Contributions

Diolch, Lywydd. Dwi'n croesawu'r cyfle i ymateb i'r ddadl hon, ac i gydnabod y teimladau cryfion ymhlith pobl yng Ngheredigion Penfro am ddyfodol gwasanaethau gofal iechyd a rôl Ysbyty Llwynhelyg yn y dyfodol. A gaf i ddechrau gyda phwynt yr ydw i'n credu y gall pob Aelod yn y Siambr hon gytuno arno? Mae gwasanaethau NHS lleol yn bwysig. Maen nhw'n bwysig oherwydd nad sefydliadau haniaethol yw gwasanaethau iechyd. Pan fydd pobl yn siarad yn angerddol am wasanaethau lleol, mae hynny oherwydd eu bod nhw'n deall y rôl hanfodol sydd gan y gwasanaethau hynny yn eu bywydau. Yn y Siambr hon ym mis Mehefin, mi ddywedais i ein bod ni, wrth sôn am newid yn yr NHS, yn sôn am rywbeth sy'n bersonol iawn i bob unigolyn yng Nghymru. Rŷn ni'n sôn am wasanaethau y mae pobl yn dibynnu arnyn nhw pan maen nhw'n fwyaf bregus. Yn y pen draw, rŷn ni'n siarad am y gofal y byddem ni i gyd am ei gael i'n teuluoedd ein hunain: gofal diogel o safon uchel sy'n cyflawni'r canlyniadau gorau posibl. Dwi'n credu mai dyna'r man cychwyn cywir o hyd ar gyfer y ddadl hon. Er y bydd safbwyntiau gwahanol ynglyn â sut y dylai gwasanaethau gael eu trefnu, mae yna un egwyddor sy'n ein huno i gyd, sef ein bod ni am i'r bobl rŷn ni'n eu cynrychioli gael y gofal gorau posibl a'r canlyniadau gorau posibl. Dyna sydd bwysicaf. Dwi'n deall y pryderon sydd wedi codi ynglŷn â mynediad at ofal iechyd mewn cymunedau gwledig ac arfordirol. Mae'r pryderon hynny'n rhai dilys. Mae pobl sy'n byw yng Ngheredigion Penfro ac, yn wir, ar draws Cymru, yn profi gwasanaethau iechyd mewn ffordd wahanol i bobl sy'n byw mewn ardaloedd mwy trefol. Mae daearyddiaeth yn bwysig, mae pellter yn bwysig, mae trafnidiaeth yn bwysig. Fel Aelod o'r Senedd sy'n cynrychioli etholaeth wledig yn bennaf, sydd hefyd yn cynnwys nifer o gymunedau ar ein harfordir gorllewinol, ac fel rhywun sydd â phrofiad personol o gael mynediad at wasanaethau iechyd mewn ardaloedd o'r fath, dwi'n gwbl ymwybodol o'r heriau hyn. Dyna pam mae gwella mynediad at ofal iechyd mewn cymunedau gwledig ac arfordirol yn flaenoriaeth allweddol i'r Llywodraeth hon. Rŷn ni'n gwybod bod yr ardaloedd hyn yn gweld effaith anghymesur yn rhy aml. Dyna pam hefyd rŷn ni'n cryfhau'r cydweithrediad rhwng y portffolios iechyd a thrafnidiaeth, oherwydd mae'n rhaid i ni sicrhau nad yw pobl mewn cymunedau gwledig ac arfordirol o dan anfantais o ran cael mynediad at wasanaethau gofal iechyd. Er hynny, Lywydd, dim ond un rhan o'r hafaliad yw hygyrchedd. Mae pobl hefyd yn haeddu gwasanaethau sy'n ddiogel, yn wydn ac yn gynaliadwy. Pan fydd unrhyw un ohonom ni, neu aelod o'n teulu, angen gofal brys neu arbenigol, rŷn ni eisiau gwybod bod y gwasanaeth yn cael ei ddarparu yn yr amgylchedd cywir, ei fod wedi'i staffio'n briodol, yn cael ei gefnogi gan yr arbenigedd cywir ac yn gallu sicrhau safonau gofal uchel yn gyson. Er mwyn cyflawni hynny, mae angen inni weithiau gael sgyrsiau gonest am y pwysau sy'n wynebu gwasanaethau gofal iechyd heddiw, gan gynnwys prinder gweithlu, materion yn ymwneud ag ystadau, galw cynyddol a safonau clinigol sy'n newid. Ac o ystyried y tueddiadau demograffig, mae angen sgyrsiau hefyd ynglŷn â sefyll yn ein hunfan a chadw pethau fel y maen nhw, doed a ddelo. Dyw'r heriau hynny ddim yn unigryw i Geredigion Penfro. Maen nhw'n heriau sy'n codi ledled Cymru ac ar draws y Deyrnas Gyfunol. Dyna pam mae ein hagenda yn rhoi pwyslais mor gryf ar atal ac ar ofal yn agosach at adref. Mae'r pwynt a wnaed ar drafnidiaeth, er enghraifft, yn deg. Dyna pam rwy'n trafod y pethau yma'n gyson gyda'r Aelod Cabinet dros drafnidiaeth, ac mae'n rhan o'r cynllun 'franchise-o' bysys sydd yn cael ei rolio allan. Ac mae'r Gweinidog yma yn gwrando heno.

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Thank you, Llywydd. I welcome the opportunity to respond to this debate, and to acknowledge the strong feelings held by people in Ceredigion Penfro about the future of healthcare services and the role of Withybush Hospital in the future. I wish to start with a point that I believe all Members in this Chamber can agree upon. Local NHS services are important. They are important because health services are not abstract organisations. When people speak passionately about local services, it is because they understand the vital role that those services play in their lives. In this Chamber in June, I said that when we talk about change in the NHS, we are talking about something that is very personal to every individual in Wales. We are talking about services that people rely upon when they are most vulnerable. Ultimately, we are talking about the care that we would all like to have for our own families: safe, high-quality care that achieves the best possible outcomes. I believe that that is the correct starting point for this debate. Although there will be different views about how services should be organised, there is one principle that unites us all, namely that we want the people whom we represent to have the best possible care and the best possible outcomes. That is what matters most. I understand the concerns that have been raised about access to healthcare in rural and coastal communities. Those concerns are valid. People who live in Ceredigion Penfro and, indeed, across Wales, experience health services in a different way to people who live in more urban areas. Geography is important, distance is important, transport is important. As a Member of the Senedd who represents a predominantly rural constituency, which also includes a number of communities on our west coast, and as someone who has personal experience of accessing health service in those areas, I am fully aware of these challenges. That is why improving access to healthcare in rural and coastal communities is a key priority for this Government. We know that these areas experience disproportionate impacts all too often. That is also why we are strengthening collaboration between the health and transport portfolios, because we have to ensure that people in rural and coastal communities are not at a disadvantage when it comes to accessing healthcare services. Despite this, Llywydd, accessibility is only part of the equation. People also deserve services that are safe, resilient and sustainable. When any of us, or a member of our family, need urgent or specialist care, we want to know that this service is provided in the right environment, that it is staffed appropriately, is supported by the right expertise and can ensure high and consistent standards of care. To achieve that, we sometimes need to have honest conversations about the pressures facing healthcare services today, including workforce shortages, issues relating to the estate, increasing demand and changing clinical standards. And in light of demographic trends, we also need to have conversations about standing still and keeping things as they are, come what may. Those challenges are not unique to Ceredigion Penfro. They are challenges that arise throughout Wales and across the United Kingdom. That is why our agenda places such a strong emphasis on prevention and on care closer to home. The point that was made on transport, for example, is fair. That's why I discuss these things consistently with the Cabinet Minister for transport, and it's part of the bus franchising scheme that's being rolled out. And the Minister is here listening tonight.

