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Francis: The future of healthcare in Mid and West Wales

Speech to the National Assembly for Wales.

"Earlier this week, over the border in England, the Secretary of State for Health, Patricia Hewitt, decided that she wanted more NHS services and facilities to be provided in the community.

A White Paper was published setting out a vision of care and treatment provided outside the costly setting of traditional acute hospitals. The Prime Minister said that this would represent a service fitted around the patient rather than the patient having to fit around the service.

Labour's election manifesto last May promised to develop, 'a new generation of modern NHS community hospitals' providing diagnostic services, surgery and out-patient facilities, as well as access to social services closer to where people live.

The feedback that I receive from my electorate in Mid and West Wales suggests that that is exactly what people want to see developed.

Patricia Hewitt also said that community facilities should not be lost in response to 'short-term budgetary pressures' that are related to the viability of the community facility itself.

Therefore, where England dares to go, will Wales follow? Will our Minister for Health and Social Services be taking a trip on the road to Damascus along with Ms Hewitt?

On 26 August, Minister, you visited Knighton Hospital and you said: 'Community Hospitals play a crucial role in providing local people with access to high-quality services as close to home as possible.

This is a central theme in 'Designed for Life', our 10-year vision for creating a world-class health service in Wales'.

The 'Designed for Life' document states that local communities' concerns and priorities must be taken into account.

The position paper, 'Building local, safe and sustainable services for Mid and West Wales: The Case for Change', says that it will focus on 'redesign, not relocation', offering high-quality alternatives, and expanding options for developing new services that meet local needs and expectations.

Over the course of the last month, the project team for 'The Case for Change' drew up detailed proposals for consultation. These proposals have apparently been influenced by engagement meetings with staff and the public.

Yesterday, I asked the First Minister what sort of engagement events had been held and how many there had been. Sadly, he chose not to answer this question directly; in fact, he did not even offer to find out. He just said that I had a talent for asking irrelevant questions. I am just one of the voices for my electorate; perhaps he thinks that they are also irrelevant.

What about the opinions of the community and the way in which people are engaged and asked about the future of their NHS services? In my experience, the public is often presented with glossy, blurb-type questionnaires, which conveniently state that such and such community hospital is the subject of a review because it is not providing services in an efficient way.

Often, the figures presented in such documents, which disingenuously invite the public to 'have its say', can be challenged. For example, in the case of Tywyn Memorial Hospital in Gwynedd, the provision of inefficient services was attributed to low bed-occupancy rates and the provision of care for patients who required social care rather than health interventions.

However, the figures taken were from a non-representative period of time when a hospital ward was shut and senior staff were moved into clinical nurse practitioner roles.

Figures and statistics can be manipulated to fit the required situation. The 2002 document, 'A Question of Balance', describes the most efficient bed occupancy as being 85 per cent.

The all-Wales average is 77 per cent and, for 2004-05, Tywyn Memorial Hospital achieved 77 per cent. In fact, in this hospital, over a 12-month period, an 85 per cent occupancy rate, equated to one empty bed.

The document inviting the public to have its say on the Gwynedd Local Health Board's review of Tywyn and Blaenau Ffestiniog memorial hospitals kept mentioning a snapshot review, but no-one knew what this meant.

What precise length of time was the snapshot referring to here: one day, one week, or one month? The document never reflected the fact that Tywyn hospital served six different post codes, or that the high attendance rates at the hospital over the summer months was due to the influx of tourists to the area, with increases of up to 30 per cent.

No mention was ever made of the fact that the nearest district general hospital is over 31 miles away in Aberystwyth, or that Tywyn is in a geographically isolated position in terms of other hospital provision and locations.

What concerned me more than anything was that, despite the fine words set out in 'Designed for Life', there was no mention in the questionnaire sent to the public of what the actual needs of the population were. There was nothing that said that services needed to be more responsive to identified population priorities, namely older people, rural communities and children.

In short, a whole-systems approach to meet the health and social needs of the population was missing. People felt that the consultation with the public was a token gesture and that the local health board had already reached its conclusion, namely that, due to increasing costs in service provision, beds at Tywyn needed to be axed.

