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Melding: Labour confusion over Welsh health policy

Speech to the National Assembly for Wales.

"I congratulate the Minister on his first performance, and we wish him well in his presentation and delivery of the Government's vision. It is our job to criticise as appropriate, and I assure the Minister that that is what we will do.

I start with the Government's general approach. I stood as the official Conservative candidate in Ebbw Vale in the 1992 general election.

I had the distinction of losing by more votes than any other Conservative candidate in the whole country.

A total of 4,266 people voted for me, and I remember the number exactly because I never met any of them when I was canvassing. I canvassed with a wonderful Valleys Tory, Bill Price, our secretary, and if, after I had knocked on a door and someone came out and shouted, 'Buzz off, you dark and despicable Tory', or words to that effect, Bill would say, 'That was a possible Tory then.'

Whenever an official report by an independent organisation pans the Government's performance in any aspect of healthcare, or any other issue, that we are considering, the Ministers say that it is a triumph and that we cannot quote from the report without being aggressively selective, that the report confirms their present intentions, and that it says, 'Well done, continue with this marvellous job'.

Wanless was a 'great triumph' that 'endorsed' the Minister's approach, but, as Kirsty Williams said, all you need to know about Wanless is that we are delivering it through 22 local action plans, when he recommended a strategic approach.

However, this does the Government a great disservice, because at least if you take authoritative, independent reports seriously and try to ensure that you respond to them, you will have a better record as a Government when you next face the electorate.

Brian's delivery was fine but the content of his speech was not. He started by saying that there will be no organisational upheaval.

We are debating the future of quangos tomorrow, and when the First Minister first made that announcement, he said that he wanted to experiment with integrated healthcare organisations that would combine primary care and acute care in new super trusts and that they would only respond if some trusts came forward and said that they wanted to try this experiment.

The next day, we found that three were already in the pipeline in west Wales and that those in Swansea may follow suit. What is this if not the mother and father of organisational change? I will not even be deprecating and call it 'upheaval'.

That is this Government's problem: its use of language is chaotic. It seems to speak in a different fashion to those of us who live in a world of logic, where you say what you mean and are held accountable for what you have promised.

Given the whole waiting list fiasco, you would think that it was not the Labour Party that chose this as a performance indicator. It fought the whole 1997 campaign and then the 1999 campaign—the first campaign in this Assembly—saying that waiting lists were a good indicator of the health of a service, and that it should be judged on that.

Interestingly, the Audit Commission also says that waiting lists are a good general indicator of how the health service is performing, and I agree.

I once accused Brian, when he made an intervention in support of the previous Minister, of acting like Dr Pangloss. You may remember that Pangloss was the great satirical figure that Voltaire came up with in Candide. He always said that we live in the best of all possible worlds. That was not regarded as a terribly coherent world view following the Lisbon earthquake and so on, but Dr Pangloss would tell people not to worry. Given the emphasis on consolidation and stability, I fear for the future of the health service.

We want to put the patient experience first, but, to do that, we must consider the need for reform and change. We have consensus on wanting to improve the service, but we do not have consensus on the agenda that you will push, Minister, as the First Minister has encouraged you to take this approach of clear red water, namely developing the health service in a different way from Scotland and England.

We are seeing co-operation instead of any competitive element and the effective use of resources. I want co-operation to be the key word, as that is appropriate, but we must use resources effectively or we will never have the best possible health service.

That is what our people deserve, and there is consensus on that, but, at present, the only thing that the Conservatives agree with you on is that you have had six years to do something and that you have failed miserably."

"Llongyfarchaf y Gweinidog ar ei berfformiad cyntaf, a dymunaf yn dda iddo wrth iddo gyflwyno a gwireddu gweledigaeth y Llywodraeth. Ein gwaith ni yw beirniadu fel y bo'n briodol, ac yr wyf yn sicrhau'r Gweinidog mai hynny a wnawn.

Dechreuaf drwy sôn am ddull gweithredu cyffredinol y Llywodraeth. Sefais fel ymgeisydd swyddogol y Ceidwadwyr yng Nglynebwy yn yr etholiad cyffredinol yn 1992.

Cefais yr anrhydedd o golli o fwy o bleidleisiau na'r un ymgeisydd Ceidwadol arall drwy'r wlad. Pleidleisiodd 4,266 o bobl drosof i gyd, a chofiaf y nifer yn union gan na chyfarfûm â'r un ohonynt wrth ganfasio. Gwneuthum ganfasio gyda Thori rhyfeddol o'r Cymoedd, Bill Price, ein hysgrifennydd, ac os byddai rhywun yn dod allan, wedi imi guro ar ddrws, ac yn gweiddi, 'Ewch oddi yma, y Tori ffiaidd ac annymunol', neu eiriau i'r perwyl hwnnw, byddai Bill yn dweud, 'Gallai hwnnw fod yn Dori felly.'

Pryd bynnag y mae adroddiad swyddogol gan gorff annibynnol yn lladd ar berfformiad y Llywodraeth mewn unrhyw agwedd ar ofal iechyd, neu unrhyw fater arall yr ydym yn ei ystyried, dywed y Gweinidogion ei fod yn destun gorfoledd a'n bod bob amser yn ymosodol o ddethol wrth ddyfynnu o'r adroddiad, bod yr adroddiad yn cadarnhau eu bwriadau presennol, a'i fod yn dweud, "Da iawn chi, daliwch ati â'r gwaith da'.

