Health and social care

Mae gan GIG Cymru weledigaeth glir o ran y cofnod cleifion electronig, ond mae angen rhagor o waith i gyflawni hyn

Er bod elfennau allweddol yn cael eu gweithredu, bu oedi sylweddol, ac, er gwaethaf datblygiadau diweddar, mae yna wendidau allweddol yn y trefniadau cyflwyno

Mae pob rhan o GIG Cymru, gan gynnwys Llywodraeth Cymru, bellach yn wynebu penderfyniadau anodd o ran cyllido a blaenoriaethau, a hynny os yw'r weledigaeth o gofnod cleifion electronig i gael ei chyflawni o fewn amserlen resymol. Dyma rai o ganfyddiadau allweddol adroddiad a gyhoeddwyd heddiw, gan yr Archwilydd Cyffredinol, sy'n edrych ar wybodeg y GIG.

Mae'r weledigaeth lefel uchel ar gyfer gwybodeg y GIG yn glir ac yn mynd yn ôl dros ddegawd. Mae'r GIG yn gweithio tuag at gofnod cleifion electronig sy'n cynnwys nifer o systemau a all siarad â'i gilydd. Wrth ddatblygu'r weledigaeth hon, mae GIG Cymru wedi dysgu gwersi o'r problemau a brofwyd yn flaenorol gan y GIG yn Lloegr.

Er gwaethaf y weledigaeth glir, nid yw'r GIG wedi blaenoriaethu'n amlwg yr adnoddau prin sydd ar gael. Nid oes yna gynllun cytunedig ar gyfer cyllido'r gwaith o gyflawni'r weledigaeth, nac amserlen glir. A bu anghytuno yn y GIG ynghylch y cydbwysedd rhwng disgresiwn lleol i ddatblygu systemau newydd, a'r gwaith o gyflawni'r systemau cenedlaethol ledled y GIG cyfan yng Nghymru. Yn gadarnhaol, mae'r GIG 'nawr yn symud tuag at fwy o eglurder ynghylch y meysydd hyn.

Mae'r adroddiad hefyd yn nodi gwendidau o ran llywodraethu a goruchwylio Gwasanaeth Gwybodeg GIG Cymru. Canfu'r adroddiad y canlynol: bod yna ddiffyg gwaith craffu annibynnol ar Wasanaeth Gwybodeg GIG Cymru; bod angen i'r trywydd atebolrwydd fod yn gliriach; a bod adroddiadau am gynnydd a pherfformiad wedi tueddu i fod yn rhy gadarnhaol, ac nad oeddent yn rhoi darlun cytbwys.

Gwnaed peth gwaith i gryfhau arweinyddiaeth gwybodeg ledled y GIG yng Nghymru, ac mae'r Bwrdd Rheoli Gwybodeg Cenedlaethol 'nawr yn gosod cyfeiriad cliriach ar gyfer yr agenda wybodeg. Fodd bynnag, mae GIG Cymru yn llusgo y tu ôl i'r sector preifat o ran y graddau y mae gwybodeg yn cael ei chynrychioli ar lefel y bwrdd. Mae hefyd angen datblygu arweinyddiaeth glinigol leol yr wybodeg.

Amcangyfrifwn fod y GIG yn gwario llai na 2% o'i gyllid ar TGCh: mae hyn yn sylweddol is na'r ffigur o 4% a argymhellwyd gan Syr Derek Wanless yn 2003. Yn hanesyddol, nid yw byrddau iechyd wedi blaenoriaethu gwariant ar gyfer gwybodeg, ac mae cyllid Llywodraeth Cymru ar gyfer Gwasanaeth Gwybodeg GIG Cymru wedi gostwng mewn termau real. Yn 2016, amcangyfrifodd GIG Cymru y byddai arno angen £484 miliwn ar ben y cyllidebau presennol i gyflawni'r weledigaeth dros gyfnod o bum mlynedd. Mae hwn yn gynnig petrus, a luniwyd o amcangyfrifon gan gyrff unigol y GIG a Gwasanaeth Gwybodeg GIG Cymru. Mae Llywodraeth Cymru yn cydnabod bod angen gwneud gwaith pellach er mwyn profi a chadarnhau'r tybiaethau sy'n tanategu'r amcangyfrif. Fodd bynnag, mae pob rhan o'r GIG, gan gynnwys Llywodraeth Cymru, 'nawr yn wynebu penderfyniadau anodd o ran a ddylid darparu cyllid newydd er mwyn cynllunio'n effeithiol i gyflawni systemau newydd, cyfredol mewn amserlen resymol, a sut i wneud hynny.

Mae cyflwyno nifer o systemau gwybodeg newydd ledled pob rhan o GIG Cymru yn broses hanfodol gymhleth. Mae nifer o'r blociau adeiladu ar gyfer cofnod cleifion electronig – er enghraifft systemau meddygon teulu, system radioleg genedlaethol a systemau labordai – bellach ar waith neu wedi cyrraedd cam uwch. Fodd bynnag, mae oedi sylweddol o ran cyflwyno systemau newydd wedi achosi rhwystredigaeth eang, ac mae yna ffordd bell i fynd o hyd nes y bydd y cofnod cleifion electronig ar waith yn llawn. Canfu'r adroddiad fod yna broblemau o ran ymarferoldeb rhai o'r systemau cenedlaethol. Ac mae diffyg monitro yn golygu nad yw'n glir p'un a yw'r systemau hynny sydd wedi cael eu cyflwyno yn cyflawni'r buddion disgwyliedig ai peidio.

Yng nghyd-destun gwaith parhaus i wella'r dull o ymdrin â gwybodeg, mae'r adroddiad yn gwneud 13 o argymhellion, sy'n cwmpasu strategaeth, arweinyddiaeth, llywodraethu, cyllid, rheoli rhaglenni a rheoli prosiectau.

Heddiw, dywedodd yr Archwilydd Cyffredinol, Huw Vaughan Thomas: “Gwyddom fod mynediad gwell at wybodaeth yn arwain at well canlyniadau ar gyfer cleifion a llai o gamgymeriadau gan glinigwyr. Bydd rhoi'r weledigaeth o gofnod cleifion electronig ar waith yn golygu y bydd angen i bob rhan o'r GIG, gan gynnwys Llywodraeth Cymru, wneud penderfyniadau anodd, yn enwedig o ran cyllido, blaenoriaethu a galluogi clinigwyr i gael amser a lle i arwain yr agenda hon. Oni bai ei fod yn mynd i'r afael â'r materion a nodwyd yn fy adroddiad, mae yna berygl y bydd y GIG yn wynebu mwy o rwystredigaeth ymhlith staff y rheng flaen, ac, yn y pen draw, yn meddu ar systemau a fydd eisoes yn hen ffasiwn erbyn iddynt gael eu cwblhau.”

NHS Wales has a clear vision for the electronic patient record, but more work is needed to deliver it

Although key elements are being put in place, there have been significant delays and, despite recent developments, there are key weaknesses in the arrangements for delivery

All parts of NHS Wales, including Welsh Government, now face tough decisions on funding and priorities if the vision of an electronic patient record is to be achieved in a reasonable timeframe. These are among the key findings of a report published today, by the Auditor General, which looks at NHS informatics.

The high-level vision for NHS informatics is clear and goes back more than a decade. The NHS is working towards an electronic patient record made up of multiple systems that are able to talk to each other. In developing this vision, NHS Wales learnt lessons from the problems previously experienced by the NHS in England.

Despite the clear vision, the NHS has not clearly prioritised the scarce resources available. There has not been an agreed plan for funding the delivery of the vision nor a clear timeframe. And there has been disagreement within the NHS about the balance between local discretion to develop new systems and the delivery of national systems across all of NHS Wales. Positively, the NHS is now moving towards greater clarity on these areas.

The report also identifies weaknesses in the governance and oversight of NHS Wales Informatics Service (NWIS). The report found that: there is a lack of independent scrutiny of NWIS; lines of accountability need to be clearer; and that reports on progress and performance have tended to be overly positive and did not paint a balanced picture.

There has been some work to strengthen leadership of informatics across the NHS in Wales, with the National Informatics Management Board now setting a clearer direction for the informatics agenda. However, NHS Wales lags behind the private sector in the degree to which informatics is represented at board level. There is also the need to develop local clinical leadership of informatics.

We estimate that the NHS spends less than 2% of its funding on ICT: significantly below the figure of 4% recommended by Sir Derek Wanless in 2003. Historically, health boards have not prioritised spending for informatics and Welsh Government funding to NWIS has fallen in real terms. In 2016, NHS Wales estimated that it would require £484 million on top of existing budgets in order to deliver the vision over a five-year period. This is a tentative figure built up from estimates by individual NHS bodies and NWIS. The Welsh Government recognises that further work is required to test and confirm the assumptions underpinning the estimate. Nevertheless, all parts of the NHS, including Welsh Government, now face some tough decisions on whether and how to provide new funding in order to plan effectively to deliver new and updated systems in a reasonable timeframe.

Delivering multiple new informatics systems across all parts of NHS Wales is inherently complex. Many of the building blocks – such as GP systems, a national radiology system and laboratory systems – of an electronic patient record are in now place or at an advanced stage. However, significant delays to the delivery of new systems have caused widespread frustration and there is still a way to go until it the electronic patient record is fully in place. The report found that there have been issues with functionality of some of the national systems. And a lack of monitoring means it is unclear whether those systems that have been delivered are achieving the expected benefits.

In the context of ongoing work to improve the approach to informatics, the report makes 13 recommendations, covering strategy, leadership, governance, finances, programme management and project management

Auditor General, Huw Vaughan-Thomas, said today: “We know that better access to information leads to better outcomes for patients and fewer mistakes by clinicians. Putting the vision of an electronic patient record into practice means all parts of NHS Wales, including Welsh Government, need to take some tough decisions, particularly on funding, priorities and enabling clinicians to have the time and space to lead on this agenda. Unless it addresses the issues identified in my report, the NHS risks further frustration amongst frontline staff and ending up with systems that are already outdated by the time they are completed.”

Dull Bwrdd Iechyd Prifysgol Caerdydd a'r Fro o ddyfarnu contractau ymgynghori "yn llawer is na'r safonau disgwyliedig"

Yr Archwilydd Cyffredinol yn cyhoeddi adroddiad er budd y cyhoedd 

Mae'r modd yr aeth Bwrdd Iechyd Prifysgol Caerdydd a'r Fro ati i gaffael a rheoli contractau ymgynghori AD yn llawer is na'r safon y mae gan y cyhoedd hawl i'w disgwyl gan gorff cyhoeddus. Dyna yw neges adroddiad, a gyhoeddwyd gan yr Archwilydd Cyffredinol er budd y cyhoedd heddiw.

Casgliad yr adroddiad yw bod y Bwrdd Iechyd wedi methu cydymffurfio â'i ofynion caffael ei hun wrth ddyfarnu contractau ymgynghori i RKC Associates Ltd ym mis Tachwedd 2014 a mis Mehefin 2015, a'i fod wedi methu sicrhau dilysrwydd y broses gaffael a arweiniodd at ddyfarnu contract ychwanegol ym mis Chwefror 2016.

Roedd dyfarnu'r contractau hyn yn groes i reolau caffael cyhoeddus ac achosodd risg ariannol a risg i enw da'r Bwrdd Iechyd, a hynny heb fod angen. O ganlyniad i hyn, ni all y Bwrdd Iechyd ddangos bod y contractau wedi'u dyfarnu mewn modd teg, tryloyw na chyfreithlon, na'u bod wedi sicrhau gwerth am arian.

Dyfarnwyd y contract i lenwi bwlch yng nghapasiti'r arweinyddiaeth AD o fewn y bwrdd iechyd ar ôl i Gyfarwyddwr y Gweithlu a Datblygu Trefniadol adael ei swydd ar secondiad i sefydliad arall o fewn y GIG ar fyr-rybudd. Talwyd dros £290,000 i RKC Associates Ltd am y gwasanaeth a ddarparwyd.

Pan adawodd Cyfarwyddwr y Gweithlu a Datblygu Trefniadol ei swydd gyda'r Bwrdd Iechyd yn ddiweddarach, ni lwyddwyd i benodi Cyfarwyddwr arall yn ei le drwy ymarfer recriwtio, wedi i'r ymgeiswyr ar y rhestr fer dynnu'n ôl am amryfal resymau. Ni chafodd y swydd ei hail-hysbysebu, ond cafodd unig gyfarwyddwr RKC Associates Ltd ar y pryd gyfweliad a chynnig y swydd ar gontract cyfnod penodol blwyddyn o hyd, ar gyflog blynyddol o £150,000. Canfu'r adroddiad fod y broses benodi hon wedi'i thanseilio'n llwyr, nad oedd yn ddigon tryloyw, ac nad oedd wedi'i chofnodi'n ddigonol.

Dywedodd Archwilydd Cyffredinol Cymru, Huw Vaughan Thomas:
"Dyma'r tro cyntaf yr ydw i, fel Archwilydd Cyffredinol, wedi cyhoeddi adroddiad ar gorff o fewn y GIG er budd y cyhoedd. Cafwyd nifer fawr o fethiannau sylweddol, ac roedd gweithredoedd y Bwrdd Iechyd yn llawer is na'r safonau disgwyliedig. Parodd hynny i mi gymryd y cam hynod o anarferol hwn.

"Ceir gweithdrefnau clir y mae angen eu dilyn er mwyn sicrhau bod arian trethdalwyr yn cael ei wario mewn modd effeithlon ac effeithiol ac, yn yr achos hwn, diystyrwyd y gweithdrefnau hynny.

"Yr wyf wedi cyhoeddi'r adroddiad hwn i dynnu sylw at y methiannau hyn, i ddwyn Bwrdd Iechyd Prifysgol Caerdydd a'r Fro i gyfrif, a chan obeithio y bydd sefydliadau eraill yn rhoi ystyriaeth iddo, ac na fyddant yn ailadrodd y camgymeriadau hyn.”

Diwedd

Nodiadau i olygyddion:

  • Mae a wnelo casgliadau'r Archwilydd Cyffredinol â gweithredoedd caffael a recriwtio Bwrdd Iechyd Prifysgol Caerdydd a'r Fro. Nid oedd yr Archwilydd Cyffredinol yn asesu ansawdd y gwaith a gyflawnwyd gan RKC Associates Ltd o dan y contractau a ddyfarnwyd gan y Bwrdd Iechyd.
  • Terfynodd unig gyfarwyddwr RKC Associates Ltd, y cyfeirir ati yn y datganiad hwn i'r wasg, ei phenodiad fel cyfarwyddwr y cwmni ar 28 Hydref 2016, a throsglwyddwyd perchnogaeth y cwmni.
  • Lluniwyd yr adroddiad hwn yn unol â Pharagraff 19 o Atodlen 8 yn Neddf Llywodraeth Leol 2006, lle nodir y gall yr Archwilydd Cyffredinol lunio adroddiad ar fater arbennig os yw o'r farn y byddai tynnu sylw'r cyhoedd at y mater hwnnw o fudd i'r cyhoedd.
  • Archwilydd Cyffredinol Cymru yw archwilydd allanol statudol annibynnol y rhan fwyaf o sector cyhoeddus Cymru. Y mae'n gyfrifol am gynnal archwiliad blynyddol o'r rhan fwyaf o'r arian cyhoeddus a gaiff ei wario yng Nghymru, gan gynnwys y £15 biliwn o gyllid y mae'r Cynulliad Cenedlaethol yn pleidleisio yn ei gylch bob blwyddyn. Trosglwyddir elfennau o'r cyllid hwn o Lywodraeth Cymru i'r GIG yng Nghymru (dros £5 biliwn), ac i lywodraeth leol (dros £4 biliwn).
  • Yr Archwilydd Cyffredinol yw archwilydd allanol y rhan fwyaf o sector cyhoeddus Cymru. Mae annibyniaeth yr Archwilydd Cyffredinol wrth archwilio yn hollbwysig. Fe'i penodir gan y Frenhines, ac ni chaiff ei waith ei gyfarwyddo na'i reoli gan y Cynulliad Cenedlaethol na'r llywodraeth.
  • Corff corfforaethol yw Swyddfa Archwilio Cymru sy'n cynnwys Bwrdd statudol ac arno naw o aelodau. Y mae'n cyflogi staff ac yn darparu adnoddau eraill i'r Archwilydd Cyffredinol, sydd hefyd yn Brif Weithredwr a Swyddog Cyfrifo'r Bwrdd. Mae'r Bwrdd yn monitro ac yn cynghori'r Archwilydd Cyffredinol ynghylch cyflawni ei swyddogaethau.
  • Cenhadaeth Swyddfa Archwilio Cymru yw hyrwyddo gwelliant, fel bod pobl yng Nghymru yn elwa ar wasanaethau cyhoeddus atebol sydd wedi'u rheoli'n dda, ac sy'n cynnig y gwerth gorau posib am arian. Y mae hefyd yn ymrwymedig i nodi a lledaenu arferion da ar draws sector cyhoeddus Cymru. 

The way consultancy contracts were awarded by Cardiff and Vale University Health Board "fell short of expected standards"

Auditor General publishes report in the public interest

The way in which Cardiff and Vale University Health Board procured and managed HR consultancy contracts fell short of the standards that the public has a right to expect of a public body. That is according to a report, issued in the public interest, by the Auditor General for Wales.

The report concludes that the Health Board failed to comply with its own procurement requirements when it awarded consultancy contracts to RKC Associates Ltd in November 2014 and June 2015 and failed to ensure the integrity of the procurement process that led to an additional contract being awarded in February 2016.

The award of these contracts breached public procurement rules and exposed the Health Board to unnecessary financial and reputational risk. As a result, the Health Board cannot demonstrate that the contracts were awarded fairly, transparently, lawfully or that they obtained value for money.

The contracts were awarded to address a shortfall in HR leadership capacity at the Health Board after the Director of Workforce and Organisational Development was seconded to another NHS organisation at short notice. RKC Associates Ltd were paid over £290,000 for the service provided.

When the Director of Workforce and Organisational Development subsequently left the employment of the Health Board, a recruitment exercise proved unsuccessful in appointing a replacement because the shortlisted candidates withdrew for various reasons. While the position was not re-advertised, the then sole director of RKC Associates Ltd was interviewed and subsequently offered the position on a one-year fixed-term contract on an annual salary of £150,000. The report found that this appointment process was fundamentally compromised, lacked transparency and was poorly documented.

Auditor General for Wales, Huw Vaughan Thomas said:
“This is the first time as Auditor General that I have issued a report in the public interest on an NHS body. There were numerous and significant failings and the actions of the Health Board fell well short of expected standards which has led to me taking this highly unusual step.

“There are clear procedures that need to be followed to ensure that taxpayers’ money is spent efficiently and effectively and, in this case, they were disregarded.

"I’ve issued this report to highlight these failings, to hold Cardiff and Vale University Health Board to account, and in the hope that other organisations will take heed and not repeat these mistakes.”

Ends

Notes to editors:

  • The Auditor General’s conclusions relate to the procurement and recruitment actions of Cardiff and Vale University Health Board. The Auditor General did not assess the quality of work undertaken by RKC Associates Ltd under the contracts awarded by the Health Board.
  • The sole director of RKC Associates Ltd referred to in this press release and the report terminated her appointment as a director of the company on 28 October 2016 and ownership of the company transferred.
  • This report was prepared in accordance with Paragraph 19 of Schedule 8 to the Government of Wales Act 2006, which provides that if the Auditor General believes that it would be in the public interest to bring a matter to the public’s attention he may prepare a report on that matter.
  • The Auditor General is the independent statutory external auditor of most of the Welsh public sector. He is responsible for the annual audit of the majority of public money spent in Wales, including the £15 billion of funds that are voted on annually by the National Assembly. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £5 billion) and to local government (over £4 billion).
  • The Auditor General is the external auditor of most of the Welsh public sector. The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the National Assembly or government.
  • The Wales Audit Office is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General with regard to the exercise of his functions.
  • The Wales Audit Office mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identifying and spreading good practice across the Welsh public sector.

Llywodraeth Cymru yn defnyddio deddf cyllid y Gwasanaeth Iechyd Gwladol (Cymru) i sicrhau cynllunio gwell o ran gwasanaethau a chyllid

Ond mae cryn ffordd i fynd eto er mwyn sylweddoli'r buddion yn llawn, gyda phedwar allan o'r saith bwrdd iechyd heb gyflawni eu dyletswyddau o dan y Ddeddf

Ers i Ddeddf Cyllid y Gwasanaeth Iechyd Gwladol (Cymru) ddod i rym yn 2014, mae Llywodraeth Cymru wedi cynyddu'r gwariant arfaethedig ar iechyd, ond wedi parhau i ddibynnu ar gyllid ychwanegol i fynd i'r afael â phwysau a blaenoriaethau o fewn blwyddyn.

Mae'r ffordd y mae Llywodraeth Cymru'n goruchwylio ac yn dal cyrff y GIG i gyfrif am ansawdd eu gwaith cynllunio yn gadarn ar y cyfan. Ceir arwyddion o fwy o ganolbwyntio ar y tymor hirach, fel y bwriadwyd drwy'r Ddeddf. Er hynny, ar ddiwedd 2016-17 methodd pedwar allan o'r saith bwrdd iechyd â chyflawni eu dyletswyddau o dan y Ddeddf. Dyma gasgliad adroddiad diweddaraf yr Archwilydd Cyffredinol ynghylch y modd y mae Deddf Cyllid y Gwasanaeth Iechyd Gwladol (Cymru) 2014 yn cael ei gweithredu.

Yn y cyfnod o dair blynedd ers i'r Ddeddf ddod i rym, mae Llywodraeth Cymru wedi cynyddu'r gwariant ar iechyd mewn termau real o 2.9% bob blwyddyn ar gyfartaledd, sef codiad o £6.2 biliwn yn 2013-14 i £6.7 biliwn yn 2016-17. Cafodd peth o'r arian ychwanegol hwn ei ddyrannu mewn ffordd fwriadol drwy'r gyllideb cyn cychwyn y flwyddyn ariannol.

Fodd bynnag, mae Llywodraeth Cymru hefyd wedi parhau i ddyrannu arian o fewn y flwyddyn. Mae'r dyraniad hwn o fewn blwyddyn yn cynnwys arian ar gyfer blaenoriaethau penodol, megis cyffuriau newydd, yn ogystal â chyllid ar gyfer gorwariant a ragwelir neu orwariant gwirioneddol cyrff y GIG. Bwriadwyd i'r arian ychwanegol, yn rhannol, alluogi cyrff y GIG i osgoi gorfod gwneud penderfyniadau ariannol tymor byr a allai effeithio ar ansawdd gofal.

Daw'r adroddiad hefyd i'r casgliad bod canllawiau cynllunio Llywodraeth Cymru yn glir yn gyffredinol. Mae Llywodraeth Cymru wedi datblygu proses dda ar gyfer adolygu ansawdd cynlluniau cyrff y GIG, ac mae wedi adolygu a chryfhau ei dull o gysylltu'r cynlluniau hyn â chynllunio prosiectau cyfalaf.

Mae'r adroddiad yn canfod bod Llywodraeth Cymru wedi bod yn benderfynol o beidio â chymeradwyo dim ond cynlluniau y mae ganddi hyder ynddynt. Yn rhai achosion, mae hynny wedi golygu cymeradwyo cynlluniau ariannol nad oeddent wedi eu mantoli'n llawn ar ddechrau'r flwyddyn ariannol ond lle roedd gan Lywodraeth Cymru hyder yn record corff y GIG a'i gynlluniau lliniaru. 

Mae'r adroddiad yn gweld bod yna rai arwyddion o'r newid a fwriadwyd, sef meddwl a chynllunio tymor hwy, ar draws GIG Cymru. Er hynny, parhau i ganolbwyntio'n gryf ar y sefyllfa ar ddiwedd y flwyddyn ariannol y mae'r patrymau o wario a chynilo.

Er gwaethaf y Ddeddf, mae'r sefyllfa ariannol o fewn y flwyddyn o angenrheidrwydd yn dal yn ganolbwynt pwysig i waith monitro GIG Cymru. Nid oes yr un corff yn y GIG hyd yma wedi defnyddio'r hyblygrwydd ariannol dan y Ddeddf mewn ffordd gynlluniedig.

Ar ddiwedd mis Mawrth 2017, llwyddodd tri allan o'r saith Bwrdd Iechyd a phob un o dair ymddiriedolaeth y GIG i gyflawni eu dwy ddyletswydd statudol o adennill costau dros y tair blynedd flaenorol a chael cynllun tair blynedd a gymeradwywyd gan Weinidogion Cymru. Roedd y ffactorau a gyfrannodd at fethiant pedwar bwrdd iechyd i gyflawni eu dyletswyddau'n cynnwys:

  • cynlluniau cynilo gorobeithiol, a pheidio â nodi ffynonellau arbedion digonol ynghyd â methiant i gyflawni'r arbedion a nodwyd;
  • cynlluniau clinigol a chynlluniau gwasanaeth ddim yn eu lle ar gyfer cyflawni’r newidiadau mewn gwasanaethau;
  • pwysau gweithlu, sydd wedi arwain at ddibynnu ar staff locwm costus a staff asiantaeth;
  • pryderon ynghylch perfformiad rhai gwasanaethau, sydd wedi golygu buddsoddiad ychwanegol; a
  • pryderon ynghylch y capasiti i gyflawni newidiadau strategol.

Mae'r adroddiad yn gwneud dau argymhelliad ynglŷn â gwaith Llywodraeth Cymru yn gosod arweiniad a monitro cynnydd a hefyd yn diweddaru'r fformiwla sy'n sail i’r modd y dyrennir cyllid i fyrddau iechyd. Yn ogystal, mae’n nodi dau faes blaenoriaeth lle mae'r Archwilydd Cyffredinol yn ystyried bod angen i Lywodraeth Cymru wneud cynnydd - mynd i'r afael â'r ddibyniaeth ar gyllid o fewn blwyddyn a gosod cyfeiriad cliriach o ran newid strategol, yn enwedig i wasanaethau rhanbarthol a chenedlaethol.

Meddai Huw Vaughan-Thomas, yr Archwilydd Cyffredinol, heddiw:

"Mae Deddf Cyllid y Gwasanaeth Iechyd Gwladol (Cymru) 2014 yn rhoi fframwaith i GIG Cymru ar gyfer cynllunio gwasanaethau a materion ariannol yn well dros y tymor canolig, yn gysylltiedig â'u cynlluniau strategol ehangach. Er bod yna arwyddion cadarnhaol o gynnydd ers cyflwyno'r Ddeddf, mae llawer ar ôl i'w wneud. Nid oes gan rai o fyrddau iechyd mwyaf Cymru gynlluniau wedi eu cymeradwyo ac nid ydynt wedi cyflawni eu dyletswydd i adennill eu costau dros dair blynedd. Mae'r cyrff hyn yn awr yn wynebu her i gyflawni eu dyletswyddau o dan y Ddeddf yn y blynyddoedd sydd i ddod.”

Welsh Government using the NHS finances act to drive better planning of services and finances

But still a way to go to realise the full benefits with four out of seven health boards not meeting their duties under the Act

Since the implementation of the NHS Finances (Wales) Act in 2014, the Welsh Government has increased planned health spending, but has continued to rely on additional funding to address in-year pressures and priorities.

The way in which the Welsh Government oversees and holds NHS bodies to account for the quality of their planning is generally sound. There are signs of a greater focus on the longer term, as intended by the Act. Nevertheless, at the end of 2016-17 four of the seven health boards failed to meet their duties under the Act. This is the conclusion of the Auditor General’s latest report about the implementation of the NHS Finances (Wales) Act 2014.

In the three year period since the Act came into force, the Welsh Government has increased health spending in real terms by an average of 2.9% each year a real terms rise from £6.2 billion in 2013-14 to £6.7 billion in 2016-17. Some of this additional funding has been allocated in a planned way through the budget ahead of the start of the financial year.

However, the Welsh Government has also continued to allocate in-year funding. This in-year allocation includes funding for specific priorities, such as new drugs, as well as funding to cover forecast or actual overspends at NHS bodies. The additional funding is in part intended to enable NHS bodies to avoid having to take short-term financial decisions that could impact on the quality of care.

The report also concludes that the Welsh Government’s planning guidance is generally clear. The Welsh Government has developed a good process for reviewing the quality of NHS bodies’ plans, and has revised and strengthened its approach to linking these plans to the planning of capital projects.

The report finds that the Welsh Government has been resolute in only approving plans it has confidence in. In some cases that has meant approving financial plans that were not fully balanced at the start of the financial year but where the Welsh Government had confidence in the NHS body’s track record and mitigating plans. 

The report finds that there are signs of the intended shift to the longer term thinking and planning across NHS Wales. Nonetheless, patterns of spending and savings continue to have a strong annual focus on the position at the end of the financial year.

Despite the Act, the in-year financial position necessarily remains an important focus of Welsh Government monitoring. No NHS body has yet made planned use of the financial flexibility under the Act.

At the end of March 2017, three out of the seven Health Boards and all three NHS trust met the twin statutory duties of breaking even over the previous three years and having a three-year plan that is approved by Welsh Ministers. The contributing factors in the four health boards not meeting their duties include:

  • over optimistic saving plans, and not identifying sufficient sources of savings and failing to deliver identified savings;
  • clinical and services plans not being in place, to support changes in services;
  • workforce pressures, which has resulted in reliance on costly locum and agency staff;
  • concerns over performance of certain services, which have required additional investment; and
  • concerns about capacity to deliver strategic changes.

The report makes two recommendations covering the Welsh Government guidance and progress monitoring and updating the formula that underpins the allocation of funding to health boards. It also identifies two priority areas where the Auditor General considers that the Welsh Government needs to make progress – tackling the reliance on in year funding and providing a clearer direction on strategic change, particularly to regional and national services.

Auditor General, Huw Vaughan-Thomas said today:

“The NHS Finances Act 2014 provides NHS Wales with a framework to better plan services and finances over the medium term, linked to their broader strategic plans. Although there are positive signs of progress since the introduction of the Act, there remains much to do. Some of Wales’ largest health boards do not have approved plans and have not met their duty to break even over three years. These bodies now face a challenge to meet their duties under the Act in the coming years.”

Bwrdd Iechyd Betsi Cadwaladr yn symud i’r cyfeiriad cywir

Ond, er ei fod ar y trywydd iawn, mae llawer i’w wneud o hyd

Mae Archwilydd Cyffredinol Cymru a Phrif Weithredwr Arolygiaeth Gofal Iechyd Cymru wedi galw ar Fwrdd Iechyd Prifysgol Betsi Cadwaladr i barhau i roi “arweiniad egnïol, dewr ac amlwg” i adeiladu ar y cynnydd y mae eisoes wedi’i wneud o ran gwella gwasanaethau.

Mae’r adroddiad a baratowyd ar y cyd gan Swyddfa Archwilio Cymru ac Arolygiaeth Gofal Iechyd Cymru yn trafod y cynnydd a wnaed ers adolygiad gwreiddiol 2013 a’r adolygiadau dilynol. Cafodd yr adolygiad ei gyflawni tu allan i’r fframwaith mesurau arbennig ac mae’n trafod nifer o themâu, gan gynnwys effeithiolrwydd y bwrdd, strwythur y sefydliad, cynllunio strategol, a’r trefniadau ansawdd a diogelwch.

Yn gyffredinol, o’i gymharu â sefyllfa heriol 2013, mae’r adroddiad yn nodi bod yr arweinyddiaeth wedi cryfhau, bod y Bwrdd yn gweithio’n fwy effeithiol, a bod strwythur y sefydliad wedi newid yn sylfaenol. Mae hefyd yn nodi bod y mesurau arbennig yn helpu i hoelio ei sylw yn y mannau cywir.

Fodd bynnag, mae nifer o’r heriau a bennwyd yn flaenorol yn dal i fod yn amlwg. Y pwysicaf o’r rhain yw’r ffaith nad oes cynllun clir ar gael o ran sut y dylid ailsiapio gwasanaethau clinigol y Gogledd, a sut y gellir gwneud hyn mewn ffordd a fydd yn hyfyw yn y tymor hir o safbwynt clinigol ac ariannol. Yn ogystal, er bod y trefniadau ansawdd a diogelwch wedi cryfhau, mae angen iddo wneud mwy o waith i hybu dysgu ac i wella ansawdd.

Heddiw, dywedodd Huw Vaughan Thomas, yr Archwilydd Cyffredinol: “Mae’r adroddiad hwn yn tynnu sylw at y gwaith da y mae’r bwrdd wedi’i wneud i ymateb i’r problemau a’r heriau y mae wedi’u hwynebu. Fodd bynnag, rwy’n annog y bwrdd ac uwch-aelodau o’r staff i roi arweiniad egnïol, dewr ac amlwg wrth iddynt barhau i fynd i’r afael â’r materion y maent yn eu hwynebu.”

Dywedodd Kate Chamberlain, Prif Weithredwr Arolygiaeth Gofal Iechyd Cymru: “Er bod y bwrdd iechyd yn symud i’r cyfeiriad cywir, mae’r adroddiad hwn yn dangos bod angen iddo roi sylw i rai materion pwysig o hyd. Y pwysicaf o’r rhain yw cytuno ar gynllun clir ar gyfer gwasanaethau clinigol y Gogledd yn y tymor hir. Mae hyn yn hanfodol er mwyn parhau i ddarparu gofal diogel a chynaliadwy.”

Betsi Cadwaladr Health Board moving in the right direction

But while the direction of travel is positive, there is still much that needs to be done

The Auditor General for Wales and Chief Executive of Healthcare Inspectorate Wales (HIW) have called on Betsi Cadwaladr University Health Board to continue to show “energetic, brave and visible leadership” to build on the progress they have already made to improve services.

The joint report between the Wales Audit Office (WAO) and HIW looks at the progress made since an initial review in 2013 and subsequent follow-up reviews. The review has been delivered outside of the special measures framework and looks at a number of themes including the effectiveness of the board, the structure of the organisation, strategic planning and quality and safety arrangements.

Overall, the report highlights that from a challenging position in 2013, leadership has strengthened, the Board is working more effectively, and there has been a fundamental change in the organisational structure. We also highlight that the special measures they are under are helping to focus attention in the right places.

However, several challenges highlighted previously are still evident. The most crucial of these is the lack of a clear plan for how clinical services in North Wales should be reshaped, and how this can be done on a basis that is clinically and financially viable in the long term. In addition, despite the strengthening of quality and safety arrangements, more work is required to enhance learning and quality improvement.

Auditor General, Huw Vaughan Thomas said today: “This report highlights the good work that has been done by the board to respond to the issues and challenges they have faced. However, I would encourage the Board and senior staff to show energetic, brave and visible leadership as they continue to address the issues faced.”

Kate Chamberlain, Chief Executive of HIW said today: “This report demonstrates that while the health board is moving in the right direction, some significant issues remain. The most crucial of these is the agreement of a clear plan for the long-term shape of clinical services in North Wales, which is fundamental to the ongoing delivery of safe and sustainable care.”

Mae angen proffil uwch ar gyfer rheoli meddyginiaethau mewn cyrff iechyd

“Cymerir camau cadarnhaol, ond mae mwy o le i wella ansawdd a chostau”, meddai’r Archwilydd Cyffredinol

Mae cyrff iechyd yng Nghymru yn cydweithio’n dda i wella’r ffordd y caiff meddyginiaethau eu rhagnodi a’u rheoli, ond mae angen sicrhau proffil uwch. Dyna gasgliad adroddiad gan Archwilydd Cyffredinol Cymru, a gyhoeddwyd heddiw. 

 

Canfu’r adroddiad hefyd, er bod GIG Cymru’n cymryd camau i wella rhagnodi mewn gofal sylfaenol, bod lle i wella ansawdd a chostau ymhellach. Yn yr ysbyty, canmolir gwasanaethau fferylliaeth gan staff y GIG heblaw bod rhai problemau yn bodoli o ran storio meddyginiaethau, bod bylchau mewn gwybodaeth am feddyginiaethau, a bod yr oedi wrth weithredu system ragnodi electronig genedlaethol yn peri rhwystredigaeth o ran ymdrechion i wella diogelwch ac effeithlonrwydd.

 

Rhagnodi meddyginiaethau yw’r ymyrraeth therapiwtig fwyaf cyffredin yn y GIG ac mae’r galw am feddyginiaethau yn tyfu – a bu cynnydd o 46% yn nifer yr eitemau a roddwyd yng Nghymru dros y 10 mlynedd diwethaf.

 

O ystyried costau meddyginiaethau, y cynnydd mewn galw a’r niwed posibl i gleifion o ganlyniad i ragnodi anaddas, mae’n bwysig bod y GIG yn gwneud y defnydd gorau o feddyginiaethau er mwyn sicrhau y caiff cleifion ganlyniadau da o’u triniaeth ac y ceir y gwerth gorau posibl o’r gwariant hwn.

