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Morgan: Walk-in centres will ease pressure on Welsh NHS

Speech to the National Assembly for Wales.

"This debate, on the principle of nurse-led walk-in centres, is aimed at trying to drum some sense into the Assembly Government's future healthcare strategy for Wales, by bringing to the fore an issue that, if implemented correctly, could almost certainly help to ease the capacity crisis of long accident and emergency waits, overstretched general practitioner services and inappropriate hospital referrals.

When walk-in centres were established in England, by the UK Labour Government, the aims were simple.

There were three aims that drove their creation: first, improving accessibility; secondly, making the NHS more responsive to modern lifestyles; and, thirdly, increasing the skill mix, particularly maximising the skill mix of nurses.

We, on the Conservative benches, along with other members of the opposition parties, are trying to help Wales to benefit from an initiative that has been pioneered elsewhere, but, if implemented, could have a profoundly positive impact on the delivery of healthcare on this side of the border.

As a Welsh Conservative, I do not mind recognising the achievements of a Government on the other side of the border. I do not see a problem with us doing that, and I would be keen to hear whether the Labour Party on this side of the border agrees that this is an initiative that we ought to be pursuing.

Nurse-led walk-in centres, whether they are co-located with accident and emergency departments or are out on their own, have had a positive impact in England.

The set-up of walk-in centres has been exceptionally varied. I believe that we ought to be examining how these centres have been established, looking at Wales from a strategic point of view to see where these centres would have a positive impact.

In England, the NHS has been able to keep pace with the ever-increasing demands placed upon it, while our national health service has been allowed to fall further and further behind.

This, Minister, is the key point. The UK Government, your colleagues in London, took a strategic view of developing emergency care services, instead of merely allowing the English primary care trusts to do whatever they wanted in their area.

A strategic decision was taken about the delivery of these walk-in centres. In your response, you will no doubt tell me that I should have waited for you to publish your developing emergency care services strategy/plan.

However, quite frankly, Minister, you lot have had six years to sort this out, while your colleagues in London have been pursuing ideas that have had a positive impact for patients the length and breadth of England.

We know that walk-in centres allow the treatment of minor ailments and complaints with a tremendous number of important benefits, not least the fact that they allow a patient to be treated at one third of the cost to the health service of attending an accident and emergency department.

I have visited a walk-in centre—unlike members of the Government, members of the opposition have been keen to visit walk-in centres. I went to such a centre in Bristol city centre this year and, between June 2004 and June 2005, more than 1,000 people were treated for minor injuries.

Those people might otherwise have presented themselves to an accident and emergency department, if they could not be seen by somebody else.

In addition, a third of those people who attended this walk-in centre was men aged between 16 and 40—a crucial category, because we all know that men are particularly bad when told to see a doctor about something as they simply refuse.

I know that I am one of those individuals who dislikes going to a GP practice. Many of them went to the walk-in centres because they were convenient, close to their place of work, and they felt that they were not tied in the same way as other health service centres. They felt more comfortable visiting walk-in centres.

The national evaluation of walk-in centres identified that 74 per cent of consultations were entirely managed in the walk-in centre. That is crucial, because it means that there was no need to refer a patient to a GP or hospital.

The same report concluded that 45 per cent of those patients would have visited their GP if they had not had access to the walk-in centres, and that 26 per cent would have gone directly to the accident and emergency department.

These findings were subsequently endorsed by the Healthcare Commission report, 'Accident and Emergency'.

By August 2001, the first 42 walk-in centres were receiving around 110,000 patients a month, and, as the report suggests, that pressure has been taken off local NHS services that would otherwise have found it difficult to cope.

I would be the first to underline the importance of not losing any provision in GP services or any other front-line health services as a result of the implementation of these walk-in centres, but they have been seen by the UK Government as being there to complement other points of access to NHS services.

The centres provide a fast and convenient level of access to local NHS services for patients while reducing the burden on GPs and accident and emergency departments.

