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Morgan: Financial challenges ahead for NHS Wales

Speech to the National Assembly for Wales.

"First, I thank you for the statement. You have said that the NHS in Wales has faced a significant financial challenge in 2005-06. I put it to you that that is not the first financial year within which the NHS in Wales has faced significant challenges.

The people who commission services from local health boards will tell you that they have faced challenges before this particular financial year, and I am sure that the people who run the finances of NHS trusts will tell you that this particular year is not the only year in which those challenges have been faced.

Some people who work for these organisations believe that you have not fully costed many of the programmes that the Government has brought in, particularly the new contracts, the pay modernisation, the consultants' contract, 'Agenda for Change', and, of course, the general medical services contract.

Some people, particularly within the nursing profession, believe that the 'Agenda for Change' programme is facing a shortfall of some £24 million. Can you confirm whether there is a shortfall and whether that shortfall matches that figure of £24 million?

The auditor general, in March 2005, in his executive summary, when looking at the balances for the NHS in 2004-05, said that the total net debtor balances across all NHS bodies was approximately £190 million. That is a figure that Jeremy Colman has come up with.

Would you like to comment on it? Perhaps you can explain how that figure was reached and whether or not the Government accepts that there is a net debtor balance across the whole of the NHS—I presume that that would include bodies such as Health Commission Wales—of £190 million. It is in his report, which was published in March 2005.

When you look at the figures, particularly the figures from 2003-04 and 2004-05, there has been a significant increase in the cumulative deficit of NHS trusts.

The cumulative deficit in 2003-04 was just short of £43 million, and, during 2004-05, that rose to just over £51 million—roughly, a £10 million increase in the cumulative deficits of NHS trusts. Cardiff and the Vale NHS Trust was up by over £2 million, and Carmarthenshire NHS Trust was up by over £4 million.

However, it was not just the trusts. You need to explain why the trusts are struggling to manage their budgets in the light of the additional pressures that they face.

The trusts do not face the pressures on their own as they are also being faced by local health boards. Cardiff LHB strategic change and efficiency plan funding, which is, presumably, the loan that you use to bail them out, required £4 million more in 2004-05 than during 2003-04.

Similarly, the Vale of Glamorgan LHB required a loan of some £3.8 million in 2004-05 compared with £2.66 million in the previous financial year.

Can you explain why local health boards continue to struggle with their finances? What is it about the agenda that you, as a Government, are setting that is causing financial constraint to the extent that LHBs have required more Government loans in each financial year, since they were introduced in 2003-04 to bail out struggling LHBs?

Do you accept the criticism levelled by people working in the NHS Confederation and in the LHBs and trusts, that you are putting responsibilities on LHBs and trusts, but that adequate finance to cover those responsibilities is not being made available?

The sole concern of these professionals is that they are unable to deliver the agenda that you and your colleagues have set because the finances are not there to match the targets and the changes that the Government has introduced."

"Yn gyntaf, diolchaf ichi am y datganiad. Dywedasoch fod y GIG yng Nghymru wedi wynebu her ariannol sylweddol yn 2005-06. Awgrymaf ichi nad honno yw'r flwyddyn ariannol gyntaf i'r GIG yng Nghymru wynebu heriau sylweddol.

Bydd y bobl sy'n comisiynu gwasanaethau o fyrddau iechyd lleol yn dweud wrthych iddynt wynebu heriau cyn y flwyddyn ariannol benodol hon, ac yr wyf yn siwr y bydd y bobl sy'n rhedeg cyllid ymddiriedolaethau'r GIG yn dweud wrthych nad y flwyddyn benodol hon yw'r unig flwyddyn i'r heriau hynny gael eu hwynebu.

Cred rhai pobl sy'n gweithio ar gyfer y sefydliadau hyn nad ydych wedi costio llawer o'r rhaglenni y mae'r Llywodraeth wedi eu cyflwyno yn llawn, yn arbennig y contractau newydd, y broses o foderneiddio cyflogau, contract meddygon ymgynghorol, 'Agenda ar gyfer Newid' ac, wrth gwrs, y contract gwasanaethau meddygol cyffredinol.

