Jeremy Miles MS, Cabinet Secretary for Health and Social Care
In October, I made an oral statement about the work I have put in place to deliver our ambition for a more accountable, open and transparent NHS. This statement provides an important update about how we are making the health service more accountable to the public it serves and making meaningful and transparent data about services more available and accessible.
I recently concluded the first round of public accountability meetings with all NHS organisations. Each of these were live streamed, enabling people to watch – for the first time – the Welsh Government hold health boards, NHS trusts and special health authorities to account about their plans, finances, services, performance, quality and safety. The recordings of these meetings, together with the post-meeting letters, are available online. We will be publishing the evidence packs supplied by each organisation this week.
Over the course of the last 12 months, more data has been made available about NHS performance than ever before. The new Emergency Ambulance Performance Framework means there is more meaningful data about how the ambulance service is performing and about patient outcomes. The introduction of the framework has moved the Welsh Ambulance Service beyond a single response‑time measurement to a more transparent picture of the entire patient journey, from call handling to clinical outcomes.
Publishing this broader set of measures allows people to see how the ambulance service – and their partners – are delivering care where, and when, it matters most. For example, publishing data about return of spontaneous circulation rates enables clinicians and the ambulance service to focus on improving people’s outcomes after a cardiac arrest because it turns cardiac arrest care from a hidden clinical process into a measurable, learnable system, focused on the chain of survival and the role of wider society in its delivery.
The Ministerial Advisory Group (MAG) on NHS Performance and Productivity, which carried out a thorough review of the health service in Wales, reflected that the accountability environment in Wales is complex, data‑heavy, burdensome for NHS organisations lacks transparency and does not drive improvement.
I am grateful for the group’s insight and support. I have taken action to rectify this. From April, the operating and accountability framework for NHS Wales will be simplified, aligning the system to the MAG’s recommendations about productivity and performance to strengthen accountability. The NHS will move to a streamlined, risk-based oversight approach with stronger clinical leadership and clearer consequences for non-delivery. This will simplify the system and sharpen lines of accountability, while improving the way Welsh Government holds the NHS in Wales to account. It strengthens Ministerial oversight, focuses on outcomes rather than processes, and supports a culture of early intervention and improvement.
These arrangements will be implemented during the first quarter of 2026/27. They will reduce the number of direct interfaces between Welsh Government and NHS organisations with NHS Performance and Improvement providing an operational assurance interface. There will be a single, governed dataset and narrative shared for assurance and performance reporting. The frequency of meetings with Welsh Government will be dependent on an organisations level of escalation meaning there will be earned autonomy for those in lower levels of escalation.
As an initial step towards improving accountability, all health board escalation frameworks are now available on the Welsh Government website. These set out the expected actions for improvement and de-escalation criteria for each health board in escalation. The automatic de-escalation was triggered for Cwm Taf Morgannwg and Hywel Dda university health boards in February when they met the cancer performance delivery requirements, which were set out in their respective frameworks.
Finally, I set out in a written statement last month, the action we are taking to improve NHS productivity. This also responds to a recommendation made by the Ministerial Advisory Group on NHS Performance and Productivity to develop a holistic measure of system productivity.
We are committed to strengthening transparency and accountability in the NHS and will continue to act on all opportunities to use data and information to improve and transform services for the public.