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Llywydd, I said in this Chamber recently that the true measure of success for this Government is not how many hospital beds we fill, but how many people we help to live healthier lives without needing one. That means investing in prevention, early intervention and stronger community services. Our ambition is clear: better access to care closer to home, earlier support when people need it and improved health outcomes for the long term. I've made it clear to health boards that this is not optional. I expect to see a genuine shift in resources towards community based care, backed by credible plans that demonstrate how that change will be delivered and sustained. This was at the heart of the primary care summit we convened within the first 100 days of this new Government, and we will shortly be assessing the plans that the health boards have been developing in response to the challenge we've set them. The real question is whether patients receive the right care, in the right place, at the right time, from staff with the skills and resources required to deliver it safely and effectively. That must remain our guiding principle. The honest and inescapable conclusion is that the current configuration of services is not where it should be in order to deliver the improved outcomes we all want to see. I've been clear from the outset that the contours of our health and care landscape invariably reflect the needs of yesterday rather than those of today and tomorrow, and that is precisely why we can't shy away from difficult but necessary choices on service redesign if we want to build an NHS that is fit for the future. The NHS is at its strongest when it evolves to meet the needs of the community it serves. That's why we must always listen to those who know our health service best: our nurses, doctors, allied health professionals, wider NHS staff and the communities who use these services every day. As I've said before, when clinical experts tell us how we can improve outcomes, make services safer and more resilient and deliver better care for patients, it's our duty to listen. Ever since I was assigned the health portfolio, I've been of the view that health policy design has to be clinically led first and foremost, and that is precisely the ethos I have now sought to embed as a Government Minister. However, much of today's debate in reality is about the decisions taken by Hywel Dda University Health Board through its clinical services plan, and I want to address directly the concerns of communities in Ceredigion Penfro. I recognise the strength of feeling these decisions have generated and I understand why many people are protective of Withybush Hospital. People want reassurance that services will remain accessible. They want confidence that decisions are being taken in the interests of patients, and I recognise that not everyone will agree with every decision that has been taken. That's entirely understandable. But it is important to recognise that the health board followed a detailed process informed by clinical evidence and feedback from thousands of patients, staff, stakeholders and members of the public.  Some have sought to frame this issue as a choice between protecting local services and pursuing change. While I completely understand why they may have come to this conclusion, I don't accept that characterisation. The purpose of service change, where it is proposed, is not to weaken the NHS. Far from it. It is to ensure that services remain viable, safe, sustainable and ultimately stronger for future generations. We know there are ongoing workforce challenges across a range of specialist services. We know recruitment remains difficult in some disciplines. We know that national clinical reviews have repeatedly highlighted the risk associated with small services delivering low volumes of highly specialised activity. We know that demand continues to increase and outpace capacity, and we know that healthcare is changing, with more diagnostics, treatments and follow-up care increasingly delivered closer to home. Those realities can't simply be ignored because they're politically inconvenient. The story isn't simply one of services being removed. The clinical services plan also includes confirmation of the important role Withybush will continue to play through significant investment and enhancement of services. The hospital will see expanded orthopaedic services, helping more people access treatment more quickly. It will also become a key site for planned diagnostics and weekday interventional radiology, strengthening its role in diagnosis and supporting cancer care. And only recently, as was mentioned earlier, the health board announced a £750,000 investment in a new Puffin paediatric facility to improve out-patient services for children and young people. The health board itself has repeatedly stated that agreed changes will not happen overnight and that implementation will be phased over time to minimise risks and ensure services remain safe. The board has also outlined its intention to strengthen community-based services as part of its wider model of care, consistent with Welsh Government policy and ministerial expectations.

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Lywydd, mae hi hefyd yn bwysig bod yn glir ynglŷn â ble mae’r cyfrifoldebau’n gorwedd. O dan y fframwaith statudol presennol, cyfrifoldeb sefydliadau’r NHS yw gwneud penderfyniadau am ffurf gwasanaethau lleol, gan weithredu o fewn eu dyletswyddau statudol a defnyddio’u barn ar sail tystiolaeth glinigol, cynaliadwyedd y gweithlu, ansawdd, diogelwch ac ymgysylltu â’r cyhoedd. Fel Gweinidog Cabinet, gallaf i ddim—a dylwn i ddim—ceisio rhagfarnu penderfyniadau gweithredol lleol sydd, yn briodol, yn faterion i’r byrddau iechyd. Ac mae hynny’n adlewyrchu egwyddor bwysig. Mae’n gwarchod integriti’r broses o wneud penderfyniadau clinigol ac yn sicrhau bod penderfyniadau’n cael eu gwneud ar sail tystiolaeth, nid pwysau gwleidyddol. Bydd rhai Aelodau yn anghytuno â rhai agweddau ar y cynllun gwasanaethau clinigol. Dyna eu hawl. Ond beth bynnag yw ein safbwyntiau unigol, dwi’n gobeithio y gallwn ni gytuno ar dri pheth. Yn gyntaf, mae pobl Ceredigion Penfro yn haeddu gofal iechyd sy’n ddiogel, yn gynaliadwy ac yn cyflawni’r canlyniadau gorau posib. Yn ail, mae staff Ysbyty Llwynhelyg yn haeddu ein diolch, ein parch a’n cefnogaeth am y gwaith eithriadol maen nhw’n ei wneud bob dydd. Ac yn drydydd, dylai trafodaethau am ddyfodol gwasanaethau gofal iechyd gael eu llywio gan dystiolaeth, arbenigedd clinigol a buddiannau hirdymor cleifion. Caiff hyn ei sicrhau drwy drafod gonest, cynllunio gofalus, arweinyddiaeth glinigol a ffocws diflino ar wella canlyniadau i gleifion. Dyna beth mae pobl Cymru yn ei haeddu. Dyna beth mae pobl Ceredigion Penfro yn ei haeddu. A dyna beth mae’r Llywodraeth yma yn ei ddisgwyl. Diolch.

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Llywydd, it's also important to be clear about where the responsibilities lie. Under the current statutory framework, it is the responsibility of NHS organisations to make decisions about the form of local services, acting within their statutory duties and using their judgment based on clinical evidence, workforce sustainability, quality, safety and public engagement. As a Cabinet Minister, I cannot—and I should not—try to pre-judge local executive decisions that, appropriately, are matters for the health boards. That reflects an important principle. It protects the integrity of the process of making clinical decisions and ensures that decisions are made on the basis of evidence, not political pressure. Some Members will disagree with certain aspects of the clinical services plan. That is their right. But whatever our individual views are, I hope that we can agree on three things. First, the people of Ceredigion Penfro deserve healthcare that is safe, sustainable and achieves the best possible outcomes. Secondly, staff at Withybush Hospital deserve our gratitude, respect and support for the exceptional work that they do every day. And thirdly, discussions about the future of healthcare services should be informed by evidence, clinical expertise and the long-term interests of patients. This will be achieved through honest discussions, careful planning, clinical leadership and a tireless focus on improving outcomes for patients. That's what the people of Wales deserve. That is what the people of Ceredigion Penfro deserve. And that is what this Government expects. Thank you.

