The head of the Welsh NHS has told Hywel Dda in writing that it has “breached its statutory duty” over its finances and planning.
The letter from Jacqueline Totterdell, chief executive of NHS Wales, dated 23 July, is published in the papers for Hywel Dda University Health Board‘s meeting in Aberaeron on Thursday.
“Your organisation has failed to meet the statutory planning and financial requirements as set out in the NHS Wales Planning Framework,” she wrote. “You have also failed to meet the de-escalation criteria for a credible annual plan.”
“The health board has therefore breached its statutory duty,” the letter continues, concluding that “the health board does not have an agreed or supported plan.”
The health board is planning to overspend by £41m this year. Its own gross forecast puts the figure at £62.2m, with £21.2m of hoped-for savings described in the papers as “yet to be confirmed”.
The underlying deficit stands at £68.8m, a position the board’s own papers describe as “Recognised as Unsustainable”, although it has improved from £81.5m in April.
Of a £42.8m savings target, £21m has been identified, leaving a £21.8m gap. Only £5.1m of the savings found so far are recurring.
The board’s risk register scores its financial sustainability risk at 25 out of 25, the maximum possible.
Ms Totterdell had already written to the health board in June, saying it “does not have sufficient grip on its most significant challenges” and that “there appears a clear lack of ambition to deliver”.
That letter also raised patient safety concerns, including two “never events”, incidents considered so serious they should never happen. Both involved nasal-gastric feeding tubes, and the letter noted “it was of concern that there was no learning following the first event”.
The health board has now used internal Level 4 escalation, its highest, for the first time in its history, on two divisions with combined budget gaps of £24.6m. Externally, the NHS has the board at Level 4 for finance, planning, urgent and emergency care, fragile services including ophthalmology, and healthcare-associated infections.
An Escalation Board with Welsh Government will meet on 4 August, five days after Thursday’s public meeting.
The health board finished last year £23.7m in deficit, £1.6m worse than it had forecast.
Even so, the papers show the board approving three new planning posts costing £310,971 a year as “an exception to financial governance”, conceding the appointments “will deteriorate the financial position”.
Hywel Dda is not the only health board in the red: neighbouring Swansea Bay was revealed in June to be £112m in deficit and failed by its auditors.
The breach letter lands on a packed agenda: the same papers reveal the removal of Llandovery’s X-ray service and confirm the Prince Philip stroke decision will wait until November. The board meets at 10.15am on Thursday at Ceredigion County Council’s chambers in Aberaeron, streamed online.
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