National Assembly for Wales

Back to Search

Pwyllgor Diwylliant, y Gymraeg a Chyfathrebu

Culture, Welsh Language and Communications Committee

06/06/2019

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Bethan Sayed AM Cadeirydd y Pwyllgor
Committee Chair
David Melding AM
Delyth Jewell AM
Mick Antoniw AM
Rhianon Passmore AM
Vikki Howells AM

Y rhai eraill a oedd yn bresennol

Others in Attendance

Colin Nosworthy Cymdeithas yr Iaith Gymraeg
Cymdeithas yr Iaith Gymraeg
Dr Caroline Seddon Cymdeithas Ddeintyddol Prydain Cymru
British Dental Association Wales
Dr Ian Harris Pwyllgor Meddygon Teulu Cymru, Y Gymdeithas Feddygol Brydeinig Cymru
Welsh General Practitioners Committee, British Medical Association Cymru Wales
Dr Phil White Pwyllgor Meddygon Teulu Cymru, Y Gymdeithas Feddygol Brydeinig Cymru
Welsh General Practitioners Committee, British Medical Association Cymru Wales
Dyfan Sion Cyfarwyddwr, Comisiynydd y Gymraeg
Director, Welsh Language Commissioner
Heledd Gwyndaf Cymdeithas yr Iaith Gymraeg
Cymdeithas yr Iaith Gymraeg
Rhodri Thomas Fferylliaeth Gymunedol Cymru
Community Pharmacy Wales
Roger Pratley Cyngor Cymru, Cymdeithas Ddeintyddol Prydain
Welsh Council, British Dental Association
Sian Walker Optometreg Cymru
Optometry Wales
Steve Simmonds Fferylliaeth Gymunedol Cymru
Community Pharmacy Wales

Swyddogion Cynulliad Cenedlaethol Cymru a oedd yn bresennol

National Assembly for Wales Officials in Attendance

Lowri Jones Dirprwy Glerc
Deputy Clerk
Martha Da Gama Howells Ail Glerc
Second Clerk
Megan Jones Ymchwilydd
Researcher
Rhiannon Lewis Cynghorydd Cyfreithiol
Legal Adviser

Cynnwys

Contents

3. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau 3. Introductions, apologies, substitutions and declarations of interest
4. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Cymdeithas Feddygol Prydain (Cymru) a Chymdeithas Ddeintyddol Prydain (Cymru) 4. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: British Medical Association Cymru Wales and British Dental Association Wales
5. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Fferylliaeth Gymunedol Cymru ac Optometreg Cymru 5. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: Community Pharmacy Wales and Optometry Wales
6. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Cymdeithas yr Iaith Gymraeg 6. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: Cymdeithas yr Iaith Gymraeg
8. Papurau i'w nodi 8. Paper(s) to note
7. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Cynrychiolydd o swyddfa Comisiynydd y Gymraeg 7. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: Representative of the Welsh Language Commissioner's office
9. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod 9. Motion under Standing Order 17.42 (vi) to resolve to exclude the public from the remainder of this meeting

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Dechreuodd rhan gyhoeddus y cyfarfod am 09:59.

The public part of the meeting began at 09:59.

3. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
3. Introductions, apologies, substitutions and declarations of interest

Diolch, a chroeso i sesiwn gyhoeddus y pwyllgor y bore yma. Dŷn ni'n symud ymlaen yn awr at eitem 3—cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiant. Dŷn ni wedi cael ymddiheuriadau gan yr Aelod Cynulliad Jayne Bryant. Oes gan unrhyw Aelod rhywbeth i'w ddatgan yma heddiw? Na. 

Thank you, and welcome to the public session of the committee this morning. We move on now to item 3—introductions, apologies, substitutions and declarations of interest. We have received apologies from Jayne Bryant AM. Can I ask if any Members have declarations of interest here today? No. 

10:00
4. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Cymdeithas Feddygol Prydain (Cymru) a Chymdeithas Ddeintyddol Prydain (Cymru)
4. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: British Medical Association Cymru Wales and British Dental Association Wales

Eitem 4—Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019. Heddiw, mae gennym ni Gymdeithas Feddygol Prydain Cymru a Chymdeithas Ddeintyddol Prydain Cymru. Y tystion yw: Dr Phil White, pwyllgor meddygon teulu Cymru; Dr Ian Harris, pwyllgor meddygon teulu Cymru; Dr Caroline Seddon, sef cyfarwyddwr Cymdeithas Ddeintyddol Prydain Cymru; a Roger Pratley, sef dirprwy gadeirydd Cymdeithas Ddeintyddol Prydain Cymru. Diolch yn fawr iawn i chi oll am ddod mewn atom ar fyr rybudd yn sgil y byr rybudd a roddwyd i ni gan Lywodraeth Cymru. Felly, diolch yn fawr iawn i chi yn hynny o beth. Byddwn ni'n gofyn cwestiynau ar sail themâu gwahanol os yw hynny'n iawn gyda chi. Fe awn ni'n syth mewn i gwestiynau. 

Gen i—hoffwn i ofyn beth yw eich asesiad chi o bwysigrwydd yr iaith Gymraeg o ran darpariaeth i gleifion. Mae'n rhaid i mi ddweud yn onest, pan wnes i ddarllen y dystiolaeth gerbron, daeth e drosodd i mi yn weddol negyddol ac efallai ddim yn rhywbeth oeddwn i'n meddwl oedd yn groesawgar iawn i ddatblygiadau yr iaith Gymraeg. Tybed a ydy eich barn chi wedi newid—neu allech chi esbonio pam bod gennych chi bryderon yn hynny o beth? Diolch yn fawr iawn. 

Item 4—the National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019. Today we have the British Medical Association Cymru Wales and the British Dental Association Wales before us. The witnesses are: Dr Phil White, Welsh general practitioners committee; Dr Ian Harris, Welsh GP committee; Dr Caroline Seddon, director of the BDA Wales; and Roger Pratley, deputy chair, BDA Wales. Thank you very much to all of you for attending at short notice as a result of the short notice that was given to us by Welsh Government. So, thank you very much in that regard. We will be asking questions on the basis of different themes if that's okay with you. We'll go straight into questions.  

From myself—I'd like to ask you what your assessment is of the importance of the Welsh language provision for patients. I have to say honestly that when I read the evidence that came before us, it came across to me as quite negative and perhaps not something I thought was very welcoming to developments regarding the Welsh language. I wonder whether your views have changed—or could you explain why you have concerns in that respect? Thank you very much. 

Beth rydym ni'n teimlo fel y Gymdeithas Feddygol Brydeinig yw ei bod hi'n bwysig bod yr iaith Gymraeg ymysg y gwasanaeth iechyd, ond fedrwn ni ddim gorbwysleisio'r Gymraeg oherwydd mewn ardaloedd Saesneg mae'n anodd iawn cael staff. Dros Gymru i gyd, fel y mae pethau, rydym ni'n brin o arbenigwyr, rydym ni'n brin o feddygon teulu ac mae rhoi angenrheidrwydd ar siarad Cymraeg yn mynd i greu mwy o broblem nag sydd gennym ni ar y foment. Yn y fro Gymraeg, mae'r rhan fwyaf o staff meddygfeydd yn hollol rhugl yn y Gymraeg, fel rydym ni yn y gogledd-orllewin, ond yn y gogledd-ddwyrain lle mae yna nifer llawer llai o siaradwyr Cymraeg, ac mae'n fwy anodd i gael staff hyd i ddarparu'n Gymraeg i'r cleifion. 

We as the BMA feel that it is important that the Welsh language is available in the health service, but we can't overemphasise that, because in Anglicised areas, it's very difficult to get staff. We're short of specialists and we're short of GPs already and providing a requirement for providing Welsh language services will create more of a problem than we currently have. In Welsh-speaking areas, most surgery staff are fluent in Welsh, as is the case with us in the north-west, but in the north-east, where there are far fewer Welsh speakers, it's more difficult to provide staff who can communicate through the medium of Welsh with patients. 

Gaf i ddod mewn fanna? Rydym ni eisiau gweld symudiad at fwy o ddarpariaeth ac rŷm ni eisiau gweld bod yna hwb i ddarpariaeth Gymraeg drwy ofal sylfaenol. Ond, dwi'n gweithio mewn ardal fwy Seisnigaidd nag y mae Phil yng ngogledd Cymru. Dwi ym Mhen-y-bont ar Ogwr, a dwi'n darparu gwasanaeth Cymraeg i fy nghleifion i. Ond beth rŷm ni eisiau ei weld yw bod pobl yn cael eu hannog a'u hybu i wneud hynny. Felly, y pwyslais i ni, pan fod yna grisis gyda ni yng ngofal sylfaenol yn barod, yw ein bod ni'n symud i hybu'r ddarpariaeth yna drwy annog y byrddau iechyd i roi gwasanaethau cyfieithu os oes eisiau nhw, fel y signage a phethau fel hynny sydd gennym ni yn y meddygfeydd, a hefyd ein bod ni'n dodi cyrsiau ymlaen fel ein bod ni'n gallu annog mwy o bobl i gynnig Cymraeg yn y meddygfeydd sydd gennym ni. 

Can I come in there? We want to see a movement towards greater provision and we want to see that there is a boost to Welsh language provision in primary care. But, I work in an area that's more English-speaking than Phil in north Wales. I'm in the Bridgend area and I provide a Welsh language service to my patients. But what we want to see is that people are encouraged to do so. So, the emphasis for us is that when there is a crisis in primary care, as we have currently, we move to encourage that provision and boost that provision through encouraging the health boards to provide translation services if required, such as for signage et cetera, like the ones that we have in the surgeries, and that we also provide courses so that we encourage more people to provide Welsh in the surgeries that we have. 

Ond dŷch chi wedi dweud yn weddol blwmp ac yn blaen bod rhai practisys ddim yn mynd i allu rhoi unrhyw un o'r rheoliadau yma mewn i weithrediaeth. Felly, ydy'r analysis hynny dal yn bodoli? Ydych chi dal yn credu bod rhai ddim yn mynd i allu gwneud unrhyw beth yn y maes yma?  

But you've said quite clearly that some practices aren't going to be able to implement any of these regulations. So, is that analysis still standing? Do you still believe that some aren't going to be able to do anything in this field? 

Y pwyslais sydd gennym ni ar y funud yw gwneud yn siŵr bod meddygfeydd ar gael, a dyna'r pwyslais cyntaf sydd gennym ni fel cymdeithas. Rŷm ni'n becso braidd bydd hwnna ddim yn digwydd—bod meddygfeydd yn mynd i gau beth bynnag sy'n digwydd. Heb siarad am y ddarpariaeth Gymraeg, bydd dim meddygfeydd gan rai o'r cleifion yma os nag ydym ni'n ofalus. So, dŷn ni ddim eisiau gweld bod gorfodi pobl i roi darpariaeth yn yr iaith Gymraeg yn mynd i wneud i bethau fynd yn fwy clou o ran cael gwared ar y meddygfeydd yna.

Our emphasis at the moment is to ensure that GP surgeries are available, and that's the first priority for us as an association. We are slightly concerned that that won't be the case and that surgeries will be closing whatever happens. Never mind Welsh language provision, some patients won't have surgeries unless we're careful. We don't want to see that placing a requirement on providing Welsh language services is going to shift things more swiftly in that direction, as we do see surgeries disappearing. 

Oes yna sylwadau gennych chi, Caroline neu Roger? 

Do you have any comments, Caroline or Roger? 

I would echo a lot of what has already been said, but if there's any negativity that comes across, that is to do with the fact that general dental practice is offered through a model that requires practices to act as small businesses. So, unless the additional costs that would be incurred through any Welsh language duties—if those costs are not covered via the health boards in its entirety, then those costs will directly impact on those businesses, and we've already seen a significant reduction of small dental practices due to closing, and there is a concern about the financial impact. You might have noticed—we didn't have time to produce a response to the revised regulations—but in our original submission, we said that we felt there was a lack of provision around the business modelling. And we wanted to understand better how the provision would actually be financed, because that really directly impacts.

And then you've also got, as was referenced by the BMA, a recruitment and retention problem in the general dental service as much as you have in the general medical service. And our other concern, which we would reiterate still, is that you might have unintended consequences by introducing certain duties around Welsh language. If you have a lack of native Welsh speakers through a number of different causes—and if we're looking to be welcoming and inclusive, not only of general dental practitioners from other part of the UK, but also from Europe, this could have an unintended consequence of deterring GDPs to come and work and live in Wales.

10:05

So, what in this particular regulation would you make you fear that? Because, from my point of view, I can't see anything that would lead to that consequence. In fact, you could look at it in a different way entirely, but then that's a debate for another day. What in these regulations would deter people? Because it's about encouraging people to wear lanyards, it's about encouraging people to go on courses. People from different nations can come here and learn Welsh—that's not something that's not happened before. So, tell me where you find that a problem here in the regulations.

So, obviously, the regulations have been amended from the draft. We felt that, particularly in the draft, there was that potential for an unintended consequence. But I think it's really about perception. So, it doesn't really matter what is actually written in the regulations; it's how it might be perceived from GDPs or GPs when they understand that there is this sort of move towards having the emphasis on the Welsh language. So, it's really about perception. It's not about the actualities of the legislation. 

But you are assuming the perception is negative. Why does the perception have to be negative?

Because if people don't have the language, then they might feel that they wouldn't be able to—that it wouldn't be the sort of environment that they would necessarily feel that they could do everything that was required of them. It's about patient expectation, and I think it's about what the patients will be expecting now and in the future. And one of the points we mentioned in our original response was about how you manage the patient expectation. If patients expect to be conversing in Welsh within a practice where you don't have a native Welsh speaker, then you're going to be disappointing that expectation.

I don't know about the expectation that they should have to—but, Delyth, did you want to come in?

Just on that point. Under that logic, the use of Welsh would never increase, though, because of a fear of an expectation. We'll come onto this later more, but there would certainly be ways—. We'd like to discuss how different practices could be encouraged to see this as a potential asset for people to come in, and not something to fear. But perhaps we can go into this later.

10:10

Can I just add to that, because there is another aspect that we must look at? The General Dental Council has standards that all registrants have to follow. Now, then, there's absolutely no problem with leaflets for patients, for example, which are coming from the health authority; there's no problem with that. That happens now, in fact, doesn't it?

But there is a problem, though, because I've had evidence already that one dentist has been taking the Welsh and English apart and has put to the Welsh to one side and is only distributing the English leaflets from the health board. And, in fact, they have got rid of them. So, there is a problem already in the system, even from the health board. 

Right, okay, well there shouldn't be a problem with that. I would agree with you that there's no need for that to happen. 

But the other thing are the GDC standards, and I want to separate translation and interpretation—. Translation should not be a problem, because translation services are going to be done by the health boards, aren't they? Interpretation is another matter, because standards from the General Dental Council might not be met if, for example, you have—say you don't have a dentist in the practice who speaks Welsh but there are a number of dental care professionals, dental nurses or maybe a dental therapist or dental hygienist, who might be Welsh speaking, but is their Welsh good enough to interpret on a clinical level the conversation between a patient and a dentist? Because I've worked with interpreters for 10 years in the past, and they're all graduate people who have been properly trained in medical interpretation, similar to a medical secretary. Any old secretary cannot become a medical secretary; there's specific training for that. So, if a young person is trying to interpret and is not particularly efficient at it and cannot hit the right notes in terms of technical terms, then maybe they would be running a risk of not conforming to the General Dental Council's standards. So, that is a possibility, and I think we need to separate the translation element and the interpretation element. 

Ond o ble yn y rheoliadau ydych chi'n cael y consérn hynny? O ble yn y rheoliadau hyn y mae'r consérn hynny'n dod?

But where in the regulations do you see that concern? In the regulations as they stand, where does that concern stem from?

Well, the regulations don't actually distinguish between interpretation and translation, and what I'm saying is that interpretation is a different element altogether. 

I think there's a fundamental question here, and it goes as much to the BMA: you have a constant challenge about translating very dry clinical language, often with a heavy use of Latin and Greek names when you communicate, so why is it possible to do that bit through English—making real what the diagnosis is so people can understand it—but the introduction of a reasonable use of Welsh where that capacity exists is mission impossible? I find this a really, really strange argument. 

Can I jump in on that, because I think you're spot on? Being someone who does consult in Welsh and will own up to his Welsh being quite variable on some of the technical terms anyway, it isn't as much of a problem as it's perceived to be. And my Wenglish is very good, as is my jargon and non-jargon. So, I think there is a perception there that it's a barrier for those who don't deliver it in those terms, and the expectation from patients is not that you are perfectly fluent technically in every aspect of Welsh, because if it is, they're very disappointed when they come to see me. [Laughter.] They're very keen that you make that Welsh offer, and I think that's where we want to try to encourage people to move in that direction, even if it is with basic greetings in Welsh to start with, to make the patient feel at home, and then moving into an English consultation.

We're very supportive of the regulations as laid out, and I think the direction of travel is one where we'd like to see more and more Welsh provision. And I don't think—. I would be quite reassuring to my dental colleagues on that, that, actually, as someone who does it, I don't think it's as big a concern, especially when most Welsh-speaking patients, let's be frank, are bilingual, and will accept the bilingualism as well as the monoglot Welsh. And, frankly, if we do need to move towards that monoglot provision, then provision of actual, bespoke, LanguageLine services, which we're quite used to delivering in general practice, particularly with those from the middle east and Africa and other places, where they don't have any English even, is the direction we would look to move in, in that scenario, I think. 

10:15

A few quick questions. Clearly, there are issues over perception and management of perception and so on, and those are things that, in many other areas, we're used to overcoming over a period of time. I get a certain degree of confusion and mixed messages on comfortableness with regard to the regulations themselves. To what extent do you feel you've been adequately involved in the actual development of the regulations? What has been your role in the development of these regulations?

