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Under the Joint Escalation and Intervention Arrangements, Welsh Government officials meet with the Wales Audit Office 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 4 escalation levels:


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


The latest meeting took place in December 2019 and the tripartite group considered the position of all organisations since the previous meeting in August 2019\. Following the collective discussions, the Minister has received advice from officials to retain all organisations at their current escalation levels.


In Betsi Cadwaladr University Health Board, despite improvements in some areas such as mental health, the health board still faces a challenging improvement agenda. Current performance in planned and unscheduled care, together with the forecast financial position, are of concern and remain key areas in which I expect to see meaningful improvement. There is also a concern there is no agreed clinical strategy in place and I expect further development on this front during the next quarter. A revised improvement framework has recently been published to clarify the progress the health board will need to demonstrate is being made in the outstanding special measures concerns.


With regards to Cwm Taf Morgannwg, the group noted the positive manner the health board had responded to the maternity services and governance concerns it faces in an open and transparent manner, including how it is now engaging with external review bodies. However, the seriousness of the issues and the scale of the challenge that the organisation faces in achieving sustainable change and improvement remain considerable. It was noted that steps had, and continue to be taken to enhance capacity and capability in a number of key areas and a wide range of actions were underway. This included responding to the concerns that have been raised around the culture within the organisation and the need to rebuild patient, public, staff and stakeholder confidence and trust. Ensuring rapid improvements are made in how the organisation responds to patient concerns and complaints will be an essential component of this.


With regards to Swansea Bay, to the group noted concerns around the financial position and the ability of the health board to meet its financial requirements, as well as a deteriorating performance in unscheduled care and planned care.


For Hywel Dda, noting progress over the last couple of years, the group noted the continued challenge around the financial position for the health board to meet its financial obligations, as well as challenges in out of hours provision.


For Aneurin Bevan, there was discussion around the deterioration in performance in both unscheduled care and planned care and having to see clear actions in response of this. These matters will be kept under review as part of welsh Government’s routine monitoring of the Health Board.


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




| Organisation | Previous status (Aug. 2019\) | Current status (Dec. 2019\) |
| --- | --- | --- |
| Aneurin Bevan UHB | Routine arrangements | Routine arrangements |
| Betsi Cadwaladr UHB | Special Measures | Special measures |
| Cardiff and Vale UHB | Enhanced monitoring | 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 | Targeted intervention |
| Powys tHB | Routine arrangements | Routine arrangements |
| Public Health Wales NHS Trust | Routine arrangements | Routine arrangements |
| Swansea Bay UHB | Targeted intervention | Targeted intervention |
| 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.


Cynhaliwyd y cyfarfod diweddaraf ym mis Rhagfyr 2019 ac ystyriodd y grŵp sefyllfa'r holl sefydliadau ers y cyfarfod blaenorol ym mis Awst 2019\. Yn dilyn y trafodaethau, mae’r Gweinidog wedi cael ei gynghori gan swyddogion i gadw'r holl sefydliadau ar eu lefelau uwchgyfeirio presennol.


Ym Mwrdd Iechyd Prifysgol Betsi Cadwaladr, er gwaethaf gwelliannau mewn rhai meysydd, megis iechyd meddwl, mae'r bwrdd iechyd yn parhau i wynebu agenda heriol ar gyfer gwella. Mae perfformiad presennol gwasanaethau gofal wedi'i gynllunio a gofal heb ei drefnu, ynghyd â'r sefyllfa ariannol a ragwelir, yn peri pryder ac mae'r rhain yn parhau i fod yn feysydd allweddol lle yr wyf yn disgwyl gweld gwelliannau ystyrlon. Mae pryder hefyd nad oes strategaeth glinigol gytunedig wedi'i sefydlu ac rwy'n disgwyl gweld datblygu pellach yn hyn o beth yn ystod y chwarter nesaf. Cafodd fframwaith gwella diwygiedig ei gyhoeddi’n ddiweddar. Nod y fframwaith ar ei newydd wedd yw egluro pa fath o gynnydd y bydd angen i’r bwrdd iechyd ddangos sy’n cael ei wneud ar gyfer ymateb i’r pryderon mesurau arbennig sy’n weddill.


Mewn perthynas â Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg, nododd y grŵp bod y bwrdd iechyd wedi ymateb yn gadarnhaol ac mewn modd agored a thryloyw i’r pryderon ynghylch y gwasanaethau mamolaeth a llywodraethu, gan gyfeirio at sut mae bellach yn ymgysylltu â chyrff adolygu allanol. Fodd bynnag, mae difrifoldeb y problemau a graddfa'r her sy'n wynebu'r sefydliad wrth gyflawni newidiadau a gwelliannau cynaliadwy yn parhau i fod yn sylweddol. Nodwyd bod camau wedi’u cymryd, ac yn parhau i gael eu cymryd, i wella capasiti a gallu mewn sawl maes allweddol a bod amrywiaeth eang o gamau gweithredu ar y gweill. Roedd hyn yn cynnwys ymateb i'r pryderon ynghylch y diwylliant yn y sefydliad a'r angen i adennill hyder ac ymddiriedaeth y cleifion, y cyhoedd, y staff a'r rhanddeiliaid. Bydd sicrhau bod gwelliannau’n cael eu gwneud yn gyflym i'r modd y mae'r sefydliad yn ymateb i bryderon a chwynion cleifion yn rhan hanfodol o hyn.


Mewn perthynas â Bwrdd Iechyd Prifysgol Bae Abertawe, nododd y grŵp bryderon ynghylch sefyllfa ariannol y bwrdd iechyd a’i allu i fodloni ei ofynion ariannol, yn ogystal â dirywiad ym mherfformiad gwasanaethau gofal heb ei drefnu a gofal wedi'i gynllunio.


O ran Bwrdd Iechyd Prifysgol Hywel Dda, wrth gyfeirio at y cynnydd a wnaed dros y ddwy flynedd ddiwethaf, nododd y grŵp bod y bwrdd iechyd yn parhau i wynebu heriau wrth fodloni ei rwymedigaethau ariannol, yn ogystal â heriau wrth ddarparu gofal y tu allan i oriau arferol.


O ran Bwrdd Iechyd Prifysgol Aneurin Bevan, cafwyd trafodaeth ynghylch dirywiad ym mherfformiad gwasanaethau gofal heb ei drefnu a gofal wedi'i gynllunio a'r ffaith bod angen gweld camau gweithredu clir mewn ymateb i hyn. Bydd y materion hyn yn parhau i gael eu hadolygu fel rhan o waith monitro byrddau iechyd arferol Llywodraeth Cymru.


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




| Sefydliad | Statws blaenorol (Awst 2019\) | Statws presennol (Rhag 2019\) |
| --- | --- | --- |
| 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 | Monitro uwch | 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 | Ymyrraeth wedi'i thargedu |
| 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 | Ymyrraeth wedi'i thargedu |
| 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.