Translate the text from English to Welsh.



 
Under the Joint Escalation and Intervention Arrangements, Welsh Government officials meet with Audit Wales and Healthcare Inspectorate Wales twice a year to discuss the overall position of each health board and NHS trust in respect of quality, service performance and financial management.  A wide range of information and intelligence is considered to identify any issues and inform the assessment.


It was agreed that the escalation status of each NHS organisation would be published.


The framework has four escalation levels:


* Routine arrangements
* Enhanced monitoring
* Targeted intervention
* Special measures.


Due to the current pandemic, the latest meeting took place virtually in September 2020 and the tripartite group was complimentary of the way the NHS in Wales had responded to dealing with the pandemic.  They also considered that prior to the pandemic, progress had been demonstrated since the last meeting in December 2019 in those organisations in raised levels of escalation:


* Hywel Dda UHB had made progress in key performance areas with the organisation making progress against its year end targets and was on track to deliver against the RTT target.  However, there was still concern around the financial position within the organisation, but it was recognised that the health board had reacted positively to the KPMG review.  Future financial plans would be dependent on delivering the clinical strategy that had been developed.  In view of the improvements in service, and noting that in practice monitoring had reduced, it was agreed that the organisation should be de\-escalated to ‘enhanced monitoring’.


 


* The group was complimentary of the way in which Swansea Bay UHB had dealt with the current pandemic.  It had also demonstrated that it had a clearer understanding of its finances and the required actions.  There has been a clearer approach to performance and an improvement in some of the measures under consideration, including cancer and infections; however, there remain concerns that unscheduled care and waiting times need to see sustained improvement in performance. In view of the improvements in approach and response, it was agreed that the organisation should be de\-escalated to ‘enhanced monitoring’.


 


The group acknowledged the positive way in which Betsi Cadwaladr UHB had responded to the pandemic over recent months, recognising that the trend had affected North Wales on a more sustained basis to the rest of Wales.  It reviewed evidence submitted by the health board that demonstrated progress over recent years including on the areas which had originally been designated as special measures.  However, there remained concerns on performance and strategic solutions that may require specific external support.  Specifically, the group wanted some further assurance from the health board in respect of progress in mental health services.  The group felt it was important for the health board to promote the good work it was doing and to focus on its actions, rather than be distracted by the status label.  At this stage, there was no recommendation for a change to escalation status.  To allow for the opportunity for further progress to be considered, the group proposed to have an additional tripartite meeting specifically on Betsi Cadwaladr UHB before the end of the year.


With regards to Cwm Taf Morgannwg, the group noted that the health board was continuing to respond effectively and openly to the external review bodies and the Independent Maternity Panel, including over recent months.  The group noted that any progress had to be considered in the context of the priority of the pandemic response.  Whilst the latest Maternity Oversight Panel had been undertaken virtually, the Panel had acknowledged progress in maternity services since the last review.  The group noted the improved partnership and stakeholder engagement, particularly with the Local Authority partners and the constructive way in which the status of the emergency department at the Royal Glamorgan had been concluded.  Despite this, it remains important for the health board to continue to rebuild the trust and confidence of the local population, as well as with stakeholders.  At this stage there was no recommendation for a change to escalation status.


The table below shows the previous and current escalation status of each organisation.




| **Organisation** | **Previous Status (Dec 19\)** | **Current Status (Sept 20\)** |
| --- | --- | --- |
| Aneurin Bevan UHB | Routine arrangements | Routine arrangements |
| Betsi Cadwaladr UHB | Special Measures | Special measures |
| Cardiff and Vale UHB | Routine arrangements | Routine arrangements |
| Cwm Taf Morgannwg UHB\* | Special measures for maternity, targeted intervention for quality and governance | Special measures for maternity, targeted intervention for quality and governance |
| Health Education and Improvement Wales | Routine arrangements | Routine arrangements |
| Hywel Dda UHB | Targeted intervention | Enhanced monitoring |
| Powys tHB | Routine arrangements | Routine arrangements |
| Public Health Wales NHS Trust | Routine arrangements | Routine arrangements |
| Swansea Bay UHB | Targeted intervention | Enhanced monitoring |
| Velindre NHS Trust | Routine arrangements | Routine arrangements |
| Welsh Ambulance Services NHS Trust | Routine arrangements | Routine arrangements |


\* The previous Cwm Taf UHB was escalated to ‘enhanced monitoring’ at a meeting at the beginning of January 2019\.  At a meeting in April 2019, it was agreed to raise the escalation status of Cwm Taf Morgannwg to ‘Special measures’ for maternity services following the publication of the Royal College report and to ‘targeted intervention’ for governance and quality.


