Health and social care

Follow-up report highlights ongoing issues with retrospective claims for Continuing NHS Healthcare

Some good progress but approach to those seeking re-imbursement of care home fees still a concern. 

There has been a positive response from the Welsh Government to many of the issues raised and recommendations previously made by the Auditor General and the National Assembly’s Public Accounts Committee. However, the approach to clearing retrospective claims for Continuing NHS Healthcare remains a concern, according to a report released today by the Auditor General for Wales.

The report, which follows up on findings from June 2013, looks at how the NHS is performing in managing Continuing NHS Healthcare. Continuing NHS Healthcare is a package of care provided to people who are assessed as having a primary health need. These care packages can include the funding of care home fees. Individuals are able to request retrospective reviews seeking reimbursement for care home fees where they feel they could have been eligible for a continuing healthcare package.

The report found that the Welsh Government has taken a number of important steps since June 2013, including the launch of a revised National Framework for Continuing NHS Healthcare backed by a staff training programme, and strengthened leadership and oversight. These provide the basis for ensuring people across Wales are dealt with fairly and consistently. Public information has been expanded and this will help people better understand this complex topic. 

The Powys Project (a national project set up to deal with retrospective claims), successfully reviewed the 2,525 claims that it received up to 15 August 2010. Since that date the NHS has received a further 4,092 claims, many of which were received in response to the announcement by the Welsh Government of a July 2014 cut-off date for claims relating to a period between 1 April 2003 and 31 July 2013. The majority of the claims received since 16 August  2010 are now being dealt with by the Powys Project but a significant number are the responsibility of health boards. The report raises important concerns over the approach to dealing with these claims. Specifically:

  • the Powys Project, although it has demonstrated its ability to deliver, now faces an even greater challenge in processing its share of the current claims;
  • health boards have failed to agree and report meaningful and accurate information on the progress being made with claims; and
  • some health boards have not demonstrated that they are able to deal in a timely way with the claims they are responsible for and some claimants are being dealt with unreasonably.
     
  • The report concludes that the Welsh Government needs to take a stronger and more directive role with health boards to improve and speed up the processing of retrospective claims and to meet deadlines that it has set. The Welsh Government has accepted and is to address the main concerns raised in the report, which recommends a number of specific actions designed to ensure that:
  •  information is available to monitor progress with retrospective claims;
  • individual health boards are allocating appropriate staff resources to processing retrospective claims;
  •  health boards provide adequate funding for the Powys Project to support its work;
  • people are dealt with fairly when asked to provide proof they have paid care home fees; and
  • public information is promoted as widely as possible.

The Auditor General, Huw Vaughan Thomas, said today: ‘Today’s follow-up report shows that there have been some good successes but that work remains to be done to ensure a step change in how some health boards deal with retrospective claims. The Welsh Government needs to strengthen its role in managing Continuing NHS Healthcare to ensure that claims are dealt with as quickly and efficiently as possible.’

Rhywfaint o gynnydd da ond mae'r modd yr ymdrinnir â cheisiadau am ad-daliad ffioedd cartrefi gofal yn destun pryder o hyd

Adroddiad dilynol yn nodi materion parhaus yn ymwneud â hawliadau ôl-weithredol ar gyfer Gofal Iechyd Parhaus y GIG

Cafwyd ymateb cadarnhaol gan Lywodraeth Cymru i nifer o'r materion a godwyd a'r argymhellion a wnaed yn flaenorol gan yr Archwilydd Cyffredinol a Phwyllgor Cyfrifon Cyhoeddus y Cynulliad Cenedlaethol. Er hynny, mae'r dull o glirio hawliadau ôl-weithredol ar gyfer Gofal Iechyd Parhaus y GIG yn destun pryder o hyd, yn ôl adroddiad a gyhoeddwyd heddiw gan Archwilydd Cyffredinol Cymru.

