Speeches recovered from the Conservative party’s online archive More…

Morgan: Mental health care needs urgent re-think

Speech to the National Assembly for Wales.

"I am delighted to lead this important debate focusing on mental health services and looking at a variety of actions that are being undertaken by the Assembly Government to improve mental health services in Wales.

I hope that the Government will send out the right message this afternoon by supporting the motion, and I hope that other parties will also support what, I hope, will be a constructive debate, looking at where we are with mental health services in Wales and where we need to be.

The reason for the debate is absolutely clear. The national service framework published last year contains an ambitious, but, for many, an unachievable list of objectives. Eight standards were achieved; there are 44 key actions and 93 performance targets—all to be met by 2012, so, to be fair, there is not long to go.

Many of those performance targets were to be achieved this year, next year, and in 2008. Therefore, we are rapidly getting to a position where many of the targets set out in the national service framework were meant to be achieved.

It is time that we examined where we are with the national service framework—we need to look at what is being done and whether the Assembly Government is on course to implement what is outlined.

That is why we felt that it was important that mental health services should be brought to the attention of the Assembly today, giving Members an opportunity to debate this important matter.

We are happy to support amendments 1, 2 and 4, and I am delighted that Helen Mary Jones has included the amendment recognising the concern about child and adolescent mental health services. It is right that we also focus on that as a way by which we can assess how successful the Assembly Government has been.

Reforming mental health services, and investing in them, is a challenge to commissioners, who lack capacity and experience in planning effective services with local health boards whose fragmented status and competing priorities push mental health down the list, although the national service framework was supposed to deal with this as one of its objectives.

You should leave health matters to your official spokesperson. Is that the best intervention that we can get from Plaid Cymru on what is a serious debate about the strategic framework for mental health services?

This has nothing to do with the neurosurgery debate, during which you tried to get the Assembly to determine whether services should be in Cardiff or Swansea. We are not saying where services should be provided; we are saying that we want world-class services for the people of Wales.

A national service framework has been voted on here, supported by opposition parties, including your spokesperson, and it is meant to be implemented by the Assembly Government in order to reach those world-class services.

I am saddened that Plaid Cymru cannot engage in what is a serious debate about the future of mental health services, because that is what we are seeking to do this afternoon. I hope that the contribution from your official spokesperson will be slightly more grown up than that contribution.

Therefore, this is a challenge to commissioners and to the Government, which promised, through the NSF, to deliver those high-quality services; however, it has already ditched that strategy, and has replaced it with another.

A sum of £5 million was allocated by the Government to build the achievement of that national service framework, but, as per usual, it was a bidding process, with local health boards, local authorities and others having to bid into that pot to put forward projects that could deliver the NSF.

It is also a challenge to patients, their families and carers, and those who feel excluded from the planning process, either when restructuring occurs or when their own care pathway is altered. That was a powerful message that we received in the Health and Social Services Committee when we looked at adult mental health services.

Many users and carers came to us with their evidence and advice about what suits them best, and also, the way in which they are treated by people who work within the mental health field.

As I said, the 2002 national service framework was ditched very quickly by the Assembly Government, which introduced a revised version just over a year ago. The Children's Commissioner for Wales has already been critical of the Government's approach to its child and adolescents mental health services strategy, stating that the Government should either fund it or give up the pretence of supporting it.

That is an interesting but damning criticism of the Assembly Government. However, for many people—patients, carers and those who work in mental health, in the statutory or voluntary sector—the same could be said about the mental health strategy and that which is set out to be achieved in the national service framework. It is high time that we looked at what was set out, and how or whether it is being achieved.

I agree with what the national service framework says. I agree with the eight standards, and I would like the Minister to focus on four standards in particular. The first of those is standard two, on empowering users and carers. It is absolutely fundamental in delivering a coherent health service, particularly when dealing with sensitive issues, such as mental health, that people are involved in planning their care pathway.

