22 organisations come together to call for a single national body with strategic oversight of NHS Wales

‘The new NHS Wales Executive needs to be independent and empowered’

As the worst ever performance figures for hospital emergency departments and the ambulance service in Wales are published, one health board fears that this winter will be the ‘most challenging period in NHS history’, doctors in north Wales say that patients are dying in ambulances and waiting rooms due to overcrowding and the first minister calls long ambulance waits ‘clearly not acceptable’, a group of 22 organisations working across health and social care have come together (22 November 2021) to launch Ending the postcode lottery (attached) which calls for an end to fragmented health services.


A single, independent national NHS Wales executive would be better placed to improve patient care and deliver on the aims of A healthier Wales. An independent body with the right powers would have the authority to:


  • support system transformation across health board boundaries
  • play a national leadership role in service improvement
  • collect and analyse data to improve performance
  • improve patient outcomes across clinical specialties, public health and inequalities
  • provide strong governance and accountability to ensure that the NHS in Wales gets the best value from its combined resources. 


Dr Abrie Theron, Academy of Medical Royal Colleges in Wales chair said:


‘I cannot see how the Welsh NHS is going to implement the changes needed for a COVID recovery without a NHS Executive team facilitating health boards working together as one for the patients of Wales.’


Dr Olwen Williams, RCP vice president for Wales said:


‘First promised by the Welsh government in 2018, we have seen almost no progress on the creation of an NHS Wales Executive to drive improvements in patient care. Doctors have repeatedly raised concerns with the Welsh government about the very real postcode lottery of care which comes at an enormous human and financial cost. Regional health planning would allow for a more strategic approach – but this is not happening effectively in most of Wales and is certainly not happening quickly enough. A single national body with strategic oversight would be able to drive transformation more quickly and more efficiently. Let’s face it, the current system is not working.’


Ana Palazon, Parkinson's UK Cymru Wales director said:


‘Parkinson's UK Cymru is pleased to support to the case for an independent NHS Executive to drive improvements and reduce variation. Prior to Covid-19, people living with Parkinson's in Wales already faced disconnected services and inequity of access to the full range of multidisciplinary support required to live well with Parkinson's. Differing clinical pathways across neurology and care of older people services, as well as geographically throughout Wales, coupled with workforce shortages as Parkinson's clinical specialists retire, requires national focus to ensure Wales is able to meet the needs of those living with the fastest growing neurological condition in the world now and in the future.’


Gemma Roberts, BHF Cymru policy and public affairs manager said:


‘The pandemic has only served to increase health inequalities in Wales. There is massive variation in treatment and care for people with heart and circulatory diseases. This is a national problem which needs national direction in the form of all-Wales cardiac pathways to ensure that everyone in Wales gets the best possible care.’


Lynn Mackay-Thomas, British Society for Heart Failure chief executive said: 


‘Around one in four deaths in Wales are due to cardiovascular diseases including heart failure. There is a fivefold variation in the percentage of heart failure emergency readmissions within 30 days of discharge for primary care clusters and massive variation across Wales in terms of treatment for these diseases. Even with the national guidance of the Wales Cardiac Network, these variations persist and will continue to do so without strong central leadership and oversight.’


Ann Tate, Cancer Research Wales chief executive said:


‘In a developed nation like Wales, cancer inequalities are unacceptable. A person’s cancer outcomes should not depend on your postcode. The variations are stark: only 55% of people in Swansea Bay survive their cancer for 5 years compared with 58.9% in Cardiff and Vale, and 59.3% in Powys, a difference of almost 5%. A single, all-Wales NHS Executive should be able to oversee health boards and drive improvement, co-producing long-term patient-centred strategic transformation. To achieve this the new NHS Wales Executive needs to be independent and empowered. ‘Ending the postcode lottery’ makes a strong case for the Welsh government delivering such a body.’




  1. In June 2018, the Welsh Government published A healthier Wales, their plan for health and social care. This was informed by the parliamentary review of health and social services, which was, in turn, a consequence of a 2016 OECD review of health care quality. The parliamentary review was clear that: ‘there needs to be a clearer distinction between on the one hand, the national executive function strategically developing and managing the NHS, and on the other the national civil service function to support delivery of the NHS and Social Care priorities as set by Welsh Government Ministers.’ The parliamentary review also recommended that: ‘the national executive function in NHS Wales must be strengthened to develop a more strategic and coordinated set of incentives for LHBs and providers to ensure faster progress towards … new models of care, and effective use of pooled budgets.’ The timelines set out in A healthier Wales commit to action on this by the end of 2018, with further consolidation of activity by the end of 2019. However, three years later, there has been little to no progress in meeting these actions. The lack of progress cannot entirely be blamed on the COVID-19 pandemic, which didn’t begin until early 2020.
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