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This statement sets out the new escalation levels of NHS trusts, special health authorities (SHAs) and health boards in Wales.


The environment in which health boards, trusts and SHAs operate remains difficult. There are growing financial deficits, operational pressures, long waiting lists, as well as an extremely challenging financial position that is not unique to Wales. 


For the current financial year, health boards were unable to submit financially balanced Integrated Medium\-Term Plans (IMTPs) and were therefore required to submit annual plans.  In doing so, they have not provided plans in accordance with the direction given by the Welsh Ministers and the NHS Planning Framework, which I could consider for approval under section 175(2A) of the NHS (Wales) Act 2006 (“the 2006 Act”).


In line with the Escalation and Intervention Arrangements, this represents a serious concern to service delivery which exceeds that which can be dealt through routine arrangements, and I have therefore accepted the recommendation from officials that those organisations that were not already in escalation for planning and finance will now be escalated to enhanced monitoring. 


I have agreed the escalation status of NHS bodies as follows:


* **Hywel Dda** **University Health Board** to remain at its current escalation status of targeted intervention for planning and finance and enhanced monitoring for performance and quality.
* **Swansea Bay** **University Health Board** to be escalated to enhanced monitoring for planning and finance and to remain in enhanced monitoring for quality and performance.
* **Cardiff and Vale** **University Health Board** to remain in enhanced monitoring for planning and finance.
* **Aneurin Bevan** **University Health Board** to be escalated to enhanced monitoring for planning and finance.
* **Powys Teaching Health Board** to be escalated to enhanced monitoring for planning and finance.
* **Betsi Cadwaladr** **University Health Board** to remain in special measures.
* **Cwm Taf Morgannwg University Health Board** to remain in targeted intervention for quality concerns related to performance and long waiting times and planning and finance to remain in enhanced monitoring. Maternity and neonatal services will be de\-escalated from targeted intervention to enhanced monitoring. Quality and governance, leadership and culture, trust and confidence will be de\-escalated from targeted intervention to enhanced monitoring.
* All NHS **trusts** and **SHAs** to remain at their current escalation level of routine arrangements.


**Cwm Taf Morgannwg University Health Board**


The escalation status of Cwm Taf Morgannwg University Health Board has changed considerably, the reasons for this are set out below.


I announced on 7 November 2022 that maternity services at the health board would be de\-escalated from special measures to targeted intervention, in recognition of the clear progress the health board had made in this area over the previous three\-and\-a\-half years.  I am pleased to note that the health board has continued to make improvements across both maternity and neonatal services.


There has been significant progress in implementing the remaining recommendations from the Independent Maternity Services Oversight Panel (IMSOP) and embedding them into practice. Some of the key achievements include achieving Unicef Stage 3 Baby Friendly Accreditation, being nominated as finalists for the Royal College of Midwifes (RCM) awards, implementation of an integrated maternity dashboard and development of the maternity and neonatal culture and leadership plan.


The NHS Wales Executive has recently undertaken an assurance review of the service. This 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 operational day\-to\-day delivery of maternity and neonatal services. There is a strong supportive infrastructure of key critical corporate functions in place demonstrating Board connectivity and commitment. This is another positive step on the health board’s maternity and neonatal journey. There are still areas where further improvements are required, and it will take time before some of the changes are fully embedded in the service.


I am encouraged by the progress that the health board is making and would like to thank all the staff across the health board for all their hard work in supporting and transforming this service. I am now in a position to de\-escalate the health board to enhanced monitoring for maternity and neonatal services.


Turning to governance, leadership and culture, trust and confidence, the health board has been in targeted intervention since 2019\. As with maternity and neonatal services, it is encouraging to note that the health board has made significant progress in reforming these functions. On 24 August 2023, Audit Wales and Healthcare Inspectorate Wales published the outcomes of their Cwm Taf Morgannwg University Health Board – quality governance arrangements joint review follow\-up.


The joint follow\-up review highlights that the health board has made significant progress in addressing the concerns and recommendations set out in their original joint review in 2019, but it still needs to take further action to fully embed its new operating model and revised quality governance arrangements across the organisation.


I am encouraged by the progress the health board is making in this area, and I am now de\-escalating the health board to enhanced monitoring for governance, leadership and culture, trust and confidence.


In terms of performance, I have not seen the required improvements across child and adolescent mental health services (CAMHS), planned care, cancer and urgent and emergency care. The Welsh Government has commissioned several interventions from the NHS Executive to ensure these services improve. There are some encouraging signs of improvement in reducing the number of long waiting times and recent progress in reducing ambulance handover delays.


However, the health board remains an outlier across many of these services and people are waiting too long for assessment and treatment. I have accepted the advice I have received from officials and the health board will remain in targeted intervention for quality concerns related to performance and long waiting times.


For the current financial year, Cwm Taf Morgannwg University Health Board was unable to submit a financially balanced IMTP and, as a result, has submitted an annual plan.  Therefore, in line with other health boards, it will remain in enhanced monitoring for planning and finance.


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




| **Organisation** | **Previous Status**  **(Sept 22\)** | **Current Status (Jul 23\)** |
| --- | --- | --- |
| Aneurin Bevan UHB | Routine arrangements | Enhanced monitoring for planning and finance |
| Betsi Cadwaladr UHB | Targeted Intervention but escalated to Special Measures in February 2023 | Special measures |
| Cardiff and Vale UHB | Enhanced monitoring for planning and finance | Enhanced monitoring for planning and finance |
| Cwm Taf Morgannwg UHB | Enhanced monitoring for planning and finance Targeted intervention for maternity and neonatal Targeted intervention for quality and governance, leadership and culture, trust and confidence Targeted intervention for quality issues relating to performance | Enhanced monitoring for planning and finance Enhanced monitoring for maternity and neonatal Enhanced monitoring for quality and governance, leadership and culture, trust and confidence Targeted intervention for quality issues relating to performance |
| Hywel Dda UHB | Targeted intervention for planning and finance Enhanced monitoring for performance and quality | Targeted intervention for planning and finance Enhanced monitoring for performance and quality |
| Powys tHB | Routine arrangements | Enhanced monitoring for planning and finance |
| Swansea Bay UHB | Enhanced monitoring for performance and quality | Enhanced monitoring for planning and finance Enhanced monitoring for performance and quality |
| Public Health Wales NHS Trust | Routine arrangements | Routine arrangements |
| Velindre University NHS Trust | Routine arrangements | Routine arrangements |
| Welsh Ambulance Services NHS Trust | Routine arrangements | Routine arrangements |
| Digital Health and Care Wales | Routine arrangements | Routine arrangements |
| Health Education and Improvement Wales | Routine arrangements | Routine arrangements |


Link to webpage: NHS Wales escalation and intervention arrangements







Translation:


 
Mae'r datganiad hwn yn nodi lefelau uwchgyfeirio newydd ymddiriedolaethau'r GIG, awdurdodau iechyd arbennig a byrddau iechyd yng Nghymru.


Mae'r amgylchedd y mae byrddau iechyd, ymddiriedolaethau ac Awdurdodau Iechyd Arbennig yn gweithredu ynddo yn parhau i fod yn anodd. Ceir diffygion ariannol cynyddol, pwysau gweithredol, rhestrau aros hir, yn ogystal â sefyllfa ariannol heriol dros ben; sefyllfa nad yw'n unigryw i Gymru. 


Ar gyfer y flwyddyn ariannol bresennol, nid oedd y byrddau iechyd yn gallu cyflwyno Cynlluniau Tymor Canolig Integredig wedi'u mantoli'n ariannol. Felly, roedd yn ofynnol iddynt gyflwyno cynlluniau blynyddol. O ganlyniad, nid ydynt wedi darparu cynlluniau yn unol â'r cyfarwyddyd a roddwyd gan Weinidogion Cymru a Fframwaith Cynllunio y GIG, y gallwn eu hystyried i'w cymeradwyo o dan adran 175(2A) o Ddeddf y GIG (Cymru) 2006 ("Deddf 2006").


Yn unol â'r Trefniadau Uwchgyfeirio ac Ymyrryd, mae hyn yn gyfystyr â phryder difrifol o ran darparu gwasanaethau; pryder sy'n fwy na'r hyn y gellir ei drin trwy drefniadau arferol. Rwyf felly wedi derbyn argymhelliad swyddogion y bydd y sefydliadau hynny nad oeddent eisoes wedi'u huwchgyfeirio ar gyfer cynllunio a chyllid yn cael eu huwchgyfeirio nawr i statws monitro uwch. 


Rwyf wedi cytuno ar y statws uwchgyfeirio a ganlyn ar gyfer cyrff y GIG:


* **Bwrdd Iechyd Prifysgol Hywel Dda** i aros yn ei statws uwchgyfeirio presennol sef ymyrraeth wedi'i thargedu ar gyfer cynllunio a chyllid a monitro uwch ar gyfer perfformiad ac ansawdd.
* **Bwrdd Iechyd Prifysgol Bae Abertawe** i gael ei uwchgyfeirio i statws monitro uwch ar gyfer cynllunio a chyllid ac i aros o dan statws monitro uwch ar gyfer ansawdd a pherfformiad.
* **Bwrdd Iechyd Prifysgol Caerdydd a'r Fro** i aros o dan statws monitro uwch ar gyfer cynllunio a chyllid.
* **Bwrdd Iechyd Prifysgol Aneurin Bevan** i gael ei uwchgyfeirio i statws monitro uwch ar gyfer cynllunio a chyllid.
* **Bwrdd Iechyd Addysgu Powys** i gael ei uwchgyfeirio i statws monitro uwch ar gyfer cynllunio a chyllid.
* **Bwrdd Iechyd Prifysgol Betsi Cadwaladr** i aros o dan fesurau arbennig.
* **Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg** i aros o dan ymyrraeth wedi'i thargedu ar gyfer pryderon ansawdd yn gysylltiedig â pherfformiad ac amseroedd aros hir ac i aros o dan statws monitro uwch ar gyfer cynllunio a chyllid. Gwasanaethau mamolaeth a newyddenedigol i gael eu hisgyfeirio o ymyrraeth wedi'i thargedu i statws monitro uwch. Ansawdd a llywodraethu, arweinyddiaeth a diwylliant, ymddiriedaeth a hyder i gael eu hisgyfeirio o ymyrraeth wedi'i thargedu i statws monitro uwch.
* Holl **ymddiriedolaethau’r GIG** ac **Awdurdodau Iechyd Arbennig** i aros ar eu lefel uwchgyfeirio bresennol sef trefniadau arferol.


**Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg**


Mae statws uwchgyfeirio Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg wedi newid yn sylweddol. Nodir y rhesymau dros hyn isod.


Ar 7 Tachwedd 2022, cyhoeddais y byddai gwasanaethau mamolaeth y bwrdd iechyd yn cael eu hisgyfeirio o fesurau arbennig i ymyrraeth wedi'i thargedu, i gydnabod y cynnydd clir yr oedd y bwrdd iechyd wedi'i wneud yn y maes hwn dros y tair blynedd a hanner blaenorol. Rwy'n falch o nodi bod y bwrdd iechyd wedi parhau i wneud gwelliannau ar draws gwasanaethau mamolaeth a newyddenedigol.


Bu cynnydd sylweddol o ran gweithredu gweddill argymhellion y Panel Trosolwg Annibynnol ar Wasanaethau Mamolaeth a'u gwneud yn rhan annatod o arferion y bwrdd. Roedd rhai o'r cyflawniadau allweddol yn cynnwys sicrhau Achrediad Cyfeillgar i Fabanod Cam 3 Unicef, cael enwebiad ar gyfer rownd derfynol gwobrau Coleg Brenhinol y Bydwragedd, gweithredu dangosfwrdd mamolaeth integredig a datblygu'r cynllun diwylliant ac arweinyddiaeth mamolaeth a newyddenedigol.


Mae Gweithrediaeth GIG Cymru yn ddiweddar wedi cynnal adolygiad sicrwydd o'r gwasanaeth. Nododd yr adolygiad fod yna nawr uchelgais a strategaeth glir ar gyfer un gwasanaeth amenedigol, gydag uwch arweinyddiaeth amlddisgyblaethol gydlynol gref yn darparu llywodraethiant integredig sy'n sail ar gyfer darparu gwasanaethau mamolaeth a newyddenedigol bob dydd. Mae yna seilwaith cefnogol cryf ar waith o ran swyddogaethau corfforaethol allweddol sy'n dangos cysylltedd ac ymrwymiad y Bwrdd. Dyma gam cadarnhaol arall yn nhaith mamolaeth a newyddenedigol y bwrdd iechyd. Mae dal i fod meysydd lle mae angen gwelliannau pellach, a bydd yn cymryd amser cyn i rai o'r newidiadau gael eu hymgorffori'n llawn yn y gwasanaeth.


Mae'r cynnydd y mae'r bwrdd iechyd yn ei wneud yn galonogol a hoffwn ddiolch i'r holl aelodau o staff yn y bwrdd iechyd am eu holl waith caled i gefnogi a thrawsnewid y gwasanaeth hwn. Gallaf bellach isgyfeirio'r bwrdd iechyd i statws monitro uwch ar gyfer gwasanaethau mamolaeth a newyddenedigol.


O ran llywodraethu, arweinyddiaeth a diwylliant, ymddiriedaeth a hyder, mae'r bwrdd iechyd wedi bod o dan statws ymyrraeth wedi'i thargedu ers 2019\. Yn yr un modd â gwasanaethau mamolaeth a newyddenedigol, mae'n galonogol nodi bod y bwrdd iechyd wedi gwneud cynnydd sylweddol o ran diwygio'r swyddogaethau hyn. Ar 24 Awst 2023, cyhoeddodd Archwilio Cymru ac Arolygiaeth Gofal Iechyd Cymru ganlyniadau eu hadolygiad dilynol ar y cyd o drefniadau llywodraethu ansawdd Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg.


Mae'r adolygiad dilynol ar y cyd yn nodi bod y bwrdd iechyd wedi gwneud cynnydd sylweddol o ran mynd i'r afael â phryderon ac argymhellion yr adolygiad gwreiddiol ar y cyd yn 2019, ond bod angen cymryd camau pellach o hyd i ymgorffori'n llawn ei fodel gweithredu newydd a'i drefniadau llywodraethu ansawdd diwygiedig yn y sefydliad drwyddo draw.


Mae'r cynnydd y mae'r bwrdd iechyd yn ei wneud yn y maes hwn yn galonogol, ac rwyf nawr yn isgyfeirio'r bwrdd iechyd i statws monitro uwch ar gyfer llywodraethu, arweinyddiaeth a diwylliant, ymddiriedaeth a hyder.


O ran perfformiad, nid wyf wedi gweld y gwelliannau gofynnol ar draws gwasanaethau iechyd meddwl plant a'r glasoed (CAMHS), gofal a gynlluniwyd, canser a gofal brys ac argyfwng. Mae Llywodraeth Cymru wedi comisiynu sawl ymyriad gan Weithrediaeth y GIG i sicrhau bod y gwasanaethau hyn yn gwella. Mae rhai arwyddion calonogol o welliant o ran lleihau nifer y cleifion sy'n aros yn hir a'r gwelliant diweddar o ran lleihau oedi wrth drosglwyddo cleifion o ambiwlansys.