Mae'r adroddiad, sy'n mynd ar drywydd canfyddiadau o fis Mehefin 2013, yn edrych ar berfformiad y GIG wrth reoli Gofal Iechyd Parhaus y GIG. Gofal Iechyd Parhaus y GIG yw pecyn o ofal a ddarperir i bobl yr asesir eu bod ag anghenion gofal sylfaenol. Gall y pecynnau gofal hyn gynnwys ariannu ffioedd cartref gofal. Gall unigolion wneud cais am adolygiadau ôl-weithredol ar gyfer ad-daliad ffioedd cartrefi gofal os teimlant y gallent fod wedi bod yn gymwys am becyn gofal iechyd parhaus.

Canfu'r adroddiad fod Llywodraeth Cymru wedi cymryd nifer o gamau pwysig ers mis Mehefin 2013, gan gynnwys lansio Fframwaith Cenedlaethol diwygiedig ar gyfer Gofal Iechyd Parhaus y GIG wedi'i ategu gan raglen hyfforddiant staff, arweinyddiaeth a goruchwyliaeth mwy cadarn. Mae’r rhain yn darparu sylfaen i sicrhau bod pobl drwy gydol Cymru yn cael eu trin yn deg ac yn gyson. Mae wybodaeth gyhoeddus wedi’i chynyddu a bydd hyn yn cynorthwyo pobl i ddeall y fater gymhleth hon yn well. 

Llwyddodd Prosiect Powys (prosiect cenedlaethol a sefydlwyd i ymdrin â hawliadau ôl-weithredol) i adolygu'r 2,525 o hawliadau a dderbyniodd hyd at 15 Awst 2010.  Ers y dyddiad hwnnw, mae'r GIG wedi derbyn 4,092 o hawliadau eraill, llawer ohonynt mewn ymateb i ddatganiad gan Lywodraeth Cymru  mai mis Gorffennaf 2014 fyddai'r terfyn amser ar gyfer derbyn hawliadau yn ymwneud â chyfnod rhwng 1 Ebrill 2003 a 31 Gorffennaf 2013. Prosiect Powys sy'n ymdrin â'r mwyafrif o'r hawliadau a dderbyniwyd ers 16 Awst 2010 ond cyfrifoldeb y byrddau iechyd yw nifer sylweddol ohonynt. Mae'r adroddiad yn codi nifer o bryderon ynglŷn â'r dull o ymdrin â'r hawliadau hyn. Yn benodol:

  • mae Prosiect Powys, er iddo ddangos ei allu i gyflawni, bellach yn wynebu her hyd yn oed fwy wrth brosesu ei gyfran o'r hawliadau presennol;
  • nid yw byrddau iechyd wedi llwyddo i gytuno ar wybodaeth ystyrlon a chywir ar gynnydd yr hawliadau, nac wedi adrodd ar hyn; ac
  • nid yw rhai byrddau iechyd wedi dangos eu bod yn gallu ymdrin â'r hawliadau y maent yn gyfrifol amdanynt mewn ffordd amserol, ac o ganlyniad ymdrinnir â rhai hawlwyr yn afresymol.

Daw'r adroddiad i'r casgliad bod angen i Lywodraeth Cymru ymgymryd â rôl gryfach a rhoi mwy o gyfarwyddyd i fyrddau iechyd er mwyn gwella a chyflawni'r gwaith o brosesu hawliadau ôl-weithredol o fewn y terfyn amser. Mae Llywodraeth Cymru wedi derbyn y prif pryderon a godir yn yr adroddiad a bydd yn mynd i’r afael â hwythau: mae’r adroddiad yn argymell nifer o gamau gweithredu penodol, a gynlluniwyd i sicrhau'r canlynol:

  • bod gwybodaeth ar gael i fonitro cynnydd hawliadau ôl-weithredol;
  • bod byrddau iechyd unigol yn neilltuo adnoddau staff priodol at brosesu hawliadau ôl-weithredol;
  • bod byrddau iechyd yn darparu cyllid digonol ar gyfer Prosiect Powys er mwyn cefnogi ei waith;
  • y caiff pobl eu trin yn deg pan ofynnir iddynt gyflwyno prawf eu bod wedi talu ffioedd cartref gofal; a
  • bod gwybodaeth gyhoeddus yn cael ei hyrwyddo mor eang â phosibl.

