Health boards face increased scrutiny over planning, finances and emergency care

Chris Haines, ICNN Senedd reporter

Three of Wales’ health boards face increased Welsh Government scrutiny amid concerns about planning, finances and emergency care.

Eluned Morgan, Wales’ health minister, told the Senedd she has escalated intervention at Aneurin Bevan, Hywel Dda and Swansea Bay University Health Boards (UHBs).

She announced new oversight guidance which has five tiers: routine arrangements; area of concern; enhanced monitoring; targeted intervention; and special measures, the highest.

Baroness Morgan warned that all health organisations are facing very real financial challenges, with their budgets worth less today due to inflation.

She stressed that health boards must meet financial targets to help balance the overall Welsh budget, saying: “That’s why we do have to keep breathing down their necks.”

Aneurin Bevan

Baroness Morgan told the chamber that Aneurin Bevan UHB has made insufficient progress on tackling its growing financial deficit.

She said the Gwent health board will be placed into targeted intervention – the second highest tier of escalation – for finance and planning.

The minister raised concerns about the A&E department at The Grange University Hospital, saying enhanced monitoring will be introduced for emergency care.

She announced an additional £14m to extend and reconfigure parts of the £350m hospital which opened its doors in 2020.

Baroness Morgan said: “It’s my expectation that this considerable investment will result in improved patient safety, comfort and privacy.

“I’m expecting the organisation to respond to ensure further improvements are made.”

Russell George, the Conservatives’ shadow minister, raised concerns that a hospital built only four years ago requires a £14m expansion.

Baroness Morgan pointed to soaring demand, saying: “Nobody would have foreseen that.”

Hefin David said while it is naturally concerning that any health board requires targeted intervention, it is as a result of huge UK-wide financial pressures on the NHS.

The Labour MS for Caerphilly stressed that the Welsh Government has protected the NHS budget as he welcomed the extra £14m to resolve A&E issues at The Grange.

“I will be contacting the health board for more information on how this will be used to help alleviate the problems,” said Dr David.

Hywel Dda

Baroness Morgan said Hywel Dda UHB is facing similar finance and planning issues which are now impacting on its performance.

She told MSs: “The health board needs to take some difficult decisions relating to its clinical services strategy and plan to support sustainable improvements.”

She said the entire mid and West Wales health board will be placed in targeted intervention.

Mr George, who represents Montgomeryshire, questioned whether the cuts ministers are urging Hywel Dda to make to its deficit are too extreme.

Baroness Morgan fired back at the Conservative: “For you to ask whether the cuts are too drastic, well I think you should go and ask your own government that.”

In light of the extra £14m for The Grange hospital near Cwmbran, Mabon ap Gwynfor, Plaid Cymru’s shadow minister, called for further funding to support other health boards.

Mr Gwynfor argued decisions around escalation and intervention arrangements should rest with an independent expert body, rather than politicians.

Baroness Morgan said that’s what happens in England and there is no accountability.

Swansea Bay

Baroness Morgan also highlighted a lack of progress on planned and unscheduled care at Swansea Bay University Health Board.

Raising concerns about unacceptable ambulance handover delays and long waiting times, she said: “I have decided to escalate performance and outcomes to targeted intervention.

“But the health board will remain in enhanced monitoring for planning and finance.”

Before Christmas, the health minister escalated Swansea Bay’s maternity and neonatal services in enhanced monitoring after failings uncovered by ITV Wales.

Sioned Williams, the Plaid Cymru MS for South Wales West, questioned whether the Welsh Government’s monitoring framework is fit for purpose

She pointed out that Swansea Bay was in enhanced monitoring in 2016 but government intervention was insufficient to prevent serious failings in maternity services in 2020.

Ms Williams said: “When intervention levels are having to creep higher and higher, it really begs the question of how much control the Labour Welsh Government has over the NHS.”

Mr George urged ministers to rethink a proposed real-terms cut for Healthcare Inspectorate Wales, which recently issued a report on maternity services at Singleton Hospital.

‘No change’

Baroness Morgan did not make any changes to the escalation level of Wales’ other four health boards, with Betsi Cadwaladr UHB staying in special measures.

In September, all health boards were placed in enhanced monitoring for planning and finance after failing to balance their books.

Racking up a combined deficit of £150m in 2022-23, six of Wales’ seven boards breached their statutory duty to break even over a three-year period.

Cardiff and Vale, Powys and Cwm Taf Morgannwg remain in enhanced monitoring for planning and finance, with the latter also in targeted intervention for performance.

In closing a statement to the Senedd on Tuesday January 23, Baroness Morgan said: “These decisions have not been taken lightly.

“They’re the best way to support these NHS organisations and they will improve the quality of service and care people receive in Wales from the health service in their local area; and, ultimately, improve patients’ clinical outcomes.”