Urgent action needed to reform NHS Wales, says major report

A hard-hitting new report has warned that NHS Wales must urgently improve its performance or face growing risks to patient safety and value for taxpayers.

The Ministerial Advisory Group, set up last October to review NHS Wales’ productivity and leadership, has called for a “relentless focus” on delivering existing commitments, not more new policies. The 68-page report highlights record waiting lists, poor cancer care performance, fragile emergency care, and a “blurred” system of leadership and accountability.

Health Secretary Jeremy Miles has accepted all 29 of the group’s recommendations, either fully or in part. The Welsh Government published its official response alongside the report and said work was already underway to deliver many of the changes.

Speaking today at an event in Cardiff to mark the report’s publication, Mr Miles said: “The message in the report is very clear: we have a significant challenge in performance and in productivity. The service is not performing at the levels that we or the public need and expect it to.”

He added: “There are some hard hitting messages in the report… but it also spells out a path towards how we can get that level of performance to where we all want it to be, so people get fast access to the best possible care.”

The report, led by Sir David Sloman, a former NHS England Chief Operating Officer, emphasised that Wales already has strong foundations, including an integrated health system, skilled staff, and good national strategies. Sir David said Wales should aim to have the “leading healthcare system in the world” but warned the starting position was challenging, with worsening health inequalities and historic high waiting lists.

Among the report’s key proposals are:

• Better management of waiting lists and prioritisation of the longest waiters
• National contracts with independent providers to help tackle backlogs, especially in cataract surgery
• Stronger medical leadership within the NHS and Welsh Government
• Creation of a new NHS Wales Performance and Productivity Unit
• Clearer, sharper accountability processes to replace what the report called the current “muddy” oversight systems
• A push for greater transparency and public reporting on performance
• Removal of unnecessary bureaucracy, with a narrowing of targets

The report strongly warns against endless new strategies and urges leaders to focus on practical delivery, saying “implementation, not invention” is what is urgently needed.

Jeremy Miles, who recently made a major speech on NHS leadership and accountability, said the decision to bring in external experts showed the Welsh Government’s “confidence” rather than a lack of ideas after 26 years in charge. He described the report as “essentially optimistic” and said it highlighted the “commitment and skill” of NHS Wales staff.

Sir David Sloman echoed that sentiment, saying: “The Welsh healthcare system is set up to succeed. It is going really well in everything somewhere, but not everything everywhere. The key is to bring everyone up to the level of the very best.”

Locally, Betsi Cadwaladr University Health Board, which covers Deeside and much of Flintshire, will face pressure to improve waiting list management and diagnostics, alongside other boards across Wales.

The Welsh Government confirmed that extra NHS funding in future will be more tightly linked to performance, following the report’s advice that additional financial support should be conditional on delivering clear improvements.

The report concludes by saying Wales has a unique opportunity to lead the world if it can harness its strengths and deliver for the public: “They deserve the best, and you have the opportunity to give them the best.”