Lywydd, diolch am y cyfle i agor y ddadl yma ar gynnig a gafodd ei gyflwyno yn enw Simon Thomas. Dadl ydy hon sy’n gofyn i’r Cynulliad nodi y sialensiau demograffig sy’n wynebu’r NHS yng Nghymru ac sy’n galw ar Lywodraeth Cymru i ymateb rŵan i’r heriau hynny, yn cynnwys symud tuag at integreiddio iechyd a gofal cymdeithasol, yn ogystal â gweithredu ar frys efo cyfres o gamau i gynyddu’r niferoedd o staff, yn cynnwys meddygon teulu, a fydd ar gael yn y gwasanaeth iechyd yng Nghymru mewn blynyddoedd i ddod. Rwy’n gwybod nad ydy ‘crisis’ yn air y mae’r Llywodraeth yn licio ei glywed. Rwy’n gwybod bod y Gweinidog yn gyndyn iawn o gydnabod cyhuddiadau o grisis, ac mae o’n sicr yn air na ddylai gael ei ddefnyddio yn ysgafn—rwy’n cytuno â hynny. Ond, yn wir mi fydd sefyllfa argyfyngus o fewn yr NHS yn sicr o ddatblygu a dyfnhau heb i gamau pendant iawn a chynllunio strategol gofalus gael eu cyflwyno ar gyfer y dyfodol.

Mae rhagolygon poblogaeth ar gyfer Cymru yn awgrymu y bydd niferoedd a’r ganran o’n poblogaeth ni sydd dros 65 yn cynyddu’n sylweddol dros yr 20 mlynedd nesaf. Erbyn 2037, mae disgwyl i’r nifer dros 65 oed fod yn 47 y cant o’r boblogaeth, o’i gymharu â 30 y cant rŵan, a’r ganran dros 85 oed yn mwy na dyblu i 10 y cant o’r boblogaeth oedolion. Os ydy cyfraddau presennol o afiechydon ac anghenion gofal cymdeithasol yn y boblogaeth yn parhau yn debyg, ond o fewn patrwm demograffig newydd o boblogaeth hŷn, mae’n amlwg yn mynd i olygu cynnydd yn y galw am wasanaethau iechyd a gofal cymdeithasol ychwanegol a gwahanol yn y dyfodol. Mi fydd pobl yn byw’n hirach, efo mwy o gyflyrau cronig y bydd angen eu rheoli a’u monitro y tu allan i’r ysbyty. Bydd hyn yn golygu’r angen am lawer mwy o wasanaethau o fewn iechyd sylfaenol, yn cynnwys rhagor o feddygon teulu i gynnig cefnogaeth feddygol, mwy o nyrsys ardal a chymunedol, a gofal cymdeithasol i gadw pobl efo’r cyflyrau hyn yn byw yn annibynnol. Wrth gwrs, bydd angen integreiddio: ni allwn wastraffu amser, nac, yn allweddol, wastraffu arian ar frwydrau biwrocrataidd ynglŷn â phwy sy’n talu am ofal neu gael cyfarfodydd hirfaith mewn byrddau partneriaeth sy’n arwain efallai at ambell gynllun peilot a fawr ddim arall.

Ond peidiwch â gadael inni fod yn gwbl negyddol. Yn ystod y cyfnod a ddaw o gynnydd o bwysau am wasanaethau, mi ddaw yna hefyd datblygiadau technolegol—technoleg triniaethau, aps iechyd i ffonau symudol, er enghraifft. Mi fydd datblygiadau o’r math yma yn rhoi cyfleon i ddelifro gwasanaethau iechyd a gofal mewn ffyrdd sy’n hybu byw yn annibynnol, a hynny ar gost is a gobeithio efo gwell canlyniadau. Mi allwch chi hefyd ystyried pethau fel y cynnydd mewn capasiti ymhlith poblogaeth hŷn i wirfoddoli, i ofalu am blant ac aelodau eraill o’r teulu, yn ogystal â chynnydd mewn cyfraniadau at fywyd diwylliannol, economaidd a chymdeithasol Cymru.

