Welsh Government sets out new support for struggling NHS bodies

Mark Mansfield

Health boards and NHS trusts in Wales will receive earlier help to tackle problems and face clear targets for improvement under changes to how they are monitored.

The Welsh Government’s NHS Wales Accountability and Support Framework sets out when organisations should receive outside help, when stronger action is needed and what they must achieve before oversight is reduced.

It replaces the previous Oversight and Escalation Framework, following a commitment in the government’s first 100-day plan to review how it deals with struggling NHS organisations.

The five-level system remains, ranging from routine monitoring to intensive intervention. Each stage will have a defined package of support, matched to the scale of the problems, with targets, deadlines and regular reviews.

Organisations will be assessed on leadership, quality of care, staffing, finance and planning, and service performance. This is intended to identify links between problems, rather than treating each in isolation.

Health and Care Minister Mabon ap Gwynfor said: “This new approach marks an important step forward for NHS Wales. Accountability and support go hand in hand. We will continue to hold organisations to account for delivering safe, high-quality services, but we will also make sure they have the right help in place when they need it.”

The framework applies to health boards, trusts and special health authorities. Action can cover an entire organisation or focus on particular areas of concern.

At level two, organisations would receive additional monitoring and help where emerging problems cannot be resolved through their normal arrangements.

This could include expert advice, mentoring, focused reviews or assistance with staffing, finances and patient care.

Level three requires a formal recovery plan and closer scrutiny where concerns are significant or earlier support has not produced enough progress.

At levels four and five, a specialist Intensive Support, Recovery and Turnaround team would investigate the causes of problems and help staff and managers put improvements into practice.

The highest level can involve ministers using their existing legal powers. The framework does not create new powers or remove NHS boards’ responsibility for running their organisations.

Serious or urgent concerns could trigger immediate intervention at any level, without an organisation having to pass through each stage first.

Reasons for stronger action include risks of avoidable harm, repeated missed targets, poor leadership and financial problems putting services at risk.

NHS Wales Performance and Improvement will organise support and bring together evidence on how organisations are performing. Audit Wales and Healthcare Inspectorate Wales will contribute their findings while remaining independent.

Progress

Organisations that fail to make sufficient progress could face stronger action. Those seeking reduced oversight must show that risks have fallen and improvements have lasted.

Completing an action plan alone will not be enough. Boards and chief executives must provide evidence that they can maintain progress without the same level of outside help.

Oversight will normally be reduced one level at a time. Where organisations have met pre-agreed targets and maintained that progress for the required period, they may move down a level without waiting for the next scheduled review.

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