Just before Christmas, the Pembrokeshire and Derwen NHS Trust wrote to me assuring me that 'The Case for Change' document for mid and west Wales was designed to appraise and inform the public of key issues, although it also said that it failed to see what the public could usefully add to this position paper. Who is the public after all? What would the public know about healthcare? It just uses the facilities. I am inclined to be sarcastic, of course.

For months, there has been a constant stream of reports about threatened cut-backs in hospital provision at Withybush General Hospital. Understandably, the people served by these facilities in Pembrokeshire are concerned by what the future holds for them.

As it stands, Withybush hospital is an invaluable social resource with an exceptionally high reputation and high standard of facilities. There are extensive services available, among them departments for coronary health, palliative care, stroke treatments and chemotherapy.

It is undeniable, therefore, that Withybush hospital is able to deliver progress and quality healthcare in the Pembrokeshire area. However, the downgrading of vital services has already occurred. In 2004, gynaecology services at Withybush were severely decreased, and, more recently, there have been cuts in the high dependency unit, which have already resulted in the departure of two members of staff.

Above all, what really concerns me about all these reviews and consultations—call them what you will—on the efficiency of hospital services, is that they are designed and centred around an apparent reliance upon the much-bandied-about 'Designed for Life' document.

This is clearly not an action plan and is, therefore, unable to stand as an effective strategy when dealing with a specific case such as Withybush. Furthermore, it is the hospital's unique location that makes it imperative that a full range of front-line services be kept open in the future.

The geography of the area means that in frequently experienced harsh weather conditions, main transport links are severed and ambulances are physically unable to reach the nearest services at Swansea or Carmarthen. Even when these roads are fully navigable, as you will know, Minister, the route is both inefficient and time-consuming.

Later on, Minister, when you respond to this debate, I know that you are going to tell me that 'Designed for Life' is underpinned by tens of millions of pounds in a capital programme and that capital investment is required to change the way in which a community hospital operates in order for it to deliver better services for the community. Therefore, if you do not mind, I have just said that bit for you now, so you will not have to bother with it.

However, I would like you to respond today, if you would be so obliging, to a quote by your colleague Val Lloyd. She said to you before Christmas: 'If the proposals in "Designed for Life"…are to be a success,'— and clearly you believe that they will be—'it is very important that there is public engagement and consultation that provides factual and correct information on the benefits to be gained'.

What does this mean to the people who we all represent? It means not sending out glossy ill-researched questionnaires that are scanty on obvious and factual detail.

It means not allowing local health boards carte blanche to pay private consultants exorbitant sums of money to chalk-up their observations into grids on blackboards in village halls, which are not big enough to write your name and telephone number on.

I am asking you today to respect people and to listen properly to their opinions, to record those opinions and to act upon them. This is not about the micro-management of the health service, but about telling health boards and NHS trusts to really start listening to the heartbeat of the people whom they serve, you serve, and whom we all serve."

"Yn gynharach yr wythnos hon, dros y ffin yn Lloegr, penderfynodd yr Ysgrifennydd Gwladol dros Iechyd, Patricia Hewitt, ei bod am sicrhau bod mwy o wasanaethau a chyfleusterau GIG yn cael eu darparu yn y gymuned.

Cyhoeddwyd Papur Gwyn yn nodi gweledigaeth o ofal a thriniaeth a ddarperir y tu allan i leoliad costus ysbytai acíwt traddodiadol. Dywedodd y Prif Weinidog y byddai hyn yn cynrychioli gwasanaeth sy'n ymateb i'r claf yn hytrach na bod yn rhaid i'r claf ymateb i'r gwasanaeth.

Bu i faniffesto etholiad Llafur fis Mai y llynedd addo datblygu, cenhedlaeth newydd o ysbytai cymuned GIG modern yn darparu gwasanaethau diagnostig, llawdriniaeth a chyfleusterau cleifion allanol, yn ogystal â defnydd o wasanaethau cymdeithasol yn agosach at gartrefi pobl.

Mae'r adborth a gaf gan fy etholaeth yn y canolbarth a'r gorllewin yn awgrymu mai dyna'n union beth mae pobl am ei weld yn cael ei ddatblygu.

