English: Now, we all know, of course, that areas like Blaenau Ffestiniog and its surrounding district pose problems. There's always going to be a tension with the provision of health services in sparsely populated rural areas, but the models that have been chosen are more related to what is appropriate for urban areas rather than rural areas. In urban settings, of course, the tendency is, for very obvious reasons, to pull services together into community healthcare hubs, but in rural north Wales it has been in the other direction. What we should be doing is pushing services into rural areas to gain the patient outcomes without too great a loss of financial efficiency. What we have seen is a very substantial expenditure of money in Blaenau recently - well over £1 million, I believe - but not a single bed is created; we've created dozens and dozens of desks for national health service pen-pushers instead. So, they closed the memorial hospital and replaced it with an office block. That is not what we expect from a health service, and the poor residents of Blaenau and district deserve a great deal better than that. Other countries seem to be able to manage to do this. Why can't we? In the United States, rural areas have long enjoyed support and protection from the Rural Health Clinic Services Act of 1977, and the Federal Office of Rural Health Policy and the National Rural Health Association provide a mechanism for rural health campaigners to receive significant support in their interface with Congress. We know that there is something called distance decay - that is, the further away you live from a hospital the worse the health outcomes tend to be, because people find it much more difficult to get to hospital so they don't go for treatment in time and regularly enough. There are problems with poverty in rural areas. People have to pay to travel to hospitals that are a distance from their homes, so they don't have a free health service because it actually costs them a great deal of money often in order to get the treatment that they deserve. In Scotland, there are some more imaginative models than we've got here in Wales. For example, in the Isle of Skye, they have a model of rural practitioners where the Broadford Hospital is staffed by GPs with additional skills and training in anaesthetics and trauma. The model was developed after a consultation with the local community, and the realisation that the size of their community, which was about 13,000, had a need for some emergency service but couldn't sustain a general hospital. Instead, the Broadford is now an enhanced community hospital. Why can't we do that in Blaenau? The previous health Secretary refused to intervene in the closure of the hospital services in Blaenau because it was supported by the local community health council, but, of course, the local community health council is not elected by anybody in the area that is covered by the hospital closures. That's why we need to introduce the kind of democracy to the health service that Michelle referred to.
Welsh: Erbyn hyn, mae pawb ohonom yn gwybod, wrth gwrs, fod ardaloedd fel Blaenau Ffestiniog a'r cylch cyfagos yn achosi problemau. Mae tensiwn yn mynd i fod bob amser wrth ddarparu gwasanaethau iechyd mewn ardaloedd gwledig tenau eu poblogaeth, ond mae'r modelau a ddewiswyd yn ymwneud mwy â'r hyn sy'n briodol ar gyfer ardaloedd trefol yn hytrach nag ardaloedd gwledig. Mewn lleoliadau trefol, wrth gwrs, am resymau amlwg iawn, y duedd yw crynhoi gwasanaethau mewn canolfannau gofal iechyd cymunedol, ond yn ardaloedd gwledig gogledd Cymru, mae wedi digwydd i'r cyfeiriad arall. Yr hyn y dylem ei wneud yw gwthio gwasanaethau i ardaloedd gwledig er mwyn sicrhau canlyniadau i gleifion heb golli gormod o effeithlonrwydd ariannol. Yr hyn a welsom yw gwariant sylweddol iawn o arian ym Mlaenau Ffestiniog yn ddiweddar - ymhell dros £1 filiwn, rwy'n credu - ond ni chafodd yr un gwely ei greu; rydym wedi creu dwsinau ar ddwsinau o ddesgiau i fiwrocratiaid y gwasanaeth iechyd gwladol yn lle hynny. Felly, maent wedi cau'r ysbyty coffa a gosod bloc o swyddfeydd yn ei le. Nid dyna a ddisgwyliwn gan wasanaeth iechyd, ac mae trigolion Blaenau a'r cylch, druain, yn haeddu llawer gwell na hynny. Ymddengys bod gwledydd eraill yn llwyddo i wneud hyn. Pam na allwn ni? Yn yr Unol Daleithiau, mae'r ardaloedd gwledig wedi mwynhau cymorth a diogelwch Deddf Gwasanaethau Clinigau Iechyd Gwledig 1977, ac mae Swyddfa Ffederal Polisi Iechyd Gwledig a'r Gymdeithas Genedlaethol ar gyfer Iechyd Gwledig yn darparu mecanwaith i ymgyrchwyr iechyd gwledig gael cymorth sylweddol wrth ryngwynebu â'r Gyngres. Rydym yn gwybod bod yna rywbeth a elwir yn ddirywiad pellter - hynny yw, po bellaf y byddwch yn byw o ysbyty, y gwaethaf y mae canlyniadau iechyd yn tueddu i fod, am fod pobl yn ei chael yn llawer anos mynd i'r ysbyty, felly ni fyddant yn mynd am driniaeth mewn pryd ac yn ddigon rheolaidd. Ceir problemau gyda thlodi mewn ardaloedd gwledig. Mae pobl yn gorfod talu i deithio i ysbytai sy'n bell o'u cartrefi, felly nid oes ganddynt wasanaeth iechyd am ddim am ei fod yn costio cryn dipyn o arian iddynt yn aml er mwyn cael y driniaeth y maent yn ei haeddu. Yn yr Alban, ceir rhai modelau mwy dychmygus nag sydd gennym yma yng Nghymru. Er enghraifft, ar Ynys Skye, mae ganddynt fodel ymarferwyr gwledig lle mae ysbyty Broadford yn cael ei staffio gan feddygon teulu sydd wedi'u hyfforddi â sgiliau ychwanegol mewn anaestheteg a thrawma. Datblygwyd y model ar ôl ymgynghori â'r gymuned leol, a'r sylweddoliad fod angen rhai gwasanaethau brys ar gymuned o'u maint, sef tua 13,000, ond na allent gynnal ysbyty cyffredinol. Yn hytrach, mae ysbyty Broadford bellach yn uwch-ysbyty cymunedol. Pam na allwn wneud hynny yn y Blaenau? Gwrthododd yr Ysgrifennydd iechyd blaenorol ymyrryd mewn camau i gau gwasanaethau ysbyty ym Mlaenau Ffestiniog am fod y cyngor iechyd cymuned lleol yn cefnogi'r cau, ond wrth gwrs, ni chaiff y cyngor iechyd cymuned lleol ei ethol gan neb yn yr ardal lle mae'r ysbytai'n cael eu cau. Dyna pam fod angen inni gyflwyno'r math o ddemocratiaeth y cyfeiriodd Michelle ati yn y gwasanaeth iechyd.