Written Statement: Escalation and Intervention Arrangements – Cwm Taf University Health Board

Under the joint Escalation and Intervention Arrangements, the Welsh Government meets with the Wales Audit Office (WAO) and Healthcare Inspectorate Wales (HIW) twice a year to discuss the overall position of each health board and NHS trust.  A wide range of information and intelligence is considered to help identify any issues of particular concern in relation to quality or performance.

Under the terms of the Escalation Arrangements, a meeting can be called outside the usual meeting cycle if there are particular concerns about an NHS organisation.  Following the recent actions in respect of Cwm Taf University Health Board maternity services, a tripartite meeting took place in December 2018 to consider wider service issues.

Whilst acknowledging the health board has a good track record in terms of financial management and approved IMTPs, it was agreed the health board should have its escalation status raised from ‘routine arrangements’ to ‘enhanced monitoring’ to recognise a number of areas of concern relating to quality governance arrangements, including:

• Concerns about maternity services which have led to my recent statement and a joint review by the Royal College of Obstetricians and Gynaecologists and Royal College of Midwifery which will report in spring 2019;
• Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) compliance, with the health board being non-compliant with the Health and Safety at Work Act requirements following a recent HIW inspection;
• the need to ensure actions are in place to respond to a recent Human Tissue Authority inspection report;
• concerns in respect of quality governance arrangements;
• the quality of serious incident reporting requiring an external review of process to be commissioned to improve the local mechanisms;
• Concerns have been raised around the health board’s response to actions contained within HIW inspection reports, finding that some actions have not been completed on follow-up visits;
• Compliance with the Nurse Staffing Act and awaiting formal confirmation of compliance from the Board.

As the health board has a recently-appointed Chair and a number of new Independent Members, the group considered that some external support on quality governance expectations should be provided for the Chair and Independent Members.

I will be expecting immediate action to be taken on the areas of concern and for improvements to be evident within the next few months.  The organisation has every opportunity to respond appropriately and to return to normal monitoring arrangements quickly, given its approved plan status and a record of delivery on a range of measures and developments.  The increased escalation is intended to focus the health board on appropriate actions and to get back on track in respect of these concerns.  

The health board’s escalation status will be kept under review through the tripartite arrangements and I will keep members informed of progress.