The following amendments have been selected: amendments 1, 2 and 3 in the name of Paul Davies, and amendment 4 in the name of Caroline Jones.

The next item, therefore, is the Plaid Cymru debate on health and social services, and I call on Rhun ap Iorwerth to move the motion.

Motion NDM6029 Simon Thomas

To propose that the National Assembly for Wales:

1. Notes the challenges to the health service in looking after an older population.

2. Calls on the Welsh Government to:

a) proceed with greater integration between health and social care; and

b) increase the amount of GPs, with a focus on recruiting to rural and deprived communities.

Motion moved.

Presiding Officer, thank you for the opportunity to open this debate on a motion tabled in the name of Simon Thomas. This is a debate calling on the Assembly to note the demographic challenges facing the NHS in Wales and calling on the Welsh Government to respond now to those challenges, including moving towards integrating health and social care, as well as taking urgent action with a series of steps to increase the number of staff, including GPs, who will be available in the health service in Wales in ensuing years. I know that ‘crisis’ isn’t a word that the Government likes to hear, and I know that the Minister is very reticent in accepting the word ‘crisis’. It’s not a word that should be used lightly—I would agree with that. But there will be a critical situation within the NHS that will surely develop and deepen unless very definite steps and strategic planning are carried out for the future.

The population forecast for Wales suggests that the percentage of our population over 65 will increase substantially over the next 20 years. By 2037, the number of those over 65 years of age is expected to be 47 per cent of the population, as compared to 30 per cent now. The percentage over 85 will more than double to 10 per cent of the adult population. If the current rates of illness and demand for social care in the population remain similar but within a new demographic pattern of an older population, then it is clear that that will lead to an increase in demand for health and social care services—additional services and different services in future. People will live longer, with more chronic conditions that will need to be managed and monitored outside hospitals and this will lead to a need for far more services within primary health care, including more GPs to provide specialist care, more area and community nurses and social care to keep people who have these conditions living independently. We will also need to integrate: we cannot waste time and, crucially, waste money on fighting bureaucratic battles as to who pays for care, or have lengthy meetings in partnership boards that lead to a few local pilot schemes and little else.

But let’s not be entirely negative. During the ensuing period where there will be increased demand for services, there will also be technological advances—technology treatments, health apps for mobile phones, for example. There will be developments of this kind that will provide opportunities to deliver health and care services in ways that promote independent living at a lower cost and hopefully with better outcomes. You can also consider things such as the increase in capacity among the older population in volunteering, to care for children and other members of the family, as well as an increase in the contribution to cultural, economic and social life in Wales.

Mae’r heriau’n fawr. Ceir rhai cyfleoedd hefyd, fel rwyf wedi crybwyll, ond gadewch i mi sôn am rai pethau y mae angen iddynt ddigwydd—nifer fach o gamau, ond rhai arwyddocaol sydd angen eu dilyn. Ni fyddwch yn synnu clywed llefarydd iechyd Plaid Cymru yn dechrau gyda recriwtio, hyfforddi a chadw staff. Mae arnom angen mwy o feddygon teulu, nyrsys cymunedol a gweithwyr iechyd proffesiynol eraill. Yn anffodus, ceir llai o feddygon teulu yn awr nag yn 2013, ac mae’r ystadegau’n dangos gostyngiad yn niferoedd nyrsys ardal, er ein bod yn ymwybodol y gallai fod rhai cwestiynau ystadegol ynglŷn â hyn, sy’n adlewyrchu, rwy’n meddwl, yr angen am fwy o dryloywder a gwell data.

Ar feddygon teulu, yn benodol, mae nifer y meddygon teulu yng Nghymru wedi bod yn gostwng yn ystod y blynyddoedd diwethaf—mae’r nifer bellach wedi disgyn o dan 2000. Ond yr hyn sy’n frawychus a dweud y gwir yw bod tua chwarter y meddygon teulu sydd gennym yn dweud eu bod yn bwriadu ymddeol yn ystod y 10 mlynedd nesaf. Mae galwadau ar feddygon teulu yn codi, mae lefelau straen yn gwaethygu, nid yw ein lleoedd hyfforddi yn cael eu llenwi—maent yno, ond nid ydynt yn cael eu llenwi—ac mae’n waeth yn rhai o’r ardaloedd mwyaf difreintiedig a gwledig. Mae Plaid Cymru wedi amlinellu nifer o bolisïau i geisio denu a chadw meddygon presennol: talu dyled myfyrwyr meddygon sy’n cytuno i gwblhau hyfforddiant a threulio eu gyrfaoedd cynnar mewn ardaloedd neu arbenigeddau penodol; cyflogi meddygon teulu ar gyflogau mwy uniongyrchol i lenwi lleoedd gwag mewn ardaloedd gwledig a ffiniol i feddygon nad ydynt eisiau’r drafferth o redeg eu busnesau eu hunain. Ond mae’n rhaid i ni hefyd gael mwy o bobl ifanc i astudio meddygaeth ac i fod eisiau dod yn feddygon teulu. Nid wyf yn gwybod faint ohonoch a welodd astudiaeth 2014 Prifysgol Nottingham, a oedd yn gwbl syfrdanol: nid oedd gan 50 y cant o’r holl golegau addysg bellach a dosbarthiadau chwech neb, dim un person, yn gwneud cais i fynd i ysgol feddygol dros gyfnod o dair blynedd—dim un person. Roedd yna lawer ohonynt ag un neu ddau o ymgeiswyr yn unig, ac nid yw’n syndod fod dosbarthiad hyn, unwaith eto, yn adlewyrchu patrymau amddifadedd. Mae’r rhain yn faterion y mae’n rhaid i ni fynd i’r afael â hwy. Mae’n rhaid i ni annog ein pobl ifanc dalentog i feddwl am feddygaeth, a phan fyddant wedi dechrau ar eu hastudiaethau meddygol neu, yn well byth, cyn iddynt ddechrau ar eu hastudiaethau meddygol, i feddwl am fod yn feddyg teulu. Mae’n rhaid i ni sicrhau bod meddygon sydd newydd eu hyfforddi yng Nghymru yn dod i gysylltiad â gofal sylfaenol yn eu cyfnod cychwynnol ar ôl cymhwyso. Nid yw’n digwydd ddigon yng Nghymru, ond mae’n digwydd mewn mannau eraill. Heb feddygon teulu, nid oes gennym obaith o newid ein gwasanaeth iechyd i fod yn un sy’n gallu gofalu am boblogaeth hŷn a’u cadw’n heini. Rwyf wedi canolbwyntio ar feddygon teulu, bydd cyd-Aelodau eraill yn canolbwyntio ar elfennau eraill o’r gweithlu gofal sylfaenol sydd, wrth gwrs, yr un mor bwysig.

