English: Too many things, on return to the health portfolio after a brief absence, remain the same. The poor performance of the NHS I think has been the equivalent of a chronic condition for the current Government. It's debilitating, causing Government problems in planning for the long term, but still, we're not seeing the kind of drastic changes that we'd like to see. In many other countries facing a similar context, I think we'd have seen the removal, surely, or the change of a Minister. It is a concern that any accountability that does exist within the NHS in Wales doesn't seem to include accountability by the health Minister himself. And, if I may say, it is a matter of some regret that the Minister isn't able to be here today to be held to account in this debate of ours; it is a Deputy Minister that will be responding to that debate. It's not good enough. I see from Government amendments that the central premise of our motion, the regrets about poor performance and 'the cancellation of planned operations to deal with winter pressures' has not been amended this time. Maybe we are finally moving away from stage one denial at last now, and that's good. But instead, we're seeing blame being placed on the UK Government for austerity, which at least suggests an acknowledgement that things should be better and, of course, I agree that ideologically driven austerity has been hugely damaging to the provision of public services in Wales, but the problem is that this from Welsh Government today is rather misleading on many performance measures. Wales has been staggeringly falling behind Scotland and, to a lesser extent, England for most of the past decade, despite austerity affecting all services across the UK. Indeed, Labour themselves were trumpeting the fact that they've been spending more on health and social care, to which we simply ask the question: why haven't things been getting better in that context? Because the truth is we've had a decade where Welsh Government has repeatedly bailed out poor performance in the NHS, often at the expense of local government services, and we know how damaging that can be. There's been little or no strategic vision or control over where additional money, where it was able to be found, actually went. And I think that's more true, looking forward to the coming financial year, than it has been even over the past decade. Despite claiming to want more services in the community, for example, claiming to want to shift the focus towards prevention of ill health, the vast majority of money has still been going into firefighting in secondary care, being haemorrhaged to external management consultants, to agencies supplying NHS staff who would have stayed directly employed had conditions been better. Indeed, the health board that Welsh Government has had the most control over, Betsi Cadwaladr University Health Board, is the one where relations between management and staff are at all-time lows due to the now-dropped proposals on nurses' break times. This is also the health board with the worst waiting times for both planned treatment and accident and emergency, and the health board, of course, as is well publicised, that instead of investing in front-line services, has squandered hundreds of thousands of pounds on external management consultants working from home in Marbella. Clearly, austerity hasn't hit them. It's not all about money, although, of course, as I say, austerity has hit hard across the board, not just in health. Looking at those areas where we know performance is poor, we can only judge on performance measures that are publicly available. There