Written Statement: Escalation and Intervention Arrangements

Under the Joint Escalation and Intervention Arrangements, Welsh Government officials meet with Audit Wales 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.

Due to the current pandemic, the latest meeting took place virtually in September 2020 and the tripartite group was complimentary of the way the NHS in Wales had responded to dealing with the pandemic.  They also considered that prior to the pandemic, progress had been demonstrated since the last meeting in December 2019 in those organisations in raised levels of escalation:

• Hywel Dda UHB had made progress in key performance areas with the organisation making progress against its year end targets and was on track to deliver against the RTT target.  However, there was still concern around the financial position within the organisation, but it was recognised that the health board had reacted positively to the KPMG review.  Future financial plans would be dependent on delivering the clinical strategy that had been developed.  In view of the improvements in service, and noting that in practice monitoring had reduced, it was agreed that the organisation should be de-escalated to ‘enhanced monitoring’.

• The group was complimentary of the way in which Swansea Bay UHB had dealt with the current pandemic.  It had also demonstrated that it had a clearer understanding of its finances and the required actions.  There has been a clearer approach to performance and an improvement in some of the measures under consideration, including cancer and infections; however, there remain concerns that unscheduled care and waiting times need to see sustained improvement in performance. In view of the improvements in approach and response, it was agreed that the organisation should be de-escalated to ‘enhanced monitoring’.

The group acknowledged the positive way in which Betsi Cadwaladr UHB had responded to the pandemic over recent months, recognising that the trend had affected North Wales on a more sustained basis to the rest of Wales.  It reviewed evidence submitted by the health board that demonstrated progress over recent years including on the areas which had originally been designated as special measures.  However, there remained concerns on performance and strategic solutions that may require specific external support.  Specifically, the group wanted some further assurance from the health board in respect of progress in mental health services.  The group felt it was important for the health board to promote the good work it was doing and to focus on its actions, rather than be distracted by the status label.  At this stage, there was no recommendation for a change to escalation status.  To allow for the opportunity for further progress to be considered, the group proposed to have an additional tripartite meeting specifically on Betsi Cadwaladr UHB before the end of the year.

With regards to Cwm Taf Morgannwg, the group noted that the health board was continuing to respond effectively and openly to the external review bodies and the Independent Maternity Panel, including over recent months.  The group noted that any progress had to be considered in the context of the priority of the pandemic response.  Whilst the latest Maternity Oversight Panel had been undertaken virtually, the Panel had acknowledged progress in maternity services since the last review.  The group noted the improved partnership and stakeholder engagement, particularly with the Local Authority partners and the constructive way in which the status of the emergency department at the Royal Glamorgan had been concluded.  Despite this, it remains important for the health board to continue to rebuild the trust and confidence of the local population, as well as with stakeholders.  At this stage there was no recommendation for a change to escalation status.

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.