Yn ail, fel cam sydd angen ei gymryd, rwyf am sôn fod y gyfran o’r gyllideb sy’n mynd tuag at ofal sylfaenol yn gostwng pan ddylai fod yn cynyddu. Mae’r ffigurau diweddaraf yn dangos bod 7.4 y cant o gyllid y GIG yn mynd tuag at ofal sylfaenol. Mae hynny wedi gostwng o bron i 9 y cant oddeutu degawd yn ôl. Yn Lloegr, tua 10 y cant yw’r lefel; lefel Cymru yn hanesyddol yw tua 11 y cant. Felly, gwyddom ein bod eisiau cael mwy allan o’n sector gofal sylfaenol, ond yn gyfrannol rydym yn rhoi llai i mewn. Dangosodd Coleg Brenhinol yr Ymarferwyr Cyffredinol yma yn y Senedd ddoe fod 90 y cant o gyswllt â chleifion yn digwydd ar lefel gofal sylfaenol—90 y cant o’r cyswllt, 7.4 y cant o’r cyllid. Ac oes, wrth gwrs bod costau uwch mewn gofal eilaidd a bod gofal eilaidd yn fwy agored i chwyddiant costau, ond rwy’n credu’n wirioneddol fod y sefyllfa bresennol yn anghynaliadwy.

Yn drydydd, mae angen i ni fod yn llawer gwell am arloesi a mabwysiadu technolegau newydd, megis apiau, telefeddygaeth, a GIG di-bapur. Mae’r GIG yn rhy aml ymhell y tu ôl i’r mwyafrif o wasanaethau a diwydiannau eraill. Ni all fod yn iawn fod ysbytai yn dal i gyflogi pobl i wthio troliau o waith papur o gwmpas.

Yn bedwerydd, mae arnom angen system iechyd a gofal cymdeithasol fwy integredig, un sy’n briodol ar gyfer anghenion poblogaeth wledig a gwasgaredig, nid anghenion rheolwyr GIG sy’n cael eu hel o gwmpas i osod modelau gofal trefol mewn ardaloedd lle nad yw hynny’n addas. Rhaid i hyn hefyd gynnwys mynediad at wasanaethau arbenigol, megis adrannau damweiniau ac achosion brys, yn agos at ble mae pobl yn byw, a gwasanaeth ambiwlans sy’n treulio’i amser yn ymateb i alwadau brys, yn hytrach na chiwio mewn ysbytai neu drosglwyddo cleifion ar deithiau hir oddi cartref. Bydd fy nghyd-Aelodau’n ymhelaethu ar lawer o’r pwyntiau hynny y prynhawn yma.

Gan droi at y gwelliannau, byddwn yn ymatal ar welliant 1. Nid ydym yn hollol siŵr beth y mae’r Ceidwadwyr yn ei olygu wrth yr asesiadau gwirfoddol hyn a beth bynnag, deallwn fod fersiynau o’r asesiadau hyn yn digwydd beth bynnag. Ond nid oes amheuaeth y cawn glywed mwy gan y Ceidwadwyr. Byddwn yn cefnogi’r gwelliannau eraill. Mae angen cynllun newydd arnom ar gyfer gwasanaethau mewn cymunedau gwledig; dylid adolygu Comisiynydd Pobl Hŷn Cymru, wrth gwrs, i wneud y swydd yn fwy effeithiol, a dylai hynny ddigwydd yn rheolaidd; a gall ysbytai cymuned, wrth gwrs, chwarae rhan hanfodol yn llyfnhau’r cyfnod pontio yn ôl i’r gymuned i lawer o bobl, er bod sut y mae UKIP yn bwriadu staffio eu gwasanaeth iechyd ar ôl gadael yr UE, pan fo cymaint o weithwyr mudol yn chwarae rhan hanfodol yn ein gwasanaeth presennol, yn rhywbeth i fyfyrio yn ei gylch y prynhawn yma. Rwy’n edrych ymlaen at eich—[Torri ar draws.] Rwy’n dirwyn i ben. Rwy’n edrych ymlaen at eich cyfraniadau; fe gewch gyfle mewn eiliad i wneud eich pwyntiau mae’n siŵr. Rwy’n edrych ymlaen at gyfraniadau’r holl Aelodau y prynhawn yma. Mae hon yn un o’r dadleuon pwysicaf sy’n ein hwynebu yng Nghymru ac yn un o’n heriau mwyaf.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Thank you. Before we go on, could you all check your mobile phones, please? If you’ve got a mobile phone on, can you please switch it off? It is affecting the broadcasting and the sound in the Chamber. Thank you very much.

I have selected the four amendments to the motion, and I call on Suzy Davies to move amendments 1, 2 and 3, tabled in the name of Paul Davies. Suzy.

Gwelliant 1—Paul Davies

Add as new point at end of motion:

Calls on the Welsh Government to introduce voluntary stay at home assessments to promote independent living and planning for future need.

Gwelliant 2—Paul Davies

Add as new point at end of motion:

Calls on the Welsh Government to bring forward, at the earliest opportunity, a new plan for access to health services and health service infrastructure for rural communities.

Gwelliant 3—Paul Davies

Add as new point at end of motion:

Calls on the Welsh Government to review the role of the Older People’s Commissioner.

Amendments 1, 2 and 3 moved.

Diolch, Ddirprwy Lywydd. I move our amendments to this very broad, but very useful, debate.

The Plaid leader’s war cry in the election was that her party has nothing in common with the Tories and wouldn’t work with us. Yet, only last week, they called for an arm’s-length body for economic development—a long-standing Welsh Conservative policy—and here we are again, drawing attention to common cause, reflecting what might be a little bit uncomfortable for Leanne Wood, but which is a source of hope, I think, for voters: that opposition parties can work together to challenge the stale old status quo. We are supporting this motion, and we are supporting amendment 4.

