Written Statement: Escalation and Intervention Arrangements

Under the Joint Escalation and Intervention Arrangements, Welsh Government officials meet 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 four escalation levels:

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

The latest meeting took place in August 2019 and the tripartite group considered that progress had been demonstrated since the last meeting in January 2019 in those organisations in raised levels of escalation:

• performance in Cardiff and Vale UHB has continued to improve in key performance areas and the organisation had made progress against its year end targets.  Critically, the health board met its financial control total at the end of March.  The organisation has also demonstrated significant progress in its planning approach, and had submitted an Integrated Medium Term Plan (IMTP) to Welsh Government which was approved.  In view of the improvements in service and financial performance, and noting that in practice monitoring had reverted to normal arrangements, it was agreed that the organisation should be de-escalated to ‘routine arrangements’.

• Swansea Bay UHB has demonstrated progress in a number of the areas for which it was placed in targeted intervention, including achieving its RTT commitment at the end of March, though further improvement is required in unscheduled care and finances before the organisation could be de-escalated.  The health board is preparing a one year plan for 2019/20 and is continuing to work towards finalising its three year plan in the summer of 2019.

• Hywel Dda UHB has also made progress in key areas, including delivery of its planned care commitments at the end of March 2019, as well as meeting its financial control total.  The organisation has submitted a one year plan for 2019/20 and will continue to work towards agreement of a three year plan.

Progress has been limited in Betsi Cadwaladr UHB over recent months.  Despite improvements in some areas such as mental health and GP out of hours compared to last year, BCUHB still faces a challenging improvement agenda.  Current performance in planned and unscheduled care, together with the forecast financial position, are of significant concern and remain key areas in which I expect to see significant improvement.  I will be publishing a revised improvement framework to clarify the progress made and the outstanding special measures concerns.

With regards to Cwm Taf Morgannwg, the group noted that the health board was responding effectively and openly to the joint Healthcare Inspectorate Wales / Wales Audit Office review.  Links are working well with the recently established Maternity Oversight Panel.  The group noted the impact of the interim Chief Executive in the organisation, and that a new Director of Nursing had recently started and a new Medical Director was due to take up post shortly which would strengthen the Executive Team.

The Chief Nursing Officer advised that the health board was compliant with the Nurse Staffing Act and that this could be removed from enhanced monitoring.  It was also agreed that the actions raised in the Human Tissue Authority report had been progressed and could be removed from enhanced monitoring and be monitored through the regular quality and delivery meetings.  Despite this progress, the health board was aware of the serious nature of the situation and recognised there was still a great deal of work to do.

With regards to Health Education and Improvement Wales (HEIW), the group were complimentary following their initial set up and noted their approved one year plan.  The group agreed the organisation should be placed in ‘routine arrangements’.

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

* The previous Cwm Taf UHB was escalated to ‘enhanced monitoring’ at a meeting at the beginning of January 2019.  At a meeting in April 2019, it was agreed to raise the escalation status of Cwm Taf Morgannwg to ‘Special measures’ for maternity services following the publication of the Royal College report and to ‘targeted intervention’ for governance and quality.

Following a boundary change in March 2019, Abertawe Bro Morgannwg and Cwm Taf UHBs became Swansea Bay and Cwm Taf Morgannwg UHBs.