English: What is not clear to many outside of this Chamber is what happens when a health board is placed under special measures. In Wales, the Welsh Government, Healthcare Inspectorate Wales and the Welsh Audit Office work together to identify and respond to serious issues that affect services, quality, safety of care and organisational effectiveness. Actions can, but not always, involve placing key individual specialists or people with turn-around experience to provide support settings, actions, milestones and an improvement framework. Welsh Ministers are also able to suspend or remove powers and duties from Members of the health board, or to direct a health board to ensure that functions are performed by a specific person. In Scotland, their special measures encompass a five-stage process, ranging from surveillance to formal recovery plans, with the ultimate sanction, at stage 5, for the Scottish Government to dismiss or appoint senior leadership of a board, such as they bravely did in NHS Tayside in 2018. In England, there are five types of action that can take place, ranging from the appointment of improvement directors to the removal of freedoms that some NHS foundation trusts have compared to other NHS organisations. An innovative approach in England has been the buddying system, which acknowledges that some trusts in special measures can suffer from insularity, therefore it is essential that trusts look outwards as they seek to improve their quality. This was first introduced in 2013 and recognises how trusts can understand how other trusts approach their operations. They can learn, they can benchmark, and quality improvements come through. Buddying with another trust has often proved very valuable, but it does require commitment from both parties. It helps to define the specific terms of reference for the relationship, for example a specific clinical areas or speciality. There are a number of case studies I would love to raise with you demonstrating best practice, because the length of time it's taken to introduce some of these measures makes me realise that you have not gone out and looked at best practice around the UK. I just want to highlight the case of one, Wexham Park Hospital in Slough, where problems were identified in 2014. The Care Quality Commission described a culture of 'learned helplessness', and I think we can say that identifies closely with Betsi, and changing this was made a priority for the new leadership team. The focus was on putting patients at the heart of everything, asking staff to treat them as if they were their own family members. An external view of what looked good helped to change and challenge ingrained behaviours, allowing the hospital to make significant change to the culture in a relatively short space of time. I'm not saying that all the answers lie over the borders, but I do want to ensure, Minister, that you look at the best practice that is out there to acknowledge that there are other systems in place. I also understand that in Wales we couldn't possibly buddy up because we'd only have two health boards and they would crash under the weight of the five. But we could ask Scotland and we could ask England for their advice and support. Yesterday, in your statement, you acknowledged that a transformation team was needed, and this is a point I've made on repeated occasions. I acknowledge that you've finally decided to engage PricewaterhouseCoopers to help deliver substantial financial improvements, and, again, I applaud this. But why has it taken so long - four years? I'm not just going to say to you how awful I think this whole process has been managed. I want to give you some help. This is what the Welsh Conservatives would do: we would draught in help from experienced change managers