English: But preaching on the right thing to do often doesn't reach the people we want it to. So, we have to get alongside communities and individuals and help them to make their own choices. There's a role of leadership for people like me, of course, and for everyone else in the Chamber, including those who've departed, health and care professionals, but actually people within their communities, peers, and the way in which children are educated now, that should make a real difference in developing attitudes. That case for change, again, as I said, was articulated in the parliamentary review's outcome. We then come back to community hospitals, and when people complain about the closure of community hospitals they almost always say that loved facilities that have provided a good service were removed. The accusation always is that nefarious NHS managers deliberately ran down the service, and it was all about cost. Money is always a factor in any service that we deliver. Ultimately we give services a finite amount of money to deliver a service, and particularly so - remember, we're in the eighth year of austerity here, and that has a very real impact on the services that we can deliver. But the case for change isn't really just about saying, 'We have to close services because of money.' The case for change is about: can we deliver a better service with a better experience and better outcomes for people? A number of the community hospitals have closed in recent years because they're no longer capable of providing the levels of care that each of us should expect and demand for our communities. I think that's what the challenge always is, if you are in a position like mine, otherwise you're saying to one local community, 'If you're really attached to that care then that's okay, that's good enough for you, but it wouldn't be acceptable for my constituency.' There's a challenge about getting around and through and understanding that debate, which in itself is not an easy one to have. So, some did close due to safety concerns about staffing levels and the inability to recruit to older models of care, and that's a challenge in the mainstream hospital sector, actually, as well - about having models of care that will attract the right staff with the right experience to run and deliver effective care. And others were just about the physical state of buildings. If they're no longer able to comply with fire regulations, you shouldn't say to people, 'If you put up a big enough fight, then actually your health and safety doesn't matter anymore.' So, there are very practical reasons to want to do that as well. But in redesigning services for this century, there has to be a combination of more nearby modern community facilities and enhanced care at home or in the community. So, the term 'community hospital' may no longer be appropriate. It usually brings up the image of a local hospital with beds, doctors and nurses, and we actually think that, in many cases, that isn't what the future's going to look like in every single instance. We'll look at that more dispersed view on community care. We'll still see smaller hospitals with doctors and nurses in them, and I'll go on to talk about some of those shortly, but I think we need to have our focus on creating the sort of integrated health and care service, the seamless care system, that the parliamentary review suggested should be our future vision. If you think about those services, some of them will be physical, some of them will be virtual. Yesterday we had a debate about digital technology. We heard quite a lot about digitalisation and what that will do in sharing records, but also the ability to communicate remotely, and to deliver a service remotely, where someone either doesn't need to leave their own home or potentially goes to a local centre and not have to travel further, with the inconvenience that often produces for people, but to go to a very local facility to have access to different sorts of care. That will have an impact on people - not just our ability to stay healthy, but their physical and mental health, too. An excellent example of the sort of thing