English: Thank you for your statement, Cabinet Secretary. No-one in the Chamber would disagree with the overarching principles of your plan, which include improving patient experience whilst keeping the costs of care to a reasonable level. And in this respect, the 1000 Lives improvement to help Welsh Government and NHS wales establish sustainable services and improved patient experience in planned care specialities is welcome. Indeed, the Wales Public Services 2025 programme hosted by Cardiff Business School has put the choices in Wales into sharper relief in its recent report, when it states that under certain assumptions, 56 per cent of the budget could go into the Welsh NHS by 2021 and the percentage might be even greater in subsequent years. So, therefore, we do have an issue here where we put more money in and we're not achieving our targets, so I wonder if you could make a comment on that please, Cabinet Secretary. The term 'patient experience' covers a number of areas that include both patient outcomes and patient waiting times. As you stated in answers to my questions last January, we need to balance the reduction of waiting times with the quality of interventions and outcomes that patients receive in Wales. So, how do you, as Cabinet Secretary, plan to do this? I welcome the news in your statement concerning the redesign of the prostate cancer pathway across Wales, having heard from many constituents in my region about the difficulties of previous treatments that were around before the pathway. Similarly, the roll-out of one-stop clinics, mentioned in your statement, is also to be welcomed, and also the intention of the programme to develop patient reported experience measures - PREMs - and patient reported outcome measures - PROMs - to capture and analyse patient experience of services along elected pathways. However, I'd like to ask, Cabinet Secretary, about the extent to which community health councils will be involved in the capturing of patient experiences. If they're not sufficiently involved, then we may run the risk of having two separate records of patient experiences, one in the PREMs and PROMs reports and the other via community health councils. Would it be far better if patient experiences recorded via each of these avenues were put together in order to gain the most lucid picture of patient experiences? I welcome a holistic approach to patient care and lifestyle modification, and I would ask: what up-to-date advice and research from other groups will be incorporated into the holistic approach and lifestyle modifications? Previous documents concerning the care programme mention that one of the aims is to reduce variation across Wales. For example, such an aim may result in reducing the number of follow-up appointments that are offered following surgery, as this may be an accepted practice in other UK health services. Whilst being broadly supportive of the overarching aim of ensuring that NHS Wales's costs are kept at reasonable levels, I must emphasise, Cabinet Secretary, that every case is different. Sometimes, a variation in services and appointments to treat the same or similar conditions, maybe in different areas also, is absolutely necessary, so there needs to be room for sufficient flexibility within the programme. The evidence of 9 per cent of people not attending follow-up appointments mentioned in your statement is disturbing, but every case is different, and we must not seek to reduce follow-up appointments across the board if such a practice does not produce optimal results for the patient. The evidence