There is no material difference between Plaid’s NHS medical care homes and our plans for the innovative use of community hospitals, backed by a development fund. Some of those buildings will, of course, be beyond accommodating new ways of providing localised treatment in care, and the argument remains then for sustainable multi-purpose replacements. However, more modern facilities, like Gellinudd, Cimla and Maesgwyn in my own region, were closed, with the inevitable loss of beds, to help justify the under-use of the private finance initiative hospital in Baglan and to avoid the institutionalisation of patients. Well, now, too many elderly, frail patients are becoming institutionalised in expensive acute beds as step-down care is rare, and homecare packages are delayed. Sometimes that care at home is not meeting needs, with re-admissions due to failures in support. So, of course we’re in agreement on point 2(a) of the motion. A cross-party commission on the long-term sustainable provision of care in Wales, as called for by the Welsh Conservatives, would help gather the evidence and identify whether the changes that Plaid proposes would work or not. Such a commission would gather the evidence to underpin legislation to require health and social care providers to work collaboratively, delivering a more organic integration of both systems rather than a massive structural tsunami. Under our proposals, Wales would have a £10 million care innovation fund to promote that joint working at all levels, including convalescence and re-ablement, and which responds to the challenges of geography.

It’s all good, isn’t it, that the Welsh Conservative and Plaid manifestos committed—both of us—to the introduction of specialism in the rural delivery of medicine? I wonder whether you’ve raised that rather inconvenient common ground by agreeing that mobile units delivering cancer treatment would be a useful contribution to equalising access to treatments in rural and deprived areas, or are you going to disagree with us just to distance yourself from us? Myself, I think that supporting our second amendment would be a very encouraging sign to the voters of Wales that our equal number of votes in this Chamber are being used to hold this Labour Government to account on its failure when it comes to equalities in access to health services.

So, let’s not forget our first amendment. The stay-at-home assessments would help prevent crises that need high-end health and social care intervention by helping citizens plan ahead—that’s the difference with what’s happening primarily now—for ways to maximise their chances of independent living when age-related medical conditions and events, physical or mental, might make living at home more difficult, in the way that they want to do. It costs a fraction of the £21 million that our NHS is currently spending on keeping people in acute beds for 27 days on average as a result of delayed transfers of care. Of course, it will help some avoid the need to move into residential care in the first place—on which, the big society is still alive and well on these benches when it comes to personal care. Welsh Conservatives see the advantages of including mutuals and co-ops in the provision of first-class care—something else that Plaid and other Tories have, embarrassingly, in common.

We also recognise Plaid’s ambition for increasing the number of GPs, and the wider need for more training places in Wales to improve the capacity of the NHS where it’s needed, including the areas that you’ve identified. We’ll continue to argue for more specialist nurses, nurse prescribers and nurse consultants in the Welsh NHS, too. Do you agree with us on that, or is that too Tory for you as well?

Finally, the motion acknowledges that older people need health services more than most. The older people’s commissioner will be championing an increasing number of people in the next two decades and needs to be more powerful in terms of powerful interventions. It’s just one of the reasons why Welsh Conservatives believe that the role of the older people’s commissioner should be reviewed, and the commissioner made accountable to this Assembly—a critical friend of Government, but accountable to the people of Wales. I’d be curious to know whether on the basis of that you’ll be prepared to support this amendment, or whether you will show yourselves to be different from the Tories, to be an uncritical friend of Labour, whose anti-Tory war cry drowns out Wales’s call for constructive collaborative opposition to challenge and scrutinise Government. Thanks.

Thank you. I call on Caroline Jones to move amendment 4, tabled in her name.

Gwelliant 4—Caroline Jones

Add as new point at end of motion:

Regrets the closure of community hospitals across Wales and calls on the Welsh Government to support and, where possible, re-establish community hospitals in order to bring services closer to people’s homes.

Amendment 4 moved.

Diolch, Lywydd. I would also like to thank Plaid Cymru for bringing forward this very important debate on health and social care. My amendment seeks to add to the debate while not detracting from the overall motion. I believe passionately that cottage or community hospitals are a part of the solution to reducing the burden on our emergency departments, reducing delayed transfers of care and reducing the distances people have to travel to receive care. I urge you to support the UKIP amendment.

Moving to the Welsh Conservative amendments, UKIP will be supporting amendments 2 and 3. There is a clear need to address access to health services in rural Wales. Perhaps the Welsh Conservatives will support our calls to re-establish cottage hospitals. We also support the Welsh Conservatives’ call to review the older people’s commissioner role. As others have said, Sarah Rochira does an amazing job, but her role and remit need strengthening and expanding. UKIP also agree with the Welsh Conservatives that the commissioner should be accountable to the Assembly, not the Welsh Government.

With regard to the Welsh Conservatives’ first amendment, we shall be abstaining. We are not convinced that these stay-at-home assessments can achieve the desired outcome that we all share, which is promoting independent living and supporting people to stay in their own homes for as long as is possible.

Llywydd, our NHS is the victim of its own success. Thanks to advances in clinical care, we are living longer. The number of people aged 65 and over is projected to increase 44 per cent by 2039. Unfortunately, as many of us know only too well, with increasing age comes increasing health issues. This fact alone highlights the need for closer integration between health and social care. Far too many older people are experiencing delayed transfers of care and remaining in hospital for longer than needed.

Figures from April 2016 show a total of 495 delayed transfers of care: over half of those resulted in delays of three weeks or more; over 20 people were waiting for 26 weeks or more. It should be of huge concern to us all that so many people are staying weeks longer in hospital than necessary. These unnecessary delays cost our NHS millions of pounds a year, but the cost to the individual is immeasurable. According to Age Cymru, the main facts responsible for delayed transfers of care include a lack of appropriate facilities for re-enablement and recuperation, long delays in arranging services to support people in their own homes, and the barriers that exist between health and social services.

It is worth noting that the majority of NHS leaders said that shortfalls in local authority spending had impacted on their services. I accept there is no one simple fix. There’s no magic pill and there’s certainly no right answer in solving the problem of delayed transfers of care. However, there are some simple fixes that will go a long way in trying to eliminate delayed transfers. Greater integration between health and social care will help. Many NHS trusts in England have reduced delayed transfers by working with local authorities to keep a care-home placement open for 48 hours.

Traditionally, once a person is admitted to hospital, their care placement is ended and a new placement has to be secured once the patient is ready to be discharged. This does take time. This simple change has greatly reduced unnecessary delays. Greater funding for social care will also help. As I mentioned earlier, the NHS Confederation believes that shortfalls in local authority spending have impacted on NHS services. Our social services teams are overstretched and, if we are to have any chance of meeting the challenges of an ageing population, we need to invest in social care.

Finally, greater use of community hospitals will help. Many older people require an extended stay in hospital for observations and social-care needs. Traditionally, we used cottage hospitals for convalescence. Let’s re-establish these cottage hospitals in order to take the burden off our local, busy, hospital wards.