The Labour Party in Wales has made no secret of its feelings on walk-in centres. The Minister for Health and Social Services has never visited a walk-in centre in England.

How on earth can the Assembly Government take such a lacklustre view of an initiative that could have such a positive impact?

It is only common sense that, as an Assembly Government, perhaps demonstrating a level of political maturity, you would wish to see what is happening elsewhere—not just in the United Kingdom, but further afield, and certainly in Europe.

You should be considering what is happening in other parts of the world as a matter of course.

I understand the idea that clear red water is important. After all, you do not want to be seen as merely New Labour, like your colleagues in London, but that is a poor excuse when you consider the initiative of walk-in centres over the border and the benefits that they could bring to Wales. Rhodri Morgan was clear about clear red water.

I am grateful to you for your remarks. It is easy for us as politicians to fall into our usual disagreements, but I think that, where something is happening elsewhere that is having a positive impact, improving the points of access to healthcare services, and is making it easier for people to access front-line care, it is worth simply considering it in Wales.

The Welsh public would have a greater degree of respect for this institution if they saw us taking a mature attitude on these kinds of issues.

We have a golden opportunity in this debate to give the Government of Wales a steer in terms of the direction that the strategy for developing emergency care services should take.

I hope that the Government will recognise our concern and interest in this matter, and come back with a plan for how the centres could be established in Wales.

They are not a panacea to cure all the ills that we face within the NHS, but at certain pressure points, mostly in urban areas, walk-in centres have a very strong and beneficial role to play."

"Amcan y ddadl hon ynghylch yr egwyddor o ganolfannau galw-mewn dan ofal nyrsys yw ceisio dod ag ychydig o synnwyr i strategaeth Llywodraeth y Cynulliad ar gyfer gofal iechyd yn y dyfodol yng Nghymru, drwy dynnu sylw at rywbeth a fyddai'n sicr bron, o'i weithredu'n iawn, o helpu i liniaru'r argyfwng o ran capasiti a welir yn yr arosiadau hir mewn unedau damweiniau ac achosion brys, y gorymestyn ar wasanaethau ymarferwyr cyffredinol ac yn yr atgyfeiriadau amhriodol i ysbytai.

Pan sefydlwyd canolfannau galw-mewn yn Lloegr, gan Lywodraeth Lafur y DU, yr oedd y nodau'n syml. Yr oedd tri nod wedi rhoi hwb i'w creu: yn gyntaf, gwella hygyrchedd; yn ail, peri i'r GIG fod yn fwy ymatebol i ffyrdd o fyw modern; ac, yn drydydd, cael mwy o gymysgedd o sgiliau, a chael y cymysgedd mwyaf posibl o sgiliau ymysg nyrsys yn enwedig.

Yr ydym ni, ar feinciau'r Ceidwadwyr, ynghyd ag Aelodau eraill o'r gwrthbleidiau, yn ceisio helpu Cymru i elwa ar gynllun sydd wedi'i arloesi mewn man arall, ond a allai gael effaith lesol iawn, o'i roi ar waith, ar y dull o ddarparu gofal iechyd ar yr ochr hon i'r ffin.

Fel un o Geidwadwyr Cymru, yr wyf yn ddigon parod i gydnabod cyflawniadau Llywodraeth sydd ar yr ochr draw i'r ffin. Ni welaf fod dim o'i le ar hynny, a byddaf yn awyddus i glywed a yw'r Blaid Lafur ar yr ochr hon i'r ffin yn cytuno y dylem ddilyn y cynllun hwn.

Mae canolfannau galw-mewn dan ofal nyrsys, pa un a ydynt yn yr un man ag adrannau damweiniau ac achosion brys neu ar wahân, wedi cael effaith dda yn Lloegr. Mae'r dull o drefnu canolfannau galw-mewn wedi bod yn amrywiol dros ben.

Credaf y dylem ystyried y modd y cafodd y canolfannau hynny eu sefydlu, gan edrych ar Gymru o safbwynt strategol er mwyn gweld ym mhle y byddai'r canolfannau hyn yn llesol.