I think the BMA has been consulted on it. It's consulted its members, and we've come to the conclusions that we have. Certainly, we're supportive that the health boards themselves should promote a bilingual policy, and that, as contractors, it is not easy for us to do, but if the health authority, or health boards rather, do provide us with the translating facilities, that's fine. Everything in my surgery is bilingual: the signs are bilingual; 80 to 90 per cent of my consultations in one surgery are through the medium of Welsh, and it's fairly easy for me. Not so easy when you're—. Virtually everybody who applies for a job in our surgery is bilingual, and it is a Welsh area. But I do know that there are big issues with recruiting secondary care staff. There's a perception that, in north-west Wales, because you have to have a knowledge of Welsh or access to Welsh, and that your children will be educated in Welsh-medium schools, it is a deterrent to many people applying for jobs, because they see that as an extra burden in an already stressful profession. 

I'd also add, with the consultation—the formal consultation, if you like, which is obviously quite abridged—that we have been cited on the direction of travel within contractual negotiations as well as the GPC. So, Welsh Government perpetually do push the Welsh agenda, and furthering the Welsh provision with us, and we're quite keen to engage on that with them in contractual negotiations as well. So, we are cited on the direction of travel and support it. 

Are you satisfied that, in the process of the development of these regulations, and the consultations, you have been adequately engaged within them, and there has been adequate communication and conversation over the regulations? Because, certainly, what I see from the evidence, and certainly, from evidence that comes through, is that, obviously, there are very, very mixed views across Wales, as, inevitably, there are bound to be. I'm just wondering whether you were satisfied with that, and also, with the extent of the consultation response you had, the engagement with your own members, are you satisfied that that has been properly reflected in all the views?

Yes, the BMA does that. It goes out to consultation, either through the specialist committees, or through the BMA Welsh council. We receive responses, and then we judge our overall response based on what members have told us. And, of course, there will be those who are very keen on the Welsh language. I myself would consider myself keen to promote and use the Welsh language; others are not so keen, and others see great difficulties with providing the service when you're already stretched to capacity. It's one thing to say, 'Yes, use LanguageLine'—LanguageLine probably doubles the length of a consultation, and it makes it very, very difficult. I'm not just talking about Welsh, I'm talking about—. We have refugees from Syria, and we need to get translators in when they do come, and it does really take—. And when you're already pressured, when you're already under considerable pressure to get to see lots of patients because you're short-staffed, it makes it very difficult. 

I would say it's very similar. So, we had a full consultation within the BDA, through our committees and their representatives, to produce our original response. There did seem to be a long delay where nothing was coming out and I did actually make enquiries several times asking, 'Where's the consultation response?' I think it was something like 20 months before the Government produced their response. And what I did notice, where the Government collated responses, where it said 'other comments', there didn't seem to be anything under that heading from representatives of primary care; it only seemed that the Government was interested in other comments from the regulators, and that was disappointing, because we felt that, in that sense, our other comments, which I've already referenced about the perception issue, weren't brought out at all. And there didn't seem to be any reason not to mention it because the BMA said something similar in their original response.

But what I would say is that with the revised regulations, we feel that, actually, this is a much more pragmatic approach, because any regulations that are enforced have to be realisable, and our general view is that, in terms of the regulations as stipulated, they are realisable. Obviously, my colleague has already said that some practices will find it easier than others to provide everything that's being asked, because some practices simply won't have Welsh speakers, so they won't be wearing a badge, or they might have some Welsh language but won't feel confident. So, I think our only comment around that is we wouldn't want people to feel pressurised to wear a badge because they have some Welsh. But, to my colleague Roger's point, they would have to be competent to have a consultation in Welsh with a Welsh speaker, so it's about finding the right balance.

We think the regulations have actually been amended to the point where we think they can be realised and they seem reasonable. Obviously, the health boards have a big role to play, particularly in terms of the financing of them.

10:20

So, just in summary, then, the process of engagement that you've had with all your members, with various contractors and so on has resulted in a set of regulations that are certainly challenging in many ways, but your view is that, generally, with work and support, they are realisable, or proportionate, I suppose.

Yes, absolutely. The BDA is certainly supportive of the whole concept that's going on there. We don't want to appear negative towards it in what we're saying, but we feel we have a duty to raise issues that are raised with us and we can see might be problematic. That doesn't mean to say they're going to be problematic, but it's the sort of thing that one wants to be prepared for.

Jest i gadarnhau ar y record, dyw e ddim yn dweud bod rhaid cael ymgynghoriad clinigol drwy gyfrwng y Gymraeg. I wisgo bathodyn, mae e i siarad â chlaf ynglŷn â’r hyn sy’n digwydd o fewn y practis. Felly, dwi jest eisiau deall pam dŷch chi wedi dehongli’r rheoliad hynny fel bod angen ichi gael ymgynghoriad clinigol. Byddai rhai pobl yn dweud y dylai hynny ddigwydd, ond nid dyna sydd yn y rheoliad. I chi, Caroline Seddon.

Just to confirm for the record, it doesn't say that you would have to have a clinical consultation through the medium of Welsh. To wear a badge, that's just to communicate with a patient on what's happening within the practice, it's not a clinical consultation. So, I'm just seeking to understand why you've interpreted that regulation particularly as having to provide a clinical consultation. Some would say that that should happen, but that's not what's contained within the regulation. That's for you, Caroline Seddon.

Again, I think it comes back to the perception that if there is going to be a requirement to wear a badge to say that you can speak Welsh, then I think there will be an expectation from patients that they might well have that consultation in Welsh. And there might be the view from practitioners that that expectation will be on them. If they're wearing a badge saying, 'I can speak Welsh', then it's about how that is then managed in practice. They might feel that there is that pressure on them to do that, and we're simply saying that we would want there to be a proportionate expectation. Again, it's—

But that's what is there, isn't it? Sorry, I'm going on with this point, but that is how I see it. It is what you would see as being proportionate, is it not?

I think perception is important, but it applies to you as well. You come in and give evidence and start—expectations and perceptions are presented as huge barriers, when they are not. I think there are practical issues; I accept that. But in this latter case, in terms of if you are a receptionist wearing a 'I'm happy to speak in Welsh' badge or whatever, or a learner's badge sometimes—. Just go and talk to other public agencies, because this is absolutely standard practice. If you go to the hospital, it's standard practice there now, presumably, that these markers are used. So, I think there is some responsibility on your side as well to be proportionate in the areas where you think there may be some practical difficulty in implementing these in an appropriate way.

I think we've actually reached the position where both the BMA and the dental association agree that the six duties are reasonable, and they will reflect existing capacity, largely. I mean, all right, encourage development of more Welsh services where that is possible, but there's nothing in them that is forced or convoluted or likely to distort current service provision. Is that a fair assessment?

10:25

I think, to me, you've got to be careful of the perception, as I've said. Certainly, with secondary care, with consultant staff, there is a perception in north-west Wales and possibly for other Welsh-speaking areas of Wales that Welsh is either essential or you'll have to learn it and that your children will be taught in Welsh, which is fine if that's what you want, but there are a lot of people put off because of this perception, and it is all perception. As I said, I don't have a problem in my area with providing Welsh provision because we're virtually all Welsh. Eighty to 90 per cent of my consultations will be in Welsh, and we don't see it as an issue, but we do appreciate that there are areas of Wales where it's very difficult to find Welsh speakers, and to raise expectation amongst the population that they have a right to speak Welsh everywhere is the danger here, I think. You raise the expectation. It's not in the regulations, but that would be the expectation.

Okay. Well, you've repeatedly made that challenging and, may I say, grim observation, but I think we are where we are in this country, and we are a bilingual nation, and we do have existing law that recognises the equal validity of the languages. That's been established since the 1960s, and I dare say Government and the professional bodies could do more work. Let's hope that exists, but the situation in north-west Wales has ever been thus, hasn't it? Let's be frank. I mean, that's not changed at all.

Please may I make a comment?

But anyway, in terms of primary care, which is what we are focusing on, I think we do need to establish whether you have objections in principle to any of the six duties that are now going to be imposed?

Yes, I just want to make a comment to respond to your comment: I'd just like it to be on record that BDA Wales, although we have no Welsh-speaking staff and our staff comprise one and a half people, including me—we're a very small operational team—but when I came into post I made sure that there was a recurring budget for Welsh translation for all our policy documents. So, when you go to our landing page, you will see all our key policy documents translated into Welsh, because I felt that was an important thing to do, which we hadn't been doing hitherto. So, I'd just like it to be understood that we are very sympathetic and observe exactly the point that you're making that we are a bilingual country and that we are trying to do what we can within a very limited budget.

Thank you. That's helpful. So, the six duties seem reasonable and proportionate. Please contradict me now if you don't agree with that.

My next question. If you don't have the information to hand or you've not seen, for instance, the submission of the Welsh Language Society, there are those who feel that the problem with these regulations is not that they're there; it's that they're not strong enough. If you've seen what some of these campaigners have been calling for to strengthen the regulations, do you have any views on that? I'm quite happy if you've not seen it—just say that and we'll move on.

I think I've heard of it around the place, and, yes, they're going to want provision of everything in Welsh, which in the Welsh heartland is not a problem, but if you expect it to be done in, say, the Gwent valleys, I think it's going to be a little bit more difficult. In an ideal world, yes, we would all be bilingual, we'd all learn Welsh, and several of my English consultant colleagues have done so, and that's to be encouraged, but compulsory would make it very difficult and I think you would end up with no GPs rather than Welsh-speaking GPs with that sort of policy.

10:30

I think, to add to that, I've not seen the Cymdeithas submission, but I could probably guess the direction they want to take it in, and I could understand that. Just to echo that, I think we do have a comms issue in that we need to explain to people that we're on a journey, and we don't want to eradicate general practice along that journey, but we also want to move towards greater provision of Welsh language services and that, actually, you're right, perhaps we do have a message to deliver to the profession that we shouldn't be scared at that direction of travel. Because I think there is that perception that there is a creep to compulsory, making everybody consult and deliver all services in Welsh, and I think that is potentially quite a scary thing for a lot of people and, at the minute, we don't need any barriers to encouraging people into general practice because we have a shrinking workforce and worsening provision for our patients. So, the comms around that from Welsh Government, from health boards and from us as professional associations and bodies are really important. But the basic submission and the basic standards as set, we are very supportive of.

Again, that's helpful, but in fairness to the Welsh Language Society, essentially they're trying to make the six duties a bit more rigorous and extensive. I wouldn't say it takes us into a world of impracticality, although they obviously are pushing and would also like to see reception-area services strengthen. But, anyway, if you've not seen them, and, in any event, you're content, I think, with the regulations as they are currently drafted.

My final point is that some people have said that perhaps not the whole primary care team should be covered. I find that a little difficult. It does seem to me that the opticians, the pharmacists, dental practitioners—you know, basically everyone involved in primary care—should be covered, and there's no particular reason why they shouldn't be or why any particular parts of the team would find these regulations more onerous than others. Is that your view?

We presumed it was applicable to all of primary care.

Yes. We can't speak on behalf of anybody else. From our point of view, we've expressed our opinions.

Can I just say that we think that the approach has been sensible and proportionate? Where we've raised issues, they're purely the sort of things that we would expect our colleagues to be saying to us, and which we have to answer, basically. There's no negativity on BDA Wales's part. It is supportive of the way it's being done, certainly in terms of the gradual introduction, basically, which is a very sensible way of doing things.

Diolch, Chair. We've taken some written evidence from Optometry Wales, and they've expressed their concerns about the potential medico-legal implications of delivering a clinical examination and advice in a language other than English. I just wondered if anyone on the panel had views about that and how it might translate to your sector as well.

My optometrist does my consultations in Welsh. Certainly, it needs to be recorded in English. All medical records should be recorded in English, because our population is free to travel all across Great Britain, and we have enough difficulty when people are taken ill abroad and I end up with Greek letters in Greek and have to find interpreters, but I wouldn't have thought it was a problem—certainly not in my experience—because both she and her daughter who is now in practice with her are fluent Welsh speakers, and it makes no difference. If it's recorded in English, it's recorded.

I think it shows the communication problems that we've got around Welsh language around people's perception that it's an all-or-nothing thing. Again, in my previous answer, I've made clear that I think that any movement towards greater Welsh provision on a voluntary level is absolutely fantastic and, clinically, not delivering something in a perfect monoglot technical Welsh way is not really an issue. Your clinical acumen is not affected by the language that you deliver it in necessarily. I think that is more difficult where you're talking about somebody who doesn't have any English, for instance, when you're talking about translation services. There is a potential information-loss thing there, but generally my experience in Welsh or even in pidgin Welsh, as I think I sometimes feel I deliver, is that it's certainly not a clinical or a medico-legal risk, as far as I'm concerned.

10:35

I think the point you made there about the all-or-nothing approach is very pertinent. To take the evidence further, one of the pieces of evidence was that clinical words in Welsh are not everyday language, they said, and as a result patients and practitioners, even though their first language may be Welsh, would not always know these words. Well, I would argue that if you're going to your optician and they're telling you, for example, that you've got macular degeneration, if they tell you that in English, you probably don't understand the term anyway, and clearly the important part is how that practitioner then explains the condition to you and how it's going to affect you. And that, whether it's done through English or Welsh, surely has to be done in a way that is pertinent to that patient and how they will understand that. Would you all agree with that?

I think the important thing is not to use technical terms when you're talking to patients and to explain it in lay terms. That's what communication is all about. The technical term I might put down in the notes, so that another doctor knows what I'm talking about, but from a patient point of view you need to explain it in plain English or plain Welsh, which isn't a big issue.

Certainly my experience in delivering the service is that communication is more than just about language.

I spoke earlier about the General Dental Council standards, and the standards are that, if you're delivering in English, then it has to be understandable to the patient. So, there's no real difference. My concern was based around competence and whether a patient feels that they've been explained to properly, basically. That was my concern.

And, Phil White, you stated that you believe that records should be kept in English because patients will move around throughout the United Kingdom or perhaps further, and that's certainly the view of Optometry Wales as well. But I wonder: where does that leave patients who may be monoglot Welsh speakers? Is there a way that we can bridge that gap so that they could understand their records to the degree that they need to as well?

I think the clinical record is far more complex. It's an unexplained record. It'll have medical terms. And from a safety aspect—. I mean, the only monoglot patients I have are usually under the age of about five—they're children mainly, whose parents just speak Welsh to them. They do pick up English, of course. But I think it's vitally clinically important that medical records are kept to a standard, and that has to be English language, because we're all free to travel. The English language applies not just in the UK; it's in the States and, usually, it's the universal language if you go abroad. So, if your medical record goes with you and it is a technical document for another healthcare professional looking after you, then it should be in a language that is transmissible throughout the world, really.

We are moving towards an age where patient-held records are becoming more popular and it's certainly the direction of travel. I agree with Phil entirely on this that the basic record will have to be in English. Whether there is an option in years to come—. I mean, this is way outside the remit of these regulations, and I guess this is the sort of direction of travel that does put the hackles up on people around Welsh provision in the future, and that's where the comms around this have to be very tight that this is a direction of travel not an end point in the journey. I think that if you're going to have patient-held records and patients are going to have that right under law to have that in Welsh then that service will have to be provided externally at a cost by someone else. I've got no real problem with patients holding their own records eventually in English and Welsh, if they wish. But we are a long, long way away from that at present. At present, we are trying to make sure that patients have provision and a record. So, I think we're talking several destinations down the line here on that. Actually, I think some of that discussion around those things is what is spooking professionals, if you like, and I think that, in some respects, that's an unhelpful thing to be talking about, at the minute, when we're looking at just trying to boost provision of basic conversational Welsh, largely, and welcoming people in Welsh, and trying to provide more services through the medium of Welsh. So, I'd like to row that discussion back as best we can to start with, really, because I think that's going to be unhelpful towards furthering the provision on a voluntary and a supported basis.

10:40

Thank you. I think the rest of my questions been covered by a previous Member.

Felly, rŷm ni'n mynd i symud ymlaen at recriwtio. Delyth Jewell.

So, we're going to move on to recruitment now, and Delyth Jewell.

Diolch, Cadeirydd. Before I speak specifically about recruiting, just to pick up on one of the points that Ian had made, actually: do you think that there's more that your bodies could do to communicate with your members to show that, actually, these standards—rather than seeing them as an imposition, that they shouldn't be something to fear, that there is—to get over this problem about perception, to kind of tackle that and to show that it isn't an all-or-nothing, and that it would be using however limited Welsh would be there, and seeing that as something that might encourage your own members who might want to use their own very, very—well, pidgin Welsh or very limited Welsh themselves at the beginning of a consultation and that there would then be no obligation whatsoever to move into that? Do you think that there is more that could be done either from you to communicate with your members or is there something that you think that Welsh Government could be doing to communicate this more? Is there another body that should be doing that?

I'd like to see more in that direction from everybody, if I'm being honest. Yes, we're a broad church in the BMA and in general practice generally, and Phil and I, obviously, are strong advocates of the Welsh language and have regular discussions with colleagues who aren't quite as enthusiastic about the direction of travel. So, yes, I think there's more we can do. I think, in fairness to us as an organisation, we've been very supportive of the direction of travel through contract negotiations and supporting the direction of travel, and communicating that to our members when we get to those contract rounds and agreements that we reach or don't. So, I think we are—we can always do more, but I certainly think I would like to see more nationally around the Welsh offer, trying to encourage people to take that up and to reassure people that they don't need to be completely fluent in Welsh to be able to even break the ice in Welsh.

Not really, no. We agree with that—well, I would agree with it, anyway.

Okay, thank you. Specifically on recruitment, you've each raised concerns about the impact that you think that this could have on recruitment of practitioners into Wales, possibly from either other parts of the UK or Europe. Do you have any specific data to show why that might be an issue? Is this something that you've had any experience with, adversely, with any other comparable issue?

