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Melding: Welsh NHS leaves patients in despair

Speech to the National Assembly for Wales.

"I am delighted that the Liberal Democrats' policies have developed as well as our own, although I acknowledge that we did not protect elective care aggressively enough. We now know that that is how we need to protect the slots for in-patients that require treatment; that can be postponed, but should not be if the service is working well.

On waiting lists in general, one wants to cry out in despair like the rest of the NHS, according to the BMA, and ask, 'how long, O! Lord? How long?' It has been five years since this administration took its responsibilities within the devolved settlement and the waiting list position, in terms of the absolute numbers waiting, has continued remorselessly to worsen.

The First Minister in particular—although in fairness, I think that the Minister for Health and Social Services is more restrained on this point—often points to certain procedures and says that in target areas we are making good progress and the waiting lists are decreasing.

He talks about the 18-month wait guarantee. However, he has never accepted that unless you have a starting point when the clock starts to tick, no measure is effective.

We can currently keep people waiting indefinitely to see a consultant on an out-patient waiting list, but when they are eventually seen, you could say that the waiting list guarantee time starts then and meets your particular target. The total waiting time from seeing the GP and getting treatment could be, and often is, several years.

In fairness, I do not think that England's policies are ideal, but they have grasped this part of the problem and have guaranteed that their targets, which are much more ambitious even now than those in Wales, from 2007, which is too far away, will start measuring from the time people are referred by their GP.

It is the only fair way to do it. Otherwise, the targets are bogus and can be twisted, manipulated and used by politicians to justify a policy which is clearly failing. We have had 5 years to test our current procedures, and they have not worked well.

A few weeks ago, the First Minister delivered a speech at the NHS confederation and said that he rejected the emphasis in England on using various innovations to involve the private and independent sector.

He rejected the use of PFI to protect elective treatment fees in Wales, because it had a consequence on the equity of the services provided. It is a clear ideological position, which he was upfront about, but that is the policy. The trouble is that it does not work. It literally puts ideology before the treatment of patients.

We are now able to compare how it works in other jurisdictions. I see nothing wrong in asking the independent or private sector to come in and manage some schemes, which is what they did in England with diagnostic centres and the management of waiting lists.

They took patients in hand, from the time they were given the second offer, made travel arrangements to the alternative centre of treatment, and arranged for their relatives to be present if necessary, and booked accommodation for them.

A Welsh company made these arrangements, and set a pattern for the development, but the company was not given a cent of work in Wales. The Minister refused, as I understand, to implement the scheme.

The problem is that we are not being innovative. If we do not do something about elective care, we will start to lose the confidence of a lot of the middle classes in particular, who can afford to pay for treatment but at some point will then ask why they should not get tax relief from the NHS.

They may start to lose faith in a service which, at primary care and accident and emergency level, and, even after receiving treatment at an elective care level, is a good service.

That is the tragedy—the NHS is worth saving as a universal and comprehensive service. However, it will not be served by the kind of sterile ideology that is peddled by the First Minister. It is no wonder that he reduced the NHS confederation to such despair—I understand that Tony Calland will hopefully come out of hiding soon.

His statements have probably been rejected by the Minister. It demonstrates great frustration, and I ask the Minister and the First Minister to raise their vision, and set some really ambitious targets."

"Yr wyf wrth fy modd bod polisïau'r Democratiaid Rhyddfrydol wedi datblygu yn ogystal â'n rhai ni, er fy mod yn derbyn na wnaethom amddiffyn gofal dewisol yn ddigon cadarn. Gwyddom yn awr mai felly y dylem ddiogelu'r amseroedd ar gyfer cleifion mewnol y mae arnynt angen triniaeth; gellir ei gohirio, ond ni ddylid gwneud hynny os yw'r gwasanaeth yn rhedeg yn dda.

Ynghylch rhestrau aros yn gyffredinol, mae rhywun am godi llais mewn anobaith fel gweddill y GIG, yn ôl y Gymdeithas Feddygol Brydeinig, a gofyn, 'pa mor hir, O! Arglwydd? Pa mor hir?' Aeth pum mlynedd heibio ers i'r weinyddiaeth hon ymgymryd â'i chyfrifoldebau o dan yr ardrefniant datganoledig, ac mae sefyllfa'r rhestrau aros, o ran yr holl niferoedd sy'n disgwyl, yn dal i waethygu'n barhaus.

Mae'r Prif Weinidog yn benodol—ond er tegwch, credaf fod y Gweinidog dros Iechyd a Gwasanaethau Cymdeithasol yn fwy ymatalgar yn hyn o beth—yn cyfeirio'n aml at rai triniaethau ac yn dweud ein bod yn gwneud cynnydd da yn y meysydd a dargedwyd a bod y rhestrau aros yn lleihau.