Yn Lloegr, mae'r GIG wedi gallu cadw'n wastad â'r galwadau cynyddol sydd arno, tra gadawyd i'n gwasanaeth iechyd gwladol ni golli mwy a mwy o dir.

Dyma'r pwynt allweddol, Weinidog. Cymerodd Llywodraeth y DU, eich cymheiriaid yn Llundain, olwg strategol ar y dull o ddatblygu gwasanaethau gofal brys, yn lle dim ond gadael i'r ymddiriedolaethau gofal sylfaenol yn Lloegr wneud yr hyn a fynnent yn eu hardal.

Gwnaed penderfyniad strategol ynghylch darparu'r canolfannau galw-mewn sydd dan sylw. Yn eich ymateb, byddwch yn siwr o ddweud wrthyf y dylwn fod wedi aros ichi gael cyhoeddi'r strategaeth/cynllun gwasanaethau gofal brys sydd ar y gweill gennych.

Fodd bynnag, a siarad yn blwmp ac yn blaen, mae'ch criw chi wedi cael chwe blynedd i ddatrys hyn, tra bu'ch cymheiriaid yn Llundain yn dilyn syniadau a fu o les i gleifion ledled Lloegr.

Gwyddom fod canolfannau galw-mewn yn cynnig modd i drin mân anhwylderau ac afiechydon gan ddod â nifer mawr o fanteision pwysig ac, yn anad dim arall, y gallu i drin y claf am un rhan o dair o'r gost i'r gwasanaeth iechyd o ymbresenoli mewn adran ddamweiniau ac achosion brys.

Yr wyf wedi ymweld â chanolfan galw-mewn—yn wahanol i aelodau'r Llywodraeth, mae Aelodau'r gwrthbleidiau wedi bod yn awyddus i ymweld â chanolfannau galw-mewn.

Euthum i ganolfan o'r fath yng nghanol dinas Bryste eleni a, rhwng Mehefin 2004 a Mehefin 2005, cafodd mwy na 1,000 o bobl eu trin am fân anafiadau. Fel arall, mae'n bosibl y byddai'r bobl hynny wedi ymgyflwyno mewn adran ddamweiniau ac achosion brys, os na allai rhywun arall eu gweld.

Yn ogystal â hynny, yr oedd traean o'r bobl hynny a aeth i'r ganolfan galw-mewn honno'n ddynion rhwng 16 a 40 oed—categori hollbwysig, oherwydd yr ydym oll yn gwybod bod dynion yn arbennig o esgeulus o ran mynd i weld meddyg ynghylch rhywbeth pan ddywedir wrthynt am wneud hynny gan eu bod yn gwrthod yn lân.

Gwn fy mod yn un o'r bobl hynny nad yw'n hoffi mynd i bractis meddyg teulu. Aeth llawer ohonynt i'r canolfannau galw-mewn am eu bod yn gyfleus, yn agos i'w gweithle, a theimlent nad oeddent yn cael eu rhwymo yn yr un modd ag mewn canolfannau eraill yn y gwasanaeth iechyd. Teimlent yn fwy cyfforddus wrth ymweld â chanolfannau galw-mewn.

Yn y gwerthusiad cenedlaethol o ganolfannau galw-mewn, canfuwyd bod 74 y cant o'r ymgyngoriadau wedi'u rheoli'n gyfan gwbl yn y ganolfan galw-mewn. Mae hynny'n hollbwysig, gan ei fod yn golygu nad oedd angen atgyfeirio claf at feddyg teulu neu i ysbyty.

Daeth yr un adroddiad i'r casgliad y byddai 45 y cant o'r cleifion hynny wedi mynd at eu meddyg teulu pe na fuasai modd iddynt fynd i'r canolfannau galw-mewn, ac y byddai 26 y cant wedi mynd yn syth i'r adran ddamweiniau ac achosion brys.

