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Morgan: Taking the politics out of healthcare

Speech to the National Assembly for Wales.

"I thank you for the statement, Minister. You have been candid about the challenges that you and your department have faced and you have been open and honest with the Assembly since your appointment.

Do you accept that you have inherited a scheme that is at best disjointed and at worst shambolic?

Minister, if you were to design an NHS, or plan the reconfiguration process for the NHS, I suspect that you would not do it like this. Many people outside the Assembly think that this process has not been handled at all well, particularly when you consider the views of clinicians and of the public, as well as those expressed by many in the Chamber, including those whose constituencies were affected.

You have already stated in the Health, Wellbeing and Local Government Committee that the role of the royal colleges will be extremely important, and that you wish to engage with them to see what role they can fulfil in leading the debate. I have always argued that it is extremely important to use expert advice and to make use of professionals to lead any debates on reconfiguration.

I would be keen to hear how you are progressing matters with the royal colleges. Will you now accept that the costs of reconfiguration are likely to be higher than anticipated by the Government after the publication of the Wanless review? Will your department also publish the full costs of the capital expenditure and the revenue consequences of meeting the objectives of reconfiguration—and not only the reconfiguration of services, but also of NHS trusts?

You have already pointed out in your report that you are currently examining how to engage the communities of Wales more effectively. That applies succinctly to those in the south-east of Wales, particularly in Carmarthenshire and Pembrokeshire, where many people were concerned about reconfiguration.

Do you acknowledge that some people in Wales will never accept that services need to be reconfigured, relocated or, in some cases, even lost? What assurances will you give me and the Assembly that you will not shy away from making difficult decisions, even when the public disagrees and the clinical advice is very much in your favour?

Minister, you have also said in your report that a key component of your approach to secondary care is to give new impetus to the development of primary and community health services. I welcome that and, of course, that was the subject of a debate on reconfiguration prior to the Assembly elections.

However, do you recognise that many of the advances in technology and in diagnostic services in primary and community care over the past 20 years have led to less reliance on secondary care services? Those services have been able to move away from secondary care and into primary care settings more. Therefore, how are you able to balance the ability of secondary care to maintain high levels of services on the one hand with the need to develop primary and community care services on the other?

You referred to the work being done on the Prince Philip Hospital in Llanelli and the independent review that was undertaken. I am sure that Helen Mary Jones is more than capable of reminding you of the consequences of governments not being prepared to listen to people and making decisions that do not have the full support of clinicians or the public. Helen Mary Jones's re-election as the Assembly Member for the Llanelli constituency is one such consequence; that is what can happen when politicians do not listen.

On the review that was undertaken and the recommendations that were made, what conclusions have you drawn from that report? Do you concur with all of the recommendations, and the conclusions that Dr Goodwin has drawn from his work? What will you do now to ensure that any decision is made only after full consultation with clinicians and the public?

You said that you wished to do this in partnership with the community health councils, but many of the concerns expressed about reconfiguration, not just in south-west Wales, but elsewhere, related to how the community health councils were used, and how information was collected among various groups of people who tried to feed into the process. Therefore, we need to be certain that the process will be robust; otherwise, the same concerns will be raised over and over again.

You have talked of the need for administrative reform, and you have said that service change and administrative reform must go hand in hand because reducing the number of trusts is the key to delivering our intentions. I accept that some NHS trust mergers look quite attractive, but could you please outline what exactly has changed? Your predecessor, Dr Gibbons, simply did not accept that administrative reform was necessary to achieve sound reconfiguration of hospital, primary and community-based health services. Therefore, what has changed since the election that now leads you to believe that we need administrative reform to go hand in hand with service change?

Also on that point, what assurances are you giving to staff throughout Wales who work for NHS trusts about their future, particularly those in clinical jobs? I have no problem with reducing the number of bureaucrats, finance officers, accounting officers and chief executives, but what assurances are you giving those people who have worked in dedicated medical professions in those trusts for so many years about their future?