Llywydd, I urge Members to support our amendment and to support the Plaid Cymru motion. Diolch yn fawr.

It’s a pleasure to participate in this important debate this afternoon and I’m pleased to hear the Conservatives alluding to Plaid Cymru very frequently in their speech this afternoon.

As we’ve already heard from Rhun, there are a number of challenges facing the health service, and very often they are at their most intense in the rural and most deprived areas. It’s quite obvious, and has been for some time, that we need an integrated health and social care system in Wales. We can’t spend time and money battling about who should pay for what and who should do what whilst the person and the family requiring that service are forgotten in the midst of the bureaucratic system.

As a family, we had direct experience of the arguments that arise too often as care plans are established for individuals. We were trying to get my father home at the end of his life. It took quite a bit of energy to move things on, to get agreement about who paid for which element of the care, and many people would have given up. That would have been contrary to my father’s wishes, and he was the patient. It would also have meant significantly higher costs for the health service because, of course, keeping a patient in a hospital bed is much more expensive than looking after them at home. After my father was at last discharged from the hospital, we had a peerless service, with the health service, the voluntary sector, social services and ourselves as a family working together. The problem was before that, namely getting to the point where that collaboration was possible. So, it’s high time that we seriously set about integrating the services in a real way, on the ground, rather than in partnership boards and talking shops.

There are good examples of good practice available—planned services that are patient-centric. There’s one excellent scheme working at the Alltwen Hospital in Gwynedd and it would be good to learn from that experience there and in other places, and, more importantly, to take action on what works well. As the Government looks again at how local government will be reconfigured in future, here’s an excellent opportunity to address this seriously and an excellent opportunity to restructure in a way that truly improves how we provide and deliver services to our people, and that should be at the root of any reorganisation. We are all living longer, which is excellent news, but very often we are living longer whilst facing chronic conditions that need to be controlled and managed outside of hospital, and this, as Rhun has already said, means more services in the primary care sector, including more GPs, more community nurses and coordinated social services.

I mentioned at the outset the challenges facing rural areas, and Rhun has said that we mustn’t use the word ‘crisis’ too lightly. But I am going to use it about the circumstances that exist in some of the areas. There is a real crisis in some areas because of the lack of general practitioners. In Dwyfor, for example, almost half the GPs are about to retire. Plaid Cymru have outlined a number of policies to attract and retain GPs. We do need a long-term plan in order to train doctors, including GPs, in Wales. We need a national solution to expand the provision in Cardiff and Swansea and to create a new medical school in north Wales as part of a pan-Wales plan.

Doctors stay on to work where they have trained—there’s a great deal of evidence to back that statement. The idea of having a north Wales medical school is fast attracting support. I believe that we can create a model of a unique medical school with a focus on rural medicine. Wales can be in the vanguard on this, innovating with the use of new technology and creating new models of rural medical provision. Thank you for allowing me to participate, and I hope that everybody will support the motion.

Adapting services for an increasingly ageing population, particularly in deprived communities, is one of the key challenges for our public services. Our population is steadily growing, but is also steadily ageing. Recent statistics from the NHS Confederation show that, across the UK, the population of over-65s will rise to nearly 18 million in 20 years’ time, with the population of over-85s doubling during the same period to nearly 4 million. And, as has already been highlighted by the spokesperson for health for Plaid Cymru, in Wales, we estimate that figure to be over 1 million over-65s. It’s going to be a major element of our figures.

Now, these wider population changes will undoubtedly have a significant effect on our health and social care services, with more and more people needing extra help at a time when our public spending resources are being reduced by the UK Government on a continual basis. For secondary care in Wales, the average age of a hospital patient is 80 years old, with 10 per cent of hospital patients aged over 90. Now, added to this, the average hospital stay in Wales is seven days. We can see the impact this is having on our secondary care services. These figures give us a clear measure of the potential impact on our services. Increased demand inevitably means longer waiting times for appointments and potential delays of transfer of care, while an ageing population invariably means an increase in the number of patients with long-term conditions requiring continual attention, alongside multimorbidities. Two thirds of our population aged 65 and over have at least one chronic condition, while one third have multiple chronic conditions, all of which inevitably require more and more complex treatments and longer consultation processes. This increased pressure on our increasingly limited resources requires us to make strategic, sustainable and innovative decisions around workforce planning.

The flow of patients through the secondary care setting is crucial in order to provide high-quality care packages as fast as possible, but the role of community-based care must not be underestimated. We have often spoken in this Chamber of the need to get back to our communities and provide services that are as local to people as possible, enabling them to remain in familiar environments with social support from family and friends and making full use of the community services provided.

In discussing transfers to community-based care, we cannot neglect the warnings of the British Medical Association and the Royal College of General Practitioners around GP recruitment. We know that, in Wales, we have a challenge to recruit GPs, not just in rural areas, but also in many deprived urban areas, and these challenges are widely documented and must be tackled if we are to effect a whole-system change. We must recruit new GPs, not only to fill the vacant spaces, but also to take over from older colleagues, 23 per cent of whom are over 50, as has been highlighted already. They are ageing faster than we are training new replacements, with only 107 out of the 125 GP training places filled last year. We must do more to incentivise our young trainee medical professionals to follow a GP pathway and provide them with the training and skills that they need to address these issues. We must increase the number of places available from the current 136. That must be dealt with with the deanery and we must look for training places in GP practices to accommodate them as well.

We must also avoid focusing solely on GP provision, as we seek to provide a holistic model of community care such as we’ve seen recently in Prestatyn. We must look to our community dentists and pharmacists and our district nurses and physiotherapists to provide excellent care where GPs are not needed. In this, we must follow the principles of prudent healthcare to make full use of all their colleagues and ensure that they do what only they can do. We therefore also need to address the training of these professions practically: in-practice and district nurses and advanced practice nurses and other practice nurses. We can perhaps link and encourage alternative pathways of training for these professions.

I welcome the Welsh Government’s primary care workforce plan, which will support creating greater service delivery in practices across the sector and I look forward to its successful delivery. These are clearly targeted at addressing some of these concerns. But we must also look at our public health services, as the older population must be supported in their communities to live full and happy lives. We know that loneliness and isolation pose serious health risks, as do tobacco and excessive alcohol consumption. We must support campaigns that tackle social isolation and promote befriending groups across our communities. We must further encourage our population to make healthy life choices, providing the social, cultural and sporting environments that they need to lead active and sustainable lives, thereby reducing the likelihood of developing medical conditions and ending up in our hospital services.