Cadarnhawyd y darganfyddiadau hyn wedyn gan adroddiad y Comisiwn Gofal Iechyd, 'Accident and Emergency'. Erbyn Awst 2001, yr oedd y 42 cyntaf o'r canolfannau galw-mewn yn derbyn tua 110,000 o gleifion y mis, ac, fel y mae'r adroddiad yn awgrymu, tynnwyd y pwysau hynny oddi ar wasanaethau GIG lleol a'i cawsai'n anodd ymdopi fel arall.

Myfi fyddai'r cyntaf i dynnu sylw at y pwysigrwydd o beidio â cholli unrhyw ddarpariaeth mewn gwasanaethau meddygon teulu neu unrhyw wasanaethau iechyd rheng flaen eraill o ganlyniad i gychwyn canolfannau galw-mewn o'r fath, ond eu pwrpas yng ngolwg Llywodraeth y DU yw cydategu pwyntiau mynediad eraill i wasanaethau'r GIG.

Mae'r canolfannau'n cynnig mynediad cyflym a chyfleus i wasanaethau GIG lleol i gleifion gan ysgafnhau'r baich ar feddygon teulu ac adrannau damweiniau ac achosion brys.

Nid yw'r Blaid Lafur yng Nghymru wedi celu dim o'i theimladau ynghylch canolfannau galw-mewn. Nid yw'r Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol erioed wedi ymweld â chanolfan galw-mewn yn Lloegr.

Sut ar y ddaear y gall Llywodraeth y Cynulliad edrych mor ddifater ar gynllun a allai gael effaith mor llesol? Nid yw ond yn fater o synnwyr cyffredin y byddech chi, fel Llywodraeth y Cynulliad, gan amlygu rhywfaint o aeddfedrwydd gwleidyddol efallai, yn dymuno gweld yr hyn sydd yn digwydd mewn mannau eraill—nid yn y Deyrnas Unedig yn unig, ond ymhellach draw, ac yn sicr yn Ewrop.

Dylech ystyried yr hyn sydd yn digwydd mewn rhannau eraill o'r byd fel mater o arfer.

Deallaf y syniad ei bod yn bwysig cael dwr coch clir. Wedi'r cwbl, nid ydych am gael eich ystyried yn ddim ond Llafur Newydd, fel eich cymheiriaid yn Llundain, ond esgus gwael yw hwnnw o ystyried cynllun y canolfannau galw-mewn yr ochr draw i'r ffin a'r manteision y gallent eu dwyn i Gymru.

Yr oedd Rhodri Morgan yn glir ynghylch dwr coch clir.

Yr wyf yn ddiolchgar ichi am eich sylwadau. Mae'n hawdd i ni fel gwleidyddion fynd i rigol wrth anghytuno â'n gilydd, ond credaf, os yw rhywbeth mewn man arall yn cael effaith lesol, gan wella'r pwyntiau mynediad i wasanaethau gofal iechyd, a'i gwneud yn haws i bobl gael gofal yn y rheng flaen, ei bod yn werth ei ystyried yng Nghymru.

Byddai mwy o barch gan bobl Cymru at y sefydliad hwn pe baent yn ein gweld yn cymryd agwedd aeddfed tuag at faterion fel y rhain.

Mae gennym gyfle euraid yn y ddadl hon i roi i Lywodraeth Cymru lyw i ddewis pa gyfeiriad y dylai'r strategaeth i ddatblygu gwasanaethau gofal argyfwng ei gymryd.

Gobeithiaf y bydd y Llywodraeth yn cydnabod ein pryder a'n diddordeb yn y mater hwn, a dychwelyd gyda chynllun ar gyfer sut y gellid sefydlu'r canolfannau yng Nghymru.

Nid moddion i wella'r holl anhwylderau a welwn o fewn y gwasanaeth iechyd gwladol mohonynt, ond mewn mannau penodol sydd dan bwysau, mewn ardaloedd trefol yn bennaf, mae gan ganolfannau galw-mewn ran bendant iawn a llesol i'w chwarae."

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