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The Welsh Government must tackle the toxic culture of unaccountability in our mismanaged NHS

03 Jul 2019 5 minute read


Image by skeeze from Pixabay

Helen Mary Jones AM, Plaid Cymru Shadow Health Minister

Our Welsh NHS has a problem. It is being mismanaged.

Welsh NHS managers face no accountability and staff are afraid to raise concerns in fear of being silenced or dismissed.

In April, maternity services at Cwm Taf Health Board were placed into special measures after an external review identified “serious failings” with “little evidence of effective clinical leadership at any level” and patient concerns not taken seriously.

In June 2015, Betsi Cadwaladr University Health Board was placed in special measures after serious concerns about the health board’s governance, care, and finances, shortly before the Tawel Fan scandal exposed wide-spread abuse at the dementia ward at Glan Clwyd Hospital. The board is still in special measures to this day.

In 2014, another major scandal of patient abuse was revealed at Abertawe Bro Morgannwg University Health Board, where standards of care on some wards in both the Princess of Wales Hospital and Neath Port Talbot hospital were appalling.

For Cwm Taf, the chief executive, who has held her role since 2011, has been allowed to remain in post. As far as we know and as far as the families know, no-one has been disciplined for allowing the situation to develop and continue.

No-one there has been held to account for the trauma to the mothers and the deaths of 26 children.


In Betsi Cadwaladr, the Health Minister placed the service into special measures, sent a board in to provide advice and spoke about the need to change the culture. But he left in place all those senior individuals who presided over the development of this disastrous culture.

Donna Ockenden, who conducted the original critical report into the Tawel Fan scandal, said in correspondence with the Health Minister that her “concern is that the BCUHB board and senior management team within mental health at BCUHB do not currently have the capability and capacity to deliver upon the root and branch systemic review that is needed”.

All three major Welsh NHS scandals in recent years that have resulted in serious harm to patients have been characterised by stories of overworked and under-appreciated front line staff, management cultures where bad news is suppressed and managing the reputation of the organisation takes priority over improving it, and where complaints and concerns of patients and their families have been dismissed and ignored.

The bottom line is that there is consistent and systematic management failures across the Welsh NHS where senior managers have not been held to account.

While front-line staff can be held accountable and dismissed by the professional bodies they are members of if they fail to deliver the quality of service and the safety of service that their patients have a right to expect, managers appear to be able to move from one part of the service to another with impunity, with no sanction, regardless of how poorly they have performed.

This must change.


That’s why today I’m proposing a new law that would look to hold Wales’ NHS managers to account in order to prevent the pain and grief of scandals like Cwm Taf, Tawel Fan and Princess of Wales Hospital from ever happening again.

That’s why it is time for a core set of competencies for people who are managing our NHS and a system of registering those senior staff so they cannot fail in one local health board and pop up in another – a convention that is simply too prevalent within our health service.

Similarly, professional staff—doctors, nurses, midwives—have to be registered, and given a set of competencies so we know that they’re professionally competent. There is no such requirement for managers.

My law would establish a new body for NHS managers with the ability to hold managers to account, impose sanctions against them for poor performance, with the ability to strike off managers for serious breaches of standards or misconduct. Our NHS needs managers and leaders who can be relied on.

Alongside a values-based training for all staff, a legal duty of candour should apply to all health professionals – including managers, to empower whistle-blowers. If staff have a legal duty they can say to their manager, ‘I have to report what I have seen, because I have a legal duty of candour’.

The Welsh Government’s proposed duty of candour only applies to organisations, not professionals, and lacks protection for staff who raise concerns about services. This would go hand in hand with a genuine, robust and transparent complaints system that supports parents and families.

We also need to ensure true independence of Healthcare Inspectorate Wales and an independent body for collecting and publishing statistics on performance, one that has the power to require health boards to provide data.

Our NHS has been terribly mismanaged for far too long and the toxic culture of unaccountability has caused endless grief. No more. We know there are good people working incredibly hard on the front line to provide the best service they can in circumstances that are very difficult but that they have been let down by terrible systematic failures.

Plaid Cymru will develop and deliver an NHS that will serve the needs of our citizens not the bank balances of senior managers.

The people of Wales deserve no less.

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