These people will often have a say, and they will often be able to explain what works best for them, and what works best for their communities. Often, these people feel excluded. It is easy for managers, clinicians and NHS trusts to ignore the views of people who suffer from a mental health problem, simply because of the nature of their condition.

Put simply, this is wrong, and it must stop. It is up to the Assembly Government to enforce the rules that we have set out—that there is statutory consultation with users and carers—because those people need to inform the type of health system that we have.

The targets are clear. By March of this year, local authorities and LHBs should include service users on all relevant planning groups. Has this happened, Minister? We need to be certain that various bodies in Wales are achieving this target, which should have been reached by March of this year.

By October of this year, the Assembly Government was going to review all of this, in light of the Health and Social Services Committee review that I mentioned a few moments ago. Have you done that work, because you set it out in the national service framework?

If it has been done, we would like to know the results of that. By March 2008, another target that should be reached is the inclusion of service users in staff recruitment and monitoring; has that started?

Are we seeing the relevant bodies in Wales putting forward plans and a structure that will allow that target to be reached by March 2008? These are targets that should be achieved quickly, and I am not certain that we are doing sufficient work to get to those early targets.

On standard four, on the equity of services and access to services, the Assembly's Audit Committee said in July that it saw little evidence to indicate any positive action. We know that access to the quality of services will vary across Wales, depending on geography, the priorities of local health boards, the recruitment of professionals, and the funding that is allocated.

Mental health users, carers, professionals, and the voluntary sector, have confirmed to us—they did so last week at the MIND mental health conference in north Wales—that equity of services and access to services remains as important now as it did when the NSF was written.

Standard five is another crucial aspect of the national service framework—the ability of commissioning. We have touched on this on more than occasion. The Welsh Assembly Government must ensure that the delivery of adult mental health strategy, and the national service framework, is implemented, that progress is monitored, and that targets are achieved.

That is what you have said in the national service framework, so, Minister, it is your responsibility as an Assembly Government. It is up to you to say what the progress has been. There are targets to establish regional commissioning, effectively, admitting that the 22 local health boards are struggling.

We would like to see progress on a greater degree of collaboration, because it is clear that local health boards do not have the capacity, the experience, or the money to commission effective services.

Standard six deals with delivery, which is essential. I will support you in this one aspect—most of the key actions, and most of those objectives and targets that are allocated, fall within the 'delivery' category, which is right.

However, people are now asking how much has changed, what developments have taken place since last year, and whether you are on target to reach those aspirations that you wrote into that national service framework.

Last October, the Wales Audit Office said that there were significant gaps in service delivery and community-based services, that six out of 22 LHBs had outreach teams—the others did not—and that fewer had early intervention teams.

That is crucial for delivering effective mental health services—building the advocacy that people need, building those outreach schemes, and building the community teams that people need to access if they are going to feel that mental health services are there to deliver for them.

You need to explain to the Assembly whether or not this is being achieved, which is why we believe this motion is important. As I said, in July, the Assembly's Audit Committee had similar concerns.

There is practical evidence around Wales of where problems are occurring, and where mental health users and carers are being excluded from the process.

This morning, Nick Bourne and I visited the Tegfan Day Hospital in Cardiff; that issue demonstrates how carers and users have been excluded, up until now, when it comes to designing and restructuring mental health services. We need to involve people, and we need to recognise that, just because they have a condition, it does not preclude them from taking an active part in designing the healthcare that they need.

In conclusion, providing world-class mental health services could be a defining achievement for this Assembly and this Assembly Government, and it is one that could provide for thousands of people, the length and breadth of Wales. It is a challenge, but it is also an opportunity that we need to seize."

"Yr wyf wrth fy modd yn arwain y ddadl bwysig hon sy'n canolbwyntio ar wasanaethau iechyd meddwl ac yn edrych ar amryw o gamau sydd ar y gweill gan Lywodraeth y Cynulliad i wella gwasanaethau iechyd meddwl yng Nghymru.