I don't think—. There are problems in recruitment, not so much in the M4 corridor, although there are problems there as well, but certainly further west. Practice owners are finding it extremely difficult, at the moment, to get anybody to take up positions in their practice, and I think—is it one or two practices in north Wales that have given their contracts back, basically, and they've closed? I think it's one practice, actually. So, there does lie a problem in recruitment. We could talk about the attitude of the dental school and its recruitment policy for students; we could talk about foundation training for dentists, which is fully paid for by the Welsh Government, obviously; we could talk about those sorts of things and how can they be improved so that we are retaining Welsh-trained dentists in the area. Because when Cardiff dental school first opened in the 1960s, there was a tremendous rise in dentists staying in south Wales and even further west. So, I think those things can be looked at, but, obviously, this is not—.

10:45

No, of course. Looking specifically at the issue that's been raised a number of times about the perception of how these standards could make some people feel less willing to make an application to work in Wales, are you basing that on another adverse kind of perception that's happened with another field in the past? I'm just trying to work out why you think it would be a negative thing. 

I think there's anecdotal evidence from border areas where they do try and recruit that some people are put off by the perception that they can't apply to Welsh posts because they don't have Welsh. I certainly think that does apply along the Welsh border. I've not seen any hard evidence in that regard, but you certainly get feedback anecdotally from people who are interviewing and who are advertising posts. 

Having said that, I'd also echo the BDA's point around training and around Welsh language provision and Welsh language support to doctors in training, in that we've now got a reactive Welsh language cohort coming through the medical school in Cardiff, which is fabulous to see. And I think for years, actually, we've seen the numbers of Welsh-domiciled medical students through Cardiff University, actually, if anything, decreasing, and we've had real concerns about that because of the fact that there is plenty of evidence to say that if you train people locally, they stay in the area and give you NHS provision for years to come as well.

So, I think there's a lot more that could be done to support Welsh language development in medical schools, get the culture around—. Even if people aren't—. As we just spoke about, you don't have to be fluent. You just have to be welcoming and just give a Welsh offer of some sort. And if every student that came through the medical school had that ingrained in them, I think we would very quickly move towards a greater level of Welsh provision in Wales. So, I think that there needs to be a greater focus on that from a proper workforce planning point of view, let alone just on a Welsh provision standard as well. 

And in the shorter term, the point that we were just discussing about communicating more so that your own members won't feel possibly as fearful of this, do you think that that could play a part as well? 

I think it would do, but to go back to the recruitment, we are welcoming the medical school in Bangor, which will be a sort of attachment for, hopefully, Welsh-speaking students, because it's generally recognised that students tend to stick around the university that they qualify in, which is why around the M4 corridor is all right and if you go west or north, it isn't. Traditionally, our links have been with Liverpool, and not with Liverpool medical school, and many of our training rotations are with Liverpool. But hopefully, having a provision in Bangor for higher medical education will make a big difference. We've certainly seen an increase in the number of GP trainees in north Wales, having increased provision and now increased applications.

So, hopefully, things will improve on that front, remembering, of course—I can think of dozens of Welsh-speaking doctors who work in England, and the Liverpool Taffia has been famous over the years—[Laughter.]—and some people would say, well, possibly, that's to do with private income and things that aren't available in more rural areas.  

Thank you. Finally, Chair, if I may, in the BDA evidence you refer to the need that—that these standards might be discriminatory if they're only applied in Wales, and that the offer should be made, presumably, throughout the UK and also to any visitors from Patagonia who come to Wales. Was that a sincere point? 

Yes, absolutely. So, what we were saying is—obviously, this refers to the draft regulations—they were being proposed as applying only to people who were resident in Wales, and we were simply making the point that any Welsh speaker, wherever they came from, if they were receiving healthcare in Wales and their preferred language was Welsh, then they should be given the same offer as if they were domiciled in Wales, if they were receiving treatment in Wales. So, that was the point on that.

10:50

Okay. Do you often get patients from Patagonia coming to you?

Not many, no. 

I've treated one patient from Patagonia. 

Welsh and Spanish speaking—no English. 

There's talk of Gabriel Batistuta, who's Welsh-speaking coming to the Swans, but whether that's—[Laughter.]

Jest ar gyfer y record, dŷn ni ddim wedi clywed gan y gymdeithas ddeintyddol ar y cwestiwn roedd Delyth Jewell wedi ei roi ynglŷn â thystiolaeth o'r rhwystredigaethau i recriwtio, achos dŷch chi'n dweud hynny yn eich ymateb i ymgynghoriad y Llywodraeth. Felly, a allwch chi jest esbonio ar ba sail, felly, dŷch chi'n cael y farn honno o ran y rhwystrau? Ydy hynny'n anecdotal hefyd, neu os gyda chi dystiolaeth i ddangos bod yr iaith Gymraeg yn rhwystr? Diolch. 

Just for the record, we haven't heard from the BDA regarding the question that Delyth Jewell posed on evidence of the frustrations involving recruitment, because you say that in your response to the Welsh Government's consultation. So, could you just explain on what basis, then, that you have come to that view in terms of the barriers? Is that anecdotal as well, or do you have evidence that the Welsh language is a barrier? Thank you. 

I would say the same, that we're talking about anecdotal evidence at this stage, because we'll only be able to get hard data once these measures come in force. So, once the duties are in force, we will then monitor. And I would say that, in terms of our policies, BDA Wales always looks for hard evidence and qualitative evidence. We try and do both to support any policies. So, what we were saying is that this is a potential risk. So, sometimes, when you are doing a risk analysis, you don't have hard data, and you're saying, 'This is a risk—something to be borne in mind.' And, obviously, those comments were about the draft regulations, not the final regulations. And, as I say, we couldn't get a response, a written response, to you within a week, which is why you've got our response to the draft regulations. So, we are talking about slightly different things here. 

Felly, jest ar gyfer y record eto, mae'ch barn chi'n newid ar hyn hefyd—ei fod e ddim yn mynd i fod yn gymaint o rwystr gyda'r rheoliadau fel maen nhw'n sefyll. Roedd y rhwystrau yn sylwad ar y drafft rheoliadau. 

So, just for the record again, you're view is changing on this as well—that it's not going to be so much of a barrier as the regulations stand. The barriers was a comment regarding the draft regulations. 

Yes. So, we would hope that the risk is being diminished by the fact that the regulations have been amended to something that we think is manageable, and hopefully something that, in terms of perception—that risk will have been reduced. But we'll only know in the fullness of time, and it's something that we will monitor. But I'd also like to echo what my BMA colleagues have said, that recruitment and retention is something that we're actively looking at, both at undergraduate and postgraduate level. And, at undergraduate level, we've done an analysis, we've done freedom of information—we've done analysis to show that dental students are underrepresented. Welsh-domiciled dental students are underrepresented at Cardiff dental school when you compare with other higher education programmes. So, that's something of a concern to us, and something that we would want to pursue—how do we improve that representation from Welsh-domiciled dental students?

And the other thing that we're looking at is there's a new UK-wide placement system for foundation training, and, actually, the chief dental officer has also said that this is something that could actually work against retaining dentists in Wales, because if they're told they've got to go anywhere, and they're not allowed to decide that they want to do that last bit of training in Wales, then that will have a detrimental effect. So, the CDO is looking at that, because, as I say, it's a UK-wide system. But it's important that we look at ways of actually retaining Welsh-domiciled students and trainees, because that has an obvious effect. 

Ydych chi wedi codi hwn gyda'r coleg Cymraeg? Ydyn nhw'n gallu helpu chi gyda hyn—y Coleg Cymraeg Cenedlaethol? Maen nhw wedi ehangu eu remit nawr i addysg bellach. Ydych chi'n credu bod ganddyn nhw rôl i'ch helpu chi gydag adfer pobl i aros yng Nghymru i astudio trwy gyfrwng y Gymraeg, i'ch helpu chi gyda'r problemau recriwtio drwy gyfrwng y Gymraeg?

Have you raised this with the coleg Cymraeg? Can they help you with this—the Coleg Cymraeg Cenedlaethol? They have expanded their remit now to further education. Do you think that they have a role in assisting you in getting people to stay in Wales to study through the medium of Welsh, to help you with the recruitment problems through the medium of Welsh?

That's an interesting point, actually. It's not something that I've thought about, and I'm quite passionate about our problems with recruitment in Cardiff in particular—the recruitment of students to Cardiff, and the central recruitment of foundation training dentists, where it appears that there are a lot people coming from England, doing their foundation training in Wales and then disappearing back over the border. I think that our system should be built around trying to retain the people that Welsh Government is spending its money on to stay in Wales.

10:55

Well, I hope that's something that you can progress with them, because we're running out of time—

Yes, absolutely.

—so, hopefully you can talk to the college and see how you can work together. Rhianon Passmore.

Thank you, Chair. So, interesting evidence and obviously you're representing your colleagues across the sector. In regard then to the points that you've made around communication in regard to the points that you've made about the shift from the draft to the current regulations, there is a shift, so that point around communication, I think, has been very well made by you today. Are you fearful in regard to potential—we won't say 'litigatious', because that's probably the wrong word, but are you fearful that you'll be faced with members of the public who may think that they have that absolute right to converse clinically from point A, through the reception door, to actually that consultation stage? And if so, how are you—I know you've been asked this previously, but how do you feel that we can all work better together to translate that message that this is a journey? What should happen? Because I can understand very well the concerns that perhaps your members have actually stated.

Personally, I'm not fearful. I don't think this raises expectations a significant degree, and, in my experience, Welsh speakers are very, very tolerant of not being catered for and are actually very appreciative of any direction, any move, towards Welsh language provision, be it—

That might be the case in certain areas, for instance, within the Gwent valleys. There have been concerns raised, so, in terms of how we get this message across, that this is a journey, what do you think should happen? Should there be a communication campaign and more of a marketing campaign? I'm just looking for ideas here.

I do know of an English speaking consultant colleague who said, yes, he's happy to arrange a Welsh consultation for a patient if they request it, but they may have to wait several weeks, and would they rather have the consultation now with him in English. So, that's been the attitude of some people.

Okay. So, we've identified that there's a job of work to be done there.

I think there is. I think the question of whether you launch a mass media campaign, when the direction of travel has been relatively small—. I think, actually, in many respects, that some evolution with this, with signage and translated written and electronic materials, and maybe just organically seeing more Welsh speakers popping up with lanyards in surgeries, for me is probably not something you necessarily need to do a huge amount of comms on. 

I think, internally perhaps, Phil and I, as Welsh evangelists within the organisation, perhaps have a job of work to do. But I think we—. I don't think that necessarily going all out with a mass media campaign at present would be that helpful. I think it would be really helpful having an explanation of what the Welsh offer is to non-Welsh-speaking staff and then a real effort to offer training courses. And, from our point of view, the really important element of that is backfill, because if any of my staff—

I'm going to come to that briefly, if I may. I'm sorry, I just wanted to explore that a little bit more, but I don't have time. So, in that regard, then, the cost of implications of this in terms of backfilling have been addressed throughout a lot of this correspondence that you've submitted. So, who do you think should be paying for that?

Absolutely it should be the health boards and Welsh Government. From our point of view, unless there is some resource behind this and a little bit of drive to allow people to take time away from their day jobs, which, frankly, at the minute are relatively intolerable in our sector, unless you've actually got realistic backfill, which even with resource is quite difficult to deliver, because, actually, the locum pool—and I've certainly never heard of a locum practice manager, and without a practice manager, your practice is on a real knife edge—. So, if we're going to lose these members of staff so that they can go and further their Welsh language skills, which we are supportive of, you absolutely need that backfill and that has to be properly resourced and properly delivered by health boards and Welsh Government.

So, in that regard, do you feel that that is an issue that needs to be more explored and extrapolated in terms of how that's going to happen, because it's only when it's challenged, as you've acknowledged earlier—? It's only when that's challenged that you actually see what the actual outcome of this will be and what—. Were you going to say something?

11:00

Yes, I was just going to say I agree with everything that's been said, and, from a dental point of view, the same things apply, basically.

Okay, so around that issue, around backfill, the cost implication around that, obviously, that needs to be refined in terms of how you feel that's going to work—

Specifically because, independent practitioners, we bear the cost of any backfill that we have. So, if I'm away for the day, my practice has to fund somebody to replace me, because the patients won't stay away just because I'm on a course. That is the crux of the matter here. If Welsh Government really wants to further this agenda, which I hope they do, and I hope they want to realistically deliver better provision, then they have to support those independent contractors to deliver that, and we'd be supportive of that wholeheartedly.

Okay, thank you. In regard to monitoring and enforcement of the duties, there's a big debate as to who should be doing that. Have you got any views in terms of whether it should be the commissioner or whether it should be with the Minister? Who do feel should be the oversight monitor of the duties being carried out?

I'm not sure we're too worried about who does it, we're more worried about how it's done. I think we need to be mindful of the fact, as it's a journey, that we need be relatively light touch and supportive on this and encouraging people. I think if you start to get people who are shut down because of their Welsh language provision at a time when they're shutting down anyway because they can't continue to deliver the services on a realistic basis because of the funding levels and staffing levels and resource levels that they've got, then you're only going to exacerbate a crisis in general practice, and unnecessarily so on this issue, I think. So, I think—

Do you think that's very key to the concerns that have been expressed earlier around this, that it's that additionality that could, in a sense, reach a tipping point? I don't want to put words into your mouth, but, in terms of that follow through, the potential—and you talked about risk assessment earlier in terms of that, in a sense, risk register—do you think that is the perception of the worry around this, which is, effectively, a step forward and it's carrot, not stick, but it's what happens next?

Well, I think people feel it's another stick, potentially, and they live in a world of sticks at the minute. So, I think that the key for us is that this needs to be a process where people are encouraged to deliver better services in Welsh.

No, I would agree with that.

Ocê. Diolch yn fawr iawn ichi am roi tystiolaeth inni. Os oes unrhyw beth ychwanegol dŷn ni am ei ofyn ichi, gobeithio ei fod e'n iawn inni gyfathrebu gyda chi. Eto, ymddiheuriadau am y rhybudd byr, doedd e ddim yn rhywbeth roeddem ni'n gallu ei reoli, ac rŷm ni wedi codi hynny gyda Llywodraeth Cymru, yr amserlen i allu sgrwtineiddio'r holl broses yma, so plis deallwch ein bod ni ar eich ochr chi yn hynny o beth. Felly, mae'n bwysig ein bod ni'n ceisio rhoi barn nid yn unig y mudiadau ond y cyhoedd ac mae hynny ond yn bosib os oes amser gyda ni i sgrwtineiddio'n effeithlon ac yn effeithiol. Felly, diolch yn fawr iawn ichi am ddod i mewn atom ni heddiw.

Byddwn ni'n cymryd seibiant o bum munud i Aelodau Cynulliad. Diolch yn fawr iawn.

Okay. Thank you very much for providing us with evidence. If there's anything in addition that we'd like to ask you, I hope it's okay for us to communicate with you. Again, apologies for the short notice, it wasn't something that we could control, and we've raised that with the Welsh Government, the timetable of being able to scrutinise this whole process. So, please understand that we are on your side in that respect. It's important for us to try and provide the view of organisations and the public, and that's only possible if we have time to scrutinise effectively and efficiently. So, thank you very much for attending this morning.

We'll take a break now of five minutes for Assembly Members. Thank you very much.

11:05

Gohiriwyd y cyfarfod rhwng 11:03 a 11:09.

The meeting adjourned between 11:03 and 11:09.

5. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Fferylliaeth Gymunedol Cymru ac Optometreg Cymru
5. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: Community Pharmacy Wales and Optometry Wales

Diolch, a chroeso i eitem 5 ar yr agenda, sef Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019. Fferylliaeth Gymunedol Cymru ac Optometreg Cymru sy'n ymuno gyda ni nawr. Croeso i chi Steve Simmonds, swyddog gweithredol datblygu gwasanaethau contractwyr, Fferylliaeth Gymunedol Cymru, Rhodri Thomas, sef cyfarwyddwr cyswllt, ymgysylltu â chontractwyr, Fferylliaeth Gymunedol Cymru, ac wedyn Sian Walker, sef Optometreg Cymru—optometrydd, ontefe? Ydw i'n iawn? Ocê, diolch yn fawr iawn i chi am ddod i mewn atom. Os dŷch chi'n ymwybodol o'r hyn dŷn ni'n ei wneud fel pwyllgor, dŷn ni'n cymryd cwestiynau ar sail themâu gwahanol, a bydd Aelodau Cynulliad yn gofyn cwestiynau, os yw hynny'n iawn gyda chi.

Dwi am agor, a dwi'n credu efallai eich bod chi wedi gweld rhai o'r sesiynau cynt. Y cwestiwn cyntaf gen i yw: beth dŷch chi'n credu dylai fod yn digwydd o ran yr iaith Gymraeg yn y sector yma? Mae'n rhaid i fi ddweud yr un peth a wnes i ei ddweud wrth y tystion blaenorol—pan wnes i ddarllen y dystiolaeth, roedd yn dod drosodd braidd yn negyddol, ac, yn hynny o beth, a ydych chi yn dal i gredu bod rhai o'r concerns yna'n bodoli, neu ydych chi'n croesawu'r rheoliadau? Beth yw'ch barn chi am y rheoliadau fel maen nhw'n sefyll?

Thank you, and welcome to item 5 on the agenda—the National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019. Community Pharmacy Wales and Optometry Wales join us now. Welcome to you Steve Simmonds, contractor services development executive, Community Pharmacy Wales, Rhodri Thomas, associate director, contractor engagement, Community Pharmacy Wales, and then Sian Walker, who's from Optometry Wales, who's am optometrist. Am I right? Thank you very much for coming in. If you're aware of what we do as a committee, we take questions on the basis of different themes, and Assembly Members will ask questions, if that's all right with you.