Dywedodd Patricia Hewitt hefyd na ddylid colli cyfleusterau cymunedol mewn ymateb i 'bwysau cyllidebol tymor byr' sy'n ymwneud â dichonoldeb y cyfleuster cymunedol ei hun. Felly, lle y bydd Lloegr yn mentro, a fydd Cymru'n dilyn? A fydd ein Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol yn mynd ar daith ar y ffordd i Ddamascus ynghyd â Ms Hewitt?

Ar 26 Awst, Weinidog, bu ichi ymweld ag Ysbyty Trefyclo a dywedasoch: Mae Ysbytai Cymuned yn chwarae rôl hanfodol wrth roi cyfle i bobl leol ddefnyddio gwasanaethau o safon mor agos â phosibl i'w cartrefi. Mae hon yn thema ganolog yn 'Cynllun Oes', ein gweledigaeth 10 mlynedd ar gyfer creu gwasanaeth iechyd o'r radd flaenaf yng Nghymru.

Mae'r ddogfen 'Cynllun Oes' yn datgan bod yn rhaid ystyried pryderon a blaenoriaethau cymunedau lleol. Dywed y papur sefyllfa, 'Building local, safe and sustainable services for Mid and West Wales: The Case for Change', y bydd yn canolbwyntio ar 'ailgynllunio, nid adleoli', gan gynnig dulliau amgen o safon, ac ehangu opsiynau ar gyfer datblygu gwasanaethau newydd sy'n diwallu anghenion a disgwyliadau lleol.

Dros y mis diwethaf, lluniodd y tîm prosiect ar gyfer 'The Case for Change' gynigion manwl i ymgynghori yn eu cylch. Mae'n debyg y bu i gyfarfodydd ymgysylltu â staff a'r cyhoedd ddylanwadu ar y cynigion hyn.

Ddoe, gofynnais i'r Prif Weinidog pa fath o ddigwyddiadau ymgysylltu a gynhaliwyd a faint ohonynt a gynhaliwyd. Yn anffodus, dewisodd beidio ag ateb y cwestiwn hwn yn uniongyrchol; mewn gwirionedd, ni chynigiodd ddod o hyd i'r wybodaeth hyd yn oed.

Yr unig beth a ddywedodd oedd bod gen i ddawn am ofyn cwestiynau amherthnasol. Dim ond un o'r lleisiau ar ran fy etholaeth wyf i; efallai ei fod o'r farn eu bod hwy hefyd yn amherthnasol.

Beth am safbwyntiau'r gymuned a'r ffordd yr ymgysylltir â phobl ac y gofynnir iddynt am ddyfodol eu gwasanaethau GIG? Yn fy mhrofiad i, cyflwynir holiaduron sgleiniog, llawn broliant i'r cyhoedd yn aml, sy'n datgan yn gyfleus bod ysbyty cymuned yn destun adolygiad oherwydd nad yw'n darparu gwasanaethau mewn ffordd effeithlon.

Yn aml, gall y ffigurau a gyflwynir yn y cyfryw ddogfennau, sy'n gwahodd y cyhoedd yn anniffuant i 'leisio eu barn', gael eu herio. Er enghraifft, yn achos Ysbyty Coffa Tywyn yng Ngwynedd, priodolwyd y gwasanaethau aneffeithlon a ddarparwyd i gyfraddau llenwi gwelyau isel a darparu gofal i gleifion yr oedd angen gofal cymdeithasol arnynt yn hytrach nag ymyriadau iechyd.

Fodd bynnag, daeth y ffigurau o gyfnod anghynrychioliadol pan gafodd ward ysbyty ei chau ac uwch aelodau o staff eu symud i rolau ymarferwyr nyrsio clinigol.

Gellir camddefnyddio ffigurau ac ystadegau i gyfateb i'r sefyllfa ofynnol. Mae dogfen 2002, 'Cadw Cydbwysedd', yn nodi mai'r gyfradd llenwi gwelyau fwyaf effeithlon yw 85 y cant. Y cyfartaledd ledled Cymru yw 77 y cant ac ar gyfer 2004-05, cyflawnodd Ysbyty Coffa Tywyn 77 y cant.

