Written Statement: Integrated Medium Term Planning Update

This is the sixth annual planning cycle following the introduction of the NHS Finance (Wales) Act 2014 and the first since the publication of A Healthier Wales: our Plan for Health and Social Care. 

A Healthier Wales set out the challenge to streamline and align health planning processes and encouraged a more directive approach from Welsh Government.  I welcomed this intention and in response, we issued a revised NHS Wales Planning Framework in October 2018. 

The Framework set the tone, and provided NHS organisations with clear direction, for the next three years, with priority given to improving population health, prevention, reducing health inequalities, based on the prudent and care philosophy, primary and community care, improving access to services as and when required and stronger mental health care. 

Health boards and NHS trusts are required to set out in their Integrated Medium Term Plans how resources will be used over a three-year period to:

• Address areas of population health need;
• Improve health outcomes and quality of care; and
• Ensure best value from resources.

Organisations have developed their plans with A Healthier Wales at the heart of their thinking, and we are seeing a continuous and increased focus on health and well-being, and preventing illness through strong collaboration between health and social care.  In addition, organisations have built on the progress they have made by ensuring the way they deliver services are in line with key legislation such as the Well-being of Future Generations (Wales) Act 2015 and the Social Services & Well-being (Wales) Act 2014, as well as the national Strategy, Prosperity for All.  This is encouraging and a step in the right direction towards delivering our long term vision.

I would also like to take this opportunity to highlight that the planning engagement between my officials and NHS organisations began much earlier than in previous years.  Welsh Government, health boards, trusts and NHS supporting organisations, have had extensive engagement since October.  This involved ensuring easier access to advice and, importantly, helped identify the key challenges and solutions sooner.  This engagement also provided a timely opportunity to work with the newly established Statutory Health Authority, Health Education and Improvement Wales, as they develop their first annual plan.

This has resulted in organisations agreeing some key joint priorities and funding decisions earlier in the year through collaborative working, and consequently the submission of approvable, balanced IMTPs earlier than ever before.

This approach has been welcomed by NHS Wales and I am pleased to confirm that I have decided to approve seven organisations that have submitted balanced and achievable three year plans, which is an improvement on last year.  I have been encouraged by the way the NHS in Wales has responded to the challenges set out in A Healthier Wales and, whilst there is still further to go, they have continued to demonstrate a growing maturity in their planning arrangements. 

So, following a robust assessment process, I have approved the integrated plans from the following seven organisations –

• Aneurin Bevan University Health Board
• Cardiff & Vale University Health Board
• Cwm Taf University Health Board
• Powys teaching Health Board
• Public Health Wales NHS Trust
• Velindre NHS Trust, and
• Welsh Ambulance Services NHS Trust.

I would like to acknowledge the approval of Cardiff and Vale UHB’s IMTP. They were placed in Targeted Intervention in July 2016 and have worked constructively and maturely with my officials to address a number of delivery and financial issues, de-escalating in January this year.  I have committed to supporting health boards in escalation and this shows that there is a clear route out of escalation where organisations demonstrate a commitment to effective planning and delivery.

I expect approved organisations to continue to drive delivery at pace, working across health board and trust boundaries and with public and third sector partners to provide quality services for patients in Wales.  Performance of these organisations will also continue to be reviewed regularly throughout the three year cycle.

The approval of a plan does not prejudice the outcome of any due process required to implement the plan.  Any service reconfiguration needed must be carried out in line with legislation and our existing guidance and any application for capital investment will be subject to the normal business case approval processes.

Three organisations were unable to submit Board approved three year plans, these being Abertawe Bro Morgannwg, Hywel Dda University Health Boards and Betsi Cadwaladr.  These organisations remain in escalation and are developing annual plans for 2019-20.  

Abertawe Bro Morgannwg University Health Board

ABMU is developing a one year annual operating plan to address performance and financial challenges.  In addition, Assembly Members will be aware that, in June last year, I announced that responsibility for providing healthcare services for people in the Bridgend County Borough Council area will be transferring from ABMU to Cwm Taf University Health Board from 1st April 2019.  This is a complex transfer of services on which some practicalities and detail has been ongoing.  The annual plan will reflect the impacts of this change.  The health board expects to be in a position to develop a full IMTP during 2019/20 and I look forward to receiving this.

Hywel Dda University Health Board

Hywel Dda University Health Board has agreed its strategic vision via their Transforming Clinical Services strategy and has an ambition to develop a balanced and approvable IMTP in the future.  However, the strategic challenges combined with the ongoing performance, workforce and financial challenges preclude a balanced IMTP at this time. As with ABMU and BCU, I expect the health board’s response to these challenges to be set out in their detailed one year operating plan.

Betsi Cadwaladr University Health Board 

Assembly Members will be aware that Betsi Cadwaladr University Health Board continues to face a number of service, finance and performance challenges which require ongoing support.  The health board’s response to these challenges will be set out in their one year annual operating plan for 2019-20. 

My officials continue to work closely with the above organisations to provide the necessary support and challenge as they work towards sustainable solutions.

There are also NHS organisations that do not have a statutory duty to provide an IMTP and, as such, I am not required to approve their plans. However, I can confirm that the Emergency Ambulance Services Committee (EASC), NHS Wales Informatics Service (NWIS), NHS Wales Shared Services Partnership (NWSSP) and the Welsh Health Specialised Services Committee (WHSSC) have developed robust and balanced integrated IMTPs to support a consistent approach to planning and provide clarity on alignment with health board and trust plans.

The newly established statutory organisation Health Education and Improvement Wales (HEIW), a Special Health Authority, does not have a statutory duty to provide an IMTP for 2019-22.  However, it will be submitting an annual plan for 2019/20 shortly.

We have also strengthened our partnership working with the Wales Audit Office to share learning going forward and we will continue to explore how we can go further and faster to maximise the opportunities that the integrated planning system that the NHS in Wales provides. This includes bringing forward the submission of integrated three year plans for 2020-23 to December 2019. This will provide even greater continuity for budgeting, service planning and continuous delivery for patients in Wales.