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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.
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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:
Welsh Government:
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.