Cred rhai pobl, yn arbennig o fewn y proffesiwn nyrsio, fod y rhaglen 'Agenda ar gyfer Newid' yn wynebu diffyg o ryw £24 miliwn. A allwch gadarnhau pa un a oes diffyg a pha un a yw'r diffyg yn cyfateb i'r ffigur hwnnw o £24 miliwn?

Dywedodd yr archwilydd cyffredinol, ym mis Mawrth 2005, yn ei grynodeb gweithredol, wrth edrych ar y balansau ar gyfer y GIG yn 2004-05, fod cyfanswm y balansau dyledwyr net ar draws holl gyrff y GIG tua £190 miliwn. Mae'r ffigur hwnnw yn un y mae Jeremy Colman wedi ei gynnig. A hoffech roi sylwadau arno?

Efallai y gallwch esbonio sut y cyrhaeddwyd y ffigur hwnnw a pha un a yw'r Llywodraeth yn derbyn y ffaith bod balans dyledwyr net o £190 miliwn ar draws y GIG cyfan—rhagdybiaf y byddai hynny'n cynnwys cyrff megis Comisiwn Iechyd Cymru. Mae hyn yn ei adroddiad, a gyhoeddwyd ym mis Mawrth 2005.

Pan edrychwch ar y ffigurau, yn arbennig y ffigurau o 2003-04 a 2004-05, cafwyd cynnydd sylweddol yn niffyg cronnol ymddiriedolaethau'r GIG. Yr oedd y diffyg cronnol yn 2003-04 ychydig yn llai na £43 miliwn, ac, yn ystod 2004-05, cododd y ffigur hwnnw i ychydig dros £51 miliwn—yn fras, cynnydd o £10 miliwn yn niffygion cronnol ymddiriedolaethau'r GIG.

Yr oedd cynnydd Ymddiriedolaeth GIG Caerdydd a'r Fro dros £2 filiwn, ac yr oedd cynnydd Ymddiriedolaeth GIG Sir Gaerfyrddin dros £4 miliwn. Fodd bynnag, nid dim ond â'r ymddiriedolaethau yr oedd a wnelo hyn.

Mae angen ichi esbonio pam y mae'r ymddiriedolaethau yn cael anhawster i reoli eu cyllidebau yng ngoleuni'r pwysau ychwanegol a wynebir ganddynt.

Nid yw'r ymddiriedolaethau yn wynebu'r pwysau ar eu pen eu hunain gan fod byrddau iechyd lleol hefyd yn eu hwynebu. Yr oedd angen i gynllun newid strategol ac effeithlonrwydd BILl Caerdydd gael £4 miliwn yn fwy yn 2004-05 nag yn ystod 2003-04 sef y benthyciad a ddefnyddiwch, yn ôl pob tebyg, i achub eu croen.

Yn yr un modd, yr oedd angen i BILl Bro Morgannwg gael benthyciad o ryw £3.8 miliwn yn 2004-05 o'i gymharu â £2.66 miliwn yn y flwyddyn ariannol flaenorol. A allwch esbonio pam mae byrddau iechyd lleol yn parhau i gael trafferthion ariannol?

Beth sydd yn eich agenda chi, fel Llywodraeth, sy'n achosi cyfyngiadau ariannol i'r graddau ei bod yn ofynnol i BILlau gael mwy o fenthyciadau gan y Llywodraeth ym mhob blwyddyn ariannol ers iddynt gael eu cyflwyno yn 2003-04 i achub croen BILlau sydd mewn trafferthion?

A dderbyniwch y feirniadaeth a fynegwyd gan bobl sy'n gweithio yng Nghydffederasiwn y GIG ac yn y BILlau a'r ymddiriedolaethau, eich bod yn rhoi cyfrifoldebau i BILlau ac ymddiriedolaethau, ond nad ydych yn sicrhau bod arian digonol ar gael i gwmpasu'r cyfrifoldebau hynny?

Unig bryder y gweithwyr proffesiynol hyn yw na allant gyflawni'r agenda a bennwyd gennych chi a'ch cyd-Aelodau gan nad oes ganddynt yr arian i gyd-fynd â'r targedau a'r newidiadau a gyflwynwyd gan y Llywodraeth."

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