working in the NHS throughout the UK to help drive those changes forward. We would implement robust and independent consultation and feedback events to engage and empower staff, to help them identify areas of concern free from external pressures. We would underpin the areas that have shown such devastating failures of performance and provide them with day-to-day management support and funding to improve. We would look at rationalising the management structure, devolve the power to the lower levels of management so decisions can be made quickly, and green shoots of promise can be encouraged to grow and people feel empowered to make the difference that's so desperately needed. And - something Welsh Government seems so reluctant to do in so many health boards - we would review the core competency and skills of senior management to ensure that the right people are in the right jobs. Minister, I would like to close my contribution - . Chamber, I would like to close my contribution with a little bit of reflection. It's disheartening to remember that this struggling health board is named after Betsi Cadwaladr, a famous nurse who treated the wounded soldiers of the Crimean war. Born in north Wales, her courage on faraway battlefields inspired visions of a legacy of health provision for the people of her homeland. I only hope that, in her memory, it won't be long before the spirit of her legacy can be properly honoured again. The staff of the health board have this spirit. They just need the leadership to fully release their potential. Perhaps through proper leadership, which borrows just a little of Betsi's famous courage, this vital resource can be restored again for the people of north Wales. And, Minister, if you do not have the courage to provide this leadership, then make way for someone who does.
Welsh: Yr hyn nad yw'n glir i lawer y tu allan i'r Siambr hon yw beth sy'n digwydd pan fydd bwrdd iechyd yn cael ei roi o dan fesurau arbennig. Yng Nghymru, mae Llywodraeth Cymru, Arolygiaeth Gofal Iechyd Cymru a Swyddfa Archwilio Cymru yn gweithio gyda'i gilydd i nodi ac ymateb i faterion difrifol sy'n effeithio ar wasanaethau, ansawdd, diogelwch gofal ac effeithiolrwydd sefydliadol. Er nad yw hynny'n digwydd bob amser, gall camau gweithredu gynnwys lleoli arbenigwyr unigol allweddol neu bobl â phrofiad o sicrhau newid i ddarparu lleoliadau cymorth, camau gweithredu, cerrig milltir a fframwaith gwella. Mae Gweinidogion Cymru hefyd yn gallu atal neu ddiddymu pwerau a dyletswyddau aelodau o'r bwrdd iechyd, neu gyfarwyddo bwrdd iechyd i sicrhau bod swyddogaethau'n cael eu cyflawni gan berson penodol. Yn yr Alban, mae eu mesurau arbennig yn cwmpasu proses bum cam, yn amrywio o oruchwyliaeth i gynlluniau adfer ffurfiol, gyda'r sancsiwn eithaf, yng ngham 5, i Lywodraeth yr Alban ddiswyddo neu benodi uwch arweinwyr bwrdd, fel y gwnaethant yn ddewr iawn yn NHS Tayside yn 2018. Yn Lloegr, mae pum math o gam y gellir ei roi ar waith, yn amrywio o benodi cyfarwyddwyr gwella i gael gwared ar y rhyddid sydd gan rai ymddiriedolaethau sefydledig GIG o gymharu â sefydliadau eraill y GIG. Dull arloesol yn Lloegr yw'r system gyfeillio, sy'n cydnabod y gall rhai ymddiriedolaethau mewn mesurau arbennig ddioddef yn sgil cael eu hynysu, felly mae'n hanfodol fod ymddiriedolaethau yn edrych tuag allan wrth iddynt geisio gwella eu hansawdd. Cyflwynwyd hyn yn gyntaf yn 2013 ac mae'n cydnabod sut y gall ymddiriedolaethau ddeall sut y mae ymddiriedolaethau eraill yn mynd ati i weithredu. Gallant ddysgu, gallant feincnodi, ac mae gwelliannau o ansawdd wedi digwydd. Mae cyfeillio ag ymddiriedolaeth arall wedi bod yn werthfawr iawn yn aml, ond mae angen ymrwymiad gan y ddwy ochr. Mae'n helpu i ddiffinio'r cylch gorchwyl penodol ar gyfer y berthynas, er enghraifft