Governance at the Welsh Health Specialised Services Committee has improved, but important action is needed in several areas

Governance at the Welsh Health Specialised Services Committee has improved, but important action is needed in several areas
12 May 2021
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The preparation of a recovery plan for specialist services following the pandemic is an immediate priority but there is also a need for a wider review of the current commissioning model.

The Welsh Health Specialised Services Committee (WHSSC) is a joint committee made up of, and funded by, the seven local health boards in Wales. It is hosted by Cwm Taf Morgannwg University Health Board and has an overall annual budget of £680 million.  

The Committee makes collective decisions on the planning, procurement, and performance monitoring of specialised services for the population of Wales on behalf of health boards. Specialised services are often complex and include Cancer, Cardiac, Neurosciences, Major Trauma, and Renal services. The services commissioned are provided by a small number of specialist providers, many of which are in Wales, but some are also commissioned from the NHS in England. In Wales, Cardiff and Vale and Swansea Bay University Health Boards receive significant funding for the specialised services they provide.

In 2015, two separate reviews highlighted issues with WHSSC’s governance arrangements. We found a number of improvements have been made to the overall governance arrangements in WHSCC since 2015. Good progress has been made to strengthen arrangements for quality assurance of specialised services although scope still exists for a greater focus on quality of services at Joint Committee meetings. There is also a need to review the arrangements for recruiting and remunerating independent members that sit on the Committee given some of the challenges that have been experienced in filling these roles.

Current Joint Committee members have a healthy working relationship and operate well together. However, the current model creates potential conflicts of interest due to the fact some Joint Committee members are also the chief officers of the health bodies commissioned to provide specialised services. 
We found that arrangements for planning commissioned services are generally good and there is an improving focus on value. However, some key new services such as new service models for major trauma and thoracic surgery have taken a long time to agree and implement. We also found that the COVID-19 pandemic has significantly affected the delivery of specialised services, and that the development of a plan for the recovery of specialised services following the pandemic should now be a priority.

The Welsh Government’s long-term plan for health and social care, A Healthier Wales, signals an intention to review a number of hosted national functions, including WHSSC, with the aim of “consolidating national activity and clarifying governance and accountability”. Whilst the governance arrangements for WHSSC have continued to improve, our report shows that there are still a number of facets of the WHSSC model that merit further attention.

We make a number of recommendations for both WHSSC and Welsh Government in our report. 

WHSSC: 

  • Increase the focus on quality at the Joint Committee.
  • Implement clear programme management arrangements for new commissioned services.
  • Undertake a review on the impact of COVID-19 on recovery planning.
  • Develop a new specialised services strategy.

Welsh Government:

  • Review options to recruit and retain WHSSC independent members.
  • Ensure effective programme management arrangements are in place from concept to completion.
  • Set a revised timescale for the action of A Healthier Wales review and use the findings of this report to inform further work.

The Welsh Health Specialised Services Committee (WHSSC) commissions around £680 million of specialised services on behalf of the population of Wales and is a vital component of the Welsh healthcare system. Given this level of responsibility and investment, I’m encouraged by the progress WHSCC has made to improve its governance, management, and planning arrangements over recent years.

An immediate challenge for WHSSC is to develop a clear strategy to address the challenges associated with recovering specialised services following the Covid-19 pandemic. My report also shows that there is still a need to take a more fundamental look at the model for commissioning specialised services, in line with the commitment set out in the Welsh Government’s NHS Plan ‘A Healthier Wales’. It is important that this commitment is taken forward and I hope that the findings set out in this report can helpfully inform that debate.

Adrian Crompton, Auditor General

Notes to Editors:

  • This report considers the extent to which there are effective governance arrangements and whether the planning approach effectively supports the commissioning of specialised services for the population of Wales. 
  • Two previous reviews governance reviews were undertaken and reported in 2015. The Good Governance Institute reported on corporate governance. Healthcare Inspectorate Wales reviewed the clinical governance arrangements. WHSSC officers prepared and delivered an action plan to respond to the recommendations in those reviews.
  • Much of our review was carried out between March and June 2020, but as a result of the pandemic, we paused aspects of the review, restarting in July with a survey to all health boards and concluding the fieldwork in October. 
  • The delivery of our work included interviews with WHSS officers and WHSSC independent members, observations of Joint Committee and sub-committee meetings, questionnaires of health board chief executives and chairs and a review of documentation.  
  • The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £21 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £8 billion) and to local government (over £4 billion).
  • The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government. 
  • The Wales Audit Office (WAO) is a corporate body consisting of a nine-member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
  • Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself. 
Welsh Health Specialised Services Committee Governance Arrangements