 

Dywedodd yr Archwilydd Cyffredinol, Huw Vaughan Thomas, heddiw: “Mae adroddiad dilynol heddiw'n dangos y bu rhai llwyddiannau ond mae gwaith i'w wneud o hyd er mwyn sicrhau newid sylweddol yn y ffordd y mae rhai byrddau iechyd yn ymdrin â hawliadau ôl-weithredol. Rhaid i Lywodraeth Cymru atgyfnerthu ei rôl wrth reoli Gofal Iechyd Parhaus y GIG er mwyn sicrhau yr ymdrinnir â hawliadau mor gyflyn ac effeithlon â phosibl.

Llawer o gleifion yn disgwyl yn hir am driniaeth y GIG yng Nghymru

Mae GIG Cymru yn cael trafferthion gydag amseroedd aros ar gyfer gofal dewisol, ond gallai cynlluniau newydd i ad-drefnu gwasanaethau wella’r sefyllfa.

Mae ein hadroddiad newydd Amseroedd Aros y GIG ar gyfer Gofal Dewisol yng Nghymru yn tynnu sylw at y ffaith nad yw trefniadau presennol GIG Cymru yn sicrhau amseroedd aros isel cynaliadwy, ond bod gan gynlluniau newydd y potensial i wella’r sefyllfa os cânt eu rhoi ar waith yn effeithiol.

Daw’n hadroddiad i’r casgliad, er bod llawer o gleifion yn hapus i ddisgwyl am eu triniaeth, mae lleiafrif sylweddol yn teimlo eu bod yn disgwyl yn rhy hir. I rai cleifion, mae hyn yn golygu bod eu cyflwr yn gwaethygu tra’u bod yn aros i gael eu gweld. Mae perfformiad yn erbyn targedau Llywodraeth Cymru wedi dirywio’n sylweddol, ac er bod rhai gwahaniaethau yn y ffordd y caiff perfformiad amseroedd aros ei fesur, mae Lloegr a’r Alban yn perfformio’n well yn erbyn targedau llymach.

Meddai Huw Vaughan-Thomas, Archwilydd Cyffredinol Cymru:

Rydym ni’n gwbl glir yn ein canfyddiadau; nid yw’r dull presennol o ddarparu gwasanaethau yn sicrhau amseroedd aros isel cynaliadwy. Fel rwyf wedi nodi o’r blaen, mae angen trafodaeth agored a gonest ynglŷn â’r ffordd mae gwasanaethau’n cael eu darparu. Mae yna gynlluniau newydd sydd â’r potensial i wella’r sefyllfa hon, ond bydd angen i’r GIG fod yn gryf ac yn ddewr i ymrwymo i’r cynlluniau hyn er mwyn sicrhau newidiadau ystyrlon.

Dywed yr adroddiad, er bod y rhan fwyaf o gleifion yn cael eu trin o fewn y targed o 26 wythnos, ym mis Mawrth 2014, roedd 11 y cant o gleifion wedi disgwyl yn hirach na hyn, ac roedd 3 y cant wedi disgwyl mwy na 36 wythnos. 

Nodir hefyd nad yw targedau amseroedd aros wedi’u cyflawni ers mis Medi 2010, gyda pherfformiad yn gwaethygu dros y blynyddoedd diwethaf.

Mae’n dod i’r casgliad y bydd angen i GIG Cymru weithredu ar syniadau newydd, yn enwedig gofal iechyd darbodus, i herio a gwella’r system gyffredinol o ofal wedi’i gynllunio.

Mae’r adroddiad hwn yn dilyn ein cyhoeddiad GIG Cymru: Trosolwg o Berfformiad Ariannol a Pherfformiad Gwasanaethau 2013-14, a ryddhawyd ym mis Hydref 2014. Mae’r ddau adroddiad yn nodi ac ail-bwysleisio’r angen am newidiadau mawr i’r ffordd mae gwasanaethau’n cael eu darparu fel y gall GIG Cymru ateb y galw yn y dyfodol.

