practis. Maent yn cyflogi staff derbynfa, maent yn cyflogi meddygon teulu cyflogedig a nyrsys practis eraill ac ar ôl yr holl gyflogaeth, maent yn rhannu'r gweddill fel cyflog net fel y'i gelwir ar gyfer pob un o ymarferwyr y practis. Mae'n hynod gymhleth, ac ymdrinnir â hyn oll gan y gwasanaethau cymorth gofal sylfaenol, sy'n ymwneud yn uniongyrchol â phractisau unigol. Mae yna gannoedd o feddygon teulu, caiff ein cleifion eu monitro'n unigol, cofrestriadau cleifion unigol, gadael a mynd - mae'n anhygoel o gymhleth, ond nid yw'n dod i ben gyda phractisau meddygon teulu yn unig. Maent yn cyflawni'r un dadansoddiad manwl ar gyfer fferyllwyr, optegwyr a deintyddion. Felly, mae'r cymorth busnes, os mynnwch, ar gyfer ymarfer gofal sylfaenol yn anhygoel o gymhleth. Mae wedi esblygu dros genedlaethau ac mae'r bobl mewn partneriaethau cydwasanaethau, cymorth busnes gofal sylfaenol yng Nghymru, yn anhygoel o brofiadol, ac fel arfer maent wedi bod yno ers amser hir iawn ac maent yn adnabod y busnesau tu chwith allan. Dyna ymarfer cyffredinol, dyna fferylliaeth, dyna optometreg a deintyddiaeth - mae gan bob un ei gymhlethdodau unigol. Ni allwch ei becynnu gyda'i gilydd i greu pecyn bach cyfleus a syml i'w osod ar gontract allanol a'i gysylltu â phractisau eraill tebyg, oherwydd mae'r holl bractisau meddygon teulu neu fferyllwyr - maent yn endidau unigol gyda gwahanol bobl, anghenion gwahanol. Felly, mae'n anhygoel o gymhleth, mae pob practis yn wahanol. Caiff degawdau o brofiad ei sgubo ymaith felly, pan benderfynwyd gosod y math hwnnw o elfen gymorth busnes ar gontract allanol yn Lloegr - ei osod ar gontract allanol i Capita, ac fel y clywsom gan Lee Waters, gyda chanlyniadau trychinebus y gellid eu rhagweld. Rwy'n dyfynnu o'r adroddiad nawr, mae ymhell islaw safon dderbyniol. Oherwydd os oes manylyn bach yn mynd o'i le, mae'n tarfu ar weithrediad esmwyth llawer o bractisau neu gall danseilio'n llwyr, am ychydig ddyddiau, y ffordd y caiff y practis unigol ei weithredu, wrth i rywbeth fynd o'i le. Ac unwaith eto, fel y mae'r adroddiad yn dweud, camfarnodd y GIG yn Lloegr a Capita, ill dau, raddfa a natur y perygl o osod gwasanaethau cymorth gofal sylfaenol ar gontract allanol. Do, fe wnaethant, fel y gwnaiff pawb nad yw'n deall cymhlethdod aruthrol gofal sylfaenol yn y Deyrnas Unedig. Felly, rwy'n dweud: cadwch y GIG yn ei holl ffurfiau'n gyhoeddus. Mae gosod gwasanaeth cyhoeddus cymhleth ar gontract allanol preifat yn sicr o fynd o chwith. Cefnogwch y cynnig.