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Morgan: Welsh NHS tied up in Labour's red tape

Speech to the National Assembly for Wales.

"On behalf of the Welsh Conservative group, I welcome this debate. Despite my earlier question to Rhodri Glyn Thomas, we will support the amendment and the motion. We have been consistent on this matter. We were against the setting up of local health boards.

We expressed concerns at the time, when the Government wanted to move from having five health authorities to 22 health boards. This debate is important because the Government is keen to avoid debating whether or not local health boards are effective and efficient, but also because the Government, until now—unless we hear differently today—has refused to commission an independent review of how effective and efficient these 22 commissioning bodies have been. It is astonishing.

Any other organisation—I suspect it is true of all private sector organisations—embarking on this sort of structural change, would, at some point, review and evaluate the performance, effectiveness and efficiency of the new structures introduced. These bodies have been up and running for a couple of years. It is now necessary to have a review of how they are performing.

We have all heard anecdotal and concrete evidence from local health boards within our own areas, be they constituencies or electoral regions. There are local health boards in Wales today that are struggling with the job that they have been tasked to do.

We know that there have been budget constraints and debts and that local health boards are struggling to meet some of their targets. We know that having 22 commissioning bodies can lead to a lack of capacity.

It is difficult in many circumstances, with some of the changes that are being introduced, for LHBs to have the capacity and critical mass needed to deliver services.

You only have to consider the variety of contractual changes, whether in terms of pharmacy or general medical services, to see some of the difficulties that local health boards now face.

Having 22 LHBs has led to a fragmentation in the NHS. It is pitching LHB against LHB. Let us look back to when LHBs were set up. The Government wanted local government to be involved in the delivery and commissioning of NHS services.

This was not about making the health service more efficient; this was about having a health service commissioning platform that was coterminous with local government. In effect, what has happened is that LHBs have given local government a platform on which to get involved in commissioning NHS services.

However, I do not believe that having LHBs has led to better local government services, such as social services. Quite frankly, if there was to be influence, it should be influence in both directions.

When you consider how fragmented it is and the problems that have occurred, the bottom line is that the establishment of LHBs has provided nice cushy jobs for Labour's boys and girls."

"Ar ran grwp Ceidwadwyr Cymru, yr wyf yn croesawu'r ddadl hon. Er gwaethaf fy nghwestiwn cynharach i Rhodri Glyn Thomas, byddwn yn cefnogi'r gwelliant a'r cynnig. Yr ydym wedi bod yn gyson ar y mater hwn. Yr oeddem yn erbyn sefydlu byrddau iechyd lleol.

Mynegasom bryder ar y pryd, pan oedd y Llywodraeth eisiau newid o fod â phum awdurdod iechyd i fod â 22 bwrdd iechyd. Mae'r ddadl hon yn bwysig gan fod y Llywodraeth yn awyddus i osgoi trafod a yw byrddau iechyd lleol yn effeithiol ac yn effeithlon ai peidio, ond hefyd oherwydd bod y Llywodraeth, hyd yma—oni chlywn yn wahanol heddiw—wedi gwrthod comisiynu adolygiad annibynnol i weld pa mor effeithiol ac effeithlon y bu'r 22 corff comisiynu hwn.

Mae'n anhygoel. Byddai unrhyw gorff arall—tybiaf mai fel hyn y byddai ym mhob corff yn y sector preifat—o ddechrau ar newid strwythurol o'r math hwn, ar ryw adeg, yn adolygu ac yn arfarnu perfformiad, effeithiolrwydd ac effeithlonrwydd y strwythurau newydd a gyflwynwyd. Bu'r cyrff hyn ar waith bellach am gwpl o flynyddoedd. Bellach mae'n bryd adolygu eu perfformiad.

Clywsom oll dystiolaeth anecdotaidd a diamwys gan y byrddau iechyd lleol yn ein hardaloedd ein hunain, boed y rheiny'n etholaethau neu'n rhanbarthau etholiadol. Mae byrddau iechyd lleol yng Nghymru heddiw sy'n ymlafnio gyda'r gwaith y gofynnwyd iddynt ei wneud. Gwyddom y bu cyfyngu ar gyllidebau a dyledion a bod byrddau iechyd lleol yn ymlafnio i gyflawni rhai o'u targedau.

Gwyddom y gall y ffaith bod 22 o gyrff comisiynu arwain at ddiffyg capasiti. Mae'n anodd dan lawer o amgylchiadau, o ystyried rhai o'r newidiadau sy'n cael eu cyflwyno, i Fyrddau Iechyd Lleol feddu ar y capasiti a'r màs critigol angenrheidiol i gyflenwi gwasanaethau.

Nid oes ond raid i chi ystyried yr amryfal newidiadau i gontractau, boed o ran fferyllfeydd neu wasanaethau meddygol cyffredinol, i weld rhai o'r anawsterau y mae byrddau iechyd lleol bellach yn eu hwynebu.

Oherwydd bod 22 o fyrddau iechyd lleol mae'r Gwasanaeth Iechyd Gwladol wedi ei ddarnio. Mae'n gosod bwrdd iechyd lleol yn erbyn bwrdd iechyd lleol. Beth am inni edrych yn ôl i'r adeg y sefydlwyd y Byrddau Iechyd Lleol.

Yr oedd y Llywodraeth am i lywodraeth leol chwarae rhan yn y gwaith o gyflenwi a chomisiynu gwasanaethau'r Gwasanaeth Iechyd Gwladol. Nid mater o wneud y gwasanaeth iechyd yn fwy effeithlon oedd hyn; yr oedd a wnelo hyn â sicrhau llwyfan gomisiynu i'r gwasanaeth iechyd a oedd yn cydffinio â llywodraeth leol.

Mewn ffordd, yr hyn sydd wedi digwydd yw bod y byrddau iechyd lleol wedi rhoi llwyfan i lywodraeth leol fel y gall ymwneud â chomisiynu gwasanaethau'r Gwasanaeth Iechyd Gwladol.

Fodd bynnag, ni chredaf fod bodolaeth y Byrddau Iechyd Lleol wedi arwain at wasanaethau gwell mewn llywodraeth leol, megis y gwasanaethau cymdeithasol. Yn blwmp ac yn blaen, os oes dylanwad i fod, dylai'r dylanwad hwnnw ddod o'r ddau gyfeiriad. Os ystyriwch ba mor ddarniog ydyw a'r problemau sydd wedi codi, y pwynt sylfaenol yw bod sefydlu'r Byrddau Iechyd Lleol wedi cynnig swyddi cyfforddus braf i hogiau a genod Llafur."

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