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Agreed Special Measures Framework

Eight domains

  • Governance, board effectiveness and audit.
  • Workforce and organisational development. 
  • Financial governance and management.
  • Compassionate leadership and culture.
  • Clinical governance, patient experience and safety.
  • Operational delivery.
  • Planning and service transformation.
  • Clinically vulnerable services.

Conditions for sustainability

  • Clear strategic vision.
  • Cultural change journey.
  • Effective board.
  • Strong leadership and engagement.
  • Clinical leadership.
  • Strengthened clinical services.
  • Integrated performance and quality.
  • Accountability.
  • Responsive.
  • Learning and improving organisation.
  • Strong programme management.
  • Improved access, outcomes and experience.

Investigation into culture, quality, safety and performance

  • Focus on understanding core issues across the organisation.
  • Six Regulation 28 reports.
  • One Schedule 5.
  • Health and Safety Executive prosecution confirmed.
  • Grievances/disciplinaries.
  • Performance overview.

Work underway

  • Support for the Office of the Board Secretary in place.
  • Rapid review: Office of the Board Secretary.
  • Review of interim appointments.
  • Scoping of patient safety issues.
  • Review of mental health reviews. 
  • Mental health inpatient safety impact assessment.
  • Orthopaedics sustainability.
  • Elimination of 4-hour handover wait.
  • Vascular assurance assessment.

Workforce and organisational development

  • Establishment review commenced.
  • A scoping programme to assess the effectiveness and implementation of the new operating model is underway.
  • Workshops with local medical council and local staff-side partnerships are being arranged. 
  • A review of wellbeing, engagement and workforce policies is underway.
  • Review of interims appointments commenced.

Clinical governance, patient experience and safety

  • Clinical governance review scope is being agreed.
  • Interim assessment in relation to concerns around patient safety underway. 
  • His Majesty's Coroner and Public Safety Ombudsman Wales rapid reviews.
  • Learning and reporting programme structure in place.

Stabilise the Board

  • Six independent members in post.
  • Four committees have taken place.
  • Two board meetings and two workshops taken place.
  • Five independent advisers in place.
  • Discussions underway regarding a further three independent advisors.
  • Support for operational grip embedded in the health board.
  • Interim CEO in place and recruitment for a new CEO commenced.
  • Changes made to the Office of the Board Secretary.
  • Rapid review of Office of the Board Secretary structure and remit underway.

Operational delivery

  • Welsh Government has commissioned direct support.
  • Focus on elimination of 4-hour handover and orthopaedic delivery. 
  • Workshops held on orthopaedics and regional treatment centres.
  • Urgent and emergency care summit.

Clinical services

  • Mental health inpatient safety assessment took place in April.
  • A review of previous mental health reviews started.
  • Oversight on vascular services and assurance assessment taking place.
  • Harm review on those waiting for plastic (dermatology).
  • A clinical leadership conference of senior medical leaders held in April.

Compassionate leadership and culture

  • Preliminary review of cultural leadership led by Health Education and Improvement Wales.

Financial governance and management

  • Detailed deep dive into the reasons for the forecast financial deficit. 
  • Options for efficiencies noted. 
  • Value based approach in development.
  • Financial controls and governance.

Planning and service transformation

  • Draft annual plan. 
  • Areas of opportunity highlighted. 
  • Revised plan to be submitted at the end of June is in development. 
  • A Board workshop held to understand the challenges and options.
  • Planning and financial delegations in development.