Gobeithiaf y bydd y Llywodraeth yn cyfleu'r neges iawn y prynhawn yma drwy gefnogi'r cynnig, a gobeithiaf y bydd y pleidiau eraill hefyd yn cefnogi'r hyn a fydd, gobeithiaf, yn ddadl adeiladol, yn edrych ar y sefyllfa yr ydym ynddi o ran gwasanaethau iechyd meddwl yng Nghymru a ble mae angen inni fod.

Mae'r rheswm am y ddadl yn gwbl glir. Mae'r fframwaith gwasanaeth cenedlaethol a gyhoeddwyd y llynedd yn cynnwys rhestr uchelgeisiol o amcanion ond rhestr, i lawer, nad oes modd ei chyflawni. Cyflawnwyd wyth safon; mae 44 o gamau gweithredu allweddol a 93 o dargedau perfformiad—i gyd i gael eu cyrraedd erbyn 2012, felly, a fod yn deg, mae amser yn brin.

Yr oedd disgwyl cyflawni llawer o'r targedau perfformiad hynny eleni, y flwyddyn nesaf, ac yn 2008. Felly, yr ydym yn prysur ddynesu at adeg yr oedd llawer o'r targedau a osodir yn y fframwaith gwasanaeth cenedlaethol i fod i gael eu cyflawni.

Mae'n bryd inni archwilio'r mater i weld ble'r ydym arni o ran y fframwaith gwasanaeth cenedlaethol—mae angen inni edrych ar yr hyn sy'n cael ei wneud a ph'un ai a yw Llywodraeth y Cynulliad ar y trywydd iawn ai peidio o ran gweithredu'r hyn a amlinellir.

Dyna pam y teimlem ei bod yn bwysig dwyn y gwasanaethau iechyd meddwl i sylw'r Cynulliad heddiw, gan roi cyfle i'r Aelodau drafod y mater pwysig hwn.

Yr ydym yn falch o gefnogi gwelliannau 1, 2 a 4, ac yr wyf wrth fy modd bod Helen Mary Jones wedi cynnwys y gwelliant sy'n cydnabod y pryder sydd ohoni ynghylch gwasanaethau iechyd meddwl plant a'r glasoed. Mae'n deg inni ganolbwyntio ar hynny fel ffordd o asesu pa mor llwyddiannus y bu'r Cynulliad.

Mae diwygio'r gwasanaethau iechyd meddwl, a buddsoddi ynddynt, yn her i gomisiynwyr, nad oes ganddynt y gallu na'r profiad o gynllunio gwasanaethau effeithiol gyda byrddau iechyd lleol y mae eu statws yn ddarniog a'u blaenoriaethau'n cystadlu a'i gilydd gan wthio iechyd meddwl i lawr y rhestr, er bod y fframwaith cenedlaethol i fod i ddelio â hyn fel un o'i amcanion.

Nid oes a wnelo hyn ddim oll â'r ddadl ynghylch niwrolawdriniaeth, pan geisiasoch gael y Cynulliad i benderfynu a ddylai'r gwasanaethau fod yng Nghaerdydd ynteu yn Abertawe. Nid dweud yr ydym ymhle y dylid darparu'r gwasanaethau hyn; dweud yr ydym ein bod am sicrhau gwasanaethau gyda'r gorau yn y byd i bobl Cymru.

Pleidleisiwyd ar fframwaith gwasanaeth cenedlaethol yma, a gefnogwyd gan y gwrthbleidiau, gan gynnwys eich llefarydd chwithau, a'r bwriad yw i Lywodraeth y Cynulliad ei weithredu er mwyn cyflawni'r gwasanaethau hynny a fydd gyda'r gorau yn y byd.

