Written Statement: Escalation and Intervention Arrangements

Under the Joint Escalation and Intervention Arrangements, the Welsh Government meets with the Wales Audit Office and Healthcare Inspectorate Wales twice a year to discuss the overall position of each health board and NHS trust in respect of quality, service performance and financial management. A wide range of information and intelligence is considered to identify any issues and inform the assessment.

It was agreed that the escalation status of each NHS organisation would be published.

The framework has 4 escalation levels:

• Routine arrangements
• Enhanced monitoring
• Targeted intervention
• Special measures.

The latest meeting took place in January 2019 and the tripartite group considered that progress had been demonstrated since the last meeting in July 2018 in those organisations in targeted intervention:

• performance in Cardiff and Vale UHB has continued to be amongst the best in Wales in key performance areas and the organisation was confident that its year end targets would be achieved. The health board was on track to deliver to its financial control total at the end of March. The organisation has demonstrated significant progress in its planning, and was confident that they would be able to approve an Integrated Medium Term Plan (IMTP) for submission to Welsh Government. In view of the improvements in service and financial performance it was agreed that the organisation should be de-escalated to ‘enhanced monitoring’. The position would be reviewed again following assessment of the IMTP.
• Abertawe Bro Morgannwg UHB has demonstrated progress in a number of the areas for which it was placed in targeted intervention, though further improvement is required before the organisation could be de-escalated. In particular, the health board must deliver against its 2018/19 service and financial commitments. The health board will initially prepare a 1 year plan for 2019/20 and is working to finalise its 3 year plan in the summer of 2019.
• Hywel Dda UHB has also made progress in key areas including progress towards delivery of its planned care commitments. The health board must demonstrate delivery of its financial control total at the end of March. The organisation will be submitting a 1 year plan for 2019/20 and will continue to work towards agreement of a 3 year plan.

Progress has also been seen in several areas in Betsi Cadwaladr UHB. Out of Hours performance in the health board is now at a level that is comparable to other organisations and has been removed as a special measures concern. There have been some improvements in mental health, though there is further work to do. The tripartite group recognised the way in which the organisation had responded to the Ockenden and the Health and Social Care Advisory Service (HASCAS) reports. Quality and safety governance has been strengthened and improvements are becoming evident. The new chair is strengthening governance and board effectiveness. Despite improvements in some areas compared to last year, BCUHB still faces a challenging improvement agenda as it works to improve performance and governance within the context of a sustainable 3 year plan.

The table below shows the previous and current escalation status of each organisation.

* Cwm Taf UHB was escalated to ‘enhanced monitoring’ at a meeting at the beginning of January 2019.