English: There will always be contentious choices to be made in every single part of Wales. We, of course, must continue to engage and confront those challenges by having difficult conversations and by addressing them with clinically led choices, because, if we do not, change is less likely to happen until a point of crisis and a service collapses. We either allow change to happen to us in a chaotic, crisis-led manner or we empower our health service, our staff and the public to take ownership and to choose what the future should be. Now we do, of course, need to build additional capacity into community and primary care - that's central in our plan, 'A Healthier Wales'. We need to do that to keep people well for longer and to look after them closer to home, which is not just seen within 'A Healthier Wales', but is also within the Hywel Dda strategy. People should be able to receive advice and support across a wide range of health and care issues that matter to them and their families and also to be able to attend more current out-patient appointments outside of a hospital setting. And there are good examples across Hywel Dda of how care really is being delivered closer to home already. Now, I do, as Paul Davies has mentioned, understand the powerful attachment that people have to the future of healthcare and, in particular, to hospital locations. But the future of healthcare is about so much more than the current location of buildings; it's about that investment in communities, attracting doctors, nurses, therapists, scientists, and that does mean operating a modern healthcare system, making full use of digital technology and keeping hospital for those who really need to have their care delivered within a hospital setting. In Hywel Dda, the health board recognised that a number of their services are fragile and dependent up on significant numbers of temporary staff - it's a point our own Public Accounts Committee have made on more than one occasion. Having a large number of temporary staff delivering care can lead to poorer quality and certainly higher costs. To meet these challenges, the health board began engaging with staff and the public on its transforming clinical services programme in 2017, and a number of clinically led proposals were developed and formally consulted on between April and July last year, and I recognise that Paul Davies does not support those proposals - he's entitled not to do so. At the public board meeting in September, 11 recommendations were agreed, and, importantly, these recommendations were developed and put forward by the doctors, nurses, therapists, scientists and wider staff groups who live in, work in and serve the people of mid and west Wales. Now, some key decisions were made, including developing a business case for the construction of a new major hospital between Narberth and St Clears. I don't recognise the figure that Paul Davies came up with of £500 million. Actually, when you consider that the specialist critical care centre that I decided should be built in Gwent - the price tag for that is about £350 million, so I don't recognise Paul Davies's figure. But, even for that, they had to develop a business case to come forward to say, 'Here is the detail of why we want to spend a significant sum of public money'. Now, it did also look at the repurposing of both Withybush and Glangwili hospitals. And the health board did investigate the feedback provided during the consultation. Clinicians and staff worked with the public and other organisations on that additional detail to put together a 20-year strategy for the area. And that strategy, 'A Healthier Mid and West Wales', was agreed at the end of November last year. That sets out the direction of travel for the next 20 years. The detailed plan to support implementation will be developed over the coming months and years and, of course, I expect the health board to carry on working with key stakeholders, other organisations, their own staff, and, of course, the public. Now I really do understand the concerns felt locally by people in Pembrokeshire about Withybush. As I say, I understand the powerful attachment that people have to a local hospital, and Withybush will continue to have an important part in the future of healthcare services in the area. And, of course, we have invested in a range of services within Withybush. That includes £7.5 million for a new dialysis unit, £3.9 million to refurbish the pathology department, £600,000 for a new single photon emission CT multimode scanner, and over £3 million to complete the improvements on wards 9 and 10 to modernise haematology, oncology and palliative care services at the hospital.
