Thank you very much, Llywydd. One of our most valuable treasures, which is appreciated over and above every other public service in Wales, I’m sure I’m right in saying, is the health service, the NHS, and the most valuable resource of the NHS is its workforce—those people who, through a combination of their skills and their commitment, ensure that each and every one of us can get the best possible care when we need it most. One of the greatest duties that the Welsh Government has is to ensure that that workforce gets the support necessary, is planned properly so that we have the right people in the right places with the right skills in order to care for patients, and so there are sufficient numbers of people encouraged to come into the health service, and that they are getting the best possible training to make it a sustainable service for the future.

Unfortunately, we do know that there are major weaknesses in the workforce planning at present, which creates real problems and threatens the ability of the NHS to make provision for the people of Wales. Some of you will have seen news reports this week, following Plaid Cymru research into risk registers of the Welsh health boards, where each and every one of them identifies workforce shortages—shortages of doctors, shortages of nurses—as real risks at the highest level. The risk reports of the health boards are sobering, talking about the inability to provide services or patients facing a risk of avoidable harm. Now, this afternoon, we will pursue some of the different elements of workforce planning that we believe need to be prioritised far more than we are currently seeing from the Labour Government. Welsh patients, NHS staff, now and in the future, deserve better.

I will first of all try and paint a picture of where we are at present, and some of my fellow Members will expand on many aspects of workforce planning and the impact of having the unsustainable workforce that we currently have. Wales has one of the lowest levels in Europe of doctors per capita. A shortage in a number of areas of expertise, including in paediatrics and obstetrics, has led to a loss of some of these services in certain areas, with services being centralised in others and turning to nurse-led provision in other circumstances. The outcomes include longer waiting times, cancelled treatments and a lack of Welsh-speaking staff, having a very real impact on patients and outcomes for patients who want to have a Welsh-language service. In questions to the Cabinet Secretary earlier, I highlighted specifically the fact that thrombectomy had been withdrawn in Cardiff just nine months after it had been introduced, because staff had been lost and there were no replacements for them.

Primary care is facing grave challenges—recruitment problems, retention of staff leading to longer waiting times for appointments, and unacceptable pressure being put on those GPs that we have, and that is a reducing number of GPs. The number of GPs has declined in absolute terms from 2,026 to 2,009 over the last three years. Now, that’s only a decline of 25, but when you consider that more and more people are choosing to work part-time, then the full-time equivalent number of GPs is likely to have declined at a far greater rate, and that full-time equivalent figure isn’t published any longer, since 2013, because of concern about the quality of data. But we need that data to know exactly where we stand.

Consider then that a quarter of all our GPs are within a decade of retirement age, and the scale of the problem facing us comes into clearer focus. Dr Eamonn Jessup, the chair of the local medical committee for north Wales, said recently that he was concerned about the sustainability of one in three GP practices in north Wales. Full-time staff shortages are leading to huge costs, too—the costs of locums and agency workers is now around £150 million per annum and is increasing; it’s £44 million per annum in the Betsi Cadwaladr health board alone, up from £31 million in just a matter of three years. So, we need more doctors.

But at the same time, we have seen a reduction of 13 per cent last year in the number of students from Wales who applied to study medicine. There was a 1 per cent decline across Britain. Only some 30 per cent of medical students in Wales come from Wales compared with 85 per cent of medical students in Northern Ireland coming from Northern Ireland, a figure of 80 per cent in England and 55 per cent in Scotland. Now, I’ve reiterated these figures time and time again, but it does show a dreadful situation. We desperately need more doctors, but can’t encourage our young people to consider medicine as a career, or not enough of them, and then we can’t find placements for them to study here in Wales. Sian will expand upon that, including our call for the development of undergraduate medical education in Bangor.

Are we training more GPs given that we are desperate for more of them? Although the pressure on primary care has increased significantly over the past decade, the target for the number that we want to train has remained static—136. In England, the target has increased 30 per cent because they realise the scale of the problem. We too need to set higher targets.

I will turn to nursing. On ITV news yesterday, in response to the Plaid Cymru research that I mentioned earlier on risk registers, Tina Donnelly from the Royal College of Nursing said,

Os ydych yn dweud mai un risg eithafol yw bod gennych brinder o staff nyrsio, yna y cyfrifoldeb fyddai cau gwelyau am na ddylech fod yn gweithredu ar y lefel honno lle rydych yn staffio eich wardiau gan wybod nad yw’r lefelau staffio’n ddigonol oherwydd bydd hynny’n peryglu diogelwch cleifion. Ac mae hynny’n annerbyniol.