Finally, we must remember that the challenges of an ageing population are not unique to health and social care services. We must take a more rounded approach to our decision making, encompassing housing and education and particularly lifelong learning and improved literacy and numeracy skills, encouraging collaborative working across our public services. We must further look to the future, ensuring that the principles that are enshrined in our Well-being of Future Generations (Wales) Act 2015 underpin our actions in all portfolio areas to help our ageing population.

I’m very pleased to have the opportunity to contribute to this important debate. Perhaps I’ve mentioned before that I’m a GP, but if I haven’t mentioned that enough, I repeat it this afternoon. But the fact that people are living longer is a matter of praise for the health service, if anything. We are used to hearing people criticising the staff and the health service, but, at least, when there’s evidence and it’s a clear fact that we’re all living longer, it should be a matter of praise for the health service, for the NHS.

Of course, the surgery, as a rule, is usually the first place that people turn to when they’re in need—the first port of call. What we’re increasingly finding is that that service in the surgery is under terrific pressure. We know the figures: 90 per cent of our patients are seen in primary care—we used to say on 10 per cent of the budget, but, as we’ve heard already, that percentage of the budget has gone down to 7.45 per cent. There is a requirement, therefore, on GPs and their staff to do more with fewer resources. Following on from what the Royal College of General Practitioners and the BMA have been saying over the last few months, there is a need to divert and change the budget back to what it used to be, which was about 11 per cent of the NHS budget, because, in essence, the number of appointments that we have with our patients is on the increase. Those appointments are more intense and more complex, because of the nature of the illnesses, as we’ve heard from David Rees. Older people have more than one chronic condition, and it is a significant challenge to deal with all of them in 10 minutes. At the end of the day, what we’re concerned about as GPs is that we want to improve the quality of that discussion between the GP or the nurse and the patient. We only have 10 minutes, and that’s on a good day, because, on average, we see between 50 and 80 patients every day. What we want to see is an improvement in the quality of those 10 minutes that we have. That’s why we need more funding and resources: in order to employ more GPs in the first place, but also more nurses, more physiotherapists and so forth, and also social workers in our practices, and, I would say, on every ward in our hospitals. That’s where the collaboration with social services comes in, and is so important.

We don’t need expensive reorganisation. We want social workers working with us in surgeries, arranging social services for our patients, but also on the wards—to have one social worker there who can arrange how that patient is going to be discharged at an early stage with all the arrangements in place. That’s why there’s a need to employ more workers at grass-roots level. That’s why we need a greater part of that budget coming to primary care. We need to increase it from 7.45 per cent back to where it was, around 11 per cent, because 90 per cent of the patients are seen in primary care, and we want the resources to offer an improved service. Those resources include employing more GPs. As David has already said, there are some things that only a GP can do. We need more of them. But we have make the work, the job, more attractive to our young doctors who are now in our hospitals. They need to be better influenced than they are at the moment to become GPs. All those plans that we have already to attract doctors back to general practice—we have to improve them, and it must be made easier to attract our most able GPs back to general practice, particularly in our most rural communities and most deprived communities.

So, there are many challenges, as we’ve heard, but we need to address those challenges. Ultimately, our health service relies on general practice that is also fresh and energised and that can solve the majority of problems in our communities. If we were to divert just a small percentage more of our patients to hospitals, then our hospitals would be under even greater strain than they are at the moment. By investing more money in primary care, we could prevent many people from having to go to A&E departments or from being on waiting lists in the first place, because we have the resources and the ability to arrange things for our patients in the community, but we have to have more assistance. I would be pleased to hear from the Minister if he would be willing to meet with the leaders of GPs in Wales in order to discuss the way forward. Thank you.

I am pleased to return to what I hope will be a positive debate on the health service. Over the past weeks, I, like many other people, have been dealing with constituents who are greatly concerned about the fact that there is increasing pressure on the local surgeries, that they have to wait for 10 days or a fortnight for an appointment with a GP, and that the services in the local hospital have been reduced. It’s important that we here acknowledge that this arises directly from the decisions of the Welsh Government.

Whether good or bad, decisions that we have made over the years are responsible for this, and not immigrants from outside as has been suggested in debates over the past weeks. You are much more likely to be treated by somebody from outside Wales and outside the United Kingdom as part of the workforce that is needed from outside the United Kingdom than lying in a hospital bed side by side with an immigrant. That’s what we’re discussing here.

I believe that the Plaid Cymru debate acknowledges two things: that we did actually take the wrong turning, as it were, as regards the recruitment and retention of GPs in Wales. Another false move, if you like, is the way we treated some of our community hospitals, and the failure, particularly in rural areas, to recognise that we needed community hospitals, perhaps in a new guise—not like the old cottage hospitals—but that we needed some kind of institution in the rural areas to sustain the network of local hospitals that people appreciate but also enrich public health.

One example of this was the undoubted success, in my view, of the bargain that was struck between Plaid Cymru and the former Labour Government to establish an intermediate care fund. At the time, the Government didn’t believe that there was a need for such a fund, to provide for integration between health services and social services. By now, that fund is acknowledged as something which has been a success and has led to a number of people being able to stay in their homes, and been the means of integration between health and social services. So, I believe that we missed an opportunity to build on our community hospitals.

There are opportunities to improve. The mid Wales joint partnership was established recently by the former health Minister, and is beginning to bear fruit. It’s starting to bring new ideas to the fore to see what hospital and primary care services can do in rural areas. Examples have been portrayed during meetings of that joint partnership of places beyond Wales—Scandinavia and North America—but we don’t need to go any further than Yorkshire to see what can be done with community hospitals in Wales. In Pontefract, a brand new community hospital was established with 42 beds in order to reduce the pressure on the acute wards. That new hospital that’s only just opened, just under a year ago, has already saved money and enables patients to return from tertiary hospital treatment more successfully. So, these are the examples of what community hospitals in my constituency, such as in Blaenau Ffestiniog and in Tenby, could do in the future.

Looking at Tenby specifically, this is another example of a hospital that lost its minor injuries unit, unfortunately, as it was closed for safety reasons—we’ve heard of this a number of times—but it has returned in pilot form last Easter and it was a sweeping success, and the local GPs also wish to see this being established.

So, in rural areas—for example, 60 per cent of the population in Ceredigion and 53 per cent of the population in Carmarthen East and Dinefwr are further than 15 minutes away from their GP—we need to seriously consider how we can establish a network of community hospitals.

During this debate we are looking to reconsider the way our community hospitals and GPs can deliver services, particularly in rural areas. Perhaps we should set aside some of the debates and arguments from the past and look forward to a more affirmative and positive attitude from this new Government.