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Diolch yn fawr iawn, Lywydd. Dwi'n falch o roi'r wybodaeth ddiweddaraf am yr ymrwymiad yn ein cynllun 100 diwrnod cyntaf i gomisiynu adolygiad o effeithiolrwydd fframwaith uwchgyfeirio ac ymyrraeth gwasanaeth iechyd cenedlaethol Cymru. Mi gafodd yr adolygiad ei gomisiynu i sicrhau bod ein trefniadau ar gyfer atebolrwydd, goruchwyliaeth, cymorth ac ymyrraeth yn dal yn addas i'r diben mewn amgylchedd gofal iechyd sy'n mynd yn fwyfwy cymhleth. Mae trafodaethau efo sefydliadau'r GIG dros y misoedd diwethaf wedi atgyfnerthu'r angen am fframwaith sy'n gliriach, yn fwy cyson, ac yn canolbwyntio'n fwy ar sicrhau gwelliant cynaliadwy. Mi ddaeth yr adolygiad i'r casgliad bod trefniadau uwchgyfeirio ac ymyrraeth yn chwarae rhan bwysig wrth nodi pryderon, cryfhau goruchwyliaeth, a darparu cymorth wedi'i dargedu lle bo angen. Er hynny, mi wnaeth yr adolygiad hefyd nodi cyfleoedd i gryfhau'r cysylltiad rhwng prosesau atebolrwydd arferol a threfniadau ymyrryd ffurfiol. Yn benodol, roedd awydd i symud oddi wrth system sy'n canolbwyntio'n bennaf ar lefelau uwchgyfeirio at system newydd, system sy'n rhoi mwy o bwyslais ar asesu parhaus ac ymyrryd yn gynnar, helpu sefydliadau i wella ac, yn y pen draw, sicrhau canlyniadau gwell i gleifion. Heddiw, rydym ni'n cyhoeddi fframwaith atebolrwydd a chymorth newydd, sy'n cyflwyno un dull clir a chydlynol o ymdrin ag atebolrwydd, sicrwydd, cymorth ac ymyrraeth ledled gwasanaeth iechyd cenedlaethol Cymru. Mae'n sefydlu fframwaith cliriach a mwy tryloyw sy'n helpu Llywodraeth Cymru a sefydliadau'r GIG i asesu sut maen nhw'n perfformio, nodi risgiau'n gynnar, a chytuno ar y camau sydd eu hangen i gefnogi gwelliant. Mae hefyd yn egluro'n well sut mae cyfarfodydd atebolrwydd, trefniadau goruchwylio perfformiad arferol, cymorth i wella a gweithgarwch ymyrryd yn cyd-fynd efo'i gilydd.

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Thank you very much, Llywydd. I'm pleased to provide an update on the commitment in our first 100-day plan to commission a review of the effectiveness of the NHS Wales escalation and intervention framework. The review was commissioned to ensure that our arrangements for accountability, oversight, support and intervention remain fit for purpose in a healthcare environment that is increasingly complex. Discussions with NHS organisations in recent months have reinforced the need for a framework that is clearer, more consistent, and more focused on securing sustainable improvement. The review found that escalation and intervention arrangements provided an important mechanism for identifying concerns, strengthening oversight, and deploying targeted support where necessary. However, the review also found opportunities to strengthen the connection between routine accountability processes and formal intervention arrangements. In particular, there was a desire to move away from a system that is perceived primarily through the lens of escalation levels to a new system, a system that places greater emphasis on continuous assessment and early intervention, helping organisations to improve and, ultimately, ensures better outcomes for patients. Today, we publish a new accountability and support framework, which provides a single, coherent approach to deal with accountability, assurance, support and intervention across NHS Wales. It establishes a more transparent and structured framework that will help the Welsh Government and NHS organisations to assess how they are performing, identify emerging risks, and agree the responses required to support improvement. It also clarifies better the relationship between accountability meetings, routine performance oversight, improvement support and intervention activity.

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At its heart, the framework establishes a stronger focus on organisational maturity, capability and sustainable improvement. The framework is structured around the core pillars and domain of leadership and organisational effectiveness, quality, delivery and performance, workforce, and finance and planning. This reflects the reality that organisational challenges rarely exist in isolation and often require a system-wide understanding of the factors influencing performance and outcomes. The framework also supports a more proactive approach to intervention. Rather than waiting for issues to become deeply embedded, it provides enhanced mechanisms for earlier identification of risk and earlier deployment of support. The intention is that organisations are helped to address challenges before they become more significant and before formal escalation becomes necessary. This is particularly important given the pressures facing NHS Wales, including increasing demand, workforce challenges, financial constraints and the need to continue improving quality and patient outcomes. This preventative approach is consistent with the wider direction of Government and health policy, which places strong emphasis on earlier action, reducing avoidable harm and supporting long-term sustainability. In practical terms, this means moving from late action when performance has already deteriorated to earlier identification of risk and targeted support before concerns become entrenched. The framework works within the current legislative framework and takes us as far as we can within it, using the powers and levers available to strengthen accountability, deploy support earlier and secure improvement for patients and communities. A key principle underpinning the framework is that intervention and support should always be purposeful, proportionate and time bound. Enhanced monitoring, oversight and support arrangements should not exist for their own sake. Instead, they should support organisations to deliver measurable improvements, strengthen leadership capability, improve governance arrangements and address the underlying causes of poor performance. Equally, organisations receiving support should be able to demonstrate progress within an agreed time frame, with decisions about escalation, continuation of support or de-escalation informed by clear evidence and objective assessment. Recent discussions regarding de-escalation arrangements have reinforced the importance of ensuring that improvement is sustained and that appropriate surveillance arrangements remain in place following any reduction in oversight. Another important development within the framework is the strengthening of accountability arrangements. The revised approach seeks to make expectations clearer for NHS organisations while providing greater consistency in how evidence is reviewed and how organisational assurance is assessed. It also promotes a more comprehensive view of organisational performance, drawing together information from across the various domains to support a rounded assessment of organisational health and capability. The review has also highlighted the importance of leadership, culture and governance in determining organisational success. Recent discussions concerning organisational performance have repeatedly demonstrated that sustainable improvement is dependent not only on operational delivery, but also on strong leadership, effective governance and a culture that supports openness, learning and accountability.

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Yn bwysig, mae'r fframwaith yn cydnabod bod atebolrwydd a chymorth yn mynd law yn llaw. Mae'n rhaid i sefydliadau barhau i fod yn atebol am ddarparu gwasanaethau diogel, cynaliadwy ac o safon uchel, ond mae'n rhaid iddyn nhw hefyd gael y cymorth cywir pan fydd heriau'n codi. Dyna pam mae'r fframwaith yn ceisio taro'r cydbwysedd iawn rhwng her adeiladol a chymorth ymarferol, gan ddefnyddio arbenigedd i helpu sefydliadau i wella. Y nod ydy helpu sefydliadau i feithrin eu gallu eu hunain i wella, yn hytrach na dibynnu ar oruchwyliaeth allanol. Mi gafodd y fframwaith ei ddatblygu drwy weithio'n agos efo swyddogion Llywodraeth Cymru, sefydliadau'r GIG a rhanddeiliaid allweddol. Mae'n adlewyrchu ein huchelgais ar y cyd i gryfhau atebolrwydd, gwella tryloywder a helpu sefydliadau i sicrhau gwelliant cynaliadwy i'r bobl maen nhw'n eu gwasanaethu. Mae adolygu'r hen fframwaith a datblygu'r fframwaith newydd yn gam pwysig ymlaen yn y ffordd rydyn ni'n goruchwylio perfformiad ac yn helpu sefydliadau i wella ledled gwasanaeth iechyd cenedlaethol Cymru. Mae'r fframwaith newydd yn dod ag atebolrwydd, trefniadau uwchgyfeirio a chymorth i wella ynghyd mewn un system integredig. Mae'n darparu atebolrwydd cliriach, goruchwyliaeth fwy cymesur a chymorth cynharach pan fydd risgiau'n dod i'r amlwg. Mae hynny'n helpu i gryfhau tryloywder a chanolbwyntio ar sicrhau canlyniadau gwell i gleifion, staff a chymunedau ledled Cymru.  Yn y pen draw, nod y newidiadau hyn ydy rhoi mwy o hyder i bobl Cymru y bydd gwasanaethau'r gwasanaethau iechyd yn cael y cymorth sydd ei angen i ymateb i heriau a gwella. Mi fydd y fframwaith newydd yn helpu i nodi problemau'n gynharach, darparu cymorth mwy cyson i sefydliadau, a sicrhau bod pryderon yn cael sylw'n brydlon ac yn dryloyw. I gleifion a chymunedau, mae hyn yn golygu gwasanaethau gwell, mwy diogel a dibynadwy, gofal mwy cyson, a sicrhau bod pawb yn cael y driniaeth a'r cymorth y maen nhw'n eu haeddu. Diolch.