Dyma beth y mae cofrestr risg Hywel Dda yn ei ddweud:

Mae yna berygl o: Niwed y gellir ei osgoi i gleifion, niwed y gellir ei osgoi i ansawdd y gofal i gleifion ac oedi yn y llwybr damweiniau ac achosion brys. Caiff hyn ei achosi gan: Ddiffyg Nyrsys Cofrestredig sy’n arwain at lefelau staffio anniogel mewn Adrannau Achosion Brys. a

Lefelau staffio sylfaenol nad ydynt yn bodloni canllawiau NICE. Swyddi gwag mewn sefydliadau nyrsys cofrestredig.

Gwelodd astudiaeth o wardiau yn y DU gan yr Athro Anne Marie Rafferty fod marwolaethau wedi cynyddu 26 y cant ar wardiau â lefelau is o staff nyrsio. Yng Nghaliffornia, lle y cyflwynwyd deddf staffio diogel, cafwyd gostyngiad o 10 i 13 y cant yn y cyfraddau marwolaethau 30 diwrnod. Mae adolygiad 2011 o aelodau’r Coleg Nyrsio Brenhinol yn dangos nad oedd 25 y cant o aelodau’r Coleg Nyrsio Brenhinol yn cael datblygiad proffesiynol parhaus, ac yn 2013, cododd y ffigur hwnnw i 43 y cant. Mae llawer o fyrddau iechyd lleol wedi rhoi gwaharddiad dros dro ar ganiatâd i staff nyrsio ymgymryd ag unrhyw hyfforddiant. Mae nyrsys yng Nghymru yn llai tebygol o fod wedi cael yr hyfforddiant gorfodol hwn fel y’i gelwir—rydym yn sôn am hyfforddiant ar ddefnyddio cyfarpar, symud a chodi a chario, rheoli heintiau—na nyrsys unrhyw wlad arall yn y DU. Ac yn 2013 ni chafodd 9.7 y cant unrhyw hyfforddiant o’r fath o gwbl—bron ddwbl y ffigur ar gyfer y DU yn gyffredinol. Mae hyn yn rhoi darlun gwirioneddol lwm o GIG lle nad yw staff nyrsio yn cael y gefnogaeth sydd ei hangen arnynt, ac mae hynny’n ddrwg i gleifion.

Mae cyfarwyddyd y prif swyddog nyrsio yn argymell cymhareb o un nyrs gofrestredig i ofalu am saith o gleifion ar wardiau meddygol a llawfeddygol—1:11 yn ystod y nos. Mae’r ymatebion i arolwg diweddar o’i aelodau gan Goleg Brenhinol y Bydwragedd yn dangos bod 9.7 o gleifion ar gyfartaledd i bob nyrs gofrestredig ar shifftiau dydd yng Nghymru. Roedd 85 y cant o’r ymatebwyr yn sôn am fwy na saith o gleifion i bob nyrs gofrestredig. Nid yw hynny’n ddigon da. Canfyddiadau eraill o’r arolwg: 55 y cant yn unig o nyrsys a deimlai’n fodlon ar y gofal y gallent ei roi; 32 y cant a deimlai fod ganddynt ddigon o amser i ofalu am gleifion. Gallwn fynd ymlaen. Rydym eisoes wedi derbyn yr egwyddor, drwy ddeddfwriaeth yma, fod angen sicrhau lefelau staffio diogel. Ni allwn golli golwg ar yr angen i gael y nifer gywir o nyrsys gyda’r hyfforddiant cywir, y cymorth cywir, er mwyn rhoi’r gofal angenrheidiol i gleifion.

Fe’i gadawaf yn y fan honno am y tro. Cawn glywed mwy gan fy nghyd-Aelodau ym Mhlaid Cymru yma. Yn 2014, lansiwyd papur polisi manwl gennym ar sut y byddem yn hyfforddi a recriwtio 1,000 o feddygon ychwanegol. Cynllun 10 mlynedd, gydag enillion ymylol, yn cynnwys ystod o bolisïau: cymhellion ariannol; gan wneud y GIG yn fwy deniadol i feddygon weithio ynddo; buddsoddiadau mewn addysg a hyfforddiant meddygol, gan gynnwys datblygu hyfforddiant meddygol yn y gogledd. Yn 2016, ychwanegwyd hyfforddi a recriwtio 5,000 o nyrsys a bydwragedd dros gyfnod o 10 mlynedd. Rydym yn gwybod na ellir gwneud hyn dros nos, ond mae angen i ni osod llwybr. Nawr, mae hon yn her, ac mae’r rhain yn heriau i’r Llywodraeth. Rwy’n edrych ymlaen at y ddadl y prynhawn yma, yn edrych ymlaen at yr ymateb gan Ysgrifennydd y Cabinet, oherwydd gallaf ddweud wrthych, mae llawer o bobl sy’n gweithio’n galed yn y GIG yng Nghymru yn chwilio am lawer gwell gan y Llywodraeth a chynllunio’r gweithlu na’r hyn a welant ar hyn o bryd.