Mae'n sôn am warant yr arhosiad o 18 mis. Er hynny, nid yw erioed wedi derbyn, os na cheir man cychwyn pan ddechrau'r cloc dician, na fydd unrhyw fesur yn effeithiol.

Ar hyn o bryd, gallwn beri i bobl aros am gyfnod amhenodol i weld ymgynghorydd ar restr aros i gleifion allanol, ond pan welir hwy o'r diwedd, gallech ddweud bod amser gwarant y rhestr aros yn dechrau bryd hynny ac yn cyrraedd y targed yr ydych wedi'i osod. Gallai'r amser aros ar ei hyd rhwng gweld y meddyg teulu a chael triniaeth fod yn sawl blwyddyn, ac felly y mae'n aml.

Er tegwch, ni chredaf fod y polisïau yn Lloegr yn ddelfrydol, ond maent wedi mynd i'r afael â'r agwedd hon ar y broblem ac wedi gwarantu y bydd eu targedau hwy, sy'n llawer mwy uchelgeisiol yn awr hyd yn oed na'r rhai yng Nghymru, o 2007 ymlaen, sy'n rhy bell i ffwrdd, yn cael eu mesur o'r adeg y caiff pobl eu hatgyfeirio gan eu meddyg teulu. Dyna'r unig ddull teg o wneud hyn.

Fel arall, mae'r targedau'n ffug a gall gwleidyddion eu hystumio, eu camdrafod a'u defnyddio i gyfiawnhau polisi sy'n amlwg yn methu. Cawsom bum mlynedd i roi prawf ar y gweithdrefnau sydd gennym yn awr, ac nid ydynt wedi gweithio'n dda.

Ychydig wythnosau'n ôl, gwnaeth y Prif Weinidog draddodi araith i gydffederasiwn y GIG a dywedodd ei fod yn gwrthod y pwyslais a geir yn Lloegr ar ddefnyddio gwahanol ddulliau newydd i gynnwys y sector preifat ac annibynnol. Gwrthododd y defnydd o fentrau cyllid preifat i ddiogelu ffioedd triniaeth ddewisol yng Nghymru, am fod hynny'n effeithio ar degwch yn y gwasanaethau a ddarperid. Mae'n safbwynt ideolegol pendant, yr oedd yn barod iawn i'w arddel, ond dyna'r polisi. Y drafferth yw nad ydyw'n gweithio. Mae'n rhoi ideoleg o flaen triniaeth i gleifion, yn llythrennol.

Yn awr, gallwn ei gymharu â'r modd y mae'n gweithio o dan awdurdodaethau eraill. Ni welaf ddim o'i le ar ofyn i'r sector preifat neu annibynnol ddod i mewn a rheoli rhai cynlluniau, sef yr hyn a wnaethant yn Lloegr yn achos canolfannau diagnostig a rheoli rhestrau aros.

Gwnaethant ofalu am gleifion, o'r adeg y cawsant yr ail gynnig, gwnaethant drefniadau teithio i gyrraedd y ganolfan driniaeth arall, a threfnu i'w perthnasau fod yn bresennol os oedd angen, gan archebu llety ar eu cyfer. Cwmni o Gymru a wnaeth y trefniadau hyn, a gosod patrwm ar gyfer y datblygiad, ond ni roddwyd yr un pwt o waith i'r cwmni yng Nghymru. Fel yr wyf yn deall, gwrthododd y Gweinidog roi'r cynllun ar waith.

Y broblem yw nad ydym yn arloesi. Os na wnawn rywbeth ynghylch gofal dewisol, byddwn yn dechrau colli ymddiriedaeth llawer o bobl ddosbarth canol yn enwedig, sef y rhai sy'n gallu fforddio talu am driniaeth ond a fydd rywbryd neu'i gilydd yn gofyn pam na chânt ryddhad o'r dreth gan y GIG. Gallent ddechrau colli ffydd mewn gwasanaeth sydd, ar lefel gofal sylfaenol a damweiniau ac achosion brys, a, hyd yn oed ar ôl cael triniaeth ar lefel gofal dewisol, yn wasanaeth da.

Dyna dristwch pethau—mae'r GIG yn werth ei achub fel gwasanaeth cyffredinol a chynhwysfawr. Fodd bynnag, ni fydd y math o ideoleg ddiffaith a gaiff ei phedlera gan y Prif Weinidog o unrhyw les iddo. Nid oes ryfedd ei fod wedi gyrru cydffederasiwn y GIG i'r fath anobaith—deallaf y daw Tony Calland o'i guddfan cyn hir, gobeithio.

Mae'n debyg bod ei ddatganiadau wedi'u gwrthod gan y Gweinidog. Mae'n amlygu rhwystredigaeth fawr, a gofynnaf i'r Gweinidog a'r Prif Weinidog ddyrchafu eu gweledigaeth, a gosod rhai targedau gwironeddol uchelgeisiol."

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