I'm talking about is the Ystradgynlais Community Hospital, which has been reinvented, describing itself as a 'community hub'. It has in-patient care for older people's mental health, day care, therapy, including for dietary, occupational therapists and physiotherapist care. It also has x-ray and ultrasound services, minor injuries and a minor ailment service. There are also social care staff and third sector providers on site. That is not what you would think was a traditional community hospital, and that's the model I think we should be investing in in the future. Another example is the Flint integrated health and social care centre due to open in the coming weeks - a matter of some controversy within Flint, about the plans for it to happen. And yet the centre is adjacent to a care home and it will provide accommodation for services transferred out of secondary care, with consulting and treatment rooms being supported by telemedicine. In addition there will be community, third sector, social care services and mental health care and support on site as well. So, we're able to do more in remodelling our service, and that's why we're going to direct our capital resources in that way in local healthcare. I recently announced, in October, that I've earmarked £68 million for an initial pipeline of facilities for integrated health and care services right across the country - 19 different projects in the north, south, east and west to try and do exactly what I've been describing and talking about. I think that's where the future is, because the advances in clinical and social care practice, together with advances in technology, should allow us to change the way, positively, that we plan and deliver more and better integrated care to support people in their own homes and communities. That's what we'll continue to do in working alongside our partners in health, social care and beyond to do just that.
Welsh: Ond yn aml, ni fydd pregethu am y peth cywir i'w wneud yn cyrraedd y bobl rydym eisiau iddo ei gyrraedd. Felly, mae'n rhaid i ni sefyll ochr yn ochr â chymunedau ac unigolion a'u helpu i wneud eu penderfyniadau eu hunain. Mae rôl arweinyddiaeth i bobl fel fi, wrth gwrs, ac i bawb arall yn y Siambr, gan gynnwys y rhai sydd wedi gadael, a gweithwyr proffesiynol iechyd a gofal, ond hefyd, mewn gwirionedd, y bobl o fewn eu cymunedau, cyfoedion, a'r ffordd y caiff plant eu haddysgu yn awr, dylai hynny wneud gwahaniaeth go iawn wrth ddatblygu agweddau. Unwaith eto, fel y dywedais, cafodd yr achos dros newid ei fynegi yng nghanlyniad yr adolygiad seneddol. Yna down yn ôl at ysbytai cymuned, a phan fydd pobl yn cwyno am gau ysbytai cymuned maent bron bob amser yn dweud bod cyfleusterau hoff sydd wedi darparu gwasanaeth da wedi cael eu diddymu. Y cyhuddiad bob amser yw bod rheolwyr drygionus y GIG wedi difenwi'r gwasanaeth yn fwriadol, a bod y cyfan yn ymwneud â chost. Mae arian bob amser yn ffactor mewn unrhyw wasanaeth a ddarparwn. Yn y pen draw, rydym yn rhoi swm cyfyngedig o arian i wasanaethau ddarparu gwasanaeth, ac yn arbennig felly - cofiwch, hon yw'r wythfed flwyddyn o gyni, ac mae hynny'n cael effaith go iawn ar y gwasanaethau y gallwn eu darparu. Ond mewn gwirionedd, nid yw'r achos dros newid yn fater syml o ddweud, 'Mae'n rhaid i ni ddod â gwasanaethau i ben oherwydd arian.' Mae'r achos dros newid yn ymwneud â'r cwestiwn: a ydym yn gallu darparu gwasanaeth gwell gyda phrofiad gwell a chanlyniadau gwell i bobl? Mae nifer o ysbytai cymuned wedi cau yn ystod y blynyddoedd diwethaf oherwydd nad oeddent yn gallu darparu'r lefel o ofal y dylai pob un ohonom ei ddisgwyl a'i fynnu ar gyfer ein cymunedau. Credaf mai honno yw'r her bob amser, os ydych mewn sefyllfa fel fy un i, fel arall rydych yn dweud wrth un gymuned leol, 'Os ydych yn wirioneddol hoff o'r gofal hwnnw, mae hynny'n iawn, mae'n ddigon da i chi, ond ni fyddai'n dderbyniol yn fy etholaeth i.' Mae yna her sy'n ymwneud â mynd i graidd y ddadl honno a'i deall, ac ynddi ei hun, nid yw'n un hawdd i'w chael. Felly, cafodd rhai eu cau oherwydd pryderon diogelwch am lefelau staffio a'r anallu i recriwtio i fodelau gofal hŷn, ac mae honno'n her yn sector