I want to open the questions, and perhaps you've seen some of the previous sessions. The first question from me is: what do you think should be happening in terms of the Welsh language in this sector? I have to say the same as I told the previous witnesses—when I read the evidence, it came across as quite negative, and, in that respect, do you still believe that some of those concerns exist, or do you welcome the regulations? What are your views on the regulations as they stand?

11:10

Dŷn ni ddim yn negyddol o gwbl, a dwi'n ymddiheuro os yw e'n dod ar draws fel yna. Rŷm ni, o ran y sector, yn ymwybodol nad yw'r rhan helaeth o'r proffesiwn yn siarad Cymraeg o gwbl, felly sut rŷm ni'n mynd i wneud hwn? A beth rŷm ni'n pryderu ynglŷn ag e yw sut rŷm ni'n mynd i fedru gwneud popeth, a gwneud yn siŵr bod y proffesiwn on board. So, dyna beth dŷn ni—. Fel roeddwn i’n ei ddweud, rwy’n ymddiheuro os yw e'n dod ar draws yn negyddol. Rŷm ni yn bositif ynglŷn ag e, ond trio gweithio gyda'n gilydd i'w wneud e'n iawn o ran lles y cleifion a'r proffesiwn.

We're not negative in any sense, and I apologise if it came across as being negative. As a sector, we are aware that the majority of the profession don't speak Welsh, and the question is how we're going to deliver this. And that's our concern, how we are going to be able to deliver these services and to ensure that the profession is on board. So, as I say, I do apologise if it comes across as being negative. We are very positive about it, but we are trying to work together in order to deliver it properly for the benefit of both the patients and the profession.

Dwi'n bersonol yn gefnogol iawn a hefyd, gobeithio—. Beth roeddwn i moyn allan o'r sesiwn oedd bod yn eglur amboutu beth yw gofynion y Ddeddf hon, oherwydd un o'r pethau sydd wedi dod allan yw beth yn gwmws yw'r gofynion ar fferyllfeydd yng Nghymru. Oherwydd, o ran fel mae'r Ddeddf wedi'i hysgrifennu—ac mae e yn ein response rŷm ni wedi'i roi i mewn—pa ran o'r gwasanaethau rŷm ni'n eu rhoi sydd wedi cael eu cyfro yn y Ddeddf hon? Oherwydd, fel mae hi wedi'i hysgrifennu, dyw lot o'r gwasanaethau enhanced rŷm ni'n eu rhoi yn y fferyllfeydd heddiw ddim yn y Ddeddf hon—dim ond y dispensing sydd ynddi hi. Felly, o'n rhan ni, rŷm ni moyn bod yn siŵr beth yn gwmws yw'r gofynion.

Personally, I am very supportive and, hopefully—. What I wanted out of the session was to be clear about what the requirements are of this, because one of the things that's come out of this is exactly what the requirements are on pharmacies in Wales. Because, in terms of how the legislation has been drawn up—and it's in the response that we've submitted—what part of the services that we provide are covered in this? Because, as it's written, a number of the enhanced services that we provide in pharmacies today are not in this legislation—only the dispensing is included. So, in terms of us, we want to be sure what exactly the requirements are.

Diolch am hynny, a diolch am yr esboniad hwnnw. Dŷn ni'n croesawu hynny. Beth dŷch chi wedi'i ddweud wrth Llywodraeth Cymru yn hynny o beth? Pa drafodaethau dŷch chi wedi'u cael gyda nhw? Achos dwi'n gwybod mai eich consern oedd labelu a phresgripsiynau a gyda'r disgrifiad o'r cyffur. Dyna beth oedd un o'r concerns gyda'ch cyrff chi'n benodol. 

Thank you for that, and thank you for that explanation. We welcome that. What have you told Welsh Government in that respect? What discussions have you had? I know that your concerns were about labelling and prescriptions and the description of the drug. That was one of your concerns with your organisations specifically.

Ie, yn enwedig o ran fel mae'r fferyllfeydd yn gweithio ar hyn o bryd. Mae'n bwysig bod y cyffur yn cael ei roi i'r claf yn glir, ac un o'r pethau rŷm ni'n ei wneud yw recordio ar ein systemau, yn Saesneg, beth yw'r directions rym ni'n eu rhoi arno fe. Ble mae'r Gymraeg ar gael, rŷm ni'n berffaith hapus i gael y sgwrs gyda'r cleifion drwy gyfrwng y Gymraeg i esbonio beth i'w ddefnyddio, ond, o ran recordio ar y systemau IT a gwneud yn siŵr—. Oherwydd, os rŷm ni'n rhoi directions yn Gymraeg ar y system, gwneud yn siŵr, mewn mis, pe na fyddai'r fferyllydd sydd i mewn ddim yn deall—a gwneud yn siŵr bod y system yn consistent, a bod yr iaith yn cael ei defnyddio'n gywir.

Yes, particularly in terms of the way pharmacies work at the moment. It's important that the correct drugs are provided clearly to the patient, and one of the things we do is to record, in English, on our systems, what the directions that we give are. Where Welsh speakers are available, we're perfectly happy to have the conversation with the patients through the medium of Welsh in explaining that, but, in recording it on our IT systems—. Because, if we provide directions in Welsh on our IT system, in a month's time perhaps, perhaps a non-Welsh speaking pharmacist working wouldn't understand what's been included, and we need to ensure that the system is consistent and that language is properly used.

Dyna pam dŷch chi wedi dweud yn eich tystiolaeth bod e'n fater diogelwch. Achos dyna beth oedd yn dod yn mas i fi—pam byddai fe'n rhywbeth fyddai'n rhoi y claf mewn sefyllfa dansierus? Oherwydd y gallu i newid y labeli a newid y disgrifiadau, ontefe?

That's why you've said in your evidence that it's a matter of safety? That's what was coming out of it to me—why would it be something that was putting the patient in a dangerous situation? It's because of the ability to change the labels and to change the description, is it?

Ie, mae'n bwysig y dyddiau hyn ein bod ni'n gweithio fel proffesiynau i leihau'r perig sydd ar gael i'r cleifion. Ac unrhyw beth sy'n dod i mewn ag unrhyw elfen o berig wrth drosglwyddo neu recordio gwybodaeth yn wahanol rŷm ni'n treial ei leihau, wrth gwrs. Beth sy'n cael ei wneud yn glir yn y ddogfen hon—er enghraifft, mae'r daflen wybodaeth sy'n cael ei rhoi allan gyda meddyginiaeth yn cael ei chynhyrchu gan y cynhyrchwyr meddyginiaethau, ac maen nhw'n ddogfennau cymhleth ac wedi cael eu hysgrifennu o ran y gyfraith. I geisio trosglwyddo rheini—os byddai'r cwmnïoedd yn fodlon gwneud hynny, bydden ni'n fodlon rhoi nhw allan, ond o ran beth yn gwmws yw'r disgwyliadau o ran y Ddeddf—.

Ond, o ran cael y sgwrs gyda'r claf, ble mae'r Gymraeg ar gael—mi gawsoch chi dystiolaeth yn gynharach oddi wrth y meddygon. Yn bersonol, dwi'n berffaith hapus cael y sgwrs i esbonio beth sy'n bwysig i'r claf, ond, wrth gwrs, mae'r termau technegol—efallai clinigol—yn gael eu defnyddio yn Saesneg. Y peth pwysig yw bod y claf yn deall beth sy'n bwysig a gwneud yn siŵr bod hynny'n glir.

Yes, it's important that we work as professions to reduce the risks to our patients. And anything that may bring any element of risk, in terms of the recording of information and doing so in different ways, we try and reduce that, of course. What is made clear in this document—for example, the information sheet provided with drugs is produced by the drug manufacturers, and they are often very complex documents that have been written in legalistic terms. If the companies are willing to provide those bilingually, then, of course, we would distribute them, but in terms of what the expectations are in terms of this legislation—.

But, in terms of having the conversation with the patient, where the Welsh language is available—you heard evidence earlier from the BMA. Personally, I'm perfectly happy to have that conversation to explain what's important to the patient through the medium of Welsh. But, of course, the clinical terms are, perhaps, conveyed in English. The important thing is that the patient understands and to ensure that that is clear to the patient.

11:15

Y cwestiwn olaf gen i ar hyn o bryd yw: beth yw'r sefyllfa nawr? Sori—

The final question from me is: what is the situation now? Sorry—

Sorry, I just wanted to point out that Steve was trying to come in.

Sorry, I was the one who wrote the response, and I actually put,

'CPW is fully supportive of the desire to improve the provision of primary care services to those citizens that use Welsh as their first language and to do so in a practical and deliverable manner.'

So, I must admit we are not negative—

Some of the language in there, and from other bodies, has all been about forcing—there have been words like that, which imply negativity. That's what I'm trying to say. There's a perception there, like we talked about in the other session. So, that's what I'm trying to get at. If we talk about it in a negative way, then people will interpret it in a negative way, won't they?

As a non-Welsh speaker, I must admit I feel quite embarrassed and quite disappointed in my own lack of ability to speak Welsh, and it's something that I need to rectify—I've always thought I'd rectify that. It's difficult for a nation. If we are going to get more and more people using Welsh in all sorts of everyday conversations and things, we have to start somewhere. We have to take some very sensible and pragmatic steps forward. This is where we want you to understand that we actually see this as being a very sensible and very pragmatic way forward, and we're happy with the suggestions—the requirements—within the regulations. 

As my colleague Rhodri was explaining, there is a little bit of confusion there, because it talks about pharmaceutical services, which has always been one of our issues. It then goes on to define pharmaceutical services as those contained in the 2013 regulations, then it subsequently goes on to say it's part of the 2006 regulations. But, the 2006 regulations, actually—pharmaceutical services are defined in terms of dispensing. So, if you go into a typical pharmacy, everything that happens in the dispensary to get your medicines out appears to be covered by the regulations. Everything else that we do within the consultation areas—medicines use reviews, stop smoking services et cetera—all come under advanced and enhanced services, which are directed services. The legislation, as it is now, says, 'This does not cover directed services'.

So, our point is that we're just a little bit concerned that what we're hoping to achieve could be slightly diluted, or significantly diluted, by not encompassing all of the services that we offer within the regulations. So, we were actually a bit more positive.

Grêt. So, byddech chi eisiau cael esboniad os ydyn nhw yn rhan o'r rheoliadau ar hyn o bryd, a dŷch chi ddim wedi cael yr esboniad hynny gan Lywodraeth Cymru hyd yn hyn.

Great. So, you would want an explanation of whether they are part of the regulations currently, and you haven't had that explanation from the Welsh Government so far.

Gallwn ni helpu gyda hynny, gobeithio. Jest cwestiwn clou arall: beth yw'r sefyllfa nawr ar lawr gwlad, fel mae'n sefyll? Beth yw'r capasiti i bobl yn eich maes chi ddelifro drwy gyfrwng y Gymraeg? Oes yna ryw fath o ddata gennych chi neu asesiad o'r hyn sy'n bodoli ar hyn o bryd?

We can help with that, hopefully. Just another quick question: what is the situation now, at grass-roots level? What is the capacity for people in your area to deliver through the medium of Welsh? Do you have any data or an assessment of what exists currently?

Fel mae'n digwydd, dyw e ddim ar gael ar hyn o bryd, ond eleni, am y tro cyntaf, mae yna syrfei o'r gweithle wedi mynd allan i fferyllfeydd yng Nghymru. Health Education and Improvement Wales sy'n tynnu'r data at ei gilydd. Dŷn nhw heb anfon y wybodaeth allan ar hyn o bryd, ond cyn gynted ag y maen nhw, byddem ni'n hapus i'w rhannu gyda chi.

As it happens, it's not available at the moment, but, this year, for the very first time, there has been a workforce survey issued to pharmacists in Wales. Health Education and Improvement Wales is responsible for drawing that data together. They haven't published the information as of yet, but as soon as they do, we'd be more than happy to share it with you.

Grêt. Beth amdanoch chi, Sian?

Great. What about you, Sian?

11:20

Dŷn ni wedi gwneud syrfei, ond doedd y cwestiwn ynglŷn ag iaith ddim ynddo fe. Gyda'r General Optical Council, dydyn nhw ddim yn gofyn i ni pa ieithoedd rŷm ni—. So, ar hyn o bryd, dydy'r data ddim ar gael, ond dwi'n siŵr, os ŷch chi ei angen e, bydd modd cael e.

We have conducted a survey, but the question about language wasn't in it. With the General Optical Council, they don't ask us what languages—. So, at the moment, the data isn't available, but I'm sure, if you need it, there is a way of getting it.

Ocê. Byddai hynny jest o ddiddordeb i ni wybod, ond os dyw e ddim gyda chi, wedyn—

Okay. It would just be of interest for us to know, but if you haven't got it—

Mae yna lot o bobl yn siarad Cymraeg. Ydyn nhw'n hapus ac yn rhugl a digon cyfforddus i'w wneud e? Mae hwnna'n gwestiwn gwahanol, wedyn.

A number of people do speak Welsh. Are they happy and fluent and comfortable enough to do it? That's a different question, then.

Just a couple of short questions. You seem relatively relaxed now about the regulations per se, but just in the process of coming to them, you've obviously had to engage with your members quite extensively in terms of getting that sort of feedback. Do you feel that that consultation is adequately represented now in the regulations that are before you? Do you feel what you have said has been taken into account, or are there other aspects of them that you feel are inadequate or problematic, other than, you know—?

If I can come back on that, because I was involved in our response to the original draft regulations. Yes, we did consult quite widely, and we do that because we have the board, and they are elected representatives of the pharmacists across Wales, and they keep very close to them, and they obviously own businesses and manage businesses themselves, and run community pharmacies. So, they're very representative of Wales. So, all the comments that we put into the original draft, apart from the pharmaceutical services lack of clarity, seem to have been built into the new regulations. So, we're quite relaxed about that, but we do still have this issue around pharmaceutical services.

I want to raise one point, which is a little bit divergent. Of course, in some cities around the UK, this is nothing unusual, where pharmacists and so on have to deal with multilingual communities in all sorts of ways. So, there's nothing really abnormal within the UK about this happening. This is really, in some ways, within Wales, catching up on applying within Wales as a bilingual nation what exists, actually, in a number of cities around the UK already. I mean, is that a fair representation or comment?

Very much so, yes. I mean, every pharmacist in their daily lives just ensures they do their very best to communicate with their patients in whatever language that is, if they're able to do so. They will naturally do so, because obviously they have the discipline of being in a competitive market, and if patients don't like the service from one pharmacy, they'll simply go and use another pharmacy. So, all pharmacies will have a natural instinct to try and help their patients as much as they possibly can. So, they wouldn't knowingly put any barriers in place to accessing their services.

You made some reference to regulations and enhanced services, and of course you mentioned things like smoking cessation. Is your view at the moment that these regulations, as far as you're concerned, don't cover the actual engagement process direct within those enhanced services?

Yes. It specifically says, 'This does not cover directed services' within the regulations. I mean, we're not legal experts. We're not regulatory experts. But we read that and we say, 'Section 80 is dispensing and section 81 is directed services'—which are the enhanced and advanced services—and it specifically says, 'This covers section 80 of the Act and does not cover directed services.' We therefore feel that we're missing an opportunity, really, to make it a broader application.

I mean, what happens in practice—? Obviously, there are opportunities there, but one of the concerns we have about the quality of the regulations themselves, which today we're scrutinising—you feel there's a gap there. There's a weakness in them that probably hasn't been considered that might have been considered had there been more time for scrutiny, I suppose. I suppose that's the point. In terms of the people that provide the enhanced services and so on, are they all in-house or are some of them externally contracted services?

No, they're all delivered within the pharmacy by the pharmacist, so they're NHS Wales services. There are the occasional private services, which, obviously, pharmacies would offer, which are outside of the regulations, but the vast majority—. About 90 to 95 per cent of the work that community pharmacies now undertake is on behalf of NHS Wales. They're NHS Wales services.

11:25

Diolch yn fawr, Gadeirydd. So, we're in the position, I think, that both your organisations are satisfied that the six duties are reasonable, proportionate, will not distort the service, and that they're something that will, indeed, enhance provision, and I think you've been quite positive about that. You've mentioned the issue of special enhanced services, which, I think, we find very interesting. Are there any other amendments that you would like to see? Mr Thomas, I thought, mentioned that there's a bit of ambiguity about, say, the information that's given with prescription drugs, for instance. I mean, I'm not sure if—. Does that arise from the regulations? Because I'm not sure that it does cause an ambiguity. 

So, we just picked up on whether or not the Welsh language requirements around dispensing medicines—does that cover the requirement where the patient asks for it to be labelled in Welsh, for example? There's the importance of ensuring that there's a clinical record that's understandable. Colleagues earlier mentioned that the clinical record should be transferrable and understandable to other healthcare professionals, and anything that introduces an element of risk into that should be avoided. However, it's the advice that we give the patient, if they want it through the medium of Welsh and you're happy to converse and give that—. I would hope it happens already, because, as my colleague mentioned, it's a competitive market and a patient will take their prescription where they wish it to be dispensed.

Yes. The issue I was thinking of, really, is the information pack that we have with all prescription drugs. I mean, if that's not available in Welsh, which is very likely, given that these things are produced by multinational companies, then there's no obligation on you at all, is there?

With regard to clarification regarding leaflets, from an optometry perspective, we have to be able to give our advice verbally and in writing, and currently we use leaflets that are issued by the college of optometry, but they aren't available in Welsh. So, the question would be who's responsible for getting them through the medium of Welsh. Is it the local health board that has to translate them and then give them to us to be able to give out? Because, obviously, there's a cost implication and a huge cost implication to every profession. 

