Strong governance needed as Wales enters next phase

by Seamus Ward

05 October 2020

Andrew Goodall, NHS Wales chief executive and director general for health and social services, has reiterated the need for strong financial governance as the local health service moves beyond the initial response to Covid-19.

In a letter providing guidance on quarters 3 and 4 of this financial year, Dr Goodall (pictured) acknowledged that under previous quarter operating frameworks decisions had to be taken quickly to respond to the immediate needs of the pandemic response. ‘We were not always able to follow normal financial governance processes and significant resources were committed without funding certainty,’ he said.andrew.goodall l

‘Since the initial pandemic response, I have made clear my expectation of increased scrutiny of the cost implications of decisions taken, and strengthening financial governance arrangements.’

The letter outlines health board allocations for the final six months of the financial year and sets out expectations for the production of plans for this period. NHS Wales has adopted quarterly planning in 2020/21 and Dr Goodall said it was moving cautiously towards resetting services, recovery and contingency planning, which would include provision for the winter and transition out of the European Union.

Health and social services minister Vaughan Gething (pictured below) said: ‘Covid-19 is still present, and the threat is growing as we approach the autumn. Modelling and advice suggest we need to plan for an extra 5,000 acute beds and 350 critical care beds across Wales this winter. Some of these beds will be provided in field hospitals, others in extending hospital sites. I am looking for organisations to demonstrate their "surge" capacity locally and regionally, supported by robust workforce capacity.’

The Q3/4 plans – due by 19 October – should not be ‘new’ plans, he insisted, but should build on the quarterly discipline adopted this year. The plans will cover eight areas and should be in two parts – a minimum dataset and a narrative that addresses the management of risk and contingencies for services.

The eight areas include: finance; local prevention and response; essential services; primary and community care; winter preparations; partnership working; organisational capacity; and workforce.Vaughan Gething

Additional funding this year totals £1.3bn, with £451m allocated to cover the costs of staffing, field hospital set-up, testing, personal protective equipment (PPE) and the use of the independent sector. The balance will be used to support national priorities and local plans, and give organisations certainty to develop their plans for the rest of the financial year.

‘As this funding has been secured to ensure stabilisation within the system, it is my expectation that organisations continue to work collaboratively to ensure financial stability,’ Dr Goodall said.

‘I am clear that the allocations outlined in this framework are not anticipated to provide funding to support either recovery of planned care performance during the second half of 2020/21 or the wider recovery agenda. Additional funding support for robust recovery plans will be considered once these plans are sufficiently developed and robust.’

The minimum dataset has been developed from existing returns and will provide a baseline for quarter 3 and 4 plans. NHS boards should be able to use the dataset to triangulate risk, challenge, and opportunity in the plans. The data should also underpin the narrative in operational plans.

Dr Goodall said the dataset and plans should align. ‘I do not wish to see data returns which are ultimately divorced from the wider plan that has been developed. Rather, one must inform the other.’

He added that the minimum dataset will allow some aggregation at system level, as well as providing some assurance on equity of access, which was not possible in the first two quarters.