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Importantly, the framework recognises that accountability and support are two sides of the same coin. Organisations must continue to be held accountable for delivering high-quality, safe and sustainable services, but they must also have access to the right support when challenges emerge. That's why the framework seeks to balance constructive challenge with practical support, using expertise to help organisations improve. The aim is to help organisations build their own capability to improve, rather than creating dependency on external oversight. The framework was developed through engagement between Welsh Government officials, NHS organisations and key stakeholders. It reflects a shared ambition to strengthen accountability, improve transparency and support organisations to achieve sustained improvement for the populations they serve. The review of the old framework and the development of the new framework represents an important step forward in the way that we oversee performance and help organisations improve across NHS Wales. The new framework brings together accountability, escalation and improvement support into a single integrated system. It provides clearer accountability, more proportionate oversight and earlier support where risks emerge. That helps to strengthen transparency and focus on ensuring better outcomes for patients, staff and communities across Wales.  Ultimately, the aim of these changes is to give the people of Wales greater confidence that NHS services will receive the necessary support to respond to challenges and improve. The new framework will help identify issues earlier, provide more consistent support to organisations, and ensure that concerns are addressed in a timely and transparent way. For patients and communities, this means services that are better, safer and more reliable, more consistent care, and ensuring that everyone receives the treatment and support that they deserve. Thanks.

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Diolch yn fawr iawn am y sylwadau hynny.

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Thank you very much for those comments.

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I welcome you to your post and congratulate you on your appointment as shadow spokesperson for health and care. Good luck with it. I thank your predecessor as well for his contributions.  I welcome the fact that you see the value of what we've put forward here, and that you welcome much of what we've put forward. I would hope that we would have cross-party support for what we are hoping to achieve here. You mentioned putting outcomes at the centre of what we want to achieve, that workforce is important and that we take proactive action, which is all about making sure that we deal with issues before they become major problems that impact on the health outcomes of our people. But you did raise some questions and I'll try my best to respond to as many of them as I can in the few minutes I have. On the blurred lines you mentioned between civil servants and the Minister, ultimately, my civil servants and officials have meetings regularly with health boards, on a weekly basis, and the director general of the NHS will have regular meetings with the chief executives of health boards. When it comes to an escalated level and when we need to look at specific issues within health boards, the agreement on how we escalate them and which matters need to be looked at will be come to between Audit Wales, Healthcare Inspectorate Wales, the Welsh Government and the health boards themselves, so that they are an equal partner in this, that they realise what the issues are, and that they come up with solutions with other partners and stakeholders. Then, the work will be led by NHS Wales Performance and Improvement. NHS Wales Performance and Improvement will lead that work, but, going on to another question you asked about ensuring that lessons are learnt, they will then take those lessons and, in another health board or trust, if an issue arises, they will take those lessons and use them in the learnings for the problems that might arise in other health boards. The assessments that you mentioned and what criteria will be set will be judged by those stakeholders, including the health boards, but they will be transparent so that people can have confidence in the process. We know in the previous process, it was accused of being used as a political weapon more often than not. This shouldn't be about politics—this should be about making sure that health boards improve if they have problems and de-escalate when they can, so that people can have confidence in the healthcare that they receive. The process will be transparent, assessments will be made by the stakeholders transparently, collectively, and then the de-escalation process will also be transparent and show accountability for the process and how they have come to the judgements they've got for de-escalation purposes. I think that has responded to most of the questions you asked, at least.

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Diolch am y cwestiynau yna.

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Thank you for those questions.

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Thank you for those questions. They are fair questions. I think when you look at what we are proposing and how we propose to improve outcomes, it states early in the document that the difference between this framework and the previous one is that we have clearer thresholds, there's less duplication, there's greater transparency there, and we have an early identification of risk. So, when a health board or a health trust goes into level 2, we identify early on that there's a problem and ensure that it doesn't become a level 3 or a level 4, and we put that intervention in at an earlier stage. There's a stronger focus on outcomes, rather than just dealing with a crisis when it hits. We make sure that we deal with something earlier on so that those outcomes, whether it be ambulance times or urgent and emergency care or finance and performance, are seen at an earlier stage, and that there are better outcomes in that respect. More importantly, it also looks at the patient experience and takes on board patient experience. So that is factored into it. It looks at those four key themes, as I said, so there is the quality of service that is crucial in determining if a health board is escalated. The workforce, and the impact on the workforce, is another pillar. The finance and planning delivery and performance is a third pillar, and the leadership, the culture set there, is crucial when it comes to deciding whether or not they can be de-escalated or need to be escalated further. That's what came through in the review, that's what health boards and health managers and people working in the sector themselves told us they thought was missing—ensuring that we have the proper leadership in place. If I can just make a side note, you mentioned people going to hospitals. I would suggest that we move away from just thinking about hospitals, because the framework looks at all health trusts and health boards, and the health boards delivering primary care as well, primarily. We've got patients that need to look at care closer to home. It also looks at the performance of a health board and the finances of a health board, not just the delivery of services. But absolutely, what we will see is, when a board is put into an escalated measure, there will be transparency around that, so patients know what to expect, what level they're at and what work is being carried out. You ask about what further resource is put into it. As you will know from your time in Government—I presume that you will have seen some of the Cabinet papers by former health Ministers—hundreds of millions of pounds have been put into supporting health boards over the years, so a level of support will be put in there, there's no change in that respect, but the delivery will be carried out by NHS Wales Performance and Improvement. They are currently carrying out a well-led review with us in Betsi Cadwaladr. NHSPI will then be equipped to make sure that, if work needs to be done, if something needs to be done on let's say cancer outcomes, they can go in with a specialist to help deliver that improvement that's needed in a certain health board or trust.

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Diolch yn fawr iawn, Natasha, am y gyfres yna o gwestiynau.

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Thank you very much, Natasha, for that series of questions.