Argymhellion allweddol 

Mae angen i Lywodraeth Cymru weithio gyda byrddau iechyd i:

  • Sicrhau bod yna gynllun cliriach i greu amseroedd aros cynaliadwy a phriodol yn seiliedig ar ddealltwriaeth ymarferol o’r galw a chapasiti ledled y GIG.
  • Ad-drefnu’r system cleifion allanol bresennol yn llwyr i wella effeithlonrwydd a chanolbwyntio ar anghenion y claf.
  • Adolygu’r rheolau atgyfeirio i driniaeth a’r ffordd y maent yn cael eu dehongli’n lleol i sicrhau nad yw cleifion yn cael eu trin yn annheg.
  • Cyhoeddi mwy o ddata cenedlaethol a lleol i gefnogi’r gwaith o graffu ar amseroedd aros a’u rheoli.
  • Sicrhau gwell cyfathrebu â chleifion am eu cyfrifoldebau a’r hyn y gellir ei ddisgwyl gan y system ofal.

 

Mae’r adroddiad hefyd yn cynnwys adroddiad technegol llawn ochr yn ochr â’r prif adroddiad a’i ganfyddiadau. 

Many patients face long waits for NHS treatment in Wales

The Welsh NHS is struggling with waiting times for elective care but emerging plans to re-think services could make things better.

Our new report NHS Waiting Times for Elective Care in Wales highlights that NHS Wales' current approach "does not deliver sustainably low waiting times" but that "emerging plans have potential to improve the position if they are implemented effectively".

The report finds that while many patients are happy to wait for their treatment, a significant minority feel they wait too long. For some patients this means their condition gets worse while they are waiting to be seen. Performance against the Welsh Government’s targets has deterioriated significantly, and whilst there are some differences in the way waiting-times performance is measured, Scotland and England are doing better against more stringent targets. 

Auditor General for Wales, Huw Vaughan-Thomas said:

We are clear in our findings; the current approach to delivering services does not deliver sustainably low waiting times. As I have highlighted before, there needs to be an open and honest discussion about the way services are delivered. There are emerging plans that have the potential to improve this position, but the NHS will need to act strongly and bravely to commit to this if meaningful changes are to be achieved.

The report highlights that while a majority of patients were treated within the 26 week target in March 2014, 11 per cent of patients had waited longer than this, and 3 per cent had waited more than 36 weeks. 

It is also noted that waiting time targets have not been met since September 2010 with performance getting worse in recent years.

It concludes by stating that NHS Wales will need to ‘act on emerging ideas’ particularly prudent healthcare, to challenge and improve the overall system of planned care.

This report follows on from our publication NHS Wales: Overview of Financial and Service Performance 2013-14, which was released in October 2014. Both reports highlight and re-emphasise the need for there to be transformational changes in the way services are delivered if the NHS Wales is to meet future demand.

Key recommendations

The Welsh Government needs to work with health boards to:

  • Ensure there is a clearer plan to create sustainable and appropriate waiting times based on a realistic understanding of demand and capacity across the NHS.
  • Radically re-shape the current outpatient system to improve efficiency and focus on the needs of the patient.
  • Review the referral-to-treatment rules and the way they are interpreted locally to make sure that patients are not treated unfairly.
  • Publish more detailed national and local data to support the scrutiny and management of waiting times.
  • Ensure there is better communication with patients about their responsibilities and what to expect from the care system.

The report includes a full technical report to go alongside the main report and its findings. 

GIG Cymru yn mantoli'r gyllideb yn 2013-14 er gwaethaf perfformiad cymysg yn erbyn targedau gwasanaeth

Dengys ein hadroddiad fod rheolaeth ariannol yn gwella. Serch hynny, gorwariodd rhai o gyrff y GIG, cymysg oedd perfformiad gwasanaethau ac mae heriau mawr i ddod o hyd.

Llwyddodd GIG Cymru i fantoli'r gyllideb yn 2013-14, er gwaetha'r ffaith i dri bwrdd iechyd orwario, yn ôl adroddiad a ryddhawyd heddiw gan Archwilydd Cyffredinol Cymru.