Well, you know, I think, by inference, standard 2 is,

'Make a Welsh language version of any document or form provided by the local health board available to patients and/or members of the public'.

So, if it's available, you should—

Yes, but currently they're not available. 

—ensure that patients have access to it and are encouraged to take it if it's going to be useful to them. And my interpretation of that is that you might want to encourage your organisation to provide bilingual material, but it's not actually a legal requirement. I'm not a lawyer either, but that would be my interpretation.

So, if we take this set as—. You know, you're broadly, anyway, content with that. Some organisations, most notably the Welsh Language Society, would like to extend the obligation somewhat, building on the current duties and just making them more rigorous, I think they would argue, and also extending to a couple of other areas like reception staff. I don't know if you've had sight of their submission—

No? Okay. That's fine. I won't push that point. 

And then, in terms of the fact that the whole primary healthcare team is covered by these regulations, again, I think you all find that's quite appropriate and it would have been a bit odd if pharmacists and optometrists were not covered whilst other members of the primary healthcare team were. So, just for the record, you're content with the range of organisations that are covered by these regulations and also the fact that includes your organisations. You are. Diolch. 

Diolch. Mae'r cwestiynau nesaf gan Vikki Howells. 

Thank you. The next questions are from Vikki Howells. 

Diolch, Chair. My questions are for you, Sian, regarding Optometry Wales's submission. So, could you expand for us on your concerns about the medico-legal implications of delivering clinical examinations and advice in a language other than English?

11:30

The difficulty is that we are regulated by the General Optical Council, and they are absolutely clear that communication is the biggest place where things go wrong. So, you have to be, as a registrant, comfortable delivering a message and you also have to ensure that you use the right terminology. We aren't trained. There is no provision in Cardiff University to do your training through the medium of Welsh. Therefore, can things be lost in translation? Potentially, yes. And, therefore, we would encourage people to ensure that their patient does understand, and sometimes that is actually having to speak through the medium of English then, because, as I said, with a lack of communication the risk is that patient safety is affected, but also my own professional registration as well. 

So, is the key to this, in your opinion, about education and the way that optometry training is delivered, and ensuring that there is more bilingual capacity there?

I think it's partly due to that, but there's also—. The training is quite important, because to be able to use the right terminology, and everybody using the same terminology, common names for conditions—you know, it's a dictionary in itself. Whereas if we're communicating from one to the other, if I diagnose something with this patient, they then go for a second opinion and there's misinterpretation, I could then end up—. They could make a complaint against me because, actually, they think I've said something wrong, but I haven't because it's been miscommunicated. Therefore, the training of making sure that it's a standardised dialect throughout the optometric profession, which we don't have at the moment because it's not available.

Looking at this on the outside, as a lay person really, in the submission Optometry Wales stated that some of the clinical language in Welsh is not everyday language, and that's where the meaning could be lost in translation. But when I read that, I was thinking, 'Well, when I found out I had family member with macular degeneration, I didn't know what that term meant and neither did my family member.' And with technical phrases like that, it's all about how your optician explains the nature of the condition to you and the way that it's going to affect you. Again, I may be looking at this too simply now, but I do wonder why there can't just be a dictionary, as you say, of different terms and how they're translated from English to Welsh, and for those opticians then who are comfortable in using Welsh as a day-to-day language, surely explaining the nature of the condition and how it will affect that individual should be quite second nature to them. 

It should be. Obviously, to be competent you have to be able to explain, but it gets lost in translation in English, and if someone's not confident in the medium of Welsh and they know that you speak Welsh, it's very difficult for some people to then turn to the English language, when you know that that customer wants to be treated in Welsh. So, you'll try your best to give them the information in the language that they want, but then whether you're absolutely certain that they understand it is another thing.

But then, surely, in English, are you absolutely sure that they understand it?

But then we've got the leaflets to back it up, haven't we? If you think about it, in a consultation, you'll hear what you want to hear, and if you're given bad news, you'll dwell on that; you won't hear the rest of the conversation. But a leaflet then backs that up. We don't have that leaflet at the moment. 

So, you don't have leaflets that have been translated into Welsh to explain these conditions?

No, nothing at all. 

And whose responsibility would it be to implement that?

I suppose it's never been—. It's not for us to do that, is it? It's never been forced on us before. And it's not about forcing, but if it's in legislation, then it would be. We don't have a contract. Unlike the other professions, we don't have a contract. Therefore, nothing can be unless in it's in legislation. If it's part of our contract, then that's different, isn't it? But it's never been our contract, therefore it's never been looked at. Does that make sense?

11:35

It does, yes, thank you. I think I know what your answer to this will be, but I'll ask you anyway: what are your views on the comment that the language used in referrals and records can only be English, what would you say to that?

It's just really for continuity of care, and continuity of care is very important for patient safety. Sometimes things have to be done urgently: same-day referrals to prevent sight loss. If we know that the person at the other end isn't able to pick up that referral letter, has to have it translated in order then to administer medication to that patient, then there's a delay. A delay can cost vision. So, until we get a workforce where everybody's totally bilingual, then, you know, the referral letters can only be in English, because you don't know who's going to end up actually picking that letter up in the hospital. When the dynamic changes, and hopefully that will happen, in that we will have more people—that the shift will change, there'll be more Welsh speakers than English speakers, then there'll be a different view at that point.

Well, I think you've answered, actually, most of the questions I wanted to ask, but some of the issues that have arisen relate to the identification and recording of those within the practices who are Welsh speaking. Some other disciplines have expressed concern about whether that might be restrictive and so on. Do you see any problems with that?

Sorry, can you just clarify the question again?

Gwisgo lanyards a bathodynau i adnabod eich bod chi'n siarad Cymraeg. Mae un o'r diwygiadau mae Cymdeithas yr Iaith wedi eu gwneud yn cynnig y gallech chi wisgo un i ddweud eich bod chi'n ddysgwr. Fyddai hwnna'n rhywbeth y byddech chi'n ei groesawu?

Lanyards and badges to identify Welsh speakers. One of the suggestions that Cymdeithas yr Iaith made is that you could use a learner's lanyard or badge. Would that be something that you would welcome?

Ie, ie. Rwy'n gwisgo un, mae fy ngŵr i'n gwisgo un. Mae'n beth unigol i'w wneud ac mae e lan iddyn nhw os ydyn nhw'n moyn ei wneud e neu beth. O ran practisau, mae e lan i'r bobl sydd berchen y busnes beth maen nhw'n moyn gwneud. Yr unig beth allem ni ei wneud, fel Optometry Wales, yw dweud wrthyn nhw yw, 'Mae'r rhain ar gael. Os ŷch chi'n moyn eu gwisgo nhw, mae modd ichi eu gwisgo nhw, ac efallai ei fod e'n syniad da eich bod chi'n eu gwisgo nhw er mwyn i bobl wybod eich bod chi'n siarad Cymraeg.' Mae'r opsiwn iddyn nhw, onid yw e? Eu cael nhw ar gael a gwybod lle maen nhw ar gael, dyna'r broblem fel arfer.

Yes. I'm wearing one, my husband wears one. It's an individual choice and it's up to them as to whether they want to do that. In terms of practices, it's up to those individuals who own the business as to what they want to do. The one thing that we can do as Optometry Wales is to say to them, 'These are available. If you choose to use them, then you can do so, and it might be a good idea for you to use them so that people would know that you're a Welsh speaker.' The option is there for them, isn't it? But they should be available and knowing where to get them, that's usually the problem.

And within pharmacy, as well, it's almost a fairly simple and natural development, isn't it, in terms of communication, engagement and encouragement? So, presumably there are no obstacles or problems that you see on your side.

No, it seems entirely practical and a pragmatic way forward. I can't see there could be any objections, because, at the end of the day, it'll be the individual member of staff themselves who will make the decision as to whether or not their grasp of Welsh is enough for them to wear the badge with some degree of confidence. So, I do see that the option of having a Welsh learner badge could be really helpful in that sort of circumstance, because at least you'll end up with somebody with a badge on, not somebody who thinks, 'Well, I'm not sure, I won't wear it.'

You already made the point in respect of enhanced services as well, so I won't pursue that further.

Yes, absolutely.

I think it's face to face. If you think of the professions that we have, it's very much face to face, giving advice, and they will see that you're wearing a badge. It may be an important way of starting—'Oh, why are you wearing that badge?' And that brings an interest then to the public, not just the profession. So, that's another way of looking at it as well.

Thank you, Chair. In that regard, I mean this may already be the case, and if it is the case, then I'll learn something, is it beneficial to think that there's a differentiation between a Welsh learner badge and an actual 'I speak Welsh' badge? Would that help in terms of a person's confidence to be able to take that forward?

I think so. I think you'd have more buy-in with people having the different options—

You'd have expectations that would be appropriate. Okay, thank you for that.

So, in terms of the evidence that you've submitted, could you outline your concerns about the definition, and we've touched upon this, haven't we, in regard to 'pharmaceutical services'? Do you feel that there is an issue around that?

11:40

Yes. Obviously, as a profession, we'll do all we can to communicate to our contractors the spirit behind the legislation, and we'd probably encourage them to deliver all their services through the medium of Welsh to the public if they can. We just find it strange that the legislation itself has confined itself just to one element—the older, more traditional dispensing role of pharmacies—whereas we've expended our range of services significantly, and it would just make sense for those to be wrapped up in the same piece of legislation.  

Do you have any guess in your minds as to why that's the case?

It's always been an issue. It's always been the old issue of pharmaceutical services as defined in law. We find it now that we're moving to new control of entry arrangements with the pharmaceutical needs assessment. The health boards want to make sure they look at the whole gambit of services, and not be confined to just dispensing. So, again, they're all homing in on this old definition of pharmaceutical services. So, I think, at some stage, it would be helpful to change that in regulation, so that 'pharmaceutical services' just means all the NHS services provided through a community pharmacy. 

And in terms of these regulations, would you like to see that amendment within this?

Absolutely. 

And the reality is that these services are already being delivered in Welsh. When we record whether or not we're doing the consultation, there's a little tick-box saying, 'Did the patient want this service through the medium of Welsh?' So, we already do it, it's just the legislation as it's written doesn't catch up with it.

So, in regard to the areas that you're currently working in that are more Welsh speaking, you would say that this is normal business anyway, so this, in a sense, is just a little bit more encouragement in that direction. Do you feel that that would be the same, for instance, in the Gwent valleys? Do you feel there would be more of a culture shock in terms of pharmaceutical expectation, or do you just think that it's going to be business as usual?

Business as usual. 

Okay. Thank you very much. And the final question I've got then: do you have any concerns about the scope of the duties, and whether this could require the provision of Welsh language patient information leaflets, which we've already discussed at length, or Welsh language labelling of prescribed medicines? I know we've discussed this earlier, but is there anything further that you'd like to add to the comments that you've made, because, obviously, what was said was of great interest? Is there anything further you'd like to add on those two issues?

Well, we obviously were alert to the fact that this could cause our profession some issues, so we made a point of scrutinising the regulations to ensure that it wasn't caught up in that, and it's pretty clear to us that it's not, and it is one step on a journey, and there will be other steps in the future, I'm sure, and there should be. 

Diolch, Gadeirydd. You mentioned that you had actually listened to the previous session, so you will have heard some of what we were talking about, that some professions fear that there would be a perception amongst potential recruits that people would not want to come to work in Wales. Is that something that you fear as well, or do you not share that fear?

We do share that view, solely because the evidence shows that, because as part of the 'Train. Work. Live' campaign, a lot of research was done amongst pre-registration students the other side of the bridge. And some of them did express that concern that, 'I don't think I can work in Wales because I don't speak Welsh.' So, in reality, there is that thing, but we shouldn't over-egg that. I think we need to approach it in a very different way, and what Welsh Government are currently doing, through Andrew Evans, our chief pharmaceutical officer, is that we're defining a pharmacy service in Wales that is a much more clinical service, that our pharmacists want to be part of. So, what we're actually doing is making practising pharmacy in Wales more attractive than practising pharmacy in other parts of the UK. So, actually, it's a positive driver for people into Wales, and that's a much better way of going about it. 

And, likewise, we're doing the same. So, we are the envy at the moment in our profession. Everybody is looking at Wales to see what we're doing, so we're hoping that that will help with issues that we are likely to have in a few years' time, where we've got an ageing population, we've got more people to serve, and we do have people who are going to retire, and trying to keep those practices open—there's work being done, but actually we don't see the language as being a barrier in any way for people migrating to us; it's all about selling it as a good place to work.

11:45

If I can say, personally, that it's fantastic to hear that attitude, so thank you for that. Do you think that there is more—and again this came up in the last session—do think there's more that either your bodies or Welsh Government or another agency could be doing to encourage, not just the public, but also practitioners to see that this offer of Welsh doesn't have to be all-encompassing and that technical terms or even the consultation can very much still happen in English, but it could even be however much the practitioner and the patient are equally comfortable in engaging in Welsh? Do you think there's more that could be done to communicate that?

I think once you get them in a community where they see that the majority of their patients are speaking Welsh, they take an interest. They are likely to pick up the language anyway, because they're embracing it—they want to make the business successful and they will see that that's the way to go. It's getting them there in the first place that's the problem. Once they're there, they'd be happy to do everything, but it's getting them there in the first place.

And we see that in pharmacy as well. If you go to rural north-west Wales and strong Welsh communities, you have people coming over the border, and, at first, there's a little bit of a culture shock when they hear patients communicating with their assistants in Welsh and receiving medicines and advice in Welsh. One of the roles of the pharmacist is to oversee the supply of medicines and to make sure that they're comfortable with what is being told, and, if they're not Welsh speakers, they sometimes have to check with their assistants, 'What exactly did you tell that patient?', and once they're comfortable that they have the confidence in their technicians and assistants—that they are competent in what they're doing—they're very comfortable in doing that. So, it's a little bit of a culture shock initially, but, as my colleague said, once they're there, it's—it's an encouraging sign.

You asked about whether we could take any more action to—. Obviously, it's a new piece of legislation for us that we need to communicate out to our contractors. So, I guess it's all about the spirit in which we communicate out there and how positive we make it and we do have lots of meetings and things with contractors, so I'm sure we'll encourage that.

We would maybe encourage Welsh Government to also try and get the same commitment from health boards because some of the responsibilities in there are the responsibility of health boards to oversee and to implement. So, we have to be very careful that we don't get communications out to contractors from health boards saying, 'You must do this'; 'You are now legally required to do that' and that it is a lot more encouraging and positive, which is the intention of the regulations.

Diolch yn fawr iawn am hynny. O ran costau, a allwch chi jest esbonio beth dŷch chi'n credu bydd y goblygiadau i chi? Dŷch chi'n sôn am yr amwyster ynglŷn ag ariannu taflenni, er enghraifft, ond beth fyddai goblygiadau hynny pe tasech chi'n gorfod ariannu'r taflenni? A hefyd, o ran gadael i staff fynd am hyfforddiant, beth fyddai hynny'n ei olygu o ran gorfod cael rhywun ychwanegol mewn i'r tîm staffio er mwyn hwyluso hynny—beth yw eich barn chi am hynny o beth?

Thank you very much for that. In terms of costs, could you just explain what you think will be the implications for you? You mentioned the ambiguity regarding the funding of pamphlets, for example, but what would be the implications of those if you had to fund the pamphlets and leaflets? And also, in terms of allowing staff to go on training and what your views would be on getting people in onto the staffing team to facilitate that—what are your views on that?

Wel, ar hyn o bryd, fel dwi wedi'i ddweud, does dim contract gyda ni, felly, does dim protected learning time gyda ni, felly, os oes yn rhaid i ni wneud unrhyw fath o draeno o gwbl—

Well, at the moment, as I've said, we have no contract, so we have no protected learning time, so if we need to do any sort of training at all—

Ond byddech chi'n rhan o'r contract yma a'r rheoliadau yma.

But you would be included within these regulations, wouldn't you?

Wel, ydy hwnna wedyn yn mynd i ffurfio ein contract gyda—? Achos y contract NHS yw jest general opthalmic services; dyw e ddim byd i'w wneud gyda dim byd arall rŷm ni'n ei wneud ar gyfer yr NHS.

Well, does that then become our contract with—? Because the NHS contract is just general opthalmic services; it's nothing to do with anything else we do for the NHS.

Bydd rhaid i ni checio hynny'n gyfreithiol te, achos roeddwn i'n cymryd y byddai pawb yn yr adran yma—

I think we'll need to check that with our lawyers then, because I'd assumed that everyone captured within these regulations would be included.

So, mae'r doctoriaid yn cael protected learning time, so wedyn mae'n hawdd i chi wneud rhyw fath o draeno gyda nhw; mae'r amser gyda nhw. Dŷn ni yn breifat ac yn yr NHS, wedyn mae yna fwy o gostau wedyn, onid oes e, achos dyw'r clinics ddim dim ond yn NHS—maen nhw’n NHS/preifat, NHS/preifat/ac wedyn mae rhywbeth arall yn dod i mewn. Felly, mae'r overheads tipyn bach yn wahanol i ni ac mae'r business model yn wahanol. Felly, i'n cael ni mas, byddai eisiau 'backfill-o' ac, ar hyn o bryd, does neb i 'backfill-o', so, mae fe'n anodd gwneud hynny. Os byddai yna grant ar gael, byddai hynny'n ffordd o'i wneud e, ond i ni i fynd i mewn i'n pocedi i'w wneud e—allaf i ddim siarad ar ran pawb achos dwi ddim yn sîwr, ond rwy'n tybio efallai bydden nhw'n gofyn am rywbeth i helpu i'w wneud e, ond tybio ydw i, yn hytrach na—.