that your statement cites from Aneurin Bevan university health board, which has the potential to reduce unnecessary appointments across Wales, is welcomed, provided that we can ensure that such appointments are genuinely unnecessary - that is to say that they are routine cases without complications or exceptions. Therefore, Cabinet Secretary, could you ensure that health boards have clear guidance on what constitutes exceptional circumstances in a given case? And, moreover, when a case is deemed exceptional, please could you ensure that health boards have clear guidance concerning what further resourcing would be considered permissible or best practice? I note that your statement says that there has been a reduction in the number of non-urgent suspected cancer patients. However, I have mentioned in the past that, when someone is given a cancer diagnosis, and diagnosis is of the utmost urgency for them, we need to ensure that they have the best patient outcomes and that when a person is told that they possibly have cancer that we treat all of this as urgent, because to that person, the word 'cancer' means that something is going on that needs urgent treatment. Finally, I understand that the planned care programme currently focuses upon four surgical specialities: ophthalmology; ear, nose and throat; orthopaedics; and neurology. I have read in your statement since that there are more in the pipeline. So, without wishing to run before we can walk, I would like to ask whether there are any long-term plans for the programme to apply to other surgical specialities or other areas within NHS Wales and, if so, what methods would be used to evaluate the effectiveness of the programme upon the initial four surgical specialities. Thank you very much.
Welsh: Diolch ichi am eich datganiad, Ysgrifennydd y Cabinet. Ni fyddai unrhyw un yn y Siambr yn anghytuno ag egwyddorion cyffredinol eich cynllun chi, sy'n cynnwys gwella profiad y claf trwy gadw costau gofal ar lefel resymol. Ac yn hyn o beth, mae'r gwelliant 1000 o Fywydau i helpu Llywodraeth Cymru a GIG Cymru i sefydlu gwasanaethau cynaliadwy a sicrhau profiad gwell i gleifion mewn arbenigeddau gofal wedi'i gynllunio i'w groesawu. Yn wir, mae rhaglen Gwasanaethau Cyhoeddus Cymru 2025 a gynhelir gan Ysgol Fusnes Caerdydd wedi rhoi'r dewisiadau yng Nghymru yn gliriach yn ei hadroddiad diweddar, pan ddywed, dan rai rhagdybiaethau, y gallai 56 y cant o'r gyllideb fynd i mewn i GIG Cymru erbyn 2021 a gallai'r ganran fod hyd yn oed yn uwch yn y blynyddoedd dilynol. Felly, gan hynny, mae gennym broblem yma lle'r ydym ni'n rhoi mwy o arian i mewn ac nid ydym yn cyflawni ein targedau. Felly tybed a allech chi wneud sylwadau ar hynny, os gwelwch yn dda, Ysgrifennydd y Cabinet? Mae'r term 'profiad y claf' yn cwmpasu nifer o feysydd sy'n cynnwys canlyniadau i gleifion ac amseroedd aros i gleifion. Fel y dywedasoch mewn atebion i'm cwestiynau fis Ionawr diwethaf, mae angen i ni gydbwyso'r gostyngiad mewn amserau aros ag ansawdd yr ymyriadau a'r canlyniadau i gleifion yng Nghymru. Felly, sut ydych chi, fel Ysgrifennydd y Cabinet, yn bwriadu gwneud hyn? Croesawaf y newyddion yn eich datganiad ynghylch ailgynllunio llwybr canser y prostad ar draws Cymru, ar ôl clywed gan lawer o etholwyr yn fy rhanbarth i am anawsterau triniaethau blaenorol cyn y llwybr. Yn yr un modd, mae croeso i gyflwyno clinigau un stop, a grybwyllir yn eich datganiad, a bwriad y rhaglen hefyd i ddatblygu'r mesurau profiad yr adroddir amdanynt gan y claf - PREM - a'r mesurau canlyniad yr adroddir amdanynt gan y claf - PROM - i gofnodi a