Mewn gwirionedd, yn yr ysbyty hwn, dros gyfnod o 12 mis, roedd cyfradd llenwi gwelyau o 85 y cant yn cyfateb i un gwely gwag.

Yr oedd y ddogfen a oedd yn gwahodd y cyhoedd i leisio eu barn ar adolygiad Bwrdd Iechyd Lleol Gwynedd o ysbytai coffa Tywyn a Blaenau Ffestiniog yn crybwyll adolygiad ciplun dro ar ôl tro, ond ni wyddai neb beth oedd ystyr hyn. At ba gyfnod o amser yn union yr oedd y ciplun yn cyfeirio: diwrnod, wythnos neu fis?

Nid adlewyrchodd y ddogfen y ffaith bod Ysbyty Tywyn yn gwasanaethu chwe chod post gwahanol, neu fod y cyfraddau mynychu uchel yn yr ysbyty dros fisoedd yr haf o ganlyniad i'r mewnlif o dwristiaid i'r ardal, gyda chynnydd o hyd at 30 y cant.

Ni chrybwyllwyd y ffaith bod yr ysbyty cyffredinol dosbarth agosaf dros 31 milltir i ffwrdd yn Aberystwyth, neu fod Tywyn mewn sefyllfa ynysig yn ddaearyddol o ran darpariaeth ysbyty a lleoliadau eraill.

Yr hyn a oedd yn peri pryder i mi yn fwy nag unrhyw beth arall oedd, er gwaethaf y geiriau teg a roddwyd yn 'Cynllun Oes', na chrybwyllwyd yn yr holiadur a anfonwyd i'r cyhoedd beth oedd anghenion gwirioneddol y boblogaeth.

Nid oedd unrhyw beth a oedd yn dweud bod angen i wasanaethau fod yn fwy ymatebol i'r hyn a nodwyd fel blaenoriaethau'r boblogaeth, sef pobl hyn, cymunedau gwledig a phlant. Yn fyr, yr oedd ymagwedd system gyfan tuag at ddiwallu anghenion iechyd a chymdeithasol y boblogaeth ar goll. Symbol yn unig oedd yr ymgynghoriad â'r cyhoedd ym marn y bobl a chredwyd bod y bwrdd iechyd lleol eisoes wedi dod i'w gasgliad, sef, o ganlyniad i gostau cynyddol o ran darparu gwasanaethau, bod angen cwtogi ar nifer y gwelyau yn Nhywyn.

Ychydig cyn y Nadolig, ysgrifennodd Ymddiriedolaeth GIG Sir Benfro a Derwen ataf yn fy sicrhau bod y ddogfen 'The Case for Change' ar gyfer y canolbarth a'r gorllewin wedi'i chynllunio i arfarnu materion allweddol a hysbysu'r cyhoedd ohonynt, er iddi ddweud hefyd nad oedd yn gweld beth y gallai'r cyhoedd ei ychwanegu'n ddefnyddiol at y papur sefyllfa hwn. Pwy yw'r cyhoedd wedi'r cyfan?

Beth fyddai'r cyhoedd yn ei wybod am ofal iechyd? Dim ond defnyddio'r cyfleusterau a wnânt. Yr wyf yn tueddu i fod yn goeglyd, wrth gwrs.

Am fisoedd, cafwyd llif cyson o adroddiadau ynglyn â bygwth lleihau'r ddarpariaeth yn Ysbyty Cyffredinol Llwynhelyg. Yn ddealladwy, mae'r bobl sy'n defnyddio'r cyfleusterau hyn yn sir Benfro yn pryderu ynghylch eu dyfodol. Fel y mae, mae ysbyty Llwynhelyg yn adnodd cymdeithasol amhrisiadwy sydd ag enw eithriadol o dda a safon uchel o gyfleusterau.

Mae gwasanaethau helaeth ar gael, ac yn eu plith adrannau ar gyfer iechyd y galon, gofal lliniarol, triniaethau strôc a chemotherapi.

