Cynulliad Cenedlaethol Cymru

In November 2022, Cwm Taf Morgannwg University Health Board was escalated to Targeted Intervention for quality issues relating to performance associated with long waiting times following concerns about urgent and emergency care, including ambulance handovers, planned care, cancer and performance against part 1a of the child and adolescent mental health services (CAMHS) measure. Maternity and neonatal services, quality and governance, leadership and culture, trust and confidence were also escalated to targeted intervention with planning and finance at enhanced monitoring.

After an analysis of performance across all areas had been undertaken, we worked with the developing bodies within the emerging NHS Wales Executive (it was formed in April 2023) to provide peer support and to undertake a number of supportive interventions with the health board. This included the Planned Care Improvement and Recovery Team, the Six Goals for Urgent and Emergency Care team, the NHS Delivery Unit and the Wales Cancer Network.

The Delivery Unit, which is now part of the NHS Wales Executive, has worked with the health board for four years in areas such as maternity and neonatal services. Earlier this month I announced the de-escalation of the service from targeted intervention to enhanced monitoring.

The NHS Wales Executive undertook an assurance review of the service that indicated that there is now a clear ambition and strategy for one perinatal service, with strong cohesive senior multidisciplinary leadership providing integrated governance that underpins the delivery of maternity and neonatal services. Other improvements were recognised at the health board including quality and governance.

The Six Goals for Urgent and Emergency care team has worked closely with the health board since the targeted intervention framework was agreed last year. During this period the percentage of ambulance handovers of more than one hour has reduced by 37% since October 2022, with 314 fewer ambulance handovers over an hour in August 2023 compared to March 2023.

The NHS Wales Executive has:

• Undertaken a peer review and conducted a series of follow-up supportive and improvement meetings to assess out-of-hours and urgent primary care centres in the health board.
• Undertaken joint visits to the three emergency department sites with Delivery Unit colleagues as part of an assessment/assurance on emergency care delivery.
• Identified risks within the service and shared findings with the health board.

The Delivery Unit has supported the health board with mental health and CAMHS performance.

CAMHS Part 1a performance has increased to 88.4% in July 2023 from 31.3% in November 2022. Part 1b performance is at 41.2%, up from 23.4% and Part 2 is up to 88.2% from 34.6% for the same period.

As part of the mental health intervention, the NHS Executive has:

• Held monthly meetings with the health board to understand constraints and offer advice and support, where required.  
• Agreed trajectories with the health board, holding it to account and ensuring plans are in place to achieve them.  
• Scheduled demand and capacity training for health board staff.
• Undertaken site visits when necessary and provided constructive feedback.
• Scheduled national review work that will identify local recommendations and key messages for the health board to take forward.

The Planned Care Improvement and Recovery team and the Wales Cancer Network are working closely with the health board to improve cancer performance. The NHS Wales Executive has:

• Undertaken an opportunities assessment of the cancer pathways of most concern – lower GI, urology and gynaecology.
• Worked with the health board on endoscopy.
• Funded and enabled improved business intelligent tools to enable planning and response from operational teams.
• Supported the planning and assessment of the Cancer Improvement Plan.
• Held the health board to account for planned improvement trajectories.

The Planned Care Improvement and Recovery Team and the NHS Delivery Unit have assisted the health board with planned care performance which has led to improvements including a 34% reduction between March and June for people waiting more than 104 weeks.

The NHS Wales Executive has:

• Undertaken a planned care recovery assessment with the health board.
• Undertaken site visits where necessary and worked with operational teams.
• Completed a critical review of internal planned care governance to monitor performance progress.
• Held monthly reviews to focus on the progress of the health board against the planned care recovery assessment.
• Worked with the Getting it Right First Time and the health board to identify areas of improvement, including the theatre programme.
• Held the health board to account with trajectories and ensuring plans are in place to achieve them.  
• Met weekly with operational leads at the health board to offer support and challenge.
• Assisted with the pre-assessment process for patients.
• Secured sessions from an experienced GP to drive at pace pathway redesign.

There are a number of interventions underway, which will support more improvements but long-term changes and progress will take time.