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Thank you for those. You ask what will it do to secure improvements. I've got to just remind you that responsibility and accountability for delivery of day-to-day services is still held by the health boards. I don't personally run the health board or go in there and dictate what staff do or what theatre spaces are used and so forth. That's why we have to make sure that we have a system in place that people can have confidence in, that is transparent, where people know what the issues are, and that is consistent across Wales, and that's what we're putting in place here. Following up on part of the question that you asked at the end there, which was what the problem was with the previous framework, it's exactly that—there wasn't confidence in it. I wrote a paper on this three years ago. It's in the library upstairs if you want to go and read it. It's a very good paper. So, it shouldn't come as a surprise that we're doing this. The health boards, trusts and organisations didn't have confidence in that process, because they didn't know by what criteria they were being escalated or downgraded. There wasn't transparency around that. One health board had a different criteria set to another health board. So, we needed to set in place a consistent process whereby everybody knew what they were being measured against, which is what we're doing here. Running at the best part of 20 pages with a lot of detail in it, it is a comprehensive framework, and it will be reviewed over the next 12 months. So, you can have confidence that any lessons from implementing it that need to be learned will be learned over the next 12 months. I would, in fact, welcome and invite you to provide your own evidence at the end of the process to see if you have confidence in the process along with others within 12 months' time. So, we will be monitoring it over that 12-month period. It won't be, therefore, used as a political football. I can promise you I won't use it as a political football. I want to depoliticise things. That's why we've put transparency central in this new framework.

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Diolch yn fawr iawn, Gwyn, am y cwestiynau yna. A dwi’n gyndyn bob tro o fynd i’r afael ag unrhyw gwestiynau y mae clinigwyr arbenigol fel Gwyn, ac, yn wir, Safa, yn medru ymgymryd â nhw, felly, dwi’n falch ein bod ni’n sôn am rywbeth mwy technegol fan hyn. Ond mae’r Aelod yn berffaith gywir, Lywydd, i nodi bod ymyrraeth gynnar yn greiddiol i egwyddor y Llywodraeth yma—gwneud yn siŵr ein bod ni’n adnabod problem ac ein bod ni’n mynd i’r afael ag e cyn ei fod o’n digwydd. A dyna pam mae hynna yn ganolog i’r fframwaith newydd yma. Ond sut mae sicrhau bod cysondeb yn y ddarpariaeth ar draws Cymru? Mi fydd hwnna trwy’r ffaith ein bod ni’n ymgynnull rhanddeiliaid—HIW, fel dwi’n dweud, Archwilio Cymru, Llywodraeth Cymru, a’r byrddau iechyd eu hunain—er mwyn cael y cysondeb yna pan fo materion yn codi, a'i fod o’n cael ei weithredu gan NHSPI, a bod hwnna i gyd yn gyhoeddus. Nawr, o ran y cysondeb, yr un elfen na fydd yn gyson, hwyrach, drwy’r amser yw bod problemau unigol, unigryw yn mynd i fod mewn rhanbarthau gwahanol, a bod y byrddau iechyd yn rhoi mewnbwn yn y broses yma. Felly, bydd yna elfennau ychydig yn wahanol er mwyn galluogi ar gyfer y gwahaniaethau rhanbarthol, ond mi fydd y drefn, y fframwaith a'r system yn gweithio oddi fewn yn gyson ar draws Cymru.

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Thank you, Gwyn, for those questions. And I'm always reluctant to tackle any questions that specialist clinicians such as Gwyn, and, indeed, Safa, can ask, so I'm very pleased that we're talking about something more technical here.  But the Member is perfectly right to note that early intervention is a core part of this Government's principles—ensuring that we recognise problems and that we tackle them before they arise. And that's why this is central to the new framework. But how do we ensure that there is consistent provision across Wales? Well, that will happen through the fact that we will gather stakeholders—Healthcare Inspectorate Wales, Audit Wales, Welsh Government, and the health boards themselves—in order to have that consistency when issues arise, and that it'll be undertaken through NHSPI, and that it's all public.  In terms of consistency, one element that won't be consistent, perhaps, every time is that different regions will have unique problems, and that the health boards will provide input into that process. So, there will be slightly different elements in terms of enabling for those regional differences, but the framework will be consistent across Wales.

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Diolch, Louise. Very good points there. You're very, very right, it's a dry document, isn't it, and I think it shows in the numbers present here. It's not, probably, the most exciting thing, but it's one of the foundational pieces of work that we have to get to grips with if we're going to see improvement in the health service in Wales, hence why we've commissioned the work and we're announcing it today.  It's not that health boards will be setting their own criteria; they'll be working with HIW, Audit Wales and the Welsh Government, who will be key stakeholders in that. But what we want is for health boards to take ownership and be answerable for problems in their health boards, rather than wash their hands of it and deny any responsibility and try and palm it off to somebody else. So, we want health boards, and trusts as well, to realise, if there is a problem, they identify it—we identify it early, collectively, we put in place the intervention measures required to deal with it at an early stage before it escalates, and then they can move on in confidence that that problem has been dealt with at an earlier stage. That's why they have to be key in identifying those problems. It's not that they say, 'Well, we think that this problem is small and we're not going to deal with it.' It's taking ownership, answerability and accountability—crucial when it comes to ensuring that we have improvement in the health service. I welcome the fact that you're hopeful that this will work. I think we're all hopeful that it will work. And I'm confident that we've got a new framework in place that will ensure clarity, consistency and transparency, and that it will hold health boards to account far more than the previous framework that we had.

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Diolch am hwnna. Dwi yn siomedig eich bod chi'n cymryd y cyfle yma i wneud pwyntiau gwleidyddol am faterion sydd y tu hwnt i'r hyn rydym ni'n edrych arno. Hynny ydy, rydych chi'n gwybod yn iawn fod y Llywodraeth yn methu ymyrryd yn y broses sydd yn mynd ymlaen ar hyn o bryd pan fo'n dod i ail-edrych ar drefniadau darpariaeth iechyd ym Mhowys, neu yn unrhyw fwrdd iechyd arall. Byddwn i'n gobeithio bod pawb sy'n bresennol yn gwbl, gwbl ymwybodol o'r rheolau sy'n dweud nad yw Gweinidog yn gallu ymyrryd yn y broses honno; mae wedi bod yn wybyddus erioed. Felly, dwi ddim yn mynd i drafod y broses sydd yn mynd ymlaen ym Mhowys ar hyn o bryd. Mae Powys mewn lefel 4 o ran y drefn uwchgyfeirio presennol pan fo'n dod i gyllideb, strategaeth a chynllunio. Mae hynny'n benderfyniad a gafodd ei wneud gan y rhanddeiliad, fel dwi wedi sôn. Ac unwaith eto, pan fydd hi'n dod at edrych ar ddarpariaeth gwasanaeth iechyd ym Mhowys yn ei gyfanrwydd, yn yr un modd ag unrhyw fwrdd arall, mi fyddan nhw'n cael eu mesur yn erbyn yr un drefn ag y mae pob bwrdd iechyd arall yn mynd i gael ei fesur yn ei erbyn. Ond mi fyddwn i yn annog pobl i gysylltu os oes ganddyn nhw bryderon am yr hyn sydd yn digwydd o ran argymhellion Powys. Does yna ddim penderfyniad wedi'i wneud eto—mae'n broses fyw. Felly, os ydy pobl eisiau cyfrannu at y broses yna, yna gwnewch hynny, cysylltwch efo'r bwrdd iechyd. Yn fwy na hynny, cysylltwch efo Llais—gwnewch yn siŵr bod Llais yn ymwybodol o unrhyw bryderon neu gefnogaeth sydd gennych chi. Dwi wedi'i gwneud hi'n glir, mewn unrhyw ail-drefnu darpariaeth gwasanaeth mewn unrhyw ranbarth yng Nghymru, fod yn rhaid ystyried ffactorau fel pa mor wledig ydy'r ardal, trafnidiaeth leol, mynediad at wasanaethau. Mae'r rhain i gyd yn gorfod bod yn ystyriaethau wrth i unrhyw fwrdd iechyd lunio cynllun gwasanaethau iechyd lleol yn eu hardal nhw.