Are you now going to pursue a process of mergers with regard to local health boards? If you do not like the idea of the purchaser/provider split, surely the answer is to scrap local health boards. If you do not like the idea of having commissioning bodies, you will also agree that local health boards are therefore not necessary. I fail to understand why trusts are being singled out for merger when other bodies in Wales are struggling with capacity issues.

You have already agreed, in the Health, Wellbeing and Local Government Committee, that having larger trusts would make it more difficult for small local health boards to commission services and to negotiate professionally with those much bigger trusts.

One concern that I would raise with you about the trust mergers, which I have raised in the past, is that merging a successful trust with an unsuccessful trust does not necessarily lead to better services. We will need to be assured that you will have robust systems in place to reward NHS trusts for doing excellent work and to penalise trusts that are simply not up to the job. As put by my colleague, David Melding, taking the Wal-Mart approach to the health service will not necessarily lead to the better provision of services.

We look forward to the work that you are doing but we need to ensure as far as possible that the public and clinicians are with us on service reconfiguration changes, and that we rely on expert advice. I know that we have had debates in this Chamber before about where decisions should lie.

Should they rest with Ministers or should they be clinician-led? However, you need to ensure that clinicians are very much in the driving seat when deciding which services are safe, where they are best delivered, and what is in the best interests of patients. Unless we achieve that, we will simply continue to have the problems in the NHS that we have had over the past 10 years."

"Diolchaf i chi am y datganiad, Weinidog. Yr ydych wedi sôn yn ddidwyll am yr heriau yr ydych chi a'ch adran wedi'u hwynebu a buoch yn agored ac yn onest gyda'r Cynulliad ers eich penodi. A ydych yn derbyn eich bod wedi etifeddu cynllun sydd ar ei orau'n ddigyswllt ac ar ei waethaf yn anhrefnus?

Weinidog, pe baech chi'n dylunio GIG, neu'n cynllunio proses ad-drefnu'r GIG, yr wyf yn amau nad fel hyn y gwnaech. Mae llawer o bobl y tu allan i'r Cynulliad yn meddwl nad yw'r broses hon wedi'i thrafod yn dda o gwbl, yn enwedig pan ystyriwch farn clinigwyr a'r cyhoedd, yn ogystal â'r farn a fynegwyd gan lawer yn y Siambr, gan gynnwys rhai yr effeithid ar eu hetholaethau.

Yr ydych eisoes wedi datgan yn y Pwyllgor Iechyd, Lles a Llywodraeth Leol y bydd rôl y colegau brenhinol yn eithriadol o bwysig, a'ch bod yn awyddus i drafod â hwy i weld pa rôl y gallant ei chyflawni o ran arwain y ddadl. Yr wyf bob amser wedi dadlau ei bod yn eithriadol o bwysig defnyddio cyngor arbenigol a defnyddio pobl broffesiynol i arwain unrhyw ddadleuon ar ad-drefnu. Byddai'n dda gennyf glywed sut yr ydych yn symud pethau ymlaen gyda'r colegau brenhinol.

A wnewch chi dderbyn yn awr fod costau ad-drefnu'n debygol o fod yn uwch na'r hyn a ragwelwyd gan y Llywodraeth yn sgîl cyhoeddi adolygiad Wanless? A wnaiff eich adran gyhoeddi hefyd gostau llawn y gwariant cyfalaf a chanlyniadau refeniw cyflawni amcanion yr ad-drefnu—ac nid ad-drefnu gwasanaethau'n unig, ond ad-drefnu ymddiriedolaethau'r GIG hefyd?

Yr ydych eisoes wedi nodi yn eich adroddiad eich bod wrthi ar hyn o bryd yn edrych sut i gysylltu'n fwy effeithiol â chymunedau Cymru. Mae hynny'n arbennig o berthnasol i rai yn y de-orllewin, yn enwedig yn sir Gaerfyrddin a sir Benfro, lle'r oedd llawer o bobl yn poeni am ad-drefnu.