are far too many measures that we would like to have and we simply don't have performance measures for them, where we can, for example, quantify the anecdotal evidence of long waiting times for GP appointments; the non-existent out-of-hours care; the failures of social care to keep people in their homes. There's so much data missing, and I don't think that data, were it available, would be telling a story any better to the data that we actually have. All the performance measures that are regularly published refer, it seems, to secondary care, even though their failings there in secondary care very, very often reflect failures in primary care, failure to invest in social care. And let's imagine how the conversation would change if as well as monthly reporting on the failure to hit waiting time targets, we also had monthly reporting on the impact that cuts to local services and local authority funding is having on the ability to adapt people's homes on time, or to put care packages in place on time. So, when we reflect on the long waiting times published every month, unacceptable as they are, of course, let's be clear, what we are seeing is just one visible sign of a system failure that is deep-rooted and is failing to be transformed. And it's that transformation that we are still waiting for and that we are seeing little signs of. Turning to the Conservative amendments, we've got a minor quibble with the first one. Our view is that poor long-term workforce planning is to blame for the problems we saw reported recently. We would rather the focus was on that. But it's amendment 3, I think, that demonstrates how unfit the Conservatives are to run health services in Wales. I thought, from previous exchanges in here, that -
Welsh: Mae gormod o bethau, ar ôl dychwelyd i'r portffolio iechyd ar ôl absenoldeb byr, yn aros yr un fath. Credaf fod perfformiad gwael y GIG wedi bod yn debyg i gyflwr cronig i'r Llywodraeth bresennol. Mae'n gwanhau, gan achosi problemau i'r Llywodraeth wrth gynllunio ar gyfer y tymor hir, ond eto, nid ydym yn gweld y math o newidiadau enfawr yr hoffem eu gweld. Mewn llawer o wledydd eraill sy'n wynebu cyd-destun tebyg, does bosibl na fyddem wedi gweld Gweinidog yn colli ei swydd, neu newid Gweinidog. Mae'n bryder nad yw'n ymddangos bod unrhyw atebolrwydd sy'n bodoli o fewn y GIG yng Nghymru yn cynnwys atebolrwydd gan y Gweinidog iechyd ei hun. Ac os caf ddweud, mae'n drueni mawr nad yw'r Gweinidog yn gallu bod yma heddiw i gael ei ddwyn i gyfrif yn y ddadl hon; Dirprwy Weinidog sy'n mynd i ymateb i'r ddadl. Nid yw'n ddigon da. Gwelaf o welliannau'r Llywodraeth nad yw sail ganolog ein cynnig, y gresynu at berfformiad gwael a '[ch]anslo llawdriniaethau a oedd wedi'u cynllunio er mwyn ymdrin â phwysau'r gaeaf' wedi'i ddiwygio y tro hwn. Efallai ein bod o'r diwedd yn symud oddi wrth y cam cyntaf o wadu erbyn hyn, ac mae hynny'n dda. Ond yn lle hynny, rydym yn gweld bai'n cael ei roi ar Lywodraeth y DU am gyni, sydd o leiaf yn awgrymu cydnabyddiaeth y dylai pethau fod yn well ac wrth gwrs, rwy'n cytuno bod cyni wedi'i lywio gan ideoleg wedi bod yn hynod niweidiol i ddarpariaeth gwasanaethau cyhoeddus yng Nghymru, ond y broblem yw bod hyn, gan Lywodraeth Cymru heddiw, braidd yn gamarweiniol ar lawer o fesurau perfformiad. Mae Cymru wedi bod yn llusgo ar ôl yr Alban, a Lloegr i raddau llai, am y rhan fwyaf o'r degawd diwethaf, er bod cyni wedi effeithio ar bob gwasanaeth ar draws y DU. Yn wir, roedd Llafur eu hunain yn clodfori'r ffaith eu bod wedi bod yn gwario mwy ar iechyd a gofal cymdeithasol, ac rydym yn gofyn y cwestiwn syml: pam nad yw pethau wedi gwella