Mae'n peri tristwch imi na all Plaid Cymru gyfranogi mewn dadl ddifrifol ynghylch dyfodol gwasanaethau iechyd meddwl, oherwydd dyna yr ydym yn ceisio ei wneud y prynhawn hwn. Gobeithiaf y bydd cyfraniad eich llefarydd swyddogol yn fwy aeddfed na'r cyfraniad hwnnw.

Felly, dyma her i gomisiynwyr ac i'r Llywodraeth sydd wedi addo, trwy'r Fframwaith Gwasanaeth Cenedlaethol, y bydd yn cyflenwi'r gwasanaethau gorau hynny; fodd bynnag, mae eisoes wedi rhoi'r gorau i'r strategaeth honno, gan osod un arall yn ei lle.

Dyrannodd y Llywodraeth swm o £5 miliwn i feithrin cyflawni'r fframwaith gwasanaeth cenedlaethol hwnnw, ond, yn ôl yr arfer, proses fidio a fu, a'r byrddau iechyd lleol, awdurdodau lleol ac eraill yn gorfod bidio am y pot er mwyn cyflwyno prosiectau a allai wireddu'r fframwaith gwasanaeth cenedlaethol.

Mae'n her hefyd i gleifion, eu teuluoedd a'u gofalwyr, a'r rhai sy'n teimlo eu bod yn cael eu cau allan o'r broses gynllunio, naill ai pan fydd ailstrwythuro neu pan gaiff trywydd eu gofal hwythau ei newid.

Dyna neges gref a gawsom yn y Pwyllgor Iechyd a Gwasanaethau Cymdeithasol pan fuom yn edrych ar wasanaethau iechyd meddwl oedolion. Daeth nifer o ddefnyddwyr a gofalwyr atom gyda thystiolaeth a chyngor ynghylch yr hyn sydd orau ganddynt, a hefyd, y ffordd y cânt eu trin gan bobl sy'n gweithio ym maes iechyd meddwl.

Ys dywedais, rhoddwyd y gorau i fframwaith gwasanaeth cenedlaethol 2002 yn gyflym iawn gan Lywodraeth y Cynulliad, a gyflwynodd fersiwn diwygiedig ychydig dros flwyddyn yn ôl.

Mae Comisiynydd Plant Cymru eisoes wedi beirniadu dulliau'r Llywodraeth parthed ei strategaeth ar gyfer gwasanaethau iechyd meddwl plant a'r glasoed, gan ddweud y dylai'r Llywodraeth naill ai ei hariannu neu roi'r gorau i smalio ei gefnogi.

Dyna feirniadaeth ddiddorol ond damniol ar Lywodraeth y Cynulliad. Fodd bynnag, i lawer o bobl—yn gleifion, yn ofalwyr a'r rhai sy'n gweithio ym maes iechyd meddwl, yn y sector statudol neu wirfoddol—gellid dweud hynny hefyd am y strategaeth iechyd meddwl a'r hyn sydd i fod i gael ei gyflawni yn y fframwaith gwasanaeth cenedlaethol. Mae'n hen bryd inni edrych ar yr hyn a bennwyd, a sut y mae'n cael ei gyflawni a ph'un ai a yw'n cael ei gyflawni ai peidio.

Cytunaf â'r hyn y mae'r fframwaith gwasanaeth cenedlaethol yn ei ddweud. Cytunaf â'r wyth safon, a hoffwn i'r Gweinidog ganolbwyntio ar bedair o'r safonau'n neilltuol. Y gyntaf o'r rheiny yw safon dau, ynghylch grymuso defnyddwyr a gofalwyr.

Mae'n gwbl sylfaenol o ran cyflenwi gwasanaeth iechyd cydlynol, yn arbennig felly o ddelio â materion sensitif, megis iechyd meddwl, bod pobl yn cael eu cynnwys yn y gwaith o gynllunio eu llwybr gofal.

Yn aml bydd gan y bobl hyn rywbeth i'w ddweud, ac yn aml medrant esbonio beth sy'n gweithio orau iddynt, a'r hyn sy'n gweithio orau i'w cymunedau. Yn aml, mae'r bobl hyn yn teimlo iddynt gael eu cau allan.