I’m slightly diffident in rising to speak on the topic of the integration of health and social care, given the immense contribution that my predecessor as Assembly Member for Neath, Gwenda Thomas, has made in this particular policy area in Wales, and in particular with regard to the Social Services and Well-being (Wales) Act 2014 itself. So, I’ll take this opportunity to pay tribute to her for her political legacy in this place, which will surely benefit hundreds of thousands of people in Wales.

Like many Members, I’m sure, access to a GP is something that came up routinely on the doorstep during the election campaign we’ve just fought, and it still does. One issue it seems to me important for us to recognise, as Dai Lloyd already has, is that the increasing numbers of older people that our NHS and care services need to provide for is the result of improved healthcare provision over the years. And, in that sense, it’s a result of success. I am always mindful of the language that we use when we speak about the needs of older patients in describing the challenges facing health and social care. We would all agree that it is unequivocally a good thing and a thing to be celebrated that we have a generation of older people living longer whose needs we’re able to cater for.

But the operational challenges of addressing this need are another matter, and we do need more GPs in order to meet the needs of our population, and this is, and must be, a priority for the Government. But, actually, the overriding aim must be a primary care service that provides the right sort of care, whether that’s provided by a GP or another health professional perhaps better equipped to do that. The development of multidisciplinary practices with pharmacists, practice nurses and other professionals working alongside GPs offers the potential to provide the type of care required by the patient whilst also enabling the GP to focus on patients who have a particular clinical need to see a general practitioner. I’d refer to the excellent model of innovation in the Amman Tawe practice in my constituency, which also extends into the Carmarthen East and Dinefwr constituency of Adam Price. It seems to me that a strong practice ethos and parity of esteem between practitioners is vital to the success of that model, and the prize is not only care that better meets the needs of the population, but perhaps it also makes it easier to attract GPs to those practices. I stress that this isn’t to deny the fact that we need to recruit more GPs. We clearly do, and we need to continue to help those practices that are finding it hard, for whatever reason, to fill those vacancies.

One of the key issues, it seems to me, is that the reconfiguration of those practices is one part of the equation. But the other vital part is the role and in particular the expectations of the patient. It may be understandable for a patient who has been, over the years, used to seeing a GP to feel that seeing another healthcare professional doesn’t do the same or indeed a better job. Many of us will have examples of concerns raised over triage arrangements in particular. So, it seems to me vital that ways are found to engage local communities genuinely and deeply as partners in improving health and care provision. There is a relationship of trust at the heart of the doctor-patient relationship that is not straightforward to replicate. But, equally, successful multidisciplinary arrangements seem to me to depend on a good level of health literacy in the general population. There is an element of physical and mental self-awareness and an understanding of risk that perhaps isn’t where it needs to be in order for some of these practises to work in the best way. So, the work that Public Health Wales and others do in striving to improve health literacy is crucial.

I want to say something about the relationship between public transport and primary care services. The work done by the Government’s bus advisory group acknowledges the importance of aligning routes to key trip generators like health centres. We should also explore the potential for primary care centres themselves to partner with volunteer-based regulated community transport providers to make it easier for patients to access appointments. Indeed, we should also look at how primary care practices can be supported generally to work more closely with the voluntary sector as equal partners, which Sian Gwenllian alluded to in her contribution. A community level focus on this is important. Getting this right will support the integration of health and social care at a primary care level as well as at a secondary level, and care planning needs to focus on the holistic needs of the patient, taking into account the role of social services in the community and indeed the role and, in fact, needs of carers themselves. As many speakers have mentioned, there are excellent examples of this across Wales, and the intermediate care fund exists to support that way of working. But we must ensure that in this, as with other areas that I’ve mentioned, best practice is identified and universalised.

The Welsh Government policy on community health services and health budget cuts described by the Wales Audit Office as ‘unprecedented in UK history’ increased pressure on our general hospitals. The 2016 Welsh Conservative manifesto included proposals to drive greater integration between health, social services and communities. We also said we’d create a community hospital development fund and re-establish minor injury units to repair the damage caused by Labour’s community bed cuts and minor injury unit closures. In March 2010, the Labour health Minister then said, ‘I’m not aware of any threats to community hospitals across Wales.’ In reality, I’d established CHANT Cymru—Community Hospitals Acting Nationally Together—which successfully campaigned for suspension of Labour’s plans to close community hospitals in 2007. However, when Labour returned to single-party power in Cardiff in 2011, they again pushed ahead with their community hospital and bed closure programme.

North Wales Community Health Council wrote to the then health Minister expressing concerns about the robustness of the information provided by Betsi Cadwaladr university health board, which they had used to inform their closure decisions for community hospitals in Flint, Llangollen, Blaenau Ffestiniog and Prestatyn. Dozens of community beds were lost, despite bed occupancy levels of 95 per cent and above. The GP who set up the north Wales pilot enhanced care at home scheme with the health board said that this will bring a service that is currently frequently gridlocked further to its knees, and that a central part of the proposed shake up of health services—providing more care in people’s homes—won’t fill the gap left by shutting community hospitals.

The Labour Government ignored the Flint referendum in which 99.3 per cent voted in favour of returning in-patient beds to Flint and then ignored the Blaenau Ffestiniog referendum when an overwhelming majority voted in favour of returning beds there. When I had visited Holywell hospital, staff told me that extra investment in our local community hospitals such as Holywell and NHS community beds in Flint would take pressure off our general hospitals, help tackle the A&E crisis and enable the health board to use its resources more efficiently.

As the head of the NHS in England said not so long ago, smaller community hospitals should play a bigger role, particularly in the care of older patients. At a British Medical Association Cymru briefing in the Assembly in June 2014, the chair of the North Wales Local Medical Committee warned that general practice in north Wales is in crisis, that several practices had been unable to fill vacancies and that many GPs were seriously considering retirement. Early this year, GPs in north Wales wrote to this First Minister accusing him of being out of touch with the reality of the challenges facing them.

The Royal College of GPs states that general practice in Wales provides, as we’ve heard, 90 per cent of NHS consultations, but only 7.8 per cent of the budget. They say prolonged underinvestment means that funding for general practice has been decreasing compared to the overall Welsh NHS, yet we face the significant challenges of an ageing and growing population. As they say, consultations are becoming longer and more complicated as we deal with an increasing number of patients with multiple chronic conditions. As they stated in an Assembly meeting yesterday, nearly four in 10 patients in Wales find it difficult to make a convenient GP appointment—up 4 per cent in two years; 84 per cent of GPs in Wales worry that they miss something serious with a patient due to pressures; and more than 52 per cent of GPs face significant recruitment issues, with Wales needing to employ more than 400 more GPs.