So, doctors have protected learning time, so that is easily done then; they have the time to undertake that training. We work privately and through the NHS, so there are greater costs therefore, because the clinics aren't purely NHS—it's NHS/private, NHS/private/and then something else may come in. And then the overheads are slightly different for us and the business model is slightly different. So, in order to take us out, we would need to backfill, and, at the moment, we have no-one available to backfill. So, it's difficult to do that. If there were a grant available, that would be one way of doing it, but for us to dip into our own pockets—I can't speak on behalf of everybody speakbecause I'm not exactly sure, but I assume that they would perhaps seek some assistance in doing that, but that's an assumption on my part. 

11:50

Byddwn ni'n edrych mewn i hynny a gweld beth yw'r strwythur, achos dwi ddim yn deall yn iawn chwaith. Felly, diolch am hynny. Rhodri neu Steve—costau o ran—?

We'll would look into that and see what the structure is, because I don't understand either. Thank you for that. Rhodri or Steve—costs?

Obviously, Community Pharmacy Wales as an organisation don't actually have any money; our money comes directly from our contractors. So, anything that we do, the cost will fall on our contractors one way or another. Obviously, if we want to encourage our contractors to really get behind the spirit of what we're trying to achieve then I think it would be reasonable for them not then to be asked to fund it as individuals at the same time. So, we want to move in that direction but we want you to fund the cost of materials, we want you to fund the cost of training, et cetera. On a practical side, obviously, we're under the same sort of pressure that GP practices are under, so we would find it difficult to release people throughout the day because their priority is in patient care. I would recommend that evening training would be a better vehicle to move forward from that side, and it's reasonable—

Could you do some sort of secondment thing, where somebody who worked in a non-Welsh-speaking area could go and work in a Welsh-speaking pharmacy for a while and then they could see it hands-on in an operational way as opposed to it being a structured training process?

It would be difficult, because we've obviously got the competitive element of it. You've got different pharmacists and you've got different businesses, so you can't really—. Unless you're a locum, where you're your own voice—that's the only way that you potentially could do it. 

Isn't it? I know I answered over you, sorry. [Laughter.] I believe it's the same.

Yes. I mean, I was looking at the training within the regulations, which is about raising awareness of the Welsh language. I think there would be—. We'd obviously encourage everybody to attend that. We'd encourage our contractors to encourage their staff to attend. But, obviously, if you do want a really positive uptake, you're more likely to succeed when it doesn't actually then cost the owner of the business money out of their own pocket to send their staff to the training evening, because somebody has to pay their salaries, somebody has to pay their travel expenses. 

Yes. I did assume that that would be your response. [Laughter.]

Going back to actually putting them into—you know, embracing it, that is the only way that you are going to get confident. So, sometimes if you just go to training, you come back and you may not put it into practice whereas, if you're embracing it, then that's the way. So, your thought is great, but practically I'm not so sure. 

Ocê. Dŷn ni wedi clywed gan Mick yn flaenorol ynglŷn â'r badges, felly dŷn ni'n mynd i fynd yn syth at y monitro a gorfodi gan Delyth. Diolch. 

We have heard from Mick previously about the badges, so we'll go straight to monitoring and enforcement and questions from Delyth. Thank you.

Do you have any views on how these regulations—or these duties, sorry—should be monitored and enforced? So, cymdeithas yr iaith have suggested that the Welsh Language Commissioner should have a formal role monitoring the contracts between health boards and private contractors. Do you agree with that or would you have any other view on how that could work? 

I think we'd have concerns over that simply because we have a Government-appointed regulator, the General Pharmaceutical Council, which visits our pharmacies to inspect as to whether or not we're meeting and complying with their standards. We also then have the health board visiting to ensure that we comply with all of the contractual elements. To introduce a third visitor in the pharmacy would be disruptive and it's probably unnecessary, because we do have regular visits from health boards, who go through a large tick-box exercise to check whether or not we comply with all the requirements of the current community pharmacy contractual framework anyway. So, to me it would be sensible and simple to just make them the monitoring agents. 

Likewise with us, yes, having a third visit—yes, it would be better to incorporate it with Public Health Wales or the optometric advisers that sit within the local health boards.

Diolch. Dyna'r oll sydd gyda ni heddiw, ond os oes unrhyw gwestiynau ychwanegol a dŷn ni angen cysylltu gyda chi, gobeithio ei fod e'n iawn i wneud hynny. Diolch am ddod mewn ar fyr rybudd. Yn amlwg, mae'r broses sgrwtini wedi bod yn anodd i ni o ran yr amser, felly dŷn ni'n parchu eich bod chi wedi rhoi'r amser i ddod mewn atom heddiw. Felly, diolch yn fawr iawn.  

Thank you. That's all we have time for today, but, if there are any additional questions, I hope it's okay for us to contact you on those. Thank you very much for coming in at short notice. Clearly, the scrutiny process has been difficult for us in terms of time and so we respect the fact that you've found the time to come in to us today. Thank you very much. 

11:55

Can I just make one very small point? As somebody who's desperate to learn Welsh and needs to crack on with doing so, it is actually quite difficult. When you look out there, you can find evening classes, et cetera, which are very expensive, and for our counter staff, et cetera, that would be a barrier to them. Then you look online, and I've found something called Duolingo, and others. It would be really helpful if there were some free online resources that are good resources—maybe Welsh Government could signpost us to those so that we can signpost our contractors and their staff in that direction.

Wel, dŷn ni'n cael swyddfa'r comisiynydd mewn yn hwyrach, ac yn sicr fe fyddwn ni'n adrodd hynny nôl i'r Llywodraeth hefyd, achos mae hynny'n ein helpu ni i ddeall beth fyddai'n eich helpu chi. Diolch yn fawr iawn. 

We will have the commissioner's office here later today, and certainly we'll report that back to the Government as well, because that helps us to understand what helps you. Thank you very much. 

Okay. Thank you.

Mae yna amser nawr am ginio, wedyn fe fyddwn ni'n dod yn ôl ar gyfer dau sesiwn sgrwtini i orffen y cyfnod yma o sgrwtini. Diolch yn fawr iawn i Aelodau.

There is time now for lunch and then we will return for two further scrutiny sessions to finish this scrutiny process. Thank you very much to Members. 

Gohiriwyd y cyfarfod rhwng 11:56 a 12:33.

The meeting adjourned between 11:56 and 12:33.

12:30
6. Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019: Cymdeithas yr Iaith Gymraeg
6. The National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019: Cymdeithas yr Iaith Gymraeg

Croeso nôl i Aelodau'r Cynulliad a chroeso i'r tystion. Dŷn ni'n symud ymlaen at eitem 6, Rheoliadau’r Gwasanaeth Iechyd Gwladol (Y Gymraeg mewn Gwasanaethau Gofal Sylfaenol) (Diwygiadau Amrywiol) (Cymru) 2019, a dŷn ni'n cymryd tystiolaeth gan Gymdeithas yr Iaith Gymraeg: Heledd Gwyndaf, senedd y gymdeithas, Cymdeithas yr Iaith Gymraeg—croeso—a Colin Nosworthy, swyddog cyfathrebu a chyswllt y Cynulliad, Cymdeithas yr Iaith Gymraeg. Diolch i chi am ddod i mewn ar fyr rybudd—dŷn ni'n gwerthfawrogi hynny—yn sgil yr amserlennu tyn. Dŷn ni wedi codi hynny gyda Llywodraeth Cymru yn sicr, ond diolch yn fawr iawn i chi am wneud y trefniadau i ddod i mewn, er hynny. Fel dŷch chi'n ymwybodol, dŷn ni'n mynd i fod yn gofyn cwestiynau ar sail themâu, felly, os yw'n iawn gyda chi, awn ni'n syth i mewn i gwestiynau.

Dŷn ni wedi bod yn cymryd tystiolaeth gan nifer o'r rheini sydd yn mynd i gael eu heffeithio gan y rheoliadau, ac roeddwn i eisiau gofyn i chi: pa asesiad dŷch chi wedi'i wneud o bwysigrwydd darparu gwasanaethau Cymraeg i gleifion a darparu gwasanaethau gofal sylfaenol yn benodol drwy gyfrwng y Gymraeg, ac efallai eich ymateb chi—efallai eich bod chi wedi cael amser i ddarllen y dystiolaeth, felly eich ymateb chi i hynny hefyd? Diolch yn fawr iawn.

Welcome back to Assembly Members and welcome to the witnesses. We're moving on to item 6, the National Health Service (Welsh Language in Primary Care Services) (Miscellaneous Amendments) (Wales) Regulations 2019, and we're taking evidence from Cymdeithas yr Iaith Gymraeg: Heledd Gwyndaf, from Cymdeithas yr Iaith Gymraeg—welcome to you—and Colin Nosworthy, Assembly communications and liaison officer, Cymdeithas yr Iaith Gymraeg. Thank you for attending at short notice—we do appreciate it—as a result of the tight timetabling. We have raised that with Welsh Government, certainly, and thank you very much for making arrangements to come in here. As you're aware, we're going to be asking questions on the basis of a number of different themes, so if it's okay with you, we'll go straight into questions.

We have been taking evidence from a number of organisations that are going to be affected by the regulations, and I wanted to ask you: what assessment have you have made of the importance of providing patients with Welsh language services and of providing primary care services specifically through the medium of Welsh, and perhaps your response—perhaps you've had time to read the evidence, so your response to that as well? Thank you very much.

Diolch yn fawr am y gwahoddiad i ddod i roi tystiolaeth. Wrth gwrs, mae yna bentwr o dystiolaeth i gael am bwysigrwydd y Gymraeg mewn gofal iechyd ac, yn benodol, mewn gofal sylfaenol. Mae 90 y cant o ymwneud pobl Cymru â'r gwasanaeth iechyd yn ymwneud â gofal sylfaenol. Felly, o fod yn hepgor hynny o'r safonau, wrth gwrs, mae hynny'n hepgor 90 y cant o ymwneud pobl â'r gwasanaeth iechyd.

Efallai ei bod hi'n werth nodi ein bod ni, rili, nôl i'r cwestiwn dechreuol o ran beth yw gwerth y Gymraeg. Wel, mae'r holl waith ymchwil sydd wedi'i wneud dros y blynyddoedd—. Hefyd, wrth gwrs, mae pob un ohonon ni sy’n siaradwyr Cymraeg sydd yn mynd i gael gwasanaeth wastad yn gorfod wynebu, yn y sefyllfa hynny o wendid, efallai y byddem ni ddim yn ei gael e’n Gymraeg. Mae hwnna’n straen ychwanegol, wrth gwrs. Ond mae’r ffaith ein bod ni ddim wedi symud ymlaen o’r cwestiwn hwn, er gwaethaf holl waith ymchwil y comisiynydd, a'r Llywodraeth yn ymateb i hynny wedyn, gwaith ymchwil gan seicolegwyr, gwaith ymchwil—llawer wedi cael ei wneud yng Nghanada. Roedd Liz Lloyd wedi ysgrifennu’n ddiweddar am bwysigrwydd cael therapi yn Gymraeg ac yn y blaen, ond rŷn ni’n dal ar y cwestiwn dechreuol hwn, mewn gwirionedd, o beth yw ei bwysigrwydd e. Hynny yw, dŷn ni ddim wedi profi’r pwynt hwnnw, er bod y Llywodraeth wedi cydnabod, yn eu hymateb nhw i 'Fy Iaith, Fy Iechyd' gan y comisiynydd yn 2014, fod yn rhaid, yn rhagweithiol, fynd ati i wneud rhywbeth am hyn achos ei fod e, ddim yn ychwanegiad at y gwasanaeth, ond yn rhan greiddiol o’n gwasanaeth iechyd ni yng Nghymru. Ond rŷn ni’n dal yn gofyn y cwestiwn hwn. Ond, ar y llaw arall, dwi’n deall pam fod y cwestiwn yn cael ei ofyn, achos yn y rheoliadau rŷn ni wedi'u gweld, dyw hynny ddim yn cael ei adlewyrchu o gwbl—y pwysigrwydd hynny sydd wedi cael ei brofi. Rŷn ni’n meddwl ein bod ni wedi symud ymlaen o’r pwynt hynny.

Mae'r Llywodraeth—mae Mark Drakeford, pan oedd e’n Weinidog iechyd, wedi cydnabod pa mor ar frys y mae’n rhaid inni ymateb i hyn a pha mor hanfodol a thyngedfennol yw e, a beth yw ei effaith e ar fywydau pobl Cymru—i'r 1,000 o bobl y gwnaeth y comisiynydd gymryd tystiolaeth wrthyn nhw i greu’r adroddiad hynna, lle'r oedd rhai o’r storïau—wel, bob un o’r storïau—yn ofnadwy o frawychus am bobl yn cael gwasanaeth gwael oherwydd diffyg dealltwriaeth o ba mor bwysig yw’r Gymraeg yn hynny. Felly, y cwestiwn sydd i'w ofyn yw: beth sydd wedi digwydd rhwng ymateb Mark Drakeford yn 2014, yn dweud bod yn rhaid gweithio’n rhagweithiol, a’r rheoliadau gwan difrifol rŷn ni’n gweld nawr? Beth sydd wedi digwydd? A beth dwi’n ofni sydd wedi digwydd yw bod pobl wedi bod yn rhoi tystiolaeth—. Wel, rŷn ni wedi clywed yn y memorandwm—rŷn ni’n gweld yn y memorandwm esboniadol, mai un o’r pethau sydd yn cael ei ddweud yw gan bwy maen nhw wedi cymryd tystiolaeth, ac ar dudalen 5 mae’n dweud:

'Ymgynghorwyd â chyrff cynrychioliadol darparwyr gofal'.

Hynny yw, y cyrff, dim pobl Cymru. Ac mae’r cyrff wrth gwrs yn mynd i ddweud, 'Chi’n gwybod beth? Mae popeth yn iawn. Dŷn ni ddim yn moyn gwneud dim byd ychwanegol.' Felly, y cwestiwn mae'n rhaid i ni ei ofyn yw: pa fath o Lywodraeth ŷn ni’n moyn yng Nghymru? Pa fath o genedl ŷn ni’n moyn? Y bobl sy’n gwrando ar y cyrff, a'r bobl mewn pŵer, y cyrff sydd â chyfoeth, neu bobl Cymru, y 1,000 o bobl yma wnaeth ddweud wrth y comisiynydd pa mor ofnadwy, yn glinigol anghywir, oedd yr ymateb wedi bod iddyn nhw? Ond dwi’n deall y cwestiwn; dwi’n meddwl bod eisiau inni gwestiynu pam ŷn ni’n ôl yn dechrau ar y pwynt hynny a ddim wedi symud ymlaen. Ond, o edrych ar y rheoliadau, mae’n gwestiwn teg.

Thank you very much for the invitation to provide evidence to you. Of course, there is a great deal of evidence available as to the importance of the Welsh language in healthcare and specifically in primary care, because 90 per cent of the people of Wales's dealings with the health service is related to primary care. So, in excluding that from the standards, of course, that excludes 90 per cent of people's dealings with the health service.

It may be worth noting that we are back to that initial question, really, as to the value of the Welsh language. Now, all of the research carried out over a period of years—. And, of course, each and every one of us who is a Welsh speaker and seeks a service is always facing, in that position of weakness, the fact that we may not receive that service through the medium of Welsh. That's an additional stress, of course. But the fact that we haven't moved on from this question, despite all of the research work done by the commissioner, and the Government then responding to that, the research carried out by psychologists and the great deal of research that has been done in Canada. Liz Lloyd has written recently about the importance of the availability of therapy in the Welsh language and so on, but we're still at that initial point of asking, 'Well, what is its importance?' That is, we haven't even got beyond that point, despite the Government recognising, in their response to 'My Language, My Health' by the commissioner in 2014, that one had to proactively do something about this because it isn't a bolt-on to the service; it's an integral part of our health service here in Wales. But we are still asking that fundamental question. But, on the other hand, I understand why it's being asked, because in the regulations that we have seen tabled, that isn't reflected at all—that importance that has been proven in research. We thought we'd moved on from that point.

The Government—Mark Drakeford, when he was health Minister, acknowledged the urgency in terms of our response to this and how crucial this is and its effect on the lives of the people of Wales—to the 1,000 people that the commissioner took evidence from in drawing up that report, where some of the stories—well, in fact, all of the stories—were shocking in terms of people receiving poor services because of a lack of understanding of the importance of the Welsh language in that context. So, the question that needs to be asked is: what's happened between Mark Drakeford's response in 2014, saying that we need to be proactive, and these regulations now, which are limp, to say the least? What's happened? And what I fear has happened is that people have been providing evidence—. Well, we see in the explanatory memorandum that one of the things listed is where they've taken evidence from, and on page 5 it says:

'The representative bodies of the IPCPs…were consulted'.

That is, the representative bodies, not the people of Wales. And those bodies are always going to say, 'You know what? Everything's fine. We don't want to do anything else.' So, the question we have to ask is: what kind of Government do we want in Wales and what kind of nation do we want in Wales? Are people listening to the representative bodies and those with wealth and power, or are we listening to the people of Wales, the 1,000 people who told the commissioner how clinically poor the response that they had received was? But I understand the question; I think we need to ask the question why we've returned to that point and haven't moved forward. But, in looking at the regulations, I think it's a fair question to ask.

12:35

Gaf fi jest ategu at hynny, Gadeirydd? Mae’n rhaid cofio bod yna grwpiau o bobl, siaradwyr Cymraeg, sydd yn llythrennol methu siarad yn Saesneg. Rŷn ni’n sôn am rai o grwpiau mwyaf bregus yn ein cymdeithas—mae plant ifanc iawn a phobl sy’n dioddef â dementia yn enghreifftiau o hynny, ac, wrth gwrs, mae yna lot fawr o bobl sydd yn teimlo’n anghyfforddus yn trafod pethau o’r fath yma trwy gyfrwng y Saesneg ac yn lot fwy cyfforddus yn siarad Cymraeg.