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Thank you for that. I am disappointed that you're taking this opportunity to make political points on issues that are beyond what we're addressing today. You know full well that the Government can't intervene in the process that is currently ongoing when it comes to reviewing healthcare provision in Powys or in any other health board. I would hope that everyone present would be entirely aware of the rules saying that a Minister cannot intervene in that process; it's been well known for a very long period of time. So, I'm not going to discuss the process that's ongoing in Powys at the moment. Powys is at level 4 in relation to the current escalation framework when it comes to budget, strategy and planning. That's a decision that was made by stakeholders, as I've mentioned. And once again, when it comes to looking at the provision of health services in Powys in its entirety, just like any other health board, they will be measured according to the same system as every other health board. But I would encourage people to get in touch if they have concerns about what's happening in terms of the recommendations in Powys. No decision has yet been made—it is a live process. So, if people want to contribute to that process, then do so, contact the health board. More than that, contact Llais—ensure that Llais is aware of any concerns or support that you may have. I've made it clear, in terms of any reorganisation of services in any region in Wales, that we must take into account factors like rurality, local transport, access to services. All of these have to be considerations as any health board draws up its local health services plan in their area.

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Diolch yn fawr iawn i Anna Nicholl am y gyfres yna o gwestiynau andros o bwysig pan fo'n dod i edrych ar sut mae sicrhau ein bod ni'n creu'r lle yna i wella arweinyddiaeth. Mae arweinyddiaeth yn ganolog yn y fframwaith newydd yma. Mae'n un o'r pethau yna lle rydym ni'n ymwybodol, os ydy'r diwylliant yn iawn o'r brig, yna mi fydd hynny'n arwain at ganlyniadau gwell ar draws y bwrdd. Mae'r Aelod yn iawn i ddweud bod Hywel Dda mewn lefel 4, ac, yn wir, lefel 3 ar gyfer gofal wedi'i gynllunio, ac, yn wir, mae Digital Health and Care Wales mewn lefel 4 hefyd. Felly, does dim un o'r byrddau iechyd mewn sefyllfa ddelfrydol. Dydyn ni ddim eisiau eu gweld nhw yn y sefyllfa yma. Mae'r fframwaith rydym ni wedi ei lunio yn un sydd yn mynd mor bell ag y gallwn ni o fewn y fframweithiau deddfwriaethol sydd gennym ni, sef yr National Health Service (Wales) Act 2006, yr National Health Service Finance (Wales) Act 2014, yr Health and Social Care (Quality and Engagement) (Wales) Act 2020, a'r Well-being of Future Generations (Wales) Act 2015. Oddi fewn i'r rheini i gyd, a'r fframweithiau eraill, mae hyn yn mynd i fynd â ni mor bell â phosib er mwyn inni fedru dal byrddau iechyd i gyfrif, ond, yn fwy na hynny, sicrhau bod yna adnabyddiaeth gynnar, mor gynnar â phosib, o unrhyw broblemau, fod yna gymorth yn cael ei roi fewn yno, a'n bod ni'n mynd â byrddau iechyd ar daith i wella, er mwyn inni wella—yr union bwynt hynny—canlyniadau i bobl Cymru. Oherwydd nid y bwriad bellach ydy pwyntio bys a beirniadu a defnyddio'r fframwaith uwchgyfeirio fel erfyn gwleidyddol; ein bwriad ni rŵan ydy creu fframwaith sydd yn mynd i fynd â byrddau iechyd ar daith er mwyn gwella canlyniadau pobl yng Nghymru, o Fôn i Fynwy.

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Thank you very much to Anna Nicholl for that series of hugely important questions when it comes to looking at how we ensure that we create that space to improve leadership. Leadership is at the heart of this new framework. It is one of those things where we are aware, if the culture is right from the top down, then that will lead to better results across the board. The Member is right in saying that Hywel Dda is at level 4, and, indeed, level 3 for planned care, and, indeed, Digital Health and Care Wales is in level 4 too. So, not one of the health boards is in an ideal position. We don't want to see them in this position. The framework that we've drawn up is one that goes as far as possible within the legislative frameworks available to us, namely the National Health Service (Wales) Act 2006, the National Health Service Finance (Wales) Act 2014, the Health and Social Care (Quality and Engagement) (Wales) Act 2020, and the Well-being of Future Generations (Wales) Act 2015. Within all of those, and the other frameworks, this will take us as far as possible in terms of holding the health boards to account, but, more than that, ensure that there is early identification of any problems, that support is provided, and that we take the health boards on an improvement journey so that— exactly as you said—we improve outcomes for the people of Wales. Because the intention is no longer to point the finger and to criticise and to use the escalation framework as a political tool; our intention now is to create a framework that will take health boards on a journey in order to improve outcomes for the people of Wales, from Anglesey to Monmouthshire.

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Diolch yn fawr iawn am hwnna. Gaf i ymbellhau fy hun a'r Llywodraeth o sylwadau Joe Martin, sydd yn gwbl annerbyniol yng nghyd-destun y drafodaeth yma heddiw? Gaf i hefyd ddiolch i'r Aelod am gyflwyno'r ddadl bwysig yma a dymuno'n dda iddo ar ei daith i wellhad llwyr? Dyma'r cyfle gwirioneddol cyntaf i'r Senedd hon drafod y mater yma ac i mi roi ein hymateb ni, felly, ar gofnod. Yn gyntaf, dwi am gydnabod y boen a'r trallod y mae llawer wedi'u teimlo ers cyhoeddi'r penderfyniad. I lawer, roedd hwn yn cael ei weld fel penderfyniad arall mewn cyfres hir o benderfyniadau er mwyn tynnu hawliau pobl draws oddi arnynt, yn erydu eu hunaniaeth, ac rwy'n deall yr ofn yma. Gadewch imi bwysleisio, felly, mai penderfyniad clinigol oedd hwn, wedi'i wneud ar sail tystiolaeth glinigol heb ymyrraeth wleidyddol. Gadewch imi hefyd fod yn glir: mi ydym ni—rydw i—yn sefyll gyda’r gymuned draws. Fel Llywodraeth, rydym ni wedi ymrwymo i ddiogelu hawliau pob person LGBTQ+ yng Nghymru, ac, fel y gŵyr yr Aelodau, chwaraeodd Plaid Cymru ran allweddol wrth sicrhau bod y cynllun gweithredu LGBTQ+ yn cael ei gyflawni. Mae ein maniffesto yn nodi ein hymrwymiad i'r gymuned draws, a gallwch fod yn sicr bod Llywodraeth Cymru yn sefyll gyda'r gymuned draws ac y bydd yn parhau i amddiffyn hawliau pobl draws yn unol â'n hymrwymiad i Gymru groesawgar a chynhwysol.

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Thank you very much. May I distance myself and the Government from the comments made by Joe Martin, which are entirely unacceptable in the context of today's debate? May I also thank the Member for bringing forward this important debate and wish him well on his journey towards a full recovery? This is the first real opportunity for the Senedd to discuss this matter and for me to place our response on the record. Firstly, I would like to acknowledge the pain and distress that many have felt since the decision was announced. For many, this was seen as another decision in a long series of decisions to strip trans people of their rights, eroding their very identity, and I understand these concerns and fears. So, let me emphasise that this was a clinical decision, made on the basis of clinical evidence without political intervention. Let me also be clear that we—that I—stand with the trans community. As a Government, we are committed to safeguarding the rights of every LGBTQ+ person in Wales, and, as Members know, Plaid Cymru played a key role in ensuring the delivery of the LGBTQ+ action plan. Our manifesto sets out our commitment to the trans community, and you can be assured that the Welsh Government stands with the trans community and will continue to defend the rights of trans people in line with our commitment to a welcoming and inclusive Wales.