meysydd clinigol neu arbenigedd penodol. Ceir nifer o astudiaethau achos y buaswn wrth fy modd yn eu dwyn i'ch sylw sy'n dangos arferion gorau, oherwydd mae'r amser a gymerodd i gyflwyno rhai o'r mesurau hyn yn gwneud i mi sylweddoli nad ydych wedi mynd allan ac wedi edrych ar yr arferion gorau ledled y DU. Rwyf am dynnu sylw at un achos, ysbyty Wexham Park yn Slough, lle nodwyd problemau yn 2014. Disgrifiodd y Comisiwn Ansawdd Gofal ddiwylliant o 'ddiymadferthedd a ddysgwyd', a chredaf y gallwn ddweud bod hynny'n swnio'n debyg iawn i Betsi Cadwaladr, a gwnaed newid hyn yn flaenoriaeth i'r tîm arweinyddiaeth newydd. Roedd y ffocws ar roi'r cleifion wrth wraidd popeth, gan ofyn i'r staff eu trin fel pe baent yn aelodau o'u teuluoedd eu hunain. Roedd golwg allanol ar yr hyn a edrychai'n dda yn helpu i newid a herio ymddygiad gwreiddiedig, gan alluogi'r ysbyty i wneud newid sylweddol i'r diwylliant mewn cyfnod cymharol fyr. Nid wyf yn dweud bod yr holl atebion ar draws y ffin, ond rwyf am sicrhau, Weinidog, eich bod yn edrych ar yr arfer gorau sydd ar gael i gydnabod bod systemau eraill ar waith. Rwyf hefyd yn deall na allem gyfeillio yng Nghymru gan mai dim ond dau fwrdd iechyd a fyddai gennym a byddent yn chwalu o dan bwysau'r pump. Ond gallem ofyn i'r Alban a gallem ofyn i Loegr am eu cyngor a'u cefnogaeth. Ddoe, yn eich datganiad, roeddech yn cydnabod bod angen tîm trawsnewid, ac mae hwn yn bwynt a wneuthum dro ar ôl tro. Rwy'n cydnabod eich bod o'r diwedd wedi penderfynu cynnwys PricewaterhouseCoopers er mwyn helpu i sicrhau gwelliannau ariannol sylweddol, ac unwaith eto, rwy'n cymeradwyo hyn. Ond pam y mae wedi cymryd cymaint o amser - pedair blynedd? Nid fy mwriad yw dweud wrthych pa mor ofnadwy oedd y broses gyfan hon yn fy marn i: rwyf am roi rhywfaint o gymorth i chi hefyd. Dyma fyddai'r Ceidwadwyr Cymreig yn ei wneud: byddem yn gofyn am gymorth gan reolwyr newid profiadol sy'n gweithio yn y GIG ledled y DU i helpu i yrru'r newidiadau hynny yn eu blaen. Byddem yn gweithredu digwyddiadau ymgynghori a sesiynau adborth cadarn ac annibynnol i ymgysylltu â staff a'u grymuso, er mwyn eu helpu i nodi meysydd sy'n peri pryder yn rhydd o bwysau allanol. Byddem yn pwysleisio'r meysydd sydd wedi dangos methiannau mor ddinistriol o ran perfformiad ac yn rhoi cymorth a chyllid rheoli o ddydd i ddydd er mwyn iddynt wella. Byddem yn ystyried rhesymoli'r strwythur rheoli, datganoli'r pŵer i'r lefelau rheoli is fel y gellir gwneud penderfyniadau'n gyflym, a gellir annog egin addewid i dyfu wrth i bobl deimlo y cânt eu grymuso i wneud y gwahaniaeth sydd cymaint o'i angen. A byddem hefyd yn gwneud rhywbeth y mae Llywodraeth Cymru i'w weld mor amharod i'w wneud mewn cymaint o fyrddau iechyd - byddem yn adolygu cymhwysedd a sgiliau craidd uwch reolwyr er mwyn sicrhau bod y bobl iawn yn y swyddi cywir. Weinidog, hoffwn gloi fy nghyfraniad - . Siambr, hoffwn gloi fy nghyfraniad gydag un ystyriaeth. Mae'n dorcalonnus cofio bod y bwrdd iechyd hwn sy'n ei chael hi mor anodd wedi ei enwi ar ôl Betsi Cadwaladr, nyrs enwog a fu'n trin milwyr clwyfedig rhyfel y Crimea. Fe'i ganwyd hi yng ngogledd Cymru, a llwyddodd ei dewrder ar feysydd y gad mewn rhannau pell o'r byd i ysbrydoli gweledigaeth ynghylch darpariaeth iechyd i bobl ei mamwlad. Er cof amdani, rwy'n gobeithio na fydd yn hir cyn y gellir anrhydeddu ysbryd ei gwaddol yn iawn unwaith eto. Mae staff y bwrdd iechyd yn meddu ar yr ysbryd hwn. Y cyfan sydd ei angen arnynt yw'r arweinyddiaeth i ryddhau eu potensial yn llawn. Drwy arweiniad priodol, sy'n benthyg ychydig o ddewrder enwog Betsi, efallai y gellir adfer yr adnodd hanfodol hwn eto i bobl gogledd Cymru. Ac os nad ydych chi'n gallu dangos y dewrder i ddarparu'r arweinyddiaeth hon, Weinidog, rhowch gyfle i rywun sy'n gallu gwneud hynny.