With so much of the focus on the NHS being given to waiting times, it was easy to miss the Welsh Government’s update on the NHS Executive for Wales.
This may seem like a bureaucratic distraction from more important issues, but establishing an NHS Executive has long been seen as an essential reform to the governance of the health and social care system in Wales.
As far back as 2016, the OECD called for Welsh Government to consider ‘a stronger central guiding hand’ to drive meaningful improvement in the health and care system.
Two years later, the Parliamentary Review echoed this, and went further in describing what was needed to achieve ‘meaningful progress’:
“a wider and more creative combination of national support; incentives; benchmarking (both nationally and internationally); regulation; accountability and transparency”
The Review argued for an NHS Wales national executive function with the capacity to develop and deliver this new approach, seen as essential to achieving the necessary change across the system.
And as our efforts to map the accountability and funding arrangements show, there is certainly scope to simplify the current arrangements.
So, what do we now know about the Welsh Government’s plans?
The Welsh Government’s response to the Parliamentary Review was A Healthier Wales – a long term plan for the transformation of health and social care. In this, the Government agreed with the Review’s recommendation around the need to reform governance of the system, and committed to establishing a new NHS Executive by the end of 2018.
These plans were paused in 2020 as the system responded to the pandemic. But the recent update announced that the new NHS Executive is now being set up, and gave some clues as to the role it will play.
There had been plans to set up a new organisation – a new Special Health Authority – but the Minister announced that instead the Executive will be a “hybrid model” with a “small, strengthened senior team” in Welsh Government, and the bringing together of existing functions from across the NHS.
It seems that this small team in Welsh Government will be working with existing teams – particularly those focused on improvement, performance and planning at the national level – with some of them moving into the Executive and some staying put, but being directed by the team in Welsh Government.
What does this mean for the transformation agenda? And will this satisfy the long-standing need for governance reform? Much will depend on the details, which are yet to be finalised. But, at first contact, the “hybrid model” does nothing to simplify the system. And it has disappointed those who hoped for a greater degree of separation between policy and strategic oversight and management.
What is being proposed still has the potential to (re)design and operate a coherent system of oversight, challenge and support that drives change at pace and scale. But it remains to be seen whether the new Executive will have the capacity and standing within the system to be able to grapple with the complexities and politics of trying to achieve this.