Fodd bynnag, mae'r bwrdd iechyd yn parhau i sefyll ar wahân i fyrddau eraill ar draws llawer o'r gwasanaethau hyn ac mae pobl yn aros yn rhy hir i gael eu hasesu a'u trin. Rwyf wedi derbyn cyngor swyddogion a bydd y bwrdd iechyd yn aros o dan statws ymyrraeth wedi'i thargedu ar gyfer pryderon ansawdd yn gysylltiedig â pherfformiad ac amseroedd aros hir.


Ar gyfer y flwyddyn ariannol bresennol, nid oedd Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg yn gallu cyflwyno Cynllun Tymor Canolig Integredig wedi'i fantoli'n ariannol ac o ganlyniad mae wedi cyflwyno cynllun blynyddol. Felly, yn unol â'r byrddau iechyd eraill, bydd yn aros o dan statws monitro uwch ar gyfer cynllunio a chyllid.


Mae'r tabl isod yn dangos statws uwchgyfeirio blaenorol a phresennol pob sefydliad.




| **Sefydliad** | **Statws Blaenorol**  **(Medi 2022\)** | **Statws Presennol (Gorffennaf 2023\)** |
| --- | --- | --- |
| Bwrdd Iechyd Prifysgol Aneurin Bevan | Trefniadau arferol | Monitro uwch ar gyfer cynllunio a chyllid |
| Bwrdd Iechyd Prifysgol Betsi Cadwaladr | Ymyrraeth wedi'i thargedu ond fe'i huwchgyfeiriwyd i Fesurau Arbennig ym mis Chwefror 2023 | Mesurau arbennig |
| Bwrdd Iechyd Prifysgol Caerdydd a'r Fro | Monitro uwch ar gyfer cynllunio a chyllid | Monitro uwch ar gyfer cynllunio a chyllid |
| Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg | Monitro uwch ar gyfer cynllunio a chyllid Ymyrraeth wedi’i thargedu ar gyfer gwasanaethau mamolaeth a newyddenedigol Ymyrraeth wedi’i thargedu ar gyfer ansawdd a llywodraethu, arweinyddiaeth a diwylliant, ymddiriedaeth a hyder Ymyrraeth wedi’i thargedu ar gyfer materion ansawdd yn gysylltiedig â pherfformiad | Monitro uwch ar gyfer cynllunio a chyllid Monitro uwch ar gyfer gwasanaethau mamolaeth a newyddenedigol Monitro uwch ar gyfer ansawdd a llywodraethu, arweinyddiaeth a diwylliant, ymddiriedaeth a hyder Ymyrraeth wedi’i thargedu ar gyfer materion ansawdd yn gysylltiedig â pherfformiad |
| Bwrdd Iechyd Prifysgol Hywel Dda | Ymyrraeth wedi'i thargedu ar gyfer cynllunio a chyllid Monitro uwch ar gyfer perfformiad ac ansawdd | Ymyrraeth wedi'i thargedu ar gyfer cynllunio a chyllid Monitro uwch ar gyfer perfformiad ac ansawdd |
| Bwrdd Iechyd Addysgu Powys | Trefniadau arferol | Monitro uwch ar gyfer cynllunio a chyllid |
| Bwrdd Iechyd Prifysgol Bae Abertawe | Monitro uwch ar gyfer perfformiad ac ansawdd | Monitro uwch ar gyfer cynllunio a chyllid Monitro uwch ar gyfer perfformiad ac ansawdd |
| Ymddiriedolaeth GIG Iechyd Cyhoeddus Cymru | Trefniadau arferol | Trefniadau arferol |
| Ymddiriedolaeth GIG Prifysgol Felindre | Trefniadau arferol | Trefniadau arferol |
| Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru | Trefniadau arferol | Trefniadau arferol |
| Iechyd a Gofal Digidol Cymru | Trefniadau arferol | Trefniadau arferol |
| Addysg a Gwella Iechyd Cymru | Trefniadau arferol | Trefniadau arferol |


Dolen i'r dudalen we: Trefniadau Uwchgyfeirio ac Ymyrryd GIG Cymru