Following a boundary change in March 2019, Abertawe Bro Morgannwg and Cwm Taf UHBs became Swansea Bay and Cwm Taf Morgannwg UHBs.


 







Translation:


 
O dan y Cyd\-drefniadau Uwchgyfeirio ac Ymyrryd, mae swyddogion Llywodraeth Cymru'n cyfarfod â Swyddfa Archwilio Cymru ac Arolygiaeth Gofal Iechyd Cymru ddwywaith y flwyddyn i drafod sefyllfa gyffredinol pob un o fyrddau iechyd ac ymddiriedolaethau’r Gwasanaeth Iechyd Gwladol (GIG) mewn perthynas ag ansawdd, perfformiad gwasanaethau a rheolaeth ariannol.  Mae amrywiaeth eang o wybodaeth yn cael ei hystyried er mwyn nodi unrhyw faterion a helpu i lywio'r asesiad.


Cytunwyd y byddai statws uwchgyfeirio pob sefydliad GIG yn cael ei gyhoeddi.


Mae pedair lefel uwchgyfeirio yn y fframwaith:


* Trefniadau arferol
* Monitro uwch
* Ymyrraeth wedi'i thargedu
* Mesurau arbennig.


Oherwydd y pandemig presennol, cynhaliwyd y cyfarfod diweddaraf yn rhithiol ym Medi 2020 ac fe ganmolodd y grŵp teirochrog y ffordd yr oedd GIG Cymru wedi delio â'r pandemig. Roeddent o'r farn hefyd fod cynnydd wedi'i ddangos, cyn y pandemig ers y cyfarfod diwethaf ym mis Rhagfyr 2019 yn y sefydliadau hynny sydd mewn lefelau uwchgyfeirio uwch:


* Roedd Bwrdd Iechyd Prifysgol Hywel Dda wedi gwneud cynnydd mewn meysydd perfformiad allweddol gyda'r sefydliad yn gwneud cynnydd yn erbyn ei dargedau diwedd blwyddyn ei hun ac roedd ar y trywydd iawn i gyflawni yn erbyn targed RTT.  Er hynny, roedd pryder o hyd am y sefyllfa ariannol yn y sefydliad, ond cydnabuwyd bod y bwrdd iechyd wedi ymateb yn gadarnhaol i adolygiad KPMG.  Byddai cynlluniau ariannol yn y dyfodol yn dibynnu ar gyflawni'r strategaeth glinigol a oedd wedi'i datblygu. Yn wyneb y gwelliannau mewn gwasanaeth a chan nodi bod monitro wedi cael ei leihau yn ymarferol, cytunwyd y dylid is\-gyfeirio'r sefydliad i ‘monitro uwch’.


 


* Canmolodd y grŵp y ffordd yr oedd Bwrdd Iechyd Prifysgol Bae Abertawe wedi delio â'r pandemig presennol. Roedd hefyd wedi dangos bod ganddo ddealltwriaeth gliriach o'i gyllid a'r camau gweithredu a oedd yn angenrheidiol.  Cafwyd dull gweithredu cliriach o ran perfformiad a gwella mewn rhai o'r mesurau sy'n cael eu hystyried, gan gynnwys canser a heintiau; Er hynny, mae pryderon o hyd bod angen gwelliannau cyson mewn gofal heb ei drefnu ac amseroedd aros. Yn wyneb y gwelliannau mewn dull gweithredu ac ymateb, cytunwyd y dylid is\-gyfeirio'r sefydliad i ‘monitro uwch’.


 


Cydnabu'r grŵp y ffordd gadarnhaol yr oedd Bwrdd Iechyd Prifysgol Betsi Cadwaladr wedi ymateb i'r pandemig dros y misoedd diwethaf, gan gydnabod bod y duedd wedi effeithio ar y Gogledd yn fwy cyson o'i gymharu â gweddill Cymru.  Adolygodd dystiolaeth a gyflwynwyd gan y bwrdd iechyd a ddangosodd gynnydd dros y blynyddoedd diwethaf gan gynnwys y meysydd a oedd wedi'u dynodi yn wreiddiol fel rhai a oedd mewn mesurau arbennig.  Er hynny, roedd pryderon o hyd am berfformiad a datrysiadau strategol a allai ofyn am gymorth allanol penodol.  Yn benodol, roedd y grŵp am gael sicrwydd pellach gan y bwrdd iechyd mewn perthynas â chynnydd mewn gwasanaethau iechyd Meddwl. Teimlai'r grŵp ei bod yn bwysig i'r bwrdd iechyd hybu'r gwaith da yr oedd yn ei wneud a chanolbwyntio ar ei gamau gweithredu ei hun, yn hytrach na meddwl am y label statws.  Ar hyn o bryd, nid oedd unrhyw argymhelliad ar gyfer newid i'r statws uwchgyfeirio. Er mwyn caniatáu i'r cyfle am gynnydd pellach gael ei ystyried, cynigiodd y grŵp gael cyfarfod teirochrog yn benodol ar Fwrdd Iechyd Prifysgol Betsi Cadwaladr cyn diwedd y flwyddyn.