Ac fel roedd Heledd yn dweud, mae’n bolisi Llywodraeth Cymru i gynnig yn rhagweithiol wasanaethau Cymraeg yn y gwasanaeth iechyd ers 2012. Mae’n bolisi maen nhw wedi ailddweud ac ailddweud. Felly, mae’n rhaid dweud ei fod yn siomedig iawn, ac yn sioc, i weld rhywfaint o'r dystiolaeth gan y cyrff, achos, a dweud y gwir, dwi’n meddwl eu bod nhw yn perthyn i’r oes a fu—wel, neu ddylen nhw fod yn perthyn i’r oes a fu—achos mae rhai o’r dystiolaeth yn sioc ac yn syndod, a dweud y gwir, ac mae’r dystiolaeth hynny’n dangos yn glir sut mae strategaeth 'Mwy na geiriau' wedi methu, achos mae’r strategaeth yna’n sôn am gael y cyrff proffesiynol i newid eu hagwedd nhw. Ac o edrych ar y dystiolaeth yma—hynny yw, mae’n rhaid dweud ei fod yn sioc gweld rhai o’r honiadau sydd yn cael eu hailadrodd yn y fanna.

Could I just supplement that, Chair? I think that we have to remember that there are groups of Welsh speakers who literally can't speak in English. We're talking about some of the most vulnerable groups in society—young children, people who have dementia, and, of course, there are many people who feel uncomfortable discussing things like this through the medium of English and are much more comfortable speaking Welsh.

And as Heledd said, it has been the policy of the Welsh Government to provide an active offer of Welsh language services in the NHS since 2012. It is a policy that they have repeated and repeated, and, therefore, I have to say that it's very disappointing and shocking to see some of the evidence from the bodies, because I think it belongs to another age—or it should do—because some of the evidence is a shock and a surprise, really, and that evidence shows clearly how the strategy of 'More than just words' has failed, because that strategy talks about getting professional bodies to change their attitude. And in looking at this evidence, I have to say that it is a shock to see some of the claims that are being repeated there.

Sori, a alla i ychwanegu hefyd, jest o ran—? Dwi’n gwybod bod yna bobl, grwpiau specific—plant a phobl â dementia a phobl hŷn—y gwnaeth Colin sôn amdanyn nhw, ond y gwir amdani yw, pan ŷn ni’n mynd at feddygfa neu unrhyw beth, rŷn ni i gyd mewn sefyllfa fregus achos rŷn ni’n dibynnu ar rywun arall am wasanaeth, a dyw e ddim yn rhywbeth lle rŷch chi'n moyn dechrau arno gyda chŵyn. Ond hefyd, i ychwanegu at beth roedd Colin yn ei ddweud am newid agwedd cyrff—o ran y dystiolaeth sydd wedi dod ger eich bron chi—i fi, dyna yw’r dystiolaeth gryfaf sydd o’r angen i reoleiddio’n gryfach, achos dŷn nhw ddim wedi deall beth yw anghenion pobl Cymru.

And if I could just add too: I know that there are specific groups—children, people with dementia, older people—as Colin mentioned, but the truth is, when we go to a surgery or any other service, we're all vulnerable because we are reliant on someone else for a service, and it's not something where you want to kick off with a complaint. But also, just to add to what Colin said about the change in attitudes among these bodies—in terms of the evidence that you've received for me—for me, that is the strongest evidence possible of the need for stronger regulation, because they haven't understood what the needs of the people of Wales are.

12:40

Diolch, mae hynny'n weddol glir—eich barn ynglŷn â'r hyn dŷn ni wedi'i gael fel tystiolaeth. Yn amlwg, dŷn ni wedi clywed ganddyn nhw ar lafar y bore yma, ac er iddyn nhw ddweud eu bod nhw wedi bod yn fwy negyddol tuag at y rheoliadau drafft, maen nhw wedi newid agwedd tuag at y rheoliadau sydd yn bodoli nawr, sydd yn fwy ffafriol. Ond, yn sicr, mae'n siŵr bod gyda chi farn ar hynny.

Ond fy ail gwestiwn i yw: beth dŷch chi'n credu yw'r sefyllfa ar lawr gwlad nawr? Ydych chi wedi gwneud unrhyw fath o ymchwil i mewn i'r hyn sydd yn bodoli nawr i wybod faint yn well, neu faint o ddatblygiadau sydd angen digwydd i ni gyrraedd lefel sydd yn ddigonol ac sydd yn deilwng i bobl sydd eisiau cael mynediad trwy gyfrwng y Gymraeg?

Thank you, that's quite clear—your views are clear regarding what we've received as evidence. Clearly, we've heard from them orally this morning, and even though they said that they had been more negative towards the draft regulations, they have changed their attitude towards the regulations that exist currently, which are more favourable. But, certainly, I'm sure you have a view on that.

But my second question is: what do you think is the situation on the ground now? Have you undertaken any sort of research on what exists now to know how much better, or how many more developments are required so that we reach a sufficient level that is good for people who want to have access through the medium of Welsh?

Wel, wrth gwrs, beth ŷn ni'n cael—. Rŷn ni yma i gynrychioli'n haelodau, so rŷn ni, yn ddyddiol, yn cael pobl yn dod â'r hyn sy'n heriol iddyn nhw i ni. Rŷn ni'n casglu'r wybodaeth yna ynghyd mewn un darn, ond hefyd, wrth gwrs, rŷn ni'n edrych ar dystiolaeth arall sydd yn cael ei chasglu. Ac, wrth gwrs, mae yna lawer o dystiolaeth wedi'i gwneud. Dyma un o gryfderau'r comisiynydd, am wn i—mae hi wedi dod mas â sawl adroddiad. Beth yw'r pwynt inni gadw gwneud ymchwiliadau a chadw gwneud argymhellion os nad ŷn nhw'n cael eu gweithredu arnyn nhw? Roedd yr ymchwil diwethaf mor arswydus, mi oedd e'n amlwg, wrth ymateb y Llywodraeth, eu bod nhw wedi cael eu taro hefyd gyda'r angen. Os ŷch chi angen inni wneud ymgyrch i gasglu'r dystiolaeth hynny eto, mi allwn ni wneud hynny. Gallwn ni ddod â thystiolaeth i chi o bobl sydd wedi—

Well, of course, what we have—. We're here representing our members, so on a daily basis we have people telling us what has been challenging for them. We gather all of that information together, but also, of course, we do look at other evidence sources and other evidence that's gathered. And, of course, there's been a great deal of evidence gathered. This is one of the strengths of the commissioner—she has published a number of reports. What's the point in us carrying on having these inquiries and making recommendations unless they are implemented? The latest research was so shocking, it was clear from the Government's response that they were struck by the need to make changes. If you want us to carry out a campaign to gather that evidence again, then we can do that. We can bring evidence to you of people who—

Dŷn ni wedi cael lot o'r rheini; roeddwn i jest eisiau rhoi ar y record fod ymchwil yn digwydd a'ch bod chi wedi bod yn casglu hynny.

We've received much of that, I just wanted to put on the record that that research is happening and that you've been gathering information. 

Ydyn, rŷn ni'n casglu tystiolaeth, achos rŷn ni'n cynrychioli'r cleifion a'r bobl—. A jest i ymateb i beth roeddet ti wedi'i ddweud hefyd am y cyrff sydd wedi ymateb, ac y bydden nhw wedi gwrthod y rheoliadau drafft, ond bod y rhain yn fwy—. Ddywedoch chi fod y rhain yn fwy ffafriol, ond y cwestiwn yw: yn fwy ffafriol i bwy, yntefe?

Yes, we gather evidence, because we represent patients and the people who—. And just to respond to what you said about the organisations who've responded, saying that they would reject the draft regulations, but that these are more acceptable—well, the question is: more favourable to who?

Yn sicr, beth roedden nhw wedi'i ddweud yw ei fod yn fwy ffafriol iddyn nhw, fel cyrff, eu bod yn llai prescriptive na beth oedd y rhai y roedden nhw'n—

Certainly, what they said was that it is more favourable to them, as bodies, that they are less prescriptive than what the other regulations were.

Felly, beth mae hynny'n dweud am y rheoliadau, yntefe?

So, what does that tell you about the regulations?

A jest o ran cwestiwn ynglŷn â'r comisiynydd—beth rŷn ni wedi gweld yw bod Comisiynydd y Gymraeg ar y pryd wedi dweud bod y dyletswyddau, a dwi'n dyfynnu, yn rhesymol ac yn briodol ar hyn o bryd. Beth yw'ch barn chi ar hynny?

And just a question on the commissioner—what we've seen is that the Welsh Language Commissioner at the time sais that the duties, and I'm quoting, are reasonable and appropriate at the moment. What are your views on that?

Wel, dwi ddim yn gwybod beth yw statws hynny. Yn amlwg, yn y memorandwm esboniadol, dyw'r Llywodraeth ddim yn cyfeirio at ymgynghori â'r comisiynydd o gwbl. Ond, eto, mewn llythyr diweddar iawn, maen nhw'n dweud eu bod nhw yn, felly dŷn ni ddim yn gallu ateb ar ran y comisiynydd, ond, yn amlwg, roedd y Llywodraeth, pan wnaethon nhw gyhoeddi'r rheoliadau a'r memorandwm esboniadol, ddim yn meddwl eu bod nhw wedi ymgynghori, neu ddim yn ymwybodol eu bod nhw wedi ymgynghori â Chomisiynydd y Gymraeg. Felly, dwi ddim yn siŵr faint o bwys y gellid ei roi ar beth mae'r Llywodraeth nawr yn dweud, tra eich bod chi'n craffu, o ran eu bod nhw wedi ymgynghori. Ond, wrth gwrs, dŷn ni ddim yn credu bod y rheoliadau'n ddigonol o bell ffordd, ond, wrth gwrs, buaswn i'n cwestiynu a ydyn nhw actually wedi ymgynghori â'r comisiynydd os nad oedd e'n ddigon pwysig i'w gynnwys yn y memorandwm esboniadol.

Well, I don't know what the status of that is. Clearly, in the explanatory memorandum, the Government doesn't refer to any consultation with the commissioner. But, again, in a very recent letter, they say that they have, so we can't answer on behalf of the commissioner, but, clearly, the Government, when they published these regulations and the explanatory memorandum, weren't aware that they had consulted the Welsh Language Commissioner. So, I don't know how much weight one can put on what the Government is saying now, during your scrutiny process, in terms of consultation. But, of course, we don't believe that the regulations are sufficient by any means, and I would question whether they have actually consulted with the commissioner if they haven't included it in the explanatory memorandum.

O ran 'yn rhesymol ac yn briodol'—wrth gwrs, yn rhesymol ac yn briodol i glaf mewn sefyllfa o wendid fyddai cyfathrebu yn eu dewis iaith nhw, os yw hynny yn Gymraeg, yn eu gwlad nhw, lle mae honno'n briod iaith y wlad honno. Rwy'n deall bod eisiau atebion, wrth gwrs, ond beth rŷn ni'n gweld yw—does dim atebion yn cael eu cynnig fan hyn o gwbl, lle gallai. Mae'n golli cyfle gwych, ac mae'n mynd un wythfed y ffordd a dyw e ddim yn ychwanegu gwerth. Er enghraifft, efallai, ym mhwyntiau 1 a 6 o'r rheoliadau—mae yna chwe phwynt, onid oes—mae'n dweud bod eisiau darparu gwybodaeth i'r bwrdd iechyd am y gwasanaethau gofal sylfaenol mae'r contractwyr yn gallu eu cynnig drwy gyfrwng y Gymraeg. Iawn. Ond dyw e ddim yn nodi i ba bwrpas. Beth sy'n digwydd gyda'r wybodaeth hyn? Pam mae'n cael ei chasglu? Felly, dyw e ddim yn gwneud synnwyr i neb. Dyw e ddim yn gwneud synnwyr i'r bobl sy'n casglu'r wybodaeth achos mae'n wastraff amser—ac mae e yn—ond o ychwanegu beth roeddwn i'n meddwl, dylid rhannu'r wybodaeth honno a dylid cadw cofnod ohono, mae yna atebion clir, rhwydd ar gael, ac mae i wneud â chynllunio a phrosesau. Felly, o gofnodi, er enghraifft, dewis iaith claf ar ddechrau eu bywyd nhw, ar ddechrau eu perthynas nhw â gofal iechyd, yn yr un modd ag yr ŷch chi'n cofnodi enw, dyddiad geni a chyfeiriad, rŷch chi'n nodi dewis iaith. Mae hwnna'n eich dilyn chi wedyn ar hyd eich oes, a gallwch chi newid y dewis iaith os ŷch chi eisiau. Mae'n ddigon syml i'w wneud; mae i wneud â phroses.

Yn yr un modd, rŷch chi'n cofnodi'r iaith neu ieithoedd mae staff yn gallu siarad. A ydyn nhw'n medru'r Gymraeg, Saesneg, Pwyleg, beth bynnag? Os ŷn nhw'n medru'r Gymraeg, wedyn, rydych chi'n cydlynu hynny. Dyw hynny ddim yn digwydd o gwbl ar y funud, ond mae'n ateb hollol synhwyrol; dyw e ddim yn un anodd. Mae'n gwneud synnwyr a gallai'r gwahaniaeth hwnnw fod yn enfawr. Mae aelod, er enghraifft, yn cael gwasanaeth ffisio. Mae pum siaradwr Cymraeg, un siaradwr Saesneg, ac maen nhw'n cael eu 'team-o' gyda'r un sy'n siarad Saesneg. Does dim angen newid. Mae hwnna i gyd i wneud â chynllunio a phrosesau. So, mae hwnna'n ateb.

I wneud â beth sy'n rhesymol ac yn briodol, wel, mae'n hollol resymol a phriodol i holi am hynna, achos mae'n hollol bosib, mae'n realistig ac mae'n gyraeddadwy, ond mae jest eisiau ei wneud e. Felly, mae eisiau mynd â'r rhain ymhellach i sicrhau hynny.

In terms of 'reasonable and appropriate'—of course, reasonable and appropriate for a patient in a situation of weakness would be communicating in their language of choice, if that is Welsh, in their country, where that is the language of the country. I understand that answers are needed, but what we're seeing is that there are no solutions being offered here where there could be. There's a missed opportunity here, and it goes one eighth of the way and it does not add value. Perhaps, for example, in points 1 and 6 of the regulations—there are six points, aren't there—it says that there is a need to provide information to the local health board about the primary healthcare services that contractors can offer through the medium of Welsh. But it doesn't note to what purpose. What happens to this information? Why is it being collected? So, it doesn't make sense to anyone. It doesn't make sense to the people collecting the information because it's a waste of time—and it is—but in adding what we think, that information should be shared and that it should be recorded, there are clear, easy answers, and it relates to planning and processes. So, by recording the language of choice of a patient at the beginning of their life, at the beginning of their relationship with healthcare, in the same way as you record name, date of birth and address, you note the language of choice. That follows you then throughout your life, and you can change that with regard to your language of choice if you so choose. It's quite simple to do; it's to do with process.

In the same way, you record the language or languages that staff can speak. Can they speak Welsh, English, Polish or whatever? If they can speak Welsh, then you co-ordinate that. That is not happening at all at the moment, but it is a very sensible answer; it's not a difficult one. It makes sense and that difference could be enormous. For example, a member is receiving physiotherapy. There are five Welsh speakers, and one English speaker, and they're teamed with the one who speaks English. There's no need to change. It's all to do with planning and processes. So, that is a solution.

As to what is reasonable and appropriate, it's totally reasonable and appropriate to ask for that, because it's completely possible, it's realistic and it can be achieved, but it just needs to be done. These need to be taken further to secure that.

12:45

Jest i ategu at hynny, dwi ddim yn meddwl bod yna fodd dadlau nad oes modd gwella'r rheoliadau hyn mewn ffordd hollol ymarferol sydd ddim yn golygu fawr o gost. Mae yna'n amlwg le i allu gwella hynny er lles defnyddwyr y Gymraeg sydd yn hollol ymarferol. A'r realiti yw does dim digon o graffu ar y rheoliadau wedi digwydd neu ymgynghori arnyn nhw i ffeindio'r cyfleoedd hynny. Wel, roedd Heledd yn cyfeirio at y chweched ddyletswydd sef annog rhai i gofnodi. A ydyn ni wir yn dweud dŷn ni ddim yn gallu dweud y dylai pobl gofnodi? Hynny yw, yn 2014, roedd Mark Drakeford yn dweud bod meddygon teulu yn gallu cofnodi dewis iaith. Os maen nhw'n gallu ei wneud e, siawns ein bod ni'n gallu dweud eu bod nhw yn ei gofnodi fe a dim eu hannog nhw. Mae yna gwestiwn mawr: beth yw gwerth 'annog' yng nghyd-destun rheoliadau? Ydy e'n orfodadwy i ddweud 'annog rhywun i'w wneud e'? Beth yw gwerth dweud hynny?

If I could just add to that, I don't think one can argue that it's not possible to improve these regulations in a practical way where there wouldn't be much cost involved. There are clear ways of improving these for the benefit of users of the Welsh language that are entirely practical. And the reality is there hasn't been sufficient scrutiny or consultation on these regulations to find those opportunities. Heledd referred to the sixth duty, which is to encourage the recording of information. Are we truly saying that we can't say that people should be recording this information? In 2014, Mark Drakeford said that GPs could record language of choice. If they can do it, then surely we could say that they should do it, not encourage them to do it. There is a major question as to the value of encouragement in the context of regulations. Is it enforceable to say that you're encouraging someone to do it? What is the value of making that statement?

