Mark Drakeford, Minister for Health and Social Services
The NHS Finance (Wales) Act 2014 and associated NHS Wales Planning Framework signalled a new medium-term approach to planning, requiring health boards and NHS trusts to set out how resources will be used over a three year period to:
- address areas of population health need and improve health outcomes
- improve the quality of care, and
- ensure best value from resources.
The Act and framework also contained a provision requiring my scrutiny and approval of plans, allowing, where necessary resource allocation adjustments between financial years as a key enabler to transformational change over a rolling three-year period.
During the passage of the NHS Finances (Wales) Bill, the Auditor General for Wales, in his submission to the Finance Committee, commended the Welsh Government’s intention to create a requirement for health boards and NHS trusts to develop, scrutinise and approve Integrated Medium Term Plans, including balanced medium-term financial plans and thereby to introduce a degree of managed flexibility.
The Auditor General also recognised the vital role the Welsh Government’s approval of plans should play in ensuring that appropriate rigour and challenge is built into the planning process.
Health boards and NHS trusts have been developing their Integrated Medium Term Plans since autumn 2013 and, in line with the framework, submitted board-considered draft plans to the Welsh Government for consideration on January 31 and final plans on March 31.
Throughout the passage of the NHS Finance (Wales) Act 2014, I reassured Assembly Members on several occasions that plans would only be approved by the Welsh Government following board-level robust scrutiny and approval of health board and NHS trust plans, and when they met the requirements of the NHS Wales planning framework.
I was also clear that the Welsh Government’s approval of plans in no way abdicates health board and NHS trust board accountability for the delivery of services or prejudices the outcome of any due processes required to implement the plan. For example, any service changes should be carried out in line with the Guidance on Engagement and Consultation and would be subject to normal business case approval processes.
Following a robust scrutiny process, which has been quality assured by external, independent assessors and recognised by the Auditor General for Wales, I am able to confirm I have approved the following Integrated Medium Term Plans – Cwm Taf University Health Board; Cardiff and Vale University Health Board and Velindre NHS Trust.
Two further health boards – Aneurin Bevan University Health Board and Abertawe Bro Morgannwg University Health Board – have submitted Integrated Medium Term Plans that have been agreed in principle by their boards, with final agreement expected during May. This provides good evidence of the level of scrutiny and challenge individual boards have been applying to plans. I have agreed to the re-submission of both plans by May 30 and, following further Welsh Government scrutiny, I will make a further statement when I approve these.
The chief executive of NHS Wales will write to Abertawe Bro Morgannwg and Aneurin Bevan health boards, clarifying key deliverables and performance expectations for the intervening period.
Public Health Wales (PHW) has similarly submitted a medium-term plan, which has been agreed in principle by its board. However, it is important the new chief executive, who is due to take up post on June 2, has time to contribute to it. In addition, the interdependency of services provided by PHW to other organisations and the dependency on action by health boards for delivery of some of PHW’s services means that aspects of the plan cannot be fully finalised until all other health board and NHS trust plans have been further developed.
The remaining health boards and NHS trusts have concluded, for good reasons, that they are unable to submit robust Integrated Medium Term Plans at this point.
Betsi Cadwaladr University Health Board, Powys Teaching Health Board, and Hywel Dda University Health Board wish to respond meaningfully to the conclusions of the Mid Wales Study before committing to a medium-term plan and are keen to allow sufficient time for recent or imminent changes to key board personnel to take hold.
The Welsh Ambulance Services NHS Trust is advancing a number of the key reforms arising from the McClelland review, including the full establishment of the new commissioning arrangements, which will be vital to reviewing, inputting and approving a plan on a medium-term basis. The new legal framework governing the relationship between health boards and the ambulance trust and the newly-appointed board, only came into being on April 1, 2014.
For these reasons I have asked each of these organisations to finalise and sign off a one-year plan before May 30. The Welsh Government will work closely with each of these organisations to agree key milestones for the ongoing development of their medium-term plan over the course of this financial year.
Taken together, these decisions demonstrate the necessary rigour in putting into place the arrangements set out in the NHS Wales Planning Framework and the NHS Finance (Wales) Act 2014. Progress has been made as three-year planning arrangements mature within NHS organisations.
Managed financial flexibility has been afforded, at this point, to those health boards and NHS trust able to demonstrate a sufficiently-integrated and prioritised three-year plan, drawing together service, workforce and financial considerations.