Written Statement: Escalation and Intervention Arrangements

Under the Joint Escalation and Intervention Arrangements, 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.  A wide range of information and intelligence is considered to identify any issues and inform the assessment.

The framework has four escalation levels:

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

The latest meeting took place virtually on 7 September 2022.  Betsi Cadwaladr UHB and Cwm Taf Morgannwg UHB were not considered in this meeting – their escalation status will be discussed in a meeting later in October 2022.  

The group noted organisations continue to struggle in relation to performance, particularly urgent and emergency care, planned care recovery and cancer, noting the impact this was having on quality of care and patient experience.

Following the meeting, the Chief Executive of NHS Wales made the following recommendations to me:

• Escalate Cardiff and Vale UHB from routine arrangements to enhanced monitoring for planning and finance,
• Escalate Hywel Dda UHB to targeted intervention for planning and finance and for them to remain in enhanced monitoring for quality and performance.
• De-escalate Swansea Bay UHB to routine arrangements for planning and finance, but for it to remain in enhanced monitoring for quality and performance. 

I have accepted these recommendations for the following reasons:

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.

Swansea Bay UHB has been de-escalated to routine arrangements from enhanced monitoring for finance and planning as it has an approved IMTP. 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.

All other organisations remained at their previous level of escalation.

The table at annex 1 shows the previous and current escalation status of each organisation.

Annex 1