A ydych yn cydnabod na wnaiff rhai pobl yng Nghymru fyth dderbyn bod angen ad-drefnu gwasanaethau, eu symud neu, mewn ambell achos, eu colli, hyd yn oed? Pa sicrwydd a roddwch i mi ac i'r Cynulliad na wnewch wingo rhag gwneud penderfyniadau anodd, hyd yn oed pan fydd y cyhoedd yn anghytuno a bod y cyngor clinigol yn gadarn o'ch plaid?

Weinidog, yr ydych wedi dweud yn eich adroddiad hefyd mai un o brif gydrannau eich agwedd at ofal eilaidd yw rhoi hwb newydd i ddatblygiad gwasanaethau iechyd sylfaenol a chymunedol. Croesawaf hynny ac, wrth gwrs, bu hynny'n destun dadl ynghylch ad-drefnu cyn etholiadau'r Cynulliad.

Fodd bynnag, a gydnabyddwch fod llawer o'r datblygiadau mewn technoleg ac mewn gwasanaethau diagnostig mewn gofal sylfaenol a chymunedol dros yr 20 mlynedd diwethaf wedi arwain at lai o ddibyniaeth ar wasanaethau gofal eilaidd? Mae'r gwasanaethau hynny wedi gallu symud i ffwrdd oddi wrth ofal eilaidd ac yn fwy i mewn i leoliadau gofal sylfaenol. Felly, sut y gallwch gydbwyso gallu gofal eilaidd i gynnal lefelau uchel o wasanaethau ar y naill law â'r angen i ddatblygu gwasanaethau gofal sylfaenol a chymunedol ar y llall?

Cyfeiriasoch at y gwaith sy'n cael ei wneud ar Ysbyty'r Tywysog Philip yn Llanelli a'r adolygiad annibynnol a wnaethpwyd. Yr wyf yn siwr fod Helen Mary Jones yn fwy nag abl i'ch atgoffa am y canlyniadau a geir pan fydd llywodraethau'n amharod i wrando ar bobl ac yn gwneud penderfyniadau sydd heb gefnogaeth lawn gan glinigwyr na'r cyhoedd. Mae ailethol Helen Mary Jones yn Aelod Cynulliad dros etholaeth Llanelli yn un canlyniad o'r fath; dyna a all ddigwydd pan na fydd gwleidyddion yn gwrando.

Ynglyn â'r adolygiad a gynhaliwyd a'r argymhellion a wnaethpwyd, pa gasgliadau yr ydych chi wedi'u tynnu o'r adroddiad hwnnw? A ydych yn cyd-fynd â'r argymhellion i gyd, a'r casgliadau y daeth Dr Goodwin iddynt ar sail ei waith? Beth a wnewch chi'n awr i sicrhau mai dim ond ar ôl ymgynghori'n llawn â chlinigwyr a'r cyhoedd y gwneir unrhyw benderfyniad?

Dywedasoch eich bod yn awyddus i wneud hyn mewn partneriaeth gyda'r cynghorau iechyd cymuned, ond yr oedd llawer o'r pryderon a fynegwyd ynghylch ad-drefnu, nid dim ond yn y de-orllewin, ond mewn mannau eraill, yn ymwneud â'r modd y defnyddid cynghorau iechyd cymuned, a'r modd y cesglid gwybodaeth ymysg amryfal grwpiau o bobl a geisiai fwydo i mewn i'r broses.

Felly, mae angen inni fod yn sicr y bydd y broses yn gadarn; fel arall, codir yr un pryderon eto dro ar ôl tro.

Yr ydych wedi sôn am yr angen am ddiwygio gweinyddiaeth, ac yr ydych wedi dweud bod yn rhaid i newid gwasanaethau a diwygio'r weinyddiaeth fynd law yn llaw oherwydd mai lleihau'r nifer o ymddiriedolaethau yw'r allwedd i gyflawni ein bwriadau. Derbyniaf fod rhai cyfuniadau o ymddiriedolaethau GIG yn edrych yn eithaf deniadol, ond a allech amlinellu os gwelwch yn dda beth yn union sydd wedi newid?