I ychwanegu at hynny, felly, annog y rhai sy'n darparu gwasanaeth i sefydlu a chofnodi'r dewis iaith, dyw hwnna ddim yn gwneud unrhyw synnwyr o gwbl. Hynny yw, i ba bwrpas? Felly, cofnodi rhai pobl, efallai, ac nid rhai pobl. Does dim unrhyw fath o system, does dim unrhyw fath o broses, felly does neb yn gwybod beth sy'n digwydd, does neb yn gwybod os oes iaith wedi ei chofnodi neu beidio. Mae'n hollol ddibwrpas, mewn gwirionedd. Ond o newid e o 'annog' i 'rhaid'—ac mae'n hollol gyraeddadwy a phriodol i wneud hynny. A dweud y gwir, mae'n hollol afresymol i beidio â holi hynny, ac yn amhriodol i beidio â holi hynny. Dyna yw'r pwynt, rwy'n credu.

Just to add to that, so, encouraging people who provide services to establish and record the language preference, that doesn't make any sense at all. That is, for what purpose? Maybe you'd record some people, and not others. There's no sort of system, there's no process, so nobody knows what's happening, nobody knows if a language has been recorded. It has completely no purpose, in reality. But by changing from 'encouraging' to 'should'—it's completely achievable and appropriate to do so. It's unreasonable not to do so, and inappropriate not to ask that question. That's the point, I think.

Jest yn glou iawn ar y cofnodi yna—

Just quickly on that recording—

Ie, rŷn ni angen symud ymlaen os yw e'n iawn.

Yes, we do need to move on.

Sori, ie, rwy'n gwybod, ond o ran y cofnodi yna, mae safonau yn fwy cyffredinol mewn ysbytai yn dibynnu ar y cofnod yna, maen nhw'n dibynnu ar fod yna gofnod o ddewis iaith, so pam ydyn ni jest yn annog hynny yn lle actually gofyn iddyn nhw gofnodi? I fod yn deg, dyw e ddim yn gofyn lot i actually gofnodi yn lle annog rhywun i gofnodi. Dŷn ni ddim yn gofyn am lot fawr fanna.

Sorry, yes, I know, but in terms of that recording, standards more generally in hospitals do rely on those records, they rely on there being a record of language of choice, so why are we encouraging that rather than requiring it? To be fair, it doesn't ask much to actually require the recording of that information, rather than encouraging it. We're not asking for much there.

Jest un pwynt arall am hynny yw y gallai fe fod yn wrthgynhyrchiol i beidio â gwneud hyn, achos byddai staff yn mynd, 'Rŷm ni'n gorfod cofnodi'—hynny yw, gyda'r pwynt cyntaf—'iaith staff ond dyw e ddim yn gwneud dim byd. Mae hwnna'n sili, on'd yw e?' Achos dyna beth fuaswn i'n ei ddweud taswn i yn y job yna, achos bod dim pwrpas iddo fe a'i fod e ddim yn gwneud dim byd, ddim yn arwain at unrhyw newid o werth ar ddiwedd y dydd.

Just one further point there that it could be counter-productive not to do this, because staff will say, with that first point, 'We have to record the staff's language, but that doesn't do anything. That's silly, isn't it?' That's what I would say if I was in that job, because there's no purpose to it and it doesn't do anything, it doesn't lead to any change of any value at the end of the day.

Ocê, diolch. Rwyf i'n credu fy mod i'n deall hynny'n glir nawr. Dŷn ni wedi gweld y newidiadau hefyd dŷch chi eisiau eu rhoi gerbron, so mae'n siŵr bydd Aelodau eisiau gofyn am hynny. Mick Antoniw.

Thank you. I think I understand that point clearly. We have seen the changes that you put forward, too, so I'm sure Members will want to question you on that. Mick Antoniw.

It's very much a technical question, not about the content of the regulations themselves; it's about the process, though. In terms of the development of these regulations, are you satisfied or do you have any comments on the nature of the consultation, the extent to which you were engaged? Perhaps you could outline a little bit how you were engaged in the process and the extent to which you feel that—it doesn't mean whether they've been incorporated, but that you've actually been properly listened to and there's been a genuine and proper consultation process. What's your view of that?

Wel, does dim—hyd y gwelwn ni, dyw'r Llywodraeth ddim wedi gwneud unrhyw ymdrech i holi am farn defnyddwyr y Gymraeg. Fel maen nhw'n ei ddweud yn y memorandwm esboniadol, maen nhw ond wedi holi'r cyrff, a dwi ddim yn gallu gweld sut mae honno'n ffordd gytbwys ac agored o lunio rheoliadau sydd yn ymwneud â maes mor bwysig. Rydyn ni'n sôn am 90 y cant o ymwneud pobl â'r gwasanaeth iechyd.

Mae'n rhaid dechrau o'r cychwyn, mewn ffordd. Fe wnaeth y Llywodraeth benderfynu eithrio gofal sylfaenol o'r safonau iechyd, ac wedyn dim ond trwy gwestiwn ysgrifenedig, fel dwi'n ei deall hi, y gwnaethom ni ddod o hyd i wybodaeth ynglŷn â beth yn gyffredinol fyddai'r chwe dyletswydd yna, ac roedd hynny ym mis Ebrill y llynedd. Fe wnaethom ni orfod gofyn am gyfarfod gyda'r Llywodraeth i drafod y rheini, ac fe lwyddom ni i gael cyfarfod ym mis Hydref y llynedd am y mater. Dywedwyd yn y cyfarfod yna eu bod nhw eisoes wedi cytuno ar hyd a lled y rheoliadau gyda'r cyrff proffesiynol. Felly, mae yna le i gwestiynu a oedd yna bwynt i ni drio cael cyfarfod i drafod y peth, achos roedden nhw eisoes wedi dweud eu bod nhw wedi cytuno gyda'r proffesiwn ynglŷn â beth fyddai natur y rheoliadau hyn.

A nawr, mae'n sefyllfa lle mae gennym ni 21 diwrnod i drio ymateb i rywbeth fel hyn. Yn amlwg, dyw e ddim yn ddigonol nac yn ffordd deg i drin defnyddwyr. Felly, a dweud y gwir, dwi'n meddwl bod y broses wedi bod yn hollol amharchus i chi fel pwyllgor ac i ddemocratiaeth Cymru, ond yn amlwg yn amharchus i ddefnyddwyr y Gymraeg, achos os ŷch chi'n rhestru mewn memorandwm esboniadol eich bod chi dim ond wedi ymgynghori gyda chyrff, sut mae hwnna'n ffordd o drin pobl? Yn amlwg, os ydyn nhw'n dweud mewn cyfarfod ym mis Hydref wrthym ni, 'Rydym ni wedi cytuno ar hyd a lled y rheoliadau', mae'n amlwg eu bod nhw ar gael yn rhywle; gallen nhw fod wedi eu hanfon nhw at y pwyllgor, siawns. So, mae dweud nawr eu bod nhw'n eu cyflwyno nhw a rhoi 21 diwrnod yn hollol amharchus fel ffordd o ymdrin â democratiaeth Cymru, heb sôn am ddefnyddwyr y Gymraeg, dwi'n meddwl.

Well, as far as we can see, the Government hasn't made any effort to ask the views of users of the Welsh language. As they say in the EM, they only asked the bodies, and I can't see how that is a balanced and open means of drawing up regulations that relate to such an important field. We're talking about 90 per cent of people's engagement with the NHS.

You have to start from the beginning, in a way. The Government decided to exempt primary care from the standards, and then it was only through a written question, as I understand it, that we found the information regarding what in general the six duties would be, and that was in April of last year. We had to ask for a meeting with the Government to discuss those, and we succeeded in having a meeting in October last year about the issue. It was said in that meeting that they had already agreed on the regulations with professional bodies. So, there is a place to question whether there was a point in us trying to get a meeting to discuss it, because they'd already said that they'd agreed with the profession in relation to what the nature of these regulations would be.

And now, we're in a situation where we have 21 days to try and respond to something like this. Clearly, that's not sufficient nor a fair way of treating users. So, in reality, I think the process has been disrespectful to you as a committee and the democracy of Wales, but has also been disrespectful to Welsh language users, because if you list in the EM that you've only consulted with bodies, how is that a way of treating people? Clearly, if they say in a meeting in October, 'We've agreed on these regulations', it's clear that they're available somewhere; they could have sent them to the committee. So, to say now that they're bringing these in and giving 21 days is a totally disrespectful way of treating democracy in Wales, let alone Welsh speakers.  

12:50

Jest i ategu, wel, cytuno â beth ddywedodd Colin. Fe wnes i sôn ar y dechrau hefyd, am wn i, beth rŷm ni'n poeni amdano hefyd, yn ein hymwneud ni yn gyffredinol â'r Blaid Lafur yn ymwneud â'r safonau, rwy'n poeni'n fawr fod yna lot gormod o wrando ar gyrff a busnesau mawr ar draul pobl Cymru. Ac mae'n amlwg, fel gwnes i sôn, fod yna rywbeth wedi digwydd fan hyn rhwng adroddiad y comisiynydd, ymateb y Llywodraeth, a oedd yn gefnogol iawn i weithio'n rhagweithiol—a dydy'r rheoliadau hyn ddim yn rhagweithiol o gwbl—a'r rheoliadau hyn. Beth sydd wedi digwydd? A beth sydd wedi digwydd yw, wel, mae'n dweud yn y memorandwm eu bod nhw wedi cyfarfod â chyrff. Mae hwnna'n fy mhoeni i'n fawr o ran y trywydd mae'r Llywodraeth yn ei gymryd yn gyffredinol, a dyna yw ein profiad ni yn gyffredinol dros y tair blynedd diwethaf o'n hymwneud â'r Llywodraeth. 

Just to add, and to agree with what Colin said. I mentioned at the outset what I'm also concerned with is that in our general dealings with the Labour Party in relation to standards, I am very concerned that they listen far too much to organisations and big companies rather than the people of Wales. As I mentioned, something has happened here between the commissioner's report, the Government's response to it, which was very supportive to being proactive—and these regulations are not proactive in any sense—and these regulations. So, what's happened? And what's happened is, as it says in the EM, they've met the representative bodies. That concerns me greatly in terms of the path chosen by Government in general terms, and that's our experience over the past three years in our dealings with the Government. 

Dwi yn meddwl bod hwnnw yn bwynt teg. Dŷn ni yn poeni'n gyffredinol wrth lunio'r safonau yma bod llawer mwy o bwys yn cael ei roi i farn cyrff na defnyddwyr. Ond dwi'n meddwl yn yr achos yma, mae'n eithriadol o wael, oherwydd dwi'n sylwi bod Eluned Morgan wedi ysgrifennu at y pwyllgor yn addo mwy o amser y tro nesaf mae hyn yn digwydd. Wel, dyw hynny ddim wedi digwydd; i'r gwrthwyneb, rydym wedi colli wythnos dros yr hanner tymor. Dyw e ddim yn ffordd i ymdrin â phobl, dwi ddim yn meddwl.  

I do think that that is fair. We are concerned in general that when drawing up these standards a lot more emphasis is put on the views of bodies rather than users. But in this case it's extremely bad, because I notice that Eluned Morgan has written to the committee promising more time the next time this happens. That hasn't happened; conversely, we've lost a week because of half term. It's not a way of treating people, I don't think. 

Byddwn ni yn, dŷn ni wedi, ac mae pwyllgor Mick wedi gwneud hynny'n glir, ond diolch am ategu hynny. David Melding. 

We will, we have, and Mick's committee has made that clear, but thank you for adding that. David Melding. 

Diolch yn fawr, Cadeirydd. I share your frustrations about the consultation and the lack of scrutiny and I note, in fairness to you, that you've suggested ways to strengthen the regulations, and I think it's always useful when we have the actual concrete suggestions before us rather than just a general criticism. So, I do commend you for that, and that's your view and it can be examined by this committee and other concerned bodies. You have explained why you think those six points need strengthening and how, and particularly the point around, for instance, recording the language preference.

You also suggest two new duties, so I'd just like to hear you explain those and why you think they're important. Would that then give a minimum suite of duties for this phase of what is happening in terms of the health service, and ensuring it makes progress towards fully bilingual health provision?  

Allaf i gael diwedd y cwestiwn eto, plis? 

Could you just ask the end of that question again, please? 

Presumably, these regulations will not exist for 50 years; they're at the start of a long journey of public policy to make Wales—I say 'fully bilingual', that's not quite the aim, but, anyway, to make progress in that direction.  

Dyna yw'r nod. 

Well, that is the aim. 

12:55

Well, by 2050, it's not, is it? Obviously, beyond that, we're talking then many, many decades hence. 

Gwnaethoch chi ddweud hwnna—dechrau taith hir—a'r gwir amdani yw, mae yn nodi mai dyma ddechrau'r daith, ond dechrau'r daith saith mlynedd yn ôl yw hwn. Dyw e ddim yn ateb lle dylen ni fod wedi cyrraedd erbyn hyn o gwbl. Mae'n mynd â ni nôl eithaf llawer. Ond beth sydd, wrth gwrs, ar goll o'r rheoliadau hyn, ac o'r safonau yn ymwneud â'r sector iechyd yn gyffredinol, yw'r ymwneud wyneb yn wyneb yna. Wrth gwrs ein bod ni'n croesawu bod angen taflenni yn Gymraeg. Mae yna gymysgwch fan hyn ynglŷn â phwy sy'n darparu taflenni ac mae hwnna'n broblematig i ddefnyddwyr y gwasanaeth, achos gallech chi fynd mewn i'ch meddygfa, cael taflen gan y feddygfa, gan y gwasanaeth iechyd, gan gymdeithasau gwahanol, ac mae'ch hawliau chi'n newid—gallent newid tua phum, chwe gwaith o fewn un ymweliad â'r feddygfa. Dyw hwnna ddim yn dderbyniol o ochr y claf. Mae'n gymysglyd iawn i glaf. 

Ond, ie, yr ymwneud wyneb yn wyneb yna; mae'n hanfodol. Faint o Gymry Cymraeg sydd yn mynd mewn i feddygfa neu i unrhyw fath o wasanaeth ac yn mynd, 'O, maen nhw'n siarad Cymraeg'? Ac mae hwnna yn dweud cyfrolau, achos mae'n dangos bod straen ychwanegol wrth feddwl am fynd i rywle a gorfod cyfathrebu sut rŷch chi'n teimlo, nid dim ond yn eich ail iaith, ond mae ymchwil hefyd yn dangos os yw'r ail iaith yn gormesu'ch iaith gyntaf chi, yna mae yna waliau ychwanegol yn cael eu codi rhyngoch chi â'r iaith honno achos mae yna gysylltiadau seicolegol eraill. 

Felly, dyw'r safonau na'r rheoliadau hyn ddim yn mynd i newid ein bywydau ni fel y dylen nhw. Dŷn nhw ddim yn dod â gwerth ychwanegol i siaradwyr Cymraeg ac i bobl Cymru, ac felly mae'n golygu bod y gwasanaeth iechyd ddim yn gwneud ei waith yn iawn, achos o dderbyn nad atodiad yw'r iaith Gymraeg, ond bod e'n greiddiol i'r gwasanaeth—. Mae nifer o feddygon—. Mae meddyg ar ein his-grŵp iechyd ni yn dweud ei bod hi'n bwysig bod meddygon yn gweithio mwy tuag at drin person yn holistig, a dyma yw e. Mae iaith—. Rŷn ni'n dod yn pwy ŷn ni drwy iaith—dyna sut rŷn ni'n dod i wybod pwy ŷn ni wrth ein parabl ni yn blant. Ac o ddim rhoi unrhyw hawliau i ymdrin â'ch meddyg neu'ch deintydd wyneb yn wyneb, dyw hwnna ddim mewn gwirionedd yn newid pethau yng Nghymru.

Rŷch chi siŵr o fod wedi darllen 'Fy Iaith, Fy Iechyd' a storïau eraill sydd wedi bod am blant yn mynd at y deintydd a ddim yn gallu cyfathrebu. Fy mhlentyn i, yn ddwy flwydd oed, yn cael prawf clyw gan rywun oedd ddim yn medru'r un iaith ag e yn ei wlad ei hun. Ac mae hwnna'n bwynt. Dyw e ddim fel tasech chi mewn gwlad arall a chi'n deall wedyn. Ond yn eich gwlad eich hun. Pa fath o effeithiau pellgyrhaeddol mae hynny yn ei gael? Felly, dyna bwrpas 7 ac 8. Roedd yn rhaid nodi hynny. Ni ffaelu jest mynd am—. Wrth gwrs bod y papur a'r cyfathrebu yr holl ffordd yn bwysig, ond mae beth sydd wir yn mynd i wneud gwahaniaeth ddim yn cael ei sôn amdano o gwbl yn y rheoliadau. 

You said that this is the beginning of a long journey, and the truth is that it does note that this is the beginning of a journey, but this is the beginning of the journey seven years ago. It isn't responding to where we should have reached now. It takes us back quite a bit. But what is missing from these regulations, and from standards relating to the health sector more generally, is that face-to-face contact. Of course we welcome the fact that leaflets should be available bilingually. There is some confusion as to who provides those materials, and that's problematic for a service user, because you could go into your surgery and receive a leaflet from the surgery, from the health service, from various organisations and associations, and your rights can change five or six times within one visit to a surgery. And that's not acceptable from a patient perspective. It's hugely confusing for a patient. 

But, yes, it's that face-to-face contact; it's crucial. How many Welsh speakers go into a surgery or any other service and say, 'Oh, thank goodness, they speak Welsh'? And that speaks volumes, because it demonstrates that there is additional pressure in thinking of going somewhere and having to communicate how you feel, not just in your second language, but research also shows that if the second language oppresses your first language, then there is an additional barrier placed between you and that language because there are other psychological factors at play. 

So, the standards and these regulations aren't going to change our lives as they should. They don't provide added value for Welsh speakers and the people of Wales, and, therefore, it means that the health service isn't doing its work properly, because, in accepting that the Welsh language is not a bolt-on, but that it is a core part of the service—. There is a doctor on our health sub-group saying that doctors