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I recognise that some people accessing gender identity services will already be experiencing emotional distress, and I understand the additional distress, anxiety and uncertainty of this situation. I want to be clear that we remain committed to ensuring access to high-quality specialist gender identity services in Wales. I also want to reassure people that this decision is a temporary pause, not a stop, and a decision made by the NHS Wales Joint Commissioning Committee in the interest of patient safety. The decision to pause gender-affirming surgery was made through established clinical governance processes. These apply to all services commissioned by the NHS Wales Joint Commissioning Committee. It isn't unusual for the JCC to place services in escalation when there is a need to seek assurance on clinical or quality issues. These processes exist to ensure patient safety, and we need to be led by them, based on their independent clinical assessment of the evidence. Welsh Ministers don't have a role in the clinical governance and escalation processes within the JCC. The NHS Wales Joint Commissioning Committee are responsible for the commissioning and oversight of specialised services, including gender identity services, and are formally accountable to health boards in Wales. This provides a consistency of offer, with the necessary governance and monitoring and clinical oversight in place to ensure services are safe and effective. The JCC brings together health boards for services that need to be commissioned once for Wales. This includes specialist gender identity services. As a Government, we have been clear that we will be led by the evidence when it comes to ensuring the quality and safety of our NHS services. This is vital if we are to ensure safe services and good outcomes for our patients in Wales. For the avoidance of doubt, and let me be clear, this was a clinically-led decision made by the JCC due to concerns with the quality of assessments and the volume of referrals for gender surgery. The decision was primarily based on data provided by the gender dysphoria national referral support services. Gender surgery for Welsh patients is commissioned by NHS England, who are responsible for managing and validating referrals for surgery. The centrally held data showed higher rates of referral from Wales, but lower rates of progression to some surgeries. Concerns were also raised by clinical colleagues in NHS England about appropriateness of referrals and clinical suitability. The JCC has a duty of care to all patients who receive specialist services that it commissions to ensure that those services are safe and effective. Taken together, these concerns highlighted potential issues that the JCC needed to take seriously. Given the level of concerns across parties, I'm grateful that the JCC offered technical briefing sessions to all parties to provide more information about the data and the decisions taken. I hope you took the opportunity to engage in these sessions with the JCC to seek assurances on the questions or concerns that you have. Following the escalation of the service, the JCC committed to an urgent clinical review of those individuals on the waiting list for gender-affirming surgery. The JCC has already appointed the independent clinical review panel, and, subject to final governance approval, it is anticipated that the review will commence imminently. This review will prioritise those individuals who are further along the pathway to allow appropriate referrals to proceed as soon as possible. The JCC has identified that approximately 60 patients were due surgery between the pausing of surgery in August and the end of December. Our priority is to bring certainty to these people as quickly as possible, and the JCC are confident that all 60 of these cases can be reviewed before the end of December. There is also a wider, independent review of the Welsh Gender Service. It was always intended by the JCC that this planned review would follow the independent Levy review, which looked at adult gender identity services in England. The independent review has already commenced and comprises both quality and clinical governance elements. The review will focus primarily on assessment, referral and non-surgical aspects of the pathway, while considering relevant pathway interfaces. It will engage key stakeholders, including health boards, partner organisations, patients and carers. Initial findings are expected later this year, with recommendations to be reported to the JCC thereafter. Both reviews will include independent reviewers and are a clinical process. It is entirely consistent with existing governance arrangements of this nature that the Welsh Government will have no role or involvement in these reviews or the recommendations that they make. We will, of course, expect that both the JCC and Cardiff and Vale University Health Board act on the findings from the reviews as a matter of priority. I've met with the JCC and been clear that the urgent clinical review needs to be swift to minimise the disruption and distress for individuals on the waiting list. I've also been clear that I expect all patients impacted by this pause to have access to the necessary support whilst the review is undertaken. This includes emotional and psychological support. I've written to Cardiff and Vale University Health Board and received assurances about the support available for those who are affected by the pause. The JCC has now published the equality and Welsh language impact assessment and the quality impact assessment and other papers related to the decisions on their website.

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Rwy'n cydnabod y trallod a'r ansicrwydd y mae'r seibiant hwn yn ei achosi i'r rhai yr effeithir arnynt. Rwyf wedi clywed yn bersonol gan bobl yr effeithir arnynt gan y penderfyniad yma, ac rwy'n ddiolchgar i gydweithwyr yn y Senedd am eu gweithredoedd wrth wrando, cefnogi ac eirioli ar ran cymaint o bobl. Rwy'n gweithio gyda'r Dirprwy Brif Weinidog a Gweinidog Cabinet dros Gyfiawnder Cymdeithasol a Chydraddoldeb i sicrhau bod yr effaith ar y gymuned draws yn cael ei hystyried yn llawn wrth i'r JCC a Bwrdd Iechyd Prifysgol Caerdydd a'r Fro ymgymryd â'r gwaith adolygu a dilynol. Rwy'n cael fy niweddaru'n rheolaidd am gynnydd gan y JCC a Bwrdd Iechyd Prifysgol Caerdydd a'r Fro, a chyfarfu swyddogion â'r JCC ddoe i gael y wybodaeth ddiweddaraf am gynnydd. Rwy'n disgwyl i unrhyw gamau angenrheidiol gael eu cymryd ymlaen fel blaenoriaeth i sicrhau bod Gwasanaeth Rhywedd Cymru yn darparu'r ansawdd gwasanaeth y byddem yn ei ddisgwyl. Rwyf wedi ymrwymo i sicrhau bod ein cyrff cyhoeddus yn darparu'r lefel uchaf o wasanaeth i bawb sy'n dibynnu arnynt. Gyda hynny mewn golwg, mae'n hanfodol ein bod yn dysgu yn barhaus o benderfyniadau fel yr un hwn, felly, rwyf wedi gofyn i'r prif swyddog meddygol gynnal ymarfer myfyriol mewnol ar y broses sy'n gysylltiedig â'r penderfyniad hwn. Bydd hyn yn ystyried sut y cyfathrebwyd â chleifion ac eraill, amseriad cyfathrebu a'r prosesau sy'n eu cefnogi, gan gynnwys llais y gymuned draws. Bydd lleisiau'r gymuned draws yn ganolog i'r gwaith yma. Mae gwrando a dysgu'n hanfodol. Felly, diolch, unwaith eto, i Anthony, am gyflwyno'r ddadl, a diolch i bawb a gyfrannodd mewn modd adeiladol i'r ddadl yma.

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I acknowledge the distress and uncertainty that this pause has caused for those affected. I have heard personally from people affected by this decision, and I'm grateful to colleagues in the Senedd for their actions in listening to, supporting and advocating on behalf of so many people. I'm working with the Deputy First Minister and Cabinet Minister for Social Justice and Equality to ensure that the impact on the trans community is fully considered as the JCC and Cardiff and Vale University Health Board undertake the review and follow-up work. I'm being regularly updated on progress by the JCC and Cardiff and Vale University Health Board, and officials met with the JCC yesterday to receive a progress update. I expect any necessary steps to be taken forward as a priority to ensure that the Welsh Gender Service delivers the quality of service that we would all expect. I'm committed to ensuring that our public bodies provide the highest level of service to everyone who relies on them. With that in mind, it is essential that we continue to learn from decisions such as this one, therefore, I have asked the chief medical officer to conduct a reflective exercise regarding the processes associated with this decision. This will consider methods of communication with patients and others, the timing of that communication and the supporting processes, including the voice of the trans community. The voices of the trans community will be central to this review. Listening and learning are essential. So, thank you once again, Anthony, for presenting this debate, and thank you to everyone who has contributed in a constructive manner to this debate.