Ni wnâi eich rhagflaenydd, Dr Gibbons, dderbyn bod angen diwygio'r weinyddiaeth i sicrhau ad-drefnu gwasanaethau ysbyty, sylfaenol a chymunedol yn iawn. Felly, beth sydd wedi newid ers yr etholiad sydd yn eich arwain chi bellach i gredu bod angen diwygio'r weinyddiaeth law yn llaw â newid gwasanaethau?

Ar y pwynt hwnnw hefyd, pa sicrwydd yr ydych yn ei roi i staff drwy Gymru gyfan sy'n gweithio i ymddiriedolaethau GIG ynglyn â'u dyfodol, yn enwedig y rhai sydd mewn swyddi clinigol?

Nid oes gennyf broblem gyda lleihau nifer y biwrocratiaid, swyddogion cyllid, swyddogion cyfrifon a phrif weithredwyr, ond pa sicrwydd yr ydych yn ei roi i'r bobl hynny sydd wedi gweithio mewn swyddi meddygol un pwrpas yn yr ymddiriedolaethau hynny ers cynifer o flynyddoedd ynglyn â'u dyfodol? A ydych yn awr yn mynd i ddilyn proses o gyfuno byrddau iechyd lleol? Os nad ydych yn hoffi'r syniad o'r rhaniad rhwng prynwr a darparwr, yr ateb bid siwr yw dileu byrddau iechyd lleol.

Os nad ydych yn hoffi'r syniad o gael cyrff comisiynu, fe gytunwch hefyd nad oes angen byrddau iechyd lleol, felly. Yr wyf yn methu deall pam y mae ymddiriedolaethau'n cael eu dewis i'w huno tra bod cyrff eraill yng Nghymru'n cael trafferth gyda materion capasiti. Yr ydych eisoes wedi cytuno, yn y Pwyllgor Iechyd, Lles a Llywodraeth Leol, y byddai cael ymddiriedolaethau mwy'n ei gwneud hi'n anos i fyrddau iechyd lleol bach gomisiynu gwasanaethau a negodi'n broffesiynol gyda'r ymddiriedolaethau llawer mwy hynny.

Un pryder a godwn gyda chi ynghylch cyfuno'r ymddiriedolaethau, pryder yr wyf wedi'i godi yn y gorffennol, yw nad yw cyfuno ymddiriedolaeth lwyddiannus ag ymddiriedolaeth aflwyddiannus ddim o reidrwydd yn arwain at well gwasanaethau. Bydd angen ein sicrhau y bydd gennych systemau cadarn yn eu lle i wobrwyo ymddiriedolaethau GIG am wneud gwaith rhagorol ac i gosbi ymddiriedolaethau nad ydynt, yn syml, yn abl i wneud y gwaith.

Fel y dywedodd fy nghyd-Aelod, David Melding, ni wnaiff mabwysiadu agwedd Wal-Mart tuag at y gwasanaeth iechyd arwain o reidrwydd at well darpariaeth gwasanaethau.

Edrychwn ymlaen at y gwaith yr ydych yn ei wneud ond y mae angen inni sicrhau, hyd y gellir, fod y cyhoedd a'r clinigwyr gyda ni ar newidiadau ad-drefnu gwasanaethau, ac y dibynnwn ar gyngor arbenigol.

Gwn ein bod wedi cael dadleuon yn y Siambr hon o'r blaen ynghylch ble y dylai penderfyniadau orwedd. A ddylent orwedd gyda Gweinidogion ynteu a ddylent gael eu harwain gan glinigwyr? Fodd bynnag, mae angen ichi sicrhau bod clinigwyr yn bendant wrth y llyw pan benderfynir pa wasanaethau sy'n ddiogel, ble y cânt eu darparu orau, a beth sydd er y budd gorau i gleifion.

Oni sicrhawn hynny, ni wnawn ond parhau i gael y problemau yn y GIG a gawsom am y 10 mlynedd diwethaf."

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