Yr oedd adroddiad Wanless yn 'ganmoliaeth fawr' a oedd yn 'cefnogi' dull gweithredu'r Gweinidog, ond, fel y dywedodd Kirsty Williams, y cwbl y mae'n rhaid ichi ei wybod am argymhellion Wanless yw ein bod yn eu cyflawni drwy 22 o gynlluniau gweithredu lleol, ac yntau wedi argymell dull gweithredu strategol.

Fodd bynnag, mae hyn yn gwneud drwg mawr i'r Llywodraeth, oherwydd os byddwch o leiaf yn cymryd adroddiadau awdurdodol, annibynnol o ddifrif ac yn ceisio sicrhau eich bod yn ymateb iddynt, bydd gennych well record fel Llywodraeth pan wynebwch yr etholwyr y tro nesaf.

Yr oedd dull Brian o draddodi'n iawn ond nid felly cynnwys ei araith. Dechreuodd drwy ddweud na cheir unrhyw chwyldro trefniadol. Byddwn yn cael dadl ar ddyfodol cwangos yfory, a phan wnaeth y Prif Weinidog y cyhoeddiad hwnnw gyntaf, dywedodd ei fod yn dymuno arbrofi â chyrff gofal iechyd integredig a fyddai'n cyfuno gofal sylfaenol a gofal acíwt mewn archymddiriedolaethau newydd ac na fyddent ond yn ymateb pe deuai rhai ymddiriedolaethau atynt a dweud eu bod am roi cynnig ar yr arbrawf hwn.

Y diwrnod wedyn, cawsom wybod bod tair yn yr arfaeth eisoes yn y Gorllewin ac y gallai'r rhai yn Abertawe eu dilyn. Beth yw hynny ond newid trefniadol o'r radd flaenaf? Ni wnaf ei fychanu hyd yn oed a'i alw'n 'chwyldro'.

Dyna sydd o'i le ar y Llywodraeth hon: mae ei defnydd o iaith yn ddryslyd. Ymddengys ei bod yn siarad yn wahanol i'r rhai ohonom sy'n byw yn y byd rhesymegol, lle y dywedwch yr hyn a olygwch a chael eich dal yn atebol am yr hyn y gwnaethoch ei addo.

Yn wyneb holl lanastr y rhestrau aros, tybiech nad y Blaid Lafur a ddewisodd hyn yn ddangosydd perfformiad. Ymladdodd y cwbl o'r ymgyrch yn 1997 ac wedyn yr ymgyrch yn 1999—yr ymgyrch gyntaf yn y Cynulliad hwn—gan ddweud bod rhestrau aros yn arwydd da o gyflwr gwasanaeth, ac y dylid ei barnu ar sail hynny.

Yn ddigon diddorol, mae'r Comisiwn Archwilio yntau'n dweud bod rhestrau aros yn arwydd cyffredinol da o berfformiad y gwasanaeth iechyd, a chytunaf â hynny.

Cyhuddais Brian unwaith, pan ymyrodd i gefnogi'r cyn-Weinidog, o ymddwyn fel Dr Pangloss. Efallai y cofiwch mai Pangloss oedd y cymeriad dychanol gwych a grëodd Voltaire yn Candide.

Dywedai bob amser ein bod yn byw yn y byd gorau posibl. Nid ystyrid hynny'n olwg ofnadwy o resymegol ar y byd yn dilyn y ddaeargryn yn Lisbon ac yn y blaen, ond dywedai Dr Pangloss wrth bobl am beidio â phryderu. Yng ngolwg y pwyslais ar sadio a sefydlogrwydd, ofnaf dros ddyfodol y gwasanaeth iechyd.

Yr ydym am roi profiad y claf yn gyntaf, ond, er mwyn gwneud hynny, rhaid inni ystyried yr angen am ddiwygio a newid.

Mae gennym gonsensws o ran dymuno gwella'r gwasanaeth, ond nid oes gennym gonsensws ar yr agenda y byddwch yn ei hyrwyddo, Weinidog, gan fod y Prif Weinidog wedi'ch annog i ddilyn dull gweithredu'r dwr coch clir, sef datblygu'r gwasanaeth iechyd mewn modd gwahanol i'r Alban a Lloegr. Gwelwn gydweithredu yn hytrach nag unrhyw elfen o gystadlu a defnyddio adnoddau'n effeithiol.

Yr wyf am i gydweithredu fod yn air allweddol, gan fod hynny'n briodol, ond rhaid inni ddefnyddio adnoddau'n effeithiol neu ni chawn byth y gwasanaeth iechyd gorau posibl. Hwnnw y mae ein pobl yn ei haeddu, ac mae consensws ar hynny, ond, ar hyn o bryd, yr unig beth y mae'r Ceidwadwyr yn cytuno â chi arno yw eich bod wedi cael chwe blynedd i wneud rhywbeth a'ch bod wedi methu'n druenus."

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