Two Welsh health boards have been placed under a higher level of Welsh Government intervention for failing to produce "balanced and approvable" plans on how to deliver healthcare in their areas. In a written statement by Health Minister Eluned Morgan, Cardiff and Vale University Health Board was escalated from routine arrangements to enhanced monitoring for planning and finance.
Hywel Dda University Health Board, which covers Pembrokeshire, Carmarthenshire and Ceredigion, has seen its own planning and finance escalated from enhanced monitoring to targeted intervention - one step further than Cardiff and Vale UHB. Hywel Dda UHB will also remain in enhanced monitoring for quality and performance.
Welsh Government officials meet with Audit Wales and Healthcare Inspectorate Wales at least twice a year to discuss the overall position of each health board, NHS trust and special health authority in respect of quality, governance, service performance and financial management.
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As part of its joint escalation and intervention arrangements, there are four escalation levels:
- Routine arrangements: this effectively means business as usual
- Enhanced monitoring: a pro-active response led by the NHS body to put effective processing in place to drive improvement. It is closely monitored, challenged, and reviewed by Welsh Government and external review bodies
- Targeted intervention: co-ordinated and/or unilateral action to strengthen the capacity and capability of the NHS body to drive improvements
- Special measures: measures identified when the current arrangements need significant change. Welsh ministers may intervene.
Commenting on both health boards, Health Minister Eluned Morgan said: "Cardiff and Vale UHB has been escalated to enhanced monitoring from routine arrangements because it was unable to submit a balanced and approvable three-year integrated medium term plan (IMTP). The health board is aware of the requirements and is working to address the position. This status will be reviewed at the next meeting.
"Hywel Dda UHB has been escalated to targeted intervention from enhanced monitoring for finance and planning because it has been unable to submit a balanced and approvable IMTP or a finalised annual plan and a growing financial deficit is being reported. On quality and performance, there are concerns around urgent and emergency care, including ambulance handover, cancer and performance against part 1a of the child and adolescent mental health services (CAMHS) measure."
Meanwhile Swansea Bay UHB has been de-escalated to routine arrangements from enhanced monitoring for finance and planning as it has an approved IMTP. But the health board will remain in enhanced monitoring for quality and performance as concerns remain around the speed of the restart of planned care, cancer and daily fluctuations in urgent and emergency care.
The Welsh Government said Betsi Cadwaladr UHB and Cwm Taf Morgannwg UHB were not considered in the last meeting on September 7. Their escalation status will be discussed in a meeting later in October.
Organisation |
Previous Status (Feb 22) |
Current Status (Sept 22) |
Aneurin Bevan UHB |
Routine arrangements |
Routine arrangements |
Betsi Cadwaladr UHB |
Targeted Intervention |
Targeted Intervention for mental health, Ysbyty Glan Clwyd, vascular services, leadership , engagement, finance, strategy, planning and performance, |
Cardiff and Vale UHB |
Routine arrangements |
Enhanced monitoring for planning and finance |
Cwm Taf Morgannwg UHB |
Special measures for maternity, targeted intervention for quality and governance |
Special measures for maternity, targeted intervention for quality and governance |
Digital Health and Care Wales |
Routine arrangements |
Routine arrangements |
Health Education and Improvement Wales |
Routine arrangements |
Routine arrangements |
Hywel Dda UHB |
Enhanced monitoring |
Enhanced monitoring for quality and performance, targeted intervention for finance and planning |
Powys tHB |
Routine arrangements |
Routine arrangements |
Public Health Wales NHS Trust |
Routine arrangements |
Routine arrangements |
Swansea Bay UHB |
Enhanced monitoring |
Enhanced monitoring for quality and performance |
Velindre NHS Trust |
Routine arrangements |
Routine arrangements |
Welsh Ambulance Services NHS Trust |
Routine arrangements |
Routine arrangements |
Welsh Conservative Shadow Health Minister Russell George MS said: "It is worrying to see two more health boards require increased oversight and intervention – yet this is just another problem in the Labour-run health service and shouldn't come as a surprise. In Wales, there are over 60,000 people waiting over two years for NHS treatment – when such waits have virtually been eliminated in England and Scotland – and we also have significantly worse A&E waiting times than other parts of the UK.
"Given how much of the NHS is no longer in routine arrangements, it makes you think whether these interventions will actually address these serious waits – we need greater confidence in the system that neither patients nor staff currently have. Labour needs to get a grip on the NHS and stop breaking all the wrong records."
Plaid Cymru's spokesperson for Rhun ap Iorwerth MS said: "This latest news begs the question how much control Welsh Government has over the NHS in Wales. Again and again, right across the country, we're seeing the need for various interventions because government is failing to keep on top of matters.
"Patients and staff are rightly feeling frustrated, and it shows just how unsustainable the current situation is."
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