Ni ellir gwadu felly y gall ysbyty Llwynhelyg sicrhau cynnydd a gofal iechyd o safon yn ardal sir Benfro. Fodd bynnag, cwtogwyd eisoes ar wasanaethau hollbwysig. Yn 2004, cafodd gwasanaethau gynecoleg yn Llwynhelyg eu lleihau yn sylweddol, ac, yn fwy diweddar, cafwyd toriadau yn yr uned dibyniaeth fawr, sydd eisoes wedi arwain at ymadawiad dau aelod o staff.

Yn anad dim, yr hyn sydd wir yn peri pryder imi ynglyn â'r holl adolygiadau ac ymgynghoriadau hyn—galwch hwy'r hyn a fynnoch—o ran effeithlonrwydd gwasanaethau ysbyty, yw eu bod wedi'u cynllunio a'u canoli ar ddibyniaeth amlwg ar y ddogfen 'Cynllun Oes' y bu cryn sôn amdani. Mae'n amlwg nad cynllun gweithredu yw'r ddogfen hon, felly ni all fod yn strategaeth effeithiol wrth ymdrin ag achos penodol fel Llwynhelyg. At hynny, lleoliad unigryw'r ysbyty sy'n ei gwneud yn hanfodol bod ystod lawn o wasanaethau rheng flaen yn parhau i gael eu cynnig yn y dyfodol.

O ganlyniad i ddaearyddiaeth yr ardal, mae cyfnodau o dywydd garw a brofir yn aml yn effeithio ar y prif gysylltiadau trafnidiaeth ac ni all ambiwlansys gyrraedd y gwasanaethau agosaf yn Abertawe a Chaerfyrddin.

Hyd yn oed pan fydd yn bosibl teithio ar hyd y ffyrdd hyn yn ddidrafferth, fel y gwyddoch, Weinidog, mae'r daith yn aneffeithlon ac yn llafurus.

Yn nes ymlaen, Weinidog, pan ymatebwch i'r ddadl hon, gwn y byddwch yn dweud wrthyf bod 'Cynllun Oes' wedi'i hategu gan ddegau o filoedd o bunnoedd mewn rhaglen gyfalaf a bod angen buddsoddiad cyfalaf i newid y ffordd y mae ysbyty cymuned yn gweithredu er mwyn iddo ddarparu gwell gwasanaethau i'r gymuned. Felly, os nad oes gwahaniaeth gennych, yr wyf newydd ddweud hynny ar eich rhan, felly ni fydd angen ichi drafferthu.

Fodd bynnag, hoffwn ichi ymateb heddiw, os byddech mor garedig â gwneud hynny, i ddyfyniad gan eich cyd-Aelod Val Lloyd. Dywedodd hithau wrthych cyn y Nadolig: Er mwyn i'r cynigion yn "Cynllun Oes"….fod yn llwyddiant,'— ac yr ydych yn amlwg yn meddwl y byddant yn llwyddiant — mae'n bwysig iawn bod ymgysylltiad ac ymgynghoriad â'r cyhoedd sy'n rhoi gwybodaeth ffeithiol a chywir am y buddiannau i'w hennill.

Beth y mae hyn yn ei olygu i'r bobl yr ydym yn eu cynrychioli? Mae'n golygu peidio ag anfon holiaduron sgleiniog nas ymchwiliwyd yn ddigonol iddynt sy'n brin o ran manylion amlwg a ffeithiol.

Mae'n golygu peidio â rhoi rhyddid llwyr i fyrddau iechyd lleol dalu symiau enfawr o arian i ymgynghorwyr preifat fynegi eu sylwadau mewn gridiau ar fyrddau duon mewn neuaddau pentref, nad ydynt yn ddigon mawr i ysgrifennu eich enw a'ch rhif ffôn arnynt.

Yr wyf yn gofyn i chi heddiw i barchu pobl a gwrando'n iawn ar eu barn, cofnodi'r farn honno a gweithredu arni. Nid oes a wnelo hyn â microreoli'r gwasanaeth iechyd, ond dweud wrth fyrddau iechyd ac ymddiriedolaethau'r GIG i ddechrau gwrando o ddifrif ar y bobl maent hwy yn eu gwasanaethu, yr ydych chi yn eu gwasanaethu, ac yr ydym oll yn eu gwasanaethu."

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