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Morgan: Labour lacks commitment to Welsh hospices

Speech to the National Assembly for Wales.

"The subject that we are discussing this afternoon is extremely important. I will start by thanking the Liberal Democrats for tabling this debate this afternoon, for it is high time that we discussed the impact of hospices and palliative care.

The Assembly ought to continue giving valuable time to discussing this issue. Secondly, to the Labour Party, I say that this is a lot bigger than just providing £2 million. The issue is far more complex than the provision of £2 million and how it is spent.

It is time that we examined the contribution of the hospice movement, and celebrated and examined the wonderful work that this voluntary and charitable sector provides.

It is high time that we looked at what money it raises, how it spends that money and how services are commissioned by the statutory sector. It is also time that we examined what the NHS would have to provide in the absence of the excellent work of hospices.

In celebrating their success, we should recognise that it would be up to the acute and hospital sectors to cope with what would occur if hospices were not there to provide either hospice-based palliative care or care in the patient's home if the charities that raise money for the palliative care nurses were not there.

We should recognise that well over 90 per cent of hospice funding is raised through voluntary donations. Much of that money comes from the business sector and much of it comes from a variety of events, the length and breadth of Wales, that raise millions of pounds to keep these essential services going.

We need to recognise that. We should recognise not only the financial contribution that these organisations make, but also the expert advice, support and medical attention that they can give to patients and their families.

There is a substantial challenge. There is a lack of understanding and support from the Welsh Assembly Government. A number of years ago, £10 million was given to the hospice movement to improve the situation of palliative care in Wales.

We were all under the impression that local health boards would be taking up the challenge of commissioning whatever additional services and support was provided by way of that £10 million.

We now know that the overwhelming majority, if not all, of Wales's LHBs will struggle to carry on commissioning the services and those aspects that were provided through that £10 million. When I visited St David's Hospice in north Wales on Friday, and when I visited St Kentigern hospice, it was absolutely clear that their staff, like others, believe that that £10 million has not achieved what it could have.

Many in Wales believe that the Assembly Government did not understand how to spend that money effectively.

When you look at the commitments that the Government has offered in recent years, many in Wales will see the £10 million as a wasted opportunity. I have no doubt that the hospice movement will see the announcement of £2 million in a similar vein.

However, it is more than that. The Assembly Government does not have a target to meet the core funding of the hospice movement. In England, the Department of Health has said that it will meet 50 per cent of the core funding costs by 2008.

We know that we have a two-tier health service in Britain and that will become even more marked by 2008 because, in England, more money will be spent by the statutory sector on commissioning services from within the hospice movement for palliative care. The Assembly Government, for whatever reason, does not have the guts to do the same thing.

The fundamental problem that we have at the moment—and I believe that this needs to be tackled by the Government—is not just about reviewing and mapping what is provided. We know where the hospices are, we know what services they provide, and we know what they raise in funds; but, we need to re-examine the framework that governs the relationship between the statutory sector and the voluntary sector.

The hospice movement currently believes—and I agree with it—that the statutory sector does not understand the nature of the work that it does. In fact, when you talk to the hospice movement about its relationship with local health boards, representatives of many hospices say that all that the statutory sector does is pat them on the back and send them off.

I was at a meeting with representatives of Marie Curie Cancer Care and their words were, 'They don't understand the expert nature of the work that we do. We get a grant, once a year, off the 22 LHBs; they pat us on the back and send us off'.

That is how the statutory sector views charitable and voluntary organisations in Wales and views those people who provide expert professional services. That is the culture that we need to change and that is why this review needs to examine the framework for governing the relationship between statutory services and those provided by the charitable, voluntary sector.

It is high time that we got to grips with all of these problems: what services are provided, what funding needs to be provided, and where we need to commission services.

Ultimately, in conclusion, it is about the Assembly Government recognising the valuable contribution made by the hospice movement. If you do not do that, the people of Wales simply will not forgive you."

"Mae'r pwnc yr ydym yn ei drafod y prynhawn yma yn hynod o bwysig. Dechreuaf drwy ddiolch i'r Democratiaid Rhyddfrydol am gyflwyno'r ddadl hon y prynhawn yma, oherwydd mae'n hen bryd inni drafod effaith hosbisau a gofal lliniarol.

Dylai'r Cynulliad barhau i roi amser gwerthfawr i drafod y mater hwn. Yn ail, wrth y Blaid Lafur, dywedaf fod hyn yn llawer mwy na dim ond darparu £2 filiwn. Mae'r mater yn llawer mwy cymhleth na darparu £2 filiwn a sut y caiff ei wario.

Mae'n bryd inni edrych ar gyfraniad y mudiad hosbisau, a dathlu ac archwilio'r gwaith gwych y mae'r sector gwirfoddol ac elusennol hwn yn ei ddarparu. Mae'n hen bryd inni edrych ar ba arian y mae'n ei godi, sut mae'n gwario'r arian hwnnw a sut mae gwasanaethau'n cael eu comisiynu gan y sector statudol.

Mae hefyd yn bryd inni archwilio'r hyn y byddai'n rhaid i'r GIG ei ddarparu yn niffyg gwaith rhagorol hosbisau. Wrth ddathlu eu llwyddiant, dylem gydnabod y byddai'n rhaid i'r sector aciwt a'r sector ysbytai ymdopi â'r hyn a fyddai'n digwydd pe na bai hosbisau yno i ddarparu un ai ofal lliniarol mewn hosbis neu ofal yng nghartref y claf pe na bai'r elusennau sy'n codi arian ar gyfer y nyrsys gofal lliniarol yno.

