Written Statement: Escalation and Intervention Arrangements

This statement sets out the new escalation levels of NHS trusts, special health authorities (SHAs) and health boards in Wales.

The environment in which health boards, trusts and SHAs operate remains difficult. There are growing financial deficits, operational pressures, long waiting lists, as well as an extremely challenging financial position that is not unique to Wales. 

For the current financial year, health boards were unable to submit financially balanced Integrated Medium-Term Plans (IMTPs) and were therefore required to submit annual plans.  In doing so, they have not provided plans in accordance with the direction given by the Welsh Ministers and the NHS Planning Framework, which I could consider for approval under section 175(2A) of the NHS (Wales) Act 2006 (“the 2006 Act”).

In line with the Escalation and Intervention Arrangements, this represents a serious concern to service delivery which exceeds that which can be dealt through routine arrangements, and I have therefore accepted the recommendation from officials that those organisations that were not already in escalation for planning and finance will now be escalated to enhanced monitoring. 

I have agreed the escalation status of NHS bodies as follows:

• Hywel Dda University Health Board to remain at its current escalation status of targeted intervention for planning and finance and enhanced monitoring for performance and quality.
• Swansea Bay University Health Board to be escalated to enhanced monitoring for planning and finance and to remain in enhanced monitoring for quality and performance.
• Cardiff and Vale University Health Board to remain in enhanced monitoring for planning and finance.
• Aneurin Bevan University Health Board to be escalated to enhanced monitoring for planning and finance.
• Powys Teaching Health Board to be escalated to enhanced monitoring for planning and finance.
• Betsi Cadwaladr University Health Board to remain in special measures.
• Cwm Taf Morgannwg University Health Board to remain in targeted intervention for quality concerns related to performance and long waiting times and planning and finance to remain in enhanced monitoring. Maternity and neonatal services will be de-escalated from targeted intervention to enhanced monitoring. Quality and governance, leadership and culture, trust and confidence will be de-escalated from targeted intervention to enhanced monitoring.
• All NHS trusts and SHAs to remain at their current escalation level of routine arrangements.

Cwm Taf Morgannwg University Health Board

The escalation status of Cwm Taf Morgannwg University Health Board has changed considerably, the reasons for this are set out below.

I announced on 7 November 2022 that maternity services at the health board would be de-escalated from special measures to targeted intervention, in recognition of the clear progress the health board had made in this area over the previous three-and-a-half years.  I am pleased to note that the health board has continued to make improvements across both maternity and neonatal services.

There has been significant progress in implementing the remaining recommendations from the Independent Maternity Services Oversight Panel (IMSOP) and embedding them into practice. Some of the key achievements include achieving Unicef Stage 3 Baby Friendly Accreditation, being nominated as finalists for the Royal College of Midwifes (RCM) awards, implementation of an integrated maternity dashboard and development of the maternity and neonatal culture and leadership plan.

The NHS Wales Executive has recently undertaken an assurance review of the service. This indicated that there is now a clear ambition and strategy for one perinatal service, with strong cohesive senior multidisciplinary leadership providing integrated governance that underpins the operational day-to-day delivery of maternity and neonatal services. There is a strong supportive infrastructure of key critical corporate functions in place demonstrating Board connectivity and commitment. This is another positive step on the health board’s maternity and neonatal journey. There are still areas where further improvements are required, and it will take time before some of the changes are fully embedded in the service.

I am encouraged by the progress that the health board is making and would like to thank all the staff across the health board for all their hard work in supporting and transforming this service. I am now in a position to de-escalate the health board to enhanced monitoring for maternity and neonatal services.

Turning to governance, leadership and culture, trust and confidence, the health board has been in targeted intervention since 2019. As with maternity and neonatal services, it is encouraging to note that the health board has made significant progress in reforming these functions. On 24 August 2023, Audit Wales and Healthcare Inspectorate Wales published the outcomes of their Cwm Taf Morgannwg University Health Board – quality governance arrangements joint review follow-up.

The joint follow-up review highlights that the health board has made significant progress in addressing the concerns and recommendations set out in their original joint review in 2019, but it still needs to take further action to fully embed its new operating model and revised quality governance arrangements across the organisation.

I am encouraged by the progress the health board is making in this area, and I am now de-escalating the health board to enhanced monitoring for governance, leadership and culture, trust and confidence.

In terms of performance, I have not seen the required improvements across child and adolescent mental health services (CAMHS), planned care, cancer and urgent and emergency care. The Welsh Government has commissioned several interventions from the NHS Executive to ensure these services improve. There are some encouraging signs of improvement in reducing the number of long waiting times and recent progress in reducing ambulance handover delays.

However, the health board remains an outlier across many of these services and people are waiting too long for assessment and treatment. I have accepted the advice I have received from officials and the health board will remain in targeted intervention for quality concerns related to performance and long waiting times.

For the current financial year, Cwm Taf Morgannwg University Health Board was unable to submit a financially balanced IMTP and, as a result, has submitted an annual plan.  Therefore, in line with other health boards, it will remain in enhanced monitoring for planning and finance.

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

Link to webpage: NHS Wales escalation and intervention arrangements