Mae'r adroddiad blynyddol, GIG Cymru: Trosolwg o Berfformiad Ariannol a Pherfformiad Gwasanaethau 2013-14, yn canolbwyntio ar dri phrif faes; rheolaeth ariannol, targedau perfformiad a chynllunio ar gyfer GIG Cymru yn y dyfodol. 

Canfu'r adroddiad  y llwyddwyd i fantoli'r gyllideb ar ôl i Adran Iechyd a Gwasanaethau Cymdeithasol Llywodraeth Cymru gael £200 miliwn o arian ychwanegol gan adrannau eraill a chronfeydd wrth gefn ac ar ôl i gyrff y GIG orfod gwneud arbedion ariannol sylweddol. Canfu hefyd fod tri o gyrff y GIG wedi methu â mantoli’r gyllideb gan olygu bod eu cyfrifon wedi'u hamodi.

Dywedodd Archwilydd Cyffredinol Cymru, Huw Vaughan Thomas, “Er gwaethaf ymdrech sylweddol, mae cyrff y GIG yn ei chael hi'n fwyfwy anodd rheoli arbedion, ac mae'r ffaith bod cyfrifon tri o gyrff y GIG wedi cael eu hamodi yn gynharach eleni yn arwydd o hyn.

Mae'n braf gweld bod perfformiad mewn meysydd fel atal yn gwella ond nid yw rhai targedau o ran gofal canser a strôc yn cael eu cyrraedd ac mae amseroedd aros ar y cyfan wedi gwaethygu.

Er ei bod yn galonogol gweld bod Llywodraeth Cymru yn cyflwyno fframwaith tair blynedd, mae nifer o risgiau a heriau i ddod o hyd a fydd yn profi ac yn herio'r GIG i beidio â defnyddio mwy na'r cyllidebau refeniw a chyfalaf a ddyrannwyd iddo.

Yr hyn sy'n glir yw na all y GIG barhau fel y mae. Bydd angen gwneud penderfyniadau anodd er mwyn newid y ffordd y caiff gwasanaethau eu darparu, a bydd angen cefnogaeth gwleidyddion i wneud hyn."

Canfu'r adroddiad hefyd mai "cymysg" fu perfformiad gwasanaethau ar draws GIG Cymru yn 2013-14 ac na chyflawnwyd llawer o dargedau allweddol, fel amseroedd aros ar gyfer gwasanaethau a drefnwyd a gwasanaethau brys, yn rheolaidd. Wrth edrych i'r dyfodol, noda'r adroddiad fod cynlluniau integredig tair blynedd yn gam cadarnhaol ymlaen ond y bydd yn anodd i GIG Cymru wneud cynnydd heb newid trawsnewidiol.

Noda'r adroddiad sawl pwynt cadarnhaol, gan dynnu sylw at ymrwymiad cyrff y GIG i ddod o hyd i arbedion, cynnydd cadarnhaol yn erbyn rhai targedau perfformiad (yn enwedig data marwoldeb ac integreiddio rhannau gwahanol o'r GIG) yn ogystal â'r posibilrwydd y gallai'r syniadau sy'n dod i'r amlwg am ofal iechyd darbodus arwain at wasanaethau gwell am gost is.

Mae'r adroddiad yn gwneud nifer o argymhellion i wella perfformiad ariannol a pherfformiad gwasanaethau, gan gynnwys:

  • mae angen i gyrff y GIG gyflwyno adroddiadau ar eu sefyllfa ariannol i'r Adran mewn ffordd fwy cyson.
  • Mae angen i wariant cyfalaf mewn meysydd fel adeiladau a chyfarpar gael ei feintoli a'i flaenoriaethu'n well ar lefel Cymru gyfan.
  • Mae angen gwella ansawdd y cynlluniau integredig tair blynedd.
  • Mae angen i gyrff y GIG ddeall cynlluniau arbedion eu gweithlu yn well.
  • Gellir gwneud mwy i rannu arfer da ac unrhyw wersi a ddysgwyd.

Welsh NHS breaks even in 2013-14 with mixed performance against service targets

Our report finds that financial management is getting better although some NHS bodies over-spent, service performance was mixed and major challenges remain on the horizon.