Dylem gydnabod bod dros 90 y cant ymhell o arian hosbisau yn cael ei godi drwy roddion gwirfoddol. Daw llawer o'r arian hwnnw o'r sector busnes a daw llawer ohono o amryw o ddigwyddiadau, ar hyd a lled Cymru, sy'n codi miliynau o bunnoedd i gadw'r gwasanaethau hanfodol hyn i fynd.

Mae angen inni gydnabod hynny. Dylem gydnabod nid yn unig y cyfraniad ariannol mae'r sefydliadau hyn yn ei wneud, ond hefyd y cyngor arbenigol, y gefnogaeth a'r sylw meddygol y gallant eu rhoi i gleifion a'u teuluoedd.

Mae yma her sylweddol. Mae diffyg dealltwriaeth a chefnogaeth gan Lywodraeth Cynulliad Cymru. Sawl blwyddyn yn ôl, rhoddwyd £10 miliwn i'r mudiad hosbisau i wella sefyllfa gofal lliniarol yng Nghymru.

Yr oeddem i gyd dan yr argraff y byddai'r byrddau iechyd lleol yn ymgymryd â'r her o gomisiynu pa wasanaethau a chymorth ychwanegol bynnag a gâi eu darparu drwy'r £10 miliwn hwnnw. Gwyddom erbyn hyn y bydd mwyafrif helaeth, os nad pob un, o BILlau Cymru yn cael anhawster i barhau i gomisiynu'r gwasanaethau a'r agweddau hynny a ddarparwyd drwy'r £10 miliwn hwnnw. Pan ymwelais â Hosbis Dewi Sant yn y Gogledd ddydd Gwener, a phan ymwelais â hosbis St Kentigern, yr oedd yn hollol amlwg bod eu staff hwy, fel eraill, yn credu nad yw'r £10 miliwn hwnnw wedi cyflawni'r hyn y gallai fod wedi ei gyflawni.

Mae llawer yng Nghymru yn credu nad oedd Llywodraeth y Cynulliad yn deall sut i wario'r arian hwnnw'n effeithiol.

Pan edrychwch chi ar yr ymrwymiadau y mae'r Llywodraeth wedi eu cynnig dros y blynyddoedd diwethaf, bydd llawer yng Nghymru yn gweld y £10 miliwn fel cyfle a wastraffwyd.

Nid oes gennyf unrhyw amheuaeth y bydd y mudiad hosbisau yn gweld y cyhoeddiad am y £2 filiwn yn yr un goleuni.

Fodd bynnag, mae'n fwy na hynny. Nid oes gan Lywodraeth y Cynulliad darged i ddarparu cyllid craidd y mudiad hosbisau. Yn Lloegr, mae'r Adran Iechyd wedi dweud y bydd yn darparu 50 y cant o'r costau cyllido craidd erbyn 2008.

Gwyddom fod gennym wasanaeth iechyd dwy haen ym Mhrydain a daw hynny'n fwy amlwg byth erbyn 2008 oherwydd, yn Lloegr, bydd rhagor o arian yn cael ei wario gan y sector statudol ar gomisiynu gwasanaethau gofal lliniarol gan y mudiad hosbisau. Nid oes gan Lywodraeth y Cynulliad, am ba reswm bynnag, y dewrder i wneud yr un fath.

Nid adolygu a mapio'r hyn sy'n cael ei ddarparu yw'r broblem sylfaenol sydd gennym ar hyn o bryd—a chredaf fod angen i'r Llywodraeth fynd i'r afael â hyn. Gwyddom ble mae'r hosbisau, gwyddom pa wasanaethau y maent yn eu darparu, a gwyddom faint o arian y maent yn ei godi; ond, mae angen inni edrych eto ar y fframwaith sy'n llywodraethu'r berthynas rhwng y sector statudol a'r sector gwirfoddol.

Mae'r mudiad hosbisau ar hyn o bryd yn credu—a chytunaf ag ef—nad yw'r sector statudol yn deall natur y gwaith a wna. Yn wir, wrth ichi siarad â'r mudiad hosbisau am ei berthynas â'r byrddau iechyd lleol, dywed cynrychiolwyr llawer o hosbisau mai'r cyfan a wna'r sector statudol yw eu curo ar eu cefnau a'u hanfon ymaith.

Yr oeddwn mewn cyfarfod gyda chynrychiolwyr o Ofal Canser Marie Curie a'u geiriau hwy oedd, 'Nid ydynt yn deall natur arbenigol y gwaith yr ydym yn ei wneud. Yr ydym yn cael grant, unwaith y flwyddyn, gan y 22 BILl, maent yn ein curo ar ein cefn ac yn ein hanfon ymaith.'

Dyna sut mae'r sector statudol yn edrych ar fudiadau elusennol a gwirfoddol yng Nghymru ac yn edrych ar y bobl hynny sy'n darparu gwasanaethau proffesiynol arbenigol. Dyna'r diwylliant y mae angen inni ei newid a dyna pam y mae angen i'r adolygiad hwn archwilio'r fframwaith i reoli'r berthynas rhwng gwasanaethau statudol a'r rheini a ddarperir gan y sector elusennol, gwirfoddol.

Mae'n hen bryd inni fynd i'r afael â'r holl broblemau hyn: pa wasanaethau a ddarperir, pa gyllid y mae angen ei ddarparu, a ble mae angen inni gomisiynu gwasanaethau. Yn y pen draw, i gloi, mae gofyn i Lywodraeth y Cynulliad gydnabod y cyfraniad gwerthfawr a wneir gan y mudiad hosbisau. Oni wnewch chi hynny, ni wnaiff pobl Cymru faddau ichi."

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