 

Mae angen mwy o weithredu i sicrhau y rheolir risgiau diogelwch yn ymwneud â meddyginiaethau pan fo cleifion yn symud rhwng gwahanol leoliadau gofal, ac er mwyn deall yn iawn gwir raddfa’r meddyginiaethau sy’n gysylltiedig â derbyniadau i’r ysbyty. Ceir cyfleoedd ar gyfer gweithwyr iechyd proffesiynol, yn enwedig fferyllwyr, i weithio gyda chleifion i ddeall eu profiadau, i sicrhau eu bod yn cymryd eu meddyginiaethau’n gywir a sicrhau nad ydynt yn cymryd meddyginiaethau diangen. Bydd y manteision yn cynnwys gwell diogelwch o ran meddyginiaethau, llai o wastraff a gwell canlyniadau iechyd ar gyfer cleifion.

 

Mae’r adroddiad yn gwneud 10 argymhelliad ar gyfer gwelliant, sy’n cynnwys

 

  • Er mwyn ysgogi rhagor o welliannau wrth ragnodi, dylai cyrff iechyd sicrhau bod ganddynt gynllun gweithredu wedi’i dargedu er mwyn cyflawni gwelliannau o ran costau ac ansawdd wrth ragnodi mewn gofal sylfaenol ac mewn gofal eilaidd, yn unol ag egwyddorion gofal iechyd darbodus. 
  • Mae angen esblygu’r Dangosyddion Rhagnodi Cenedlaethol presennol fel eu bod yn darparu gwybodaeth ar ba un a yw meddyginiaethau yn gwneud gwahaniaeth cadarnhaol i ganlyniadau cleifion
  • Dylai Llywodraeth Cymru, Gwasanaeth Gwybodeg GIG Cymru a phob bwrdd iechyd gytuno ar gynllun manwl, gydag amserlen, ar gyfer gweithredu systemau rhagnodi electronig mewn gofal eilaidd, ynghyd â phroses glir ar gyfer monitro cyflawniad y cynllun.
  • Er mwyn codi proffil rheoli meddyginiaethau a rhagnodi, dylai cyrff iechyd sicrhau bod eu Prif Fferyllydd yn gyfarwyddwr gweithredol neu’n atebol i gyfarwyddwr gweithredol.

Meddai Archwilydd Cyffredinol Cymru, Huw Vaughan Thomas, yn gynharach heddiw:

“Gan fod mwy na £800m yn cael ei wario ar feddyginiaethau a mwy na 79.5 miliwn o wahanol feddyginiaethau yn cael eu rhoi i bobl yn y gymuned bob blwyddyn, mae’n hanfodol bwysig y gwneir y defnydd gorau posib o feddyginiaethau fel y caiff cleifion y canlyniadau gorau posibl. Mae’n galonogol gweld cyrff GIG yn cydweithio’n dda i wella rheoli meddyginiaethau. Mae fy argymhellion wedi’u cynllunio i gryfhau trefniadau presennol ymhellach.”  

Medicines management needs a higher profile in health bodies

“Positive steps being taken, but further scope to improve quality and costs”, says Auditor General

Health bodies in Wales are working together well to improve the way medicines are prescribed and managed, but it needs a higher profile. That’s the conclusion of a report, published today, by the Auditor General for Wales.

The report also found that while NHS Wales is taking steps to improve primary care prescribing, there is scope to further improve quality and costs. In hospital, pharmacy services are rated highly by NHS staff but there are problems with medicines storage, gaps in information about medicines, and the delay in implementing a national electronic prescribing system is frustrating efforts to improve safety and efficiency.

Prescribing medicines is the most common therapeutic intervention in the NHS and demand for medicines is growing – with a 46% increase in the number of items dispensed in Wales over the last 10 years.

Given the cost of medicines, the rising demand and the potential for harm to patients from inappropriate prescribing, it is important that the NHS optimises the use of medicines to ensure patients get good outcomes from their treatment and that maximum value is secured from this expenditure.

More action is needed to ensure medicines-related safety risks are managed when patients transfer between different care settings, and to properly understand the true extent of medicines related hospital admissions.  There are opportunities for health professionals, particularly pharmacists, to work with patients to understand their experiences, ensure they are taking their medicines correctly and check that they are not taking unnecessary medicines. The benefits will be improved medicines safety, reduced wastage and better health outcomes for patients.

The report makes 10 recommendations for improvement, which include:To drive further improvements in prescribing, health bodies should ensure they have a targeted plan of action to achieve cost and quality improvements in prescribing in primary care and in secondary care, in line with prudent healthcare principles.

  • A need to evolve the current National Prescribing Indicators so that they provide information on whether medicines are making a positive difference to patient outcomes
  • The Welsh Government, NHS Wales Informatics Service and all health bodies should agree a detailed, time-bound plan for implementing electronic prescribing systems in secondary care, along with a clear process for monitoring the delivery of the plan.
  • To raise the profile of prescribing and medicines management, health bodies should ensure their Chief Pharmacist is, or reports directly to, an executive director.

The Auditor General for Wales, Huw Vaughan Thomas, said today:

“With over £800m spent on medicines and over 79.5 million different medicines dispensed in the community per year, it is vitally important that the use of medicines is optimised so that patients receive the best possible outcomes.. It is encouraging to see NHS bodies collaborating well to improve medicines management. My recommendations are designed to strengthen current arrangements further.”