The challenges are great. There are some opportunities too, as I’ve mentioned, but let me mention a few things that need to happen—a small number of steps, but significant ones that need to be pursued. You won’t be surprised to hear a Plaid Cymru health spokesman starting with recruitment, training and retention of staff. We need more GPs, community nurses and other health professionals. Unfortunately, there are fewer GPs now than in 2013, and the statistics show a decline in district nurses, though we are aware there could be some statistical issues around this, reflecting, I think, the need for more transparency and better data.

On GPs, specifically, the number of GPs in Wales has been falling in recent years—the number has now fallen under 2000. But what is frankly frightening is that around a quarter of those GPs we have say that they plan to retire in the next 10 years. Demands on GPs are rising, stress levels are getting worse, our training places aren’t getting filled—they are there, but they’re not getting filled—and it’s worse in some of the most deprived and rural areas. Plaid’s outlined several policies to try to attract and retain existing doctors: paying off student debt of doctors who agree to complete training and spend their early careers in certain areas or specialisms; employing more directly salaried GPs to fill vacancies in rural and peripheral areas for those doctors who don’t want the hassle, frankly, of running their own businesses. But we also have to get more young people into medicine and wanting to become a GP. I don’t know how many of you saw the University of Nottingham study of 2014, which was truly shocking: 50 per cent of all further education colleges and sixth forms had nobody, not a single person, applying to medical school over a three-year period—not a single person. Many more that did have applicants only had maybe one or two applicants, and the distribution of this, unsurprisingly, once again reflects patterns of deprivation. These are issues we have to address. We have to encourage our talented young people to think about medicine, and, once in medicine or, better still, before they start their medical studies, to think about being a GP. We have to ensure that newly trained doctors in Wales have exposure to primary care in their initial post-qualification period. It’s not happening enough in Wales, but it is happening elsewhere. Without GPs, we have no chance to change our health service to one that is able to look after an older population and keep them active. I have focused on GPs there, other colleagues will focus on other elements of the primary care workforce that, of course, are equally important.

I’ll mention secondly, as a step that needs to be taken, that the share of the budget going into primary care is going down when it should be going up. The latest figures show that 7.4 per cent of NHS funding goes to primary care. That’s down from nearly 9 per cent a decade or so ago. In England, the level is around 10 per cent; the Welsh historic level is around the 11 per cent mark. So, we know we want more out of our primary care sector, but proportionally we’re putting less in. The Royal College of General Practitioners here in the Senedd yesterday pointed out that 90 per cent of patient contact takes place at primary level—90 per cent of contact, 7.4 per cent of funding. And yes, of course there are higher costs in secondary care and secondary care is more vulnerable to cost inflation, but I genuinely believe that the current situation is unsustainable.

Thirdly, we need to get far better at innovation and at adopting new technologies, such as apps, telemedicine, and a paperless NHS. The NHS is too often far behind most other services and industries. It can’t be right that hospitals are still employing people to push trolleys of paperwork around.

Fourthly, we need a more integrated health and social care system that’s appropriate for the needs of a rural and scattered population, not the needs of NHS managers being shuffled around to impose urban models of care in areas where that is not suitable. This must also include access to specialist services, like accident and emergency departments, close to where people live, and an ambulance service that spends its time responding to emergency calls, rather than queued up in hospitals or transferring patients on long journeys away from home. My colleagues will elaborate on many of those points this afternoon.

Turning to the amendments, we’ll abstain on amendment 1. We’re not exactly sure what the Conservatives mean by these voluntary assessments and, in any case, our understanding is that versions of these assessments occur anyway. But, no doubt we’ll hear more from the Conservatives. We’ll support the other amendments. We need a new plan for services in rural communities; the Older People’s Commissioner for Wales should be reviewed, of course, to make it more effective, and that should happen regularly; and community hospitals, of course, can play an essential role in smoothing the transition back to the community for many people, although quite how UKIP intend to staff their post-EU health service when our existing service has so many migrant workers playing an essential role is something to reflect upon this afternoon. I look forward to all your— [Interruption.] I’m winding up. I look forward to your contributions; you’ll have an opportunity in a second to make your points, no doubt. I look forward to all Members’ contributions this afternoon. This is one of the most important debates we face in Wales and one of our biggest challenges.