Mae'n hawdd i reolwyr, clinigwyr ac ymddiriedolaethau'r gwasanaeth iechyd gwladol anwybyddu safbwyntiau pobl sydd â phroblemau iechyd meddwl, a hynny oherwydd natur eu cyflwr. Yn syml felly, mae hynny'n anghyfiawn, ac mae'n rhaid i hyn ddod i ben.

Lle Llywodraeth y Cynulliad yw gweithredu'r rheolau yr ydym wedi eu gosoda sicrhau ymgynghori statudol gyda defnyddwyr a gofalwyr—oherwydd mae angen i'r bobl hynny gael cynnig sylfaen ar gyfer y math o system iechyd sydd gennym.

Mae'r targedau'n glir. Erbyn mis Mawrth eleni, dylai'r awdurdodau lleol a'r byrddau iechyd lleol gynnwys defnyddwyr y gwasanaethau ar bob grwp cynllunio perthnasol. A yw hyn wedi digwydd, Weinidog?

Mae angen inni fod yn sicr bod gwahanol gyrff yng Nghymru'n cyflawni'r targed hwn, y dylasid ei gyrraedd erbyn mis Mawrth eleni. Erbyn mis Hydref eleni, yr oedd Llywodraeth y Cynulliad am adolygu hyn oll, yng ngoleuni adolygiad y Pwyllgor iechyd a Gwasanaethau Cymdeithasol y soniais amdano gynnau fach.

A ydych wedi gwneud y gwaith hwnnw, oherwydd ichi ei osod yn y fframwaith gwasanaeth cenedlaethol? Os yw wedi ei wneud, hoffem wybod y canlyniadau. Erbyn mis Mawrth 2008, dylid cyrraedd targed arall sef cynnwys defnyddwyr y gwasanaeth yn y gwaith o recriwtio staff a monitro; a yw hynny wedi dechrau?

A ydym yn gweld y cyrff perthnasol yng Nghymru'n cyflwyno cynlluniau a strwythur a fydd yn fodd cyrraedd y targed hwnnw erbyn mis Mawrth 2008? Dyma dargedau y dylid eu cyflawni'n gyflym, ac nid wyf yn sicr ein bod yn gwneud digon o waith i gyrraedd y targedau cynnar hynny.

Ynglyn â safon pedwar, ynglyn â thegwch a mynediad at wasanaethau, dywedodd Pwyllgor Archwilio'r Cynulliad ym mis Gorffennaf nad oedd yn gweld bod fawr ddim tystiolaeth dros gamau cadarnhaol.

Gwyddom y bydd mynediad at wasanaethau a'u hansawdd yn amrywio ar draws Cymru, gan ddibynnu ar ddaearyddiaeth, blaenoriaethau'r byrddau iechyd lleol, recriwtio staff proffesiynol, a'r arian a gaiff ei ddyrannu.

Mae defnyddwyr, gofalwyr a staff proffesiynol ym maes iechyd a'r sector gwirfoddol wedi cadarnhau hyn inni—gwnaethant hynny yr wythnos diwethaf yng nghynhadledd iechyd meddwl MIND yng ngogledd Cymru—bod tegwch gwasanaethau a mynediad atynt cyn bwysiced yn awr ag yr oedd pan gafodd y fframwaith gwasanaeth cenedlaethol ei ysgrifennu.

Mae safon pump yn agwedd allweddol arall ar y fframwaith gwasanaeth cenedlaethol—y gallu i gomisiynu. Yr ydym wedi cyfeirio at hyn sawl gwaith. Mae'n rhaid i Lywodraeth Cynulliad Cymru sicrhau y caiff y strategaeth iechyd meddwl oedolion, a'r fframwaith gwasanaeth cenedlaethol, eu gweithredu, ac y caiff y cynnydd ei fonitro, ac y caiff y targedau eu cyflawni.