dadansoddi profiad cleifion o wasanaethau ar hyd llwybrau etholedig. Fodd bynnag, hoffwn ofyn, Ysgrifennydd y Cabinet, i ba raddau y bydd cynghorau iechyd cymuned yn ymwneud â chasglu profiadau cleifion. Os nad ydynt yn cymryd rhan ddigonol, yna efallai y byddwn mewn perygl o gael dau gofnod o brofiadau cleifion, un yn yr adroddiadau PREM a PROM a'r llall trwy gynghorau iechyd cymuned. A fyddai'n llawer gwell pe gellid dwyn ynghyd brofiadau cleifion a gofnodwyd trwy bob un o'r llwybrau hyn er mwyn cael y darlun mwyaf amlwg o brofiadau cleifion? Rwy'n croesawu dull holistaidd o ofalu am gleifion ac addasu ffordd o fyw, a byddwn yn gofyn hyn: pa gyngor ac ymchwil gyfredol gan grwpiau eraill fydd yn cael eu hymgorffori yn y dull holistaidd ac addasiadau ffordd o fyw? Mae dogfennau blaenorol yn ymwneud â'r rhaglen ofal yn sôn mai un o'r nodau yw lleihau amrywiad ledled Cymru. Er enghraifft, gall nod o'r fath arwain at leihau nifer yr apwyntiadau dilynol a gynigir yn dilyn llawdriniaeth, gan y gall hyn fod yn arfer derbyniol mewn gwasanaethau iechyd eraill y DU. Er fy mod yn gefnogol yn fras i'r nod cyffredinol o sicrhau bod costau GIG Cymru yn cael eu cadw ar lefelau rhesymol, rhaid imi bwysleisio, Ysgrifennydd y Cabinet, fod pob achos yn wahanol. Weithiau, mae amrywiad mewn gwasanaethau ac apwyntiadau i drin yr un cyflyrau neu gyflyrau tebyg, mewn ardaloedd gwahanol hefyd, yn hollol angenrheidiol, felly mae angen digon o hyblygrwydd yn y rhaglen. Mae'r dystiolaeth yn eich datganiad o'r 9 y cant o bobl nad ydynt yn mynd i apwyntiadau dilynol yn peri anesmwythyd. Ond mae pob achos yn wahanol, ac ni ddylem geisio lleihau apwyntiadau dilynol yn gyffredinol os nad yw ymarfer o'r fath yn cynhyrchu'r canlyniadau gorau posib i'r claf. Croesewir y dystiolaeth y mae eich datganiad yn ei ddyfynnu gan fwrdd iechyd prifysgol Aneurin Bevan, sydd â'r potensial i leihau apwyntiadau dianghenraid ledled Cymru, ar yr amod y gallwn sicrhau bod apwyntiadau o'r fath yn wirioneddol ddiangen - hynny yw, eu bod yn achosion cyffredinol heb gymhlethdodau neu eithriadau. Felly, Ysgrifennydd y Cabinet, a allech chi sicrhau bod gan fyrddau iechyd arweiniad clir ar yr hyn sy'n gyfystyr ag amgylchiadau eithriadol mewn achos penodol? Ac, ar ben hynny, pan ystyrir bod achos yn eithriadol, a allech chi sicrhau bod gan fyrddau iechyd arweiniad clir ynghylch pa adnoddau pellach fyddai'n cael eu hystyried yn ganiataol neu'n arfer gorau? Nodaf fod eich datganiad yn dweud y bu gostyngiad yn nifer y cleifion yr amheuir sydd â chanser nad ydynt yn rhai brys. Fodd bynnag, rwyf wedi sôn yn y gorffennol, pan fydd rhywun yn cael diagnosis o ganser, a bod y diagnosis yn fater brys iawn iddyn nhw, mae angen inni sicrhau eu bod yn cael y canlyniadau gorau i gleifion. A phan fo rhywun yn cael gwybod bod posibilrwydd bod ganddyn nhw ganser, mae angen inni drin y rhain i gyd ar frys, oherwydd i'r person hwnnw, mae'r gair 'canser' yn golygu bod rhywbeth yn digwydd sydd angen triniaeth ar frys. Yn olaf, deallaf fod y rhaglen gofal wedi'i gynllunio ar hyn o bryd yn canolbwyntio ar bedwar arbenigedd llawfeddygol: offthalmoleg; y glust, y trwyn a'r gwddf; orthopedeg; a niwroleg. Rwyf wedi darllen yn eich datganiad ers hynny fod yna fwy ar y gweill. Felly, nid wyf eisiau rhedeg cyn gallu cerdded, ond hoffwn ofyn a oes unrhyw gynlluniau hirdymor i'r rhaglen fod yn berthnasol i arbenigeddau llawfeddygol eraill neu feysydd eraill yn GIG Cymru ac, os felly, pa ddulliau fyddai'n cael eu defnyddio i werthuso effeithiolrwydd y rhaglen ar y pedwar arbenigedd llawfeddygol cychwynnol. Diolch yn fawr iawn.