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Yn ffurfiol.

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Formally.

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Diolch, Lywydd. Dwi'n croesawu'r cyfle i ymateb i'r ddadl yma. Mi wnaf i ddechrau drwy ategu'r hyn sydd eisoes wedi cael ei ddweud am y rôl hanfodol sydd gan ymwelwyr iechyd wrth gefnogi babanod, plant a theuluoedd ledled Cymru. Yn aml, mae eu gwaith yn cael ei wneud gyda rhai o'r teuluoedd mwyaf agored i niwed yn ein cymunedau, ac maen nhw'n gwneud cyfraniad amhrisiadwy i wella canlyniadau a lleihau anghydraddoldeb. Dwi hefyd eisiau cydnabod yr effaith mae'r anghydfod parhaus yma wedi'i chael ar yr ymwelwyr iechyd eu hunain, ar deuluoedd sy'n dibynnu ar y gwasanaethau ac ar gydweithwyr sy'n gweithio ar draws y system iechyd a gofal ehangach. Dwi'n gwybod na fyddai'r penderfyniad i streicio wedi bod yn benderfyniad hawdd iddyn nhw. Mae'r Llywodraeth yn deall cryfder y teimladau ynglŷn â'r mater yma a'r pryder sydd wedi'i fynegi gan Aelodau ar draws y Siambr. Er hynny, mae'n bwysig bod y ddadl yma yn cael ei seilio ar ffeithiau. Wnaeth yr anghydfod hwn ddim codi dros nos. Mae'n rhagflaeni'r Llywodraeth bresennol ac mae'n fater sydd wedi bod yn mynd ymlaen ers sawl blwyddyn. Wrth wraidd yr anghydfod mae anghytundeb rhwng Unite a Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg ynglŷn â gwerthuso rolau ymwelwyr iechyd a'r trefniadau band cyflog priodol.

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Thank you, Llywydd. I welcome the opportunity to respond to this debate. I'll start by endorsing what has already been said about the vital role that health visitors have in supporting babies, children and families across Wales. Their work is often done with some of the most vulnerable families in our communities, and they make an invaluable contribution to improving outcomes and reducing inequality. I also want to acknowledge the impact that this ongoing dispute has had on the health visitors themselves, on families who rely on their services and on colleagues working across the wider health and care system. I know that the decision to strike would not have been an easy decision for them. The Government understands the strength of feelings on this issue and the concern that has been expressed by Members across the Chamber. However, it is important that this debate is based on facts. This dispute did not arise overnight. It predates the current Government and it's an issue that has been going on for several years. At the heart of the dispute is a disagreement between Unite and Cwm Taf Morgannwg University Health Board regarding the evaluation of the roles of health visitors and the appropriate pay band arrangements.

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The Government amendment reflects the reality that this remains a local employment dispute between the health board as employer and Unite as the recognised trade union, and, as such, these matters must be resolved through the established employer, trade union and industrial relations processes. That doesn't mean that the Welsh Government has been inactive. I've engaged directly with both Cwm Taf Morgannwg University Health Board and Unite since coming into Government and have repeatedly called on all parties to come together, engage constructively and work towards a resolution as quickly as possible. My focus has consistently been on minimising the impact on babies, families and staff, and from the outset I've placed clear expectations on Cwm Taf Morgannwg to bring forward credible solutions to this dispute. Andrew.

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It's not up to me to decide on the process that the health board has taken. This is an issue for the health board to resolve. They created this situation, Unite are in dispute, and they now have to come together. That's the situation we're in. It's not up to me to resolve in that respect. So, I have sought and received detailed assurances from the chair of the health board regarding the management of risks arising from the industrial action, including safeguarding arrangements and service resilience. The Welsh Government continues to keep the situation under close review and hold the health board robustly to account in this respect. While we are as frustrated as anyone that this dispute is ongoing, it is also important to acknowledge recent developments that have taken place. In the space of a few months after coming into office, this Welsh Government's pressure on Cwm Taf resulted in the health board bringing forward a financial settlement to end the dispute. This represents a significant step change compared to the prolonged state of deadlock that existed prior to the election. While the offer was rejected, it shows how we are doing what we can to ensure that this impasse comes to an end. We fully respect Unite's decision to reject this offer, and unlike Reform, who want to tear up the hard-won rights of workers at the behest of their shady, unaccountable billionaire paymasters, we also fully respect the right of the health visitors to continue industrial action. While the offer was ultimately rejected, I believe it represented an important step forward in the process of bringing this long-running dispute to a satisfactory conclusion. But this can only be achieved if both parties come around the table and talk. We continue to encourage both parties to engage constructively to achieve a resolution that supports children, families and staff. I would also urge both sides to engage in good faith on derogations and actions that could be taken during this dispute, so that critical services can still be provided during the period of industrial action. Measures are also in place to mitigate the impact of the health visitors on strike. I've said it before and I'll say it again: nobody goes on strike for fun. It's not a decision that anyone takes lightly. Collective action demands their collective support, which is what Unite are doing in supporting their members during this period. And for that, I thank them for ensuring that the health visitors are supported during a difficult time.

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Yn ogystal ag ymateb i'r sefyllfa fel y mae hi, mae'n rhaid inni hefyd ystyried dyfodol gwasanaethau ymwelwyr iechyd. Mae Llywodraeth Cymru yn dal i fod yn gwbl ymrwymedig i gynnal gweithlu ymwelwyr iechyd sicr a chynaliadwy ar draws Cymru. Dyna pam mae Prif Swyddog Nyrsio Cymru wedi comisiynu gwaith i adolygu ac ystyried y ffordd y bydd gwasanaethau ymwelwyr iechyd a threfniadau ehangach ar gyfer y gweithlu yn cael eu trefnu yn y dyfodol, gan sicrhau eu bod nhw'n parhau i ddiwallu anghenion plant, teuluoedd a chymunedau yn y blynyddoedd i ddod. Lywydd, mae pob un Aelod o'r Senedd hon eisiau gweld yr anghydfod yn dirwyn i ben. Rydym ni i gyd eisiau i blant a theuluoedd gael y gefnogaeth maen nhw ei hangen ac eisiau i staff deimlo eu bod nhw'n cael eu gwerthfawrogi a'u cefnogi. Am y rhesymau hynny, dwi'n annog yr Aelodau i gefnogi gwelliant y Llywodraeth sy'n adlewyrchu realiti'r anghydfod a'r camau mae'r Llywodraeth wedi'u cymryd i annog datrysiad, tra'n parhau i ddiogelu gwasanaethau a chefnogi dyfodol y gwasanaethau ymwelwyr iechyd yng Nghymru. Diolch.

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As well as responding to the situation as it is, we must also consider the future of health visitor services. The Welsh Government remains fully committed to maintaining a secure and sustainable health visitor workforce across Wales. That's why the Chief Nursing Officer for Wales has commissioned work to review and consider the way in which health visitor services and wider arrangements for the workforce will be organised in the future, ensuring that they continue to meet the needs of children, families and communities in the years to come. Llywydd, every single Member of this Senedd wants to see this dispute come to an end. We all want children and families to get the support that they need, and we want staff to feel that they are valued and supported. For those reasons, I encourage Members to support the Government's amendment that reflects the reality of the dispute and the steps that the Government has taken to encourage a solution, while continuing to protect services and support the future of the health visitor service in Wales. Thank you.

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