NHS Wales broke even in 2013-14, despite three health boards being over spent, according to a report released today by the Auditor General for Wales.

The annual report, NHS Wales: Overview of Financial and Service Performance 2013-14, focuses on three main areas; financial management, performance targets and future planning of the Welsh NHS.

The report found that break even was achieved by the Welsh Government’s Department of Health and Social Services receiving an additional £200 million of funding from other departments and reserves and NHS bodies having to make significant financial savings. It also found that three NHS bodies failed to break even resulting in their accounts being qualified.

The Auditor General for Wales, Huw Vaughan Thomas said “Despite significant effort, NHS bodies are finding savings increasingly difficult to manage and this was underlined by three NHS bodies having their accounts qualified earlier this year.

It is good to see performance in areas such as prevention is improving but some cancer and stroke care targets are not being met and waiting times have generally got worse.

Although it is positive that NHS Wales is introducing a three year framework, there are still a number of risks and challenges ahead that will test and challenge the NHS not exceed their allocated revenue and capital budgets.

What is clear is that the NHS cannot continue as it is, some tough decisions will need to be made to change the way services are provided and this will require the support of politicians”.

The report also found that service performance across NHS Wales in 2013-14 was “mixed” and many key targets, such as waiting times for planned and emergency services, were not regularly achieved. Looking forward, the report  identifies that three-year integrated planning is a positive step forward but “NHS Wales will struggle to make progress without transformational change”.

The report identifies several positive points, highlighting the commitment to finding savings by NHS bodies, positive progress against some performance targets (specifically mortality data and integration of different parts of the NHS) as well as the potential for the emerging ideas about ‘prudent healthcare’ to lead to better services at lower cost.

The report makes a number of recommendations to improve financial and service performance that include:

  • NHS bodies need to more consistently report their financial positions to the Department.
  • Capital expenditure in areas such as buildings and equipment need to be better quantified and prioritised at an all-Wales level.
  • The quality of the three-year integrated plans need to improve.
  • NHS bodies need to better understand their workforce savings plans.
  • More can be done to share good practice and lessons learnt.

Heriau sylfaenol yn parhau ar gyfer Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn ȏl adroddiad ar y cyd ar drefniadau llywodraethu a rheoli

Mae canfyddiadau adolygiad dilynol a edrychodd ar drefniadau llywodraethu Bwrdd Iechyd Prifysgol Betsi Cadwaladr wedi cael eu cyhoeddi heddiw. 

Mae’r adroddiad, sy’n ddarn o waith ar y cyd rhwng Arolygiaeth Gofal Iechyd Cymru a Swyddfa Archwilio Cymru (SAC), yn rhoi adroddiad cynnydd ar yr heriau corfforaethol, clinigol ac ariannol sy’n wynebu’r Bwrdd Iechyd yn dilyn adroddiad a gyhoeddwyd y llynedd a ganfu ddiffygion mewn trefniadau llywodraethu a rheoli. 

Edrychodd yr adolygiad lefel uchel hwn ar y cynnydd yn erbyn y 24 o argymhellion a wnaed yn adroddiad y llynedd gan gynnwys effeithiolrwydd y bwrdd, strwythurau rheoli ac arweinyddiaeth glinigol y sefydliad, trefniadau llywodraethu ansawdd a diogelwch, gallu’r Bwrdd Iechyd i reoli ei gyllid a datblygiad cynlluniau strategol ar gyfer moderneiddio ac ad-drefnu gwasanaethau clinigol ledled Gogledd Cymru.

Er bod tystiolaeth o gynnydd yn erbyn rhai o’r argymhellion a wnaed yn adroddiad y llynedd, mae nifer o’r heriau allweddol a nodwyd y llynedd yn parhau ac mae gan y Bwrdd Iechyd ragor o waith i’w wneud cyn y gellir ystyried bod ei drefniadau llywodraethu a rheoli yn gwbl addas at y diben.