Given the GP shortage, we heard that models such as the multi-disciplinary practice introduced in Prestatyn are needed. However, we also heard that this was based on an overseas model, which had a higher ratio of GPs to other disciplines; that we will lose the holistic view and continuity provided by GPs, damaging the well-being of patients; and that the health board is not stepping in until crisis or disaster. We heard that, in Manchester, 100 per cent of junior doctors will spend time in general practice, compared with just 13 per cent in Wales, and that every junior doctor in Wales should be exposed to general practice. We heard that north Wales needs to focus, once again, on recruiting GPs from Manchester and Liverpool universities; that support is needed for struggling practices and individual GPs suffering burnout; and that NHS community beds add to the breadth of things GPs can do, assisting both primary and secondary sectors.

So, let us hope that this reshuffled Labour Government starts listening, at last, and delivering the solutions that the professionals know that we need.

I call the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Thank you, Deputy Presiding Officer. I’m grateful to Plaid Cymru for bringing forward this debate and for the generally constructive manner in which Members across parties have engaged. In Wales, we recognise that more than a quarter of our population are over 50, and this is due to rise by more than a third in the next 20 years. Inevitably, our ageing population will increase demand and put extra pressure on the health and social care system. In 2015-16, over half of all adult hospital admissions were for patients over 65. That accounted for over 70 per cent of the total bed days in our health service.

Hospital stays should, of course, be kept to a minimum, but here it’s appropriate to comment on some of the points made about delayed transfers. We have an improving picture here in Wales, in direct contrast to England, which has record highs—the highest figure since records began. What I’m pleased to see here in Wales is that health boards and local authorities recognise their shared challenge in this area, and it’s fair to say that hasn’t always been the case. There is room for optimism, as well as room for rigour and more challenge for improvement. We recognise that we need to ensure that older people are able to maintain their independence and focus efforts on returning people to their home with appropriate care and support.

So, the Welsh Government wants to make sure that health and social services work together to improve outcomes and the well-being of older people. In March 2014 we published our integrated framework for older people with complex needs. Now, that focused on ensuring the development and delivery of integrated care and support services for older people, particularly the frail elderly.

The intermediate care fund, mentioned several times in the Chamber today, has been a key driver for integration. The fund was established, as has been mentioned, in a previous budget agreement, to improve care and support services, in particular for older people, through partnership working with health, social services, housing and the third and independent sectors. This year, £60 million of funding has been provided, and we’ve continued with the fund and its existence, and this should continue to fund initiatives that will help older people to maintain their independence, avoid unnecessary hospital admission and prevent delayed discharges. There are successful examples up and down the country.

Members will be aware of the transformational Social Services and Well-being (Wales) Act 2014, which was commenced in April this year, and I was pleased to hear recognition of the legacy of the previous Member for Neath in delivering that piece of legislation. A key principle within this new legal framework is a requirement for integrated and sustainable care and support services. Now, though I’m sure everyone has read the regulations under Part 9 of the Act, they’ve established statutory regional partnership boards. These will drive the delivery of efficient and effective integrated services. They will not be bureaucratic talking shops. They will be a key part of making partnership real and delivering change on the ground.

Supporting statutory guidance sets out that these regional partnership boards must—not ‘will’ or ‘may’, but ‘must’—prioritise the integration of services in a number of areas. That includes a continued focus on older people with complex needs and long-term conditions, including dementia.

The second part of the motion deals with GP numbers and, as part of the compact to move Wales forward agreed with Plaid Cymru, this Government is focusing on increasing the numbers of GPs and primary health care workers across Wales. A key commitment includes delivering actions to help train, recruit and retain GPs, including in rural areas. We do now have more GPs than ever before, employed in different ways, but, in Wales, we are also filling more of our training places than England or Scotland. But we know that this is still a challenge, and they don’t fill all of our places. It’s a challenge to be taken on and dealt with, and not ignored. So, we will continue to listen to workforce representatives and other parties, as we do take this work forward.

I can also confirm, given the direct question, that I’ve already met with the Royal College of GPs and the BMA’s GP committee, and I look forward to a constructive working relationship with them. They, in fact, were very supportive of the measures the Government wants to take. Their key challenge for us is to deliver on the plan that they agree with.

So, we will continue to address workload concerns and support the development of new models of care. We also need to ensure that we recruit, train and retain other primary care professionals who can support GPs. Good examples are clinical pharmacists, nurses and therapists, for example physiotherapists, who are doing a great deal of work to make sure that people have their needs dealt with appropriately, within community settings and avoiding the need for people to go onto orthopaedic waiting lists. The challenge is how consistently we share that good practice, and I continue to want to drive that improvement throughout the whole system.

The role of the GP is, of course, critical, and the leadership role within those new clusters of arrangements, but there is broader recognition that their role has to evolve so that they can be used to the best effect to focus on patients with the most complex needs—as a number of people have said today and on other occasions, to do only what a GP can only do, to provide that leadership to the practice and also within cluster activity. I’m particularly pleased to see the broadly positive welcome that clusters have had, both from the BMA and from the Royal College of GPs, and we will take that learning forward over this next year and more.

I do expect services to shift into primary care and for resources to be shifted with them. We do recognise that the recruitment of GPs is a challenge, and it’s a challenge not limited to Wales. A plan to address this issue will be developed within the first 100 days of this Government to deliver on the commitment given by the First Minister. This work, of course, is complemented by a £40 million national primary care fund. In the last year this resulted in improvements in many parts of Wales, including an increase in the number of GP appointments later in the day.

I should now turn to the amendments. We won’t support the first amendment. The Social Services and Well-being (Wales) Act introduced a care and support assessment process for all people, including older people. That assessment is person-centred and focuses on the personal outcomes that they want to achieve. The core of this process is a conversation with the individual to agree solutions to help them retain or to regain their independence. Understanding what is important to the individual citizen and agreeing how to achieve that outcome in a much more consistent way is a real challenge for health and social care services, or, to put it another way, how to work with and not simply to deliver to an individual.