Dyna a ddywedasoch yn y fframwaith gwasanaeth cenedlaethol, felly, Weinidog, dyna yw eich cyfrifoldeb fel Llywodraeth y Cynulliad. Eich lle chwithau yw dweud pa gynnydd a gyflawnwyd. Mae targedau i sefydlu comisiynu rhanbarthol, sydd fwy neu lai'n gyfaddefiad bod y 22 bwrdd iechyd lleol mewn trafferthion.

Hoffem weld cynnydd o ran rhagor o gydweithio, oherwydd mae'n amlwg nad oes gan y byrddau iechyd lleol y gallu, y profiad, na'r arian i gomisiynu gwasanaethau effeithiol.

Mae a wnelo safon chwech â chyflenwi, ac mae hynny'n hanfodol. Fe'ch cefnogaf yn hyn o beth yn unig—mae'r rhan fwyaf o'r camau allweddol, a'r rhan fwyaf o'r amcanion a'r targedau hynny sydd wedi eu dyrannu, yn perthyn i gategori 'cyflenwi', ac mae hynny'n iawn.

Fodd bynnag, bellach mae pobl yn gofyn faint o newid a fu, pa ddatblygiadau a fu ers y llynedd, ac a ydych ar y trywydd iawn o ran cyflawni'r dyheadau hynny a nodwyd gennych yn y fframwaith gwasanaeth cenedlaethol.

Fis Hydref diwethaf, dywedodd Swyddfa Archwilio Cymru fod bylchau sylweddol yn y gwasanaethau a gyflenwir a'r gwasanaethau cymunedol, fod gan chwech o blith y 22 bwrdd iechyd lleol dimau allgymorth—nid oedd rhai gan y lleill—a bod gan lai fyth dimau ymyrraeth gynnar.

Mae hynny'n allweddol o ran cyflenwi gwasanaethau iechyd meddwl effeithiol—meithrin yr eiriolaeth y mae ei hangen ar bobl, meithrin y cynlluniau allgymorth hynny, a meithrin y timau cymunedol y mae eu hangen ar bobl er mwyn iddynt deimlo bod y gwasanaethau iechyd meddwl yn mynd i gyflawni rhywbeth trostynt.

Mae angen ichi esbonio i'r Cynulliad a yw hyn yn cael ei gyflawni ai peidio, a dyna pam yr ydym yn credu bod y cynnig hwn yn bwysig. Ys dywedais, ym mis Gorffennaf, yr oedd gan bwyllgor Archwilio'r Cynulliad bryderon tebyg.

Mae tystiolaeth ymarferol i'w chael ar draws Cymru ynglyn â ble mae'r problemau'n codi, ac ymhle mae defnyddwyr y gwasanaethau iechyd meddwl a'r gofalwyr yn cael eu cau allan o'r broses.

Y bore yma, ymwelodd Nick Bourne a minnau ag Ysbyty Dydd Tegfan yng Nghaerdydd; mae hynny'n dangos sut y cafodd gofalwyr a defnyddwyr eu cau allan, hyd yma, o ran dylunio a strwythuro gwasanaethau iechyd meddwl.

Mae angen inni gynnwys pobl, ac mae angen inni gydnabod, nad yw'r ffaith bod anhwylder arnynt yn golygu na fedrant chwarae rhan weithgar yn y gwaith o gynllunio'r gofal iechyd y mae ei angen arnynt.

I gloi, gallai darparu gwasanaethau iechyd meddwl gyda'r gorau yn y byd fod yn gyflawniad sy'n diffinio'r Cynulliad hwn ac i Lywodraeth y Cynulliad hwn, a gellid darparu ar gyfer miloedd o bobl ar hyd a lled Cymru. Mae'n her ond mae hefyd yn gyfle y dylem fanteisio arno i'r eithaf."

Keyboard shortcuts

j previous speech k next speech