Welsh: Bydd yna ddewisiadau dadleuol i'w gwneud bob amser ym mhob cwr o Gymru. Rhaid inni barhau i ymgysylltu wrth gwrs ac wynebu'r heriau hynny drwy gael sgyrsiau anodd a thrwy ymdrin â hwy gyda dewisiadau dan arweiniad clinigol, oherwydd, os na wnawn hynny, mae newid yn llai tebygol o ddigwydd hyd nes y cyrhaeddir pwynt argyfwng a bydd gwasanaethau'n methu. Rydym naill ai'n caniatáu i newid ddigwydd i ni mewn modd anhrefnus, wedi'i arwain gan argyfwng neu rydym yn grymuso ein gwasanaeth iechyd, ein staff a'r cyhoedd i gymryd perchnogaeth a dewis beth ddylai ddigwydd yn y dyfodol. Nawr, mae angen inni adeiladu capasiti ychwanegol mewn gofal cymunedol a sylfaenol wrth gwrs - mae hynny'n ganolog yn ein cynllun, 'Cymru Iachach'. Mae angen inni wneud hynny er mwyn cadw pobl yn iach am amser hirach ac edrych ar eu holau'n nes adref, rhywbeth a welir yn strategaeth Hywel Dda yn ogystal ag yn 'Cymru Iachach'. Dylai pobl allu cael cyngor a chymorth ar draws ystod eang o faterion iechyd a gofal sydd o bwys iddynt hwy a'u teuluoedd a gallu mynychu apwyntiadau cleifion allanol mwy cyfredol y tu allan i leoliad ysbyty. A cheir enghreifftiau da ar draws Hywel Dda o sut y caiff gofal ei ddarparu'n nes at y cartref eisoes. Nawr, fel y soniodd Paul Davies, rwy'n deall yr ymlyniad pwerus sydd gan bobl at ddyfodol gofal iechyd ac yn arbennig at leoliadau ysbyty. Ond mae dyfodol gofal iechyd yn ymwneud â llawer mwy na lleoliad cyfredol adeiladau; mae'n ymwneud â buddsoddi mewn cymunedau, denu meddygon, nyrsys, therapyddion, gwyddonwyr, ac mae hynny'n golygu gweithredu system gofal iechyd fodern, gan wneud defnydd llawn o dechnoleg ddigidol a chadw ysbyty ar gyfer y rhai sydd angen cael eu gofal wedi'i ddarparu o fewn ysbyty. Yn Hywel Dda, roedd y bwrdd iechyd yn cydnabod bod nifer o'u gwasanaethau yn fregus ac yn dibynnu ar niferoedd sylweddol o staff dros dro - mae'n bwynt y mae ein Pwyllgor Cyfrifon Cyhoeddus wedi'i wneud ar fwy nag un achlysur. Gall cael nifer fawr o staff dros dro yn darparu gofal arwain at ansawdd gwaeth, a chostau uwch yn sicr. I oresgyn yr heriau hyn, dechreuodd y bwrdd iechyd ymgysylltu â staff a'r cyhoedd ar ei raglen trawsnewid gwasanaethau clinigol yn 2017, a datblygwyd nifer o argymhellion dan arweiniad clinigol ac ymgynghorwyd yn ffurfiol arnynt rhwng mis Ebrill a mis Gorffennaf y llynedd, ac rwy'n cydnabod nad yw Paul Davies yn cefnogi'r argymhellion hynny - mae ganddo hawl i beidio â'u cefnogi. Yng nghyfarfod cyhoeddus y bwrdd ym mis Medi, cytunwyd ar 11 o argymhellion, ac yn bwysig, datblygwyd yr argymhellion hyn a'u cyflwyno gan y meddygon, y nyrsys, y therapyddion, y gwyddonwyr a grwpiau ehangach o staff sy'n byw, yn gweithio ac yn gwasanaethu pobl canolbarth a gorllewin Cymru. Nawr, gwnaed rhai penderfyniadau allweddol, gan gynnwys datblygu achos busnes ar gyfer adeiladu ysbyty mawr newydd rhwng Arberth a Sanclêr. Nid wyf yn cydnabod y ffigur o £500 miliwn a roddodd Paul Davies. Mewn gwirionedd, pan fyddwch yn ystyried bod y ganolfan gofal critigol arbenigol y penderfynais y dylid ei hadeiladu yng Ngwent - pris honno yw tua £350 miliwn, felly nid wyf yn cydnabod ffigur Paul Davies. Ond hyd yn oed ar gyfer hynny, roedd yn rhaid iddynt ddatblygu achos busnes i allu dweud, 'Dyma fanylion y rheswm pam rydym am wario swm sylweddol o arian cyhoeddus'. Nawr, edrychodd hefyd ar ailbwrpasu ysbyty Llwynhelyg ac ysbyty Glangwili. Ac archwiliodd y bwrdd iechyd yr adborth a ddarparwyd yn ystod yr ymgynghoriad. Gweithiodd clinigwyr a staff gyda'r cyhoedd a sefydliadau eraill ar y manylion ychwanegol i lunio strategaeth 20 mlynedd ar gyfer yr ardal. A chytunwyd ar y strategaeth honno, 'Canolbarth a Gorllewin Cymru Iachach', ddiwedd mis Tachwedd y llynedd. Mae'n nodi'r cyfeiriad ar gyfer yr 20 mlynedd nesaf. Datblygir y cynllun manwl i gefnogi ei weithrediad dros y misoedd a'r blynyddoedd nesaf, ac wrth gwrs, rwy'n disgwyl i'r bwrdd iechyd barhau i weithio gyda rhanddeiliaid allweddol, sefydliadau eraill, eu staff eu hunain, a'r cyhoedd wrth gwrs. Nawr, rwy'n deall y pryderon a deimlir yn lleol gan bobl yn Sir Benfro ynglŷn ag ysbyty Llwynhelyg. Fel y dywedaf, rwy'n deall yr ymlyniad pwerus sydd gan bobl tuag at ysbyty lleol, a bydd Llwynhelyg yn parhau i fod â rhan bwysig yn nyfodol gwasanaethau gofal iechyd yn yr ardal. Ac wrth gwrs, rydym wedi buddsoddi mewn amrywiaeth o wasanaethau yn ysbyty Llwynhelyg. Mae hynny'n cynnwys £7.5 miliwn ar gyfer uned ddialysis newydd, £3.9 miliwn i adnewyddu'r adran batholeg, £600,000 ar gyfer sganiwr CT amlfodd newydd sy'n allyrru ffotonau unigol a dros £3 miliwn i gwblhau'r gwelliannau ar wardiau 9 a 10 i foderneiddio gwasanaethau haematoleg, oncoleg a gofal lliniarol yn yr ysbyty.