yn y cyd-destun hwnnw? Oherwydd y gwir amdani yw ein bod wedi cael degawd lle mae Llywodraeth Cymru wedi achub croen y GIG dro ar ôl tro mewn achosion o berfformiad gwael, a hynny'n aml ar draul gwasanaethau llywodraeth leol, a gwyddom mor niweidiol y gall hynny fod. Ychydig iawn, os o gwbl, o weledigaeth neu reolaeth strategol a fu ar arian ychwanegol, lle roedd modd dod o hyd iddo. Ac rwy'n credu bod hynny'n fwy gwir wrth edrych ymlaen at y flwyddyn ariannol sydd i ddod nag y bu hyd yn oed dros y degawd diwethaf. Er eu bod yn honni eu bod am gael mwy o wasanaethau yn y gymuned, er enghraifft, gan honni eu bod am newid y ffocws tuag at atal afiechyd, mae'r rhan fwyaf o arian yn dal i fynd tuag at ymladd tanau mewn gofal eilaidd, yn cael ei lifo tuag at ymgynghorwyr rheoli allanol, i asiantaethau sy'n cyflenwi staff y GIG a fyddai wedi parhau mewn cyflogaeth uniongyrchol pe bai'r amodau'n well. Yn wir, y bwrdd iechyd y bu gan Lywodraeth Cymru y mwyaf o reolaeth drosto, sef Bwrdd Iechyd Prifysgol Betsi Cadwaladr, yw'r un lle mae'r berthynas rhwng y rheolwyr a'r staff ar ei gwaethaf erioed oherwydd yr argymhellion sydd bellach wedi'u dileu ar amseroedd egwyl nyrsys. Dyma'r bwrdd iechyd gyda'r amseroedd aros gwaethaf ar gyfer triniaeth wedi'i chynllunio ac adrannau damweiniau ac achosion brys, ac mae'n hysbys iawn fod y bwrdd iechyd, wrth gwrs, yn hytrach na buddsoddi mewn gwasanaethau rheng flaen, wedi afradu cannoedd o filoedd o bunnoedd ar ymgynghorwyr rheoli allanol sy'n gweithio o gartref yn Marbella. Yn amlwg, nid yw cyni wedi eu taro hwy. Nid yw'n ymwneud ag arian yn unig, er, wrth gwrs, fel y dywedais, mae cyni wedi taro'n galed drwyddi draw, ac nid ym maes iechyd yn unig. O edrych ar y meysydd lle gwyddom fod y perfformiad yn wael, ni allwn ond barnu ar sail mesurau perfformiad sydd ar gael i'r cyhoedd. Mae llawer gormod o fesurau yr hoffem eu cael ac nid oes gennym fesurau perfformiad ar eu cyfer, lle gallwn feintioli'r dystiolaeth anecdotaidd ynghylch amseroedd aros hir am apwyntiadau meddygon teulu er enghraifft; y gofal y tu allan i oriau nad yw'n bodoli; methiannau gofal cymdeithasol i gadw pobl yn eu cartrefi. Mae cymaint o ddata ar goll, ac nid wyf yn meddwl y byddai'r data hwnnw, pe bai ar gael, yn adrodd stori'n well na'r data sydd gennym mewn gwirionedd. Mae'r holl fesurau perfformiad a gyhoeddir yn rheolaidd yn cyfeirio, i bob golwg, at ofal eilaidd, er bod eu methiannau ym maes gofal eilaidd yn aml iawn yn adlewyrchu methiannau mewn gofal sylfaenol, methiant i fuddsoddi mewn gofal cymdeithasol. Ac yn ogystal ag adroddiadau misol ar y methiant i gyrraedd targedau amseroedd aros, gadewch i ni ddychmygu sut y byddai'r sgwrs yn newid pe bai gennym adroddiad misol hefyd ar yr effaith y mae toriadau i wasanaethau lleol a chyllid awdurdodau lleol yn ei chael ar y gallu i addasu cartrefi pobl yn amserol, neu i roi pecynnau gofal yn eu lle mewn pryd. Felly, pan fyddwn yn myfyrio ar yr amseroedd aros hir a gyhoeddir bob mis, er mor annerbyniol ydynt wrth gwrs, gadewch inni fod yn glir mai'r hyn a welwn yw un arwydd gweladwy o fethiant yn y system sydd wedi'i wreiddio'n ddwfn ac sy'n methu cael ei drawsnewid. Rydym yn dal i aros am y trawsnewid hwnnw ac ni welwn lawer o arwyddion ohono. I droi at welliannau'r Ceidwadwyr, mae gennym fân wrthwynebiad i'r cyntaf. Yn ein barn ni, cynlluniau hirdymor gwael ar gyfer y gweithlu sydd ar fai am y problemau a welsom yn ddiweddar. Byddai'n well gennym ganolbwyntio ar hynny. Ond mae gwelliant 3, rwy'n meddwl, yn dangos pa mor anaddas yw'r Ceidwadwyr i redeg gwasanaethau iechyd yng Nghymru. O drafodaethau blaenorol yma, credwn fod -