O ran Cwm Taf Morgannwg, nododd y grŵp fod y bwrdd yn parhau i ymateb yn effeithiol ac mewn ffordd agored i'r cyrff adolygu allanol a'r Panel Mamolaeth Annibynnol, gan gynnwys dros y misoedd diwethaf. Nododd y grŵp fod angen ystyried unrhyw gynnydd yng nghyd\-destun y flaenoriaeth a roddir i'r ymateb i'r pandemig. Er bod y Panel Trosolwg ar Famolaeth wedi'i gynnal yn rhithiol, roedd y Panel wedi cydnabod cynnydd o ran gwasanaethau mamolaeth ers yr adolygiad diwethaf. Nododd y grŵp yr ymgysylltu gwell rhwng partneriaethau a rhanddeiliad, yn enwedig â'r partneriaid yn yr Awdurdod Lleol a'r ffordd adeiladol yr oedd statws yr adran frys yn Ysbyty Brenhinol Morgannwg wedi'i gwblhau. Serch hynny, mae'n dal yn bwysig i'r bwrdd iechyd barhau i feithrin ymddiriedaeth a hyder y boblogaeth leol, yn ogystal ag â rhanddeiliaid. Ar hyn o bryd, nid oedd unrhyw argymhelliad ar gyfer newid y statws uwchgyfeirio.


Dengys y tabl isod statws uwchgyfeirio blaenorol a phresennol pob sefydliad.




| **Sefydliad** | **Statws Blaenorol (Rhag 19\)** | **Statws Presennol (Medi 20\)** |
| --- | --- | --- |
| Bwrdd Iechyd Prifysgol Aneurin Bevan | Trefniadau arferol | Trefniadau arferol |
| Bwrdd Iechyd Prifysgol Betsi Cadwaladr | Mesurau Arbennig | Mesurau arbennig |
| Bwrdd Iechyd Prifysgol Caerdydd a'r Fro | Trefniadau arferol | Trefniadau arferol |
| Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg\* | Mesurau arbennig ar gyfer mamolaeth, ymyrraeth wedi'i thargedu ar gyfer ansawdd a llywodraethu | Mesurau arbennig ar gyfer mamolaeth, ymyrraeth wedi'i thargedu ar gyfer ansawdd a llywodraethu |
| Addysg a Gwella Iechyd Cymru | Trefniadau arferol | Trefniadau arferol |
| Bwrdd Iechyd Prifysgol Hywel Dda | Ymyrraeth wedi'i thargedu | Monitro uwch |
| Bwrdd Iechyd Addysgu Powys | Trefniadau arferol | Trefniadau arferol |
| Ymddiriedolaeth GIG Iechyd Cyhoeddus Cymru | Trefniadau arferol | Trefniadau arferol |
| Bwrdd Iechyd Prifysgol Bae Abertawe | Ymyrraeth wedi'i thargedu | Monitro uwch |
| Ymddiriedolaeth GIG Felindre | Trefniadau arferol | Trefniadau arferol |
| Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru | Trefniadau arferol | Trefniadau arferol |


\* Cafodd cyn\-Fwrdd Iechyd Prifysgol Cwm Taf ei uwchgyfeirio i statws 'monitro uwch' mewn cyfarfod ar ddechrau mis Ionawr 2019\.  Mewn cyfarfod ym mis Ebrill 2019, cytunwyd y dylid codi statws uwchgyfeirio Cwm Taf Morgannwg i statws 'mesurau arbennig' ar gyfer gwasanaethau mamolaeth yn dilyn cyhoeddi adroddiad y Coleg Brenhinol ac i statws 'ymyrraeth wedi'i thargedu' ar gyfer llywodraethu ac ansawdd.


Yn dilyn y broses o newid y ffin ym mis Mawrth 2019, daeth Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg a Bwrdd Iechyd Prifysgol Cwm Taf yn Fwrdd Iechyd Prifysgol Bae Abertawe a Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg.