Written Statement: Escalation and Intervention Arrangements – Betsi Cadwaladr and Cwm Taf Morgannwg University Health Boards

On 5 October, I published a written statement setting out the escalation levels of health boards across Wales. I said the escalation status of Betsi Cadwaladr and Cwm Taf Morgannwg university health boards were being considered separately and I would update Members following the tripartite meeting.

Betsi Cadwaladr University Health Board

On 7 June, I confirmed my decision to extend the targeted intervention status of the health board to incorporate Ysbyty Glan Clwyd, focusing on the vascular service and emergency department.  

It is clear there are still a number of serious challenges the health board needs to overcome. I have accepted the advice that there should be no change to the escalation status of the health board.

Cwm Taf Morgannwg University Health Board

On 7 November, I published the Independent Maternity Services Oversight Panel’s latest report.  In recognition of the progress made by Cwm Taf Morgannwg University Health Board, I announced my decision to de-escalate maternity and neonatal services from special measures to targeted intervention.

However, following the tripartite meeting, I have accepted a recommendation that there should be further changes to the escalation status of Cwm Taf Morgannwg University Health Board.

1. The escalation status for quality governance remains at targeted intervention.
2. The escalation status for quality related to performance and long waiting times is raised to targeted intervention.
3. The escalation status for planning and finance is raised to enhanced monitoring.

The health board has made considerable progress in respect of quality governance but it is in the process of implementing a new operating model.  I need to be assured this new structure is embedded across the health board and is having a positive impact on the effectiveness of the health board’s governance processes before there can be consideration of de-escalation in this area.  

Audit Wales and Healthcare Inspectorate Wales plan to undertake a joint follow-up review of the health board’s quality governance arrangements early next year.  The findings and conclusions from this follow-up review, in particular any assurance which can be provided regarding the health board’s progress in delivering against the 14 recommendations identified in the original review in 2019, will inform any future deliberations around escalation status.

Quality and performance across all areas of planned care, urgent and emergency care is a challenge for all health boards as the NHS recovers from the pandemic.  However, the challenges experienced by Cwm Taf Morgannwg University Health Board were noted as considerable, particularly in urgent and emergency care, planned care recovery, child and adolescent mental health services and cancer – these are having a negative impact on the quality of care and patient experience.  

I have clearly set out my expectations for the recovery of planned care services and the health board has not made sufficient progress against these targets.

The health board has been escalated to enhanced monitoring for planning and finance because it has not been able to submit a balanced and approved three-year Integrated Medium Term Plan (IMTP).  It has therefore breached its statutory duty and was required to submit an annual plan, which has a considerable forecast recurrent deficit of £26.5m.

All other organisations remain at the levels of escalation as set out in my previous update to Members.  The table below shows the previous and current escalation status of each organisation.

Annex 1