We also won’t support amendment 2. The Mid Wales Healthcare Collaborative is already taking action to improve access to primary care services, including the recruitment and retention of GPs. It’s already developed a range of innovative solutions, which will have a wider learning opportunity for other rural areas. The Welsh Government is supporting the move of care close to home, through initiatives such as a virtual ward scheme, and, indeed, work on the emergency medical retrieval and transfer service to make sure that people can be transferred to the most appropriate setting. I’d also mention here the scheme on Ynys Môn that I’ve mentioned previously in the past—the enhanced care scheme that is delivered between GPs, social services, advanced nurse practitioners and Ysbyty Gwynedd. The improvements that I’ve seen being directly delivered in that part of Wales—there’s learning there for the rest of the country.

We’ll also oppose amendment 3. We’re considering the review by Mike Shooter on the role of the children’s commissioner. That has lessons for us on the role of all commissioners, including the older persons’ commissioner.

And finally, we will also oppose amendment 4. Several outdated community hospitals have been replaced by modern primary care resource centres. We recognise the challenge that we face. We know that we cannot provide the same model of care and improve outcomes for our population for the changing demographics that we face. There will be, with this Government, a greater focus on integration, with care closer to home to both prevent and to treat. Our ambition is clear: to meet the changing needs of people across Wales, to deliver different services but better services with better care and better outcomes. I look forward to working with people in and outside the Chamber to do exactly that.

Thank you very much. I call on Rhun ap Iorwerth to reply to the debate. Rhun.

Thank you very much, Deputy Presiding Officer. May I thank everybody who’s taken part in this debate this afternoon? I agree with the Minister that it has been a debate that has constructive on the whole. I’m not sure why Suzy Davies, on behalf of the Conservatives, feels so prickly today. Certainly, there’s nothing from me that places barriers for collaboration with other parties for agreeing on areas where there is a way of pushing the agenda forward for the health service, because it’s the health and well-being of our people here in Wales that’s important here, not party politics.

On the amendment specifically, there was a call for us to change our minds and support it. I didn’t hear anything that persuaded me specifically, in what Suzy Davies said, to change my mind, but I hope that the fact that we support other Conservative amendments shows that we’re very willing to co-operate where that is appropriate, and says something to us. I think the fact that we support UKIP’s amendment means that, certainly, we are willing to look at important issues here, namely, as I say, the well-being of the Welsh population.

So, may I thank everybody who’s taken part constructively, even though, at times, perhaps, a little edgy, in the debate? Sian Gwenllian—thank you for outlining the pressure on providing services in rural areas. Sian, as so many of us, can speak from personal experience. All of us have an experience that drives the need to improve in the areas that we’re discussing this afternoon. May I endorse what Sian Gwenllian said with regard to a medical college in Bangor? I know that is something that is not going to be delivered overnight. I know that there are a number of challenges between us and providing a medical school in Bangor, but I think the point that Sian Gwenllian made in terms of the need for that prospective college to be innovative is an important one. We’re not trying to recreate models from other places in Bangor, but we want to be innovative.

David Rees—as so often in debates on a number of issues—talked about innovation. I know innovation in education is something that’s important for the Member for Aberavon. One issue that wasn’t mentioned today was possibly the need to consider STEM subjects in schools in the context of the need to persuade more young people to study medicine.

I’m grateful to Dai Lloyd for emphasising the point that I made about the need for balancing the expenditure between the money going to hospitals within the NHS and the money that goes to primary care. There has been a clear decline in the percentage that goes into primary care in recent years and, as I said, this is not sustainable.

Trof at sylwadau’r Gweinidog yn fyr. Ar integreiddio, rwy’n meddwl ein bod yn awyddus i weld camau gweithredu cyffredinol ar draws Cymru. Cyflwynodd Plaid Cymru ein hargymhellion ar gyfer integreiddio yn yr etholiad yn ddiweddar, ac roeddent yn argymhellion a oedd yn destun trafod ac roedd llawer o bobl yn cytuno â hwy; roedd eraill yn anghytuno â hwy. Ond rwy’n credu mai’r hyn sy’n rhaid i ni symud tuag ato yw sefyllfa lle mae gennym argymhellion penodol a all arwain at integreiddio go iawn yng Nghymru. Ac ar integreiddio, rwy’n credu bod angen i ni gofio’r angen i integreiddio gofal sylfaenol ac eilaidd yn ogystal, nid iechyd a gofal cymdeithasol yn unig. Felly, nodaf yr enghreifftiau o integreiddio a grybwyllwyd gennych. Nodaf yr enghreifftiau hefyd o’r ymdrechion i fynd i’r afael ag oedi wrth drosglwyddo gofal; nodaf eich uchelgeisiau ynglŷn â recriwtio meddygon teulu, ac rydym yn falch ein bod wedi gallu gwneud recriwtio meddygon teulu yn un o’r meysydd allweddol yn ein cytundeb ar ôl yr etholiad. Ond fel y dywedodd Jeremy Miles, mae angen i ni edrych ar arferion gorau ac ar ôl eu nodi—boed ym maes gofal sylfaenol yn Ynys Môn, neu rywle arall—mae angen gweld sut y gellir cyffredinoli hynny wedyn ledled Cymru a gwneud yn siŵr fod arferion gorau yn cael eu hailadrodd ar draws Cymru.

Rwy’n meddwl bod angen i ni symud i gyfnod newydd o frys i fynd i’r afael â’r materion rydym yn eu trafod y prynhawn yma. Rwy’n credu ei bod yn amlwg o’r ddadl y prynhawn yma fod y materion hyn yn rhai sy’n cael eu rhannu ar hyd a lled y wlad ac maent yn faterion sy’n peri pryder i ni i gyd, pa blaid bynnag rydym yn ei chynrychioli yma yn y Cynulliad Cenedlaethol. Ym Mhlaid Cymru, byddwn yn gweithio’n adeiladol gyda’r Llywodraeth i chwilio am ffyrdd newydd ymlaen, ond byddwn yn rhoi pwysau diarbed ar y Llywodraeth i gynnig yr ymdeimlad newydd o frys sydd ei angen arnom, boed er mwyn datblygu gofal sylfaenol neu integreiddio iechyd a gofal cymdeithasol, ac er mwyn mynd i’r afael â her enfawr y newid yn y boblogaeth sy’n mynd i’n hwynebu yn y blynyddoedd i ddod.

Yn olaf, rwy’n falch iawn o glywed bod y Gweinidog yn disgwyl y symudir adnoddau yn ystod y blynyddoedd i ddod tuag at ofal sylfaenol. Rwy’n credu bod hyn yn hanfodol os ydym am oresgyn yr heriau sy’n ein hwynebu. Diolch yn fawr.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Okay. There’s been an objection, therefore we’ll defer voting under this item until voting time.

Voting deferred until voting time.