yr ysbytai prif ffrwd hefyd mewn gwirionedd - ynglŷn â chael modelau gofal a fydd yn denu'r staff cywir gyda'r profiad cywir i weithredu a darparu gofal effeithiol. A chafodd rhai eraill eu cau oherwydd cyflwr yr adeiladau. Os nad ydynt yn gallu cydymffurfio â rheoliadau tân mwyach, ni ddylech ddweud wrth bobl, 'Os brwydrwch yn ddigon caled, ni fydd ots am eich iechyd a'ch diogelwch mwyach.' Felly, mae rhesymau ymarferol iawn dros fod eisiau gwneud hynny yn ogystal. Ond wrth ailgynllunio'r gwasanaethau ar gyfer y ganrif hon, mae angen cyfuniad o fwy o gyfleusterau cymunedol modern gerllaw a gwell gofal yn y cartref neu yn y gymuned. Felly, mae'n bosibl na fydd y term 'ysbyty cymuned' yn briodol mwyach. Mae'n gwneud i rywun feddwl, fel arfer, am ddelwedd o ysbyty lleol gyda gwelyau, meddygon a nyrsys, ac nid ydym yn credu, mewn gwirionedd, mewn llawer o achosion, mai felly y bydd pethau'n edrych yn y dyfodol ym mhob achos unigol. Byddwn yn edrych yn fwy gwasgarog ar ofal yn y gymuned. Byddwn yn parhau i weld ysbytai llai gyda meddygon a nyrsys ynddynt, ac rwyf am sôn am rai o'r rheini cyn bo hir, ond credaf fod angen i ni ganolbwyntio ar greu'r math o wasanaeth iechyd a gofal integredig, y system ofal ddi-dor, yr oedd yr adolygiad seneddol yn awgrymu y dylem ei mabwysiadu fel gweledigaeth ar gyfer y dyfodol. Os ystyriwch y gwasanaethau hynny, bydd rhai ohonynt yn ffisegol, bydd rhai ohonynt yn rhithwir. Ddoe, cawsom ddadl am dechnoleg ddigidol. Clywsom gryn dipyn am ddigideiddio a'r hyn y bydd hynny'n ei wneud mewn perthynas â rhannu cofnodion, ond hefyd y gallu i gyfathrebu o bell, ac i ddarparu gwasanaeth o bell, lle na fydd angen i rywun adael eu cartref, neu o bosibl, lle y gallant fynd i ganolfan leol a pheidio â gorfod teithio ymhellach, gyda'r anghyfleustra y bydd hynny'n aml yn ei greu i bobl, a mynd i gyfleuster lleol iawn er mwyn gallu cael gwahanol fathau o ofal. Bydd hynny'n cael effaith ar bobl - nid yn unig ar ein gallu i aros yn iach, ond ar eu hiechyd corfforol a meddyliol hefyd. Enghraifft wych o'r math o beth rwy'n sôn amdano yw Ysbyty Cymuned Ystradgynlais, sydd wedi'i ailgynllunio, gan ddisgrifio'i hun fel 'canolfan gymunedol'. Mae'n cynnwys gwasanaeth gofal i gleifion mewnol ar gyfer iechyd meddwl pobl hŷn, gofal dydd, therapi, gan gynnwys ar gyfer anghenion deietegol, therapyddion galwedigaethol a gofal ffisiotherapi. Mae hefyd yn cynnwys gwasanaethau pelydr-x ac uwchsain, ynghyd â gwasanaeth mân anafiadau a mân anhwylderau. Hefyd, mae staff gofal cymdeithasol a darparwyr trydydd sector ar y safle. Ni fyddech yn meddwl amdano fel ysbyty cymuned traddodiadol, ac rwy'n credu mai dyna'r model y dylem fod yn buddsoddi ynddo yn y dyfodol. Enghraifft arall yw canolfan iechyd a gofal cymdeithasol integredig y Fflint, a fydd yn agor yn ystod yr wythnosau nesaf - roedd y cynlluniau ar ei chyfer yn destun dadlau yn y Fflint. Ac eto mae'r ganolfan yn agos i gartref gofal a bydd yn darparu lle ar gyfer gwasanaethau a drosglwyddwyd allan o ofal eilaidd, gydag ystafelloedd ymgynghori a thriniaeth yn cael eu cefnogi gan delefeddygaeth. Yn ogystal, bydd gwasanaethau cymunedol, gwasanaethau'r trydydd sector, gwasanaethau gofal cymdeithasol a gofal a chymorth iechyd meddwl ar y safle hefyd. Felly, rydym yn gallu gwneud mwy wrth ailgynllunio ein gwasanaeth, a dyna pam y byddwn yn cyfeirio ein hadnoddau cyfalaf yn y ffordd honno ym maes gofal iechyd lleol. Yn ddiweddar, ym mis Hydref, cyhoeddais fy mod wedi clustnodi £68 miliwn ar gyfer cyfres gychwynnol o gyfleusterau ar gyfer gwasanaethau iechyd a gofal integredig ar draws y wlad - 19 o brosiectau gwahanol yn y gogledd, y de, y dwyrain a'r gorllewin er mwyn ceisio gwneud yn union yr hyn y bûm yn ei ddisgrifio ac yn sôn amdano. Credaf mai dyna'r dyfodol, oherwydd dylai'r datblygiadau mewn ymarfer clinigol a gofal cymdeithasol, ynghyd â datblygiadau ym maes technoleg, ganiatáu i ni newid er gwell y ffordd rydym yn cynllunio ac yn darparu mwy o ofal integredig gwell i gynnal pobl yn eu cartrefi a'u cymunedau eu hunain. Byddwn yn parhau i weithio ochr yn ochr â'n partneriaid ym maes iechyd a gofal cymdeithasol a thu hwnt i wneud yn union hynny.