Ers yr adolygiad gwreiddiol 12 mis yn ȏl bu newidiadau sylweddol yn uwch bersonél y Bwrdd Iechyd gyda Chadeirydd, Is-gadeirydd, Prif Weithredwr, Cyfarwyddwr Meddygol a Chyfarwyddwr Gweithredol Nyrsio newydd wedi eu penodi. Mae hyn wedi rhoi ysgogiad newydd a phersbectif newydd o ran arweinyddiaeth mewn nifer o feysydd allweddol. Fodd bynnag, mae cyflymder y newid wedi arafu oherwydd yr amser y mae wedi ei gymryd i benodi Prif Weithredwr newydd.  

Mae’r adolygiad yn amlygu cynnydd o ran y ffordd y mae cyfarfodydd y bwrdd yn gweithredu a sut mae aelodau’r bwrdd yn cael eu cynorthwyo, ac mae’n dangos bod gwelliannau angenrheidiol yn cael eu gwneud i drefniadau atal a rheoli heintiau yn y Bwrdd Iechyd.

Fodd bynnag, mae heriau sylweddol yn parhau, yn arbennig mewn perthynas â darparu eglurder ynghylch ffurf y gwasanaethau clinigol yng Ngogledd Cymru yn y dyfodol ac ymdrin ȃ sefyllfa ariannol ansicr y Bwrdd Iechyd, sydd eisoes yn rhagweld diffyg ariannol sylweddol ar gyfer diwedd y flwyddyn ariannol bresennol.

Mae angen cymryd camau ar fyrder i adolygu strwythur trefniadol y Bwrdd Iechyd, i gryfhau atebolrwydd mewnol ar gyfer darparu gwasanaethau diogel ac effeithiol, i wella prydlondeb yr ymateb i gwynion ac achosion difrifol, ac i gryfhau capasiti cynllunio’r Bwrdd Iechyd.

Meddai Prif Weithredwr Arolygiaeth Gofal Iechyd Cymru, Kate Chamberlain: “Mae’n galonogol bod rhywfaint o gynnydd wedi ei wneud o ran mynd i’r afael ȃ’r pryderon a godwyd am drefniadau a gweithdrefnau llywodraethu’r Bwrdd Iechyd. Mae’n amlwg bod angen gwneud rhagor o waith i sicrhau bod y Bwrdd Iechyd yn gallu adnabod problemau’n ymwneud ag ansawdd a diogelwch gofal i gleifion, mynd i’r afael â nhw a dysgu oddi wrthynt. 

Er bod cynnydd wedi ei wneud, bydd angen ymdrin â materion fel hyn ar fyrder os yw’r Bwrdd Iechyd am ailennyn hyder ymysg ei staff, rhanddeiliaid a’r bobl mae’n eu gwasanaethu.”

Meddai Archwilydd Cyffredinol Cymru, Huw Vaughan Thomas: “Mae’r newidiadau sylweddol i uwch bersonél yn y Bwrdd Iechyd ar ȏl adroddiad llynedd yn golygu bod y Bwrdd mewn cyfnod o newid. Er hyn, mae cynnydd wedi ei wneud o ran mynd i’r afael â’n hargymhellion, yn fwyaf nodedig o ran sut mae’r bwrdd yn gweithredu a ffocws newydd ar y lefel uchaf ar drefniadau ansawdd a diogelwch.

Mae nifer o heriau i’r Bwrdd Iechyd eu goresgyn a chyda Phrif Weithredwr bellach yn ei swydd, bydd rhaid i’r gwaith o ymdrin â’r heriau allweddol hyn gyflymu’n benodol i fynd i’r afael â’r angen i wneud cynnydd brys i sicrhau model o wasanaethau ar gyfer Gogledd Cymru sy’n gynaliadwy yn glinigol ac yn ariannol.”

Fundamental challenges remain for Betsi Cadwaladr University Health Board says joint report into governance and management arrangements

The findings of a follow-up review examining Betsi Cadwaladr University Health Board’s governance arrangements have been published today. 

The report, a joint piece of work between Healthcare Inspectorate Wales (HIW) and the Wales Audit Office (WAO), provides a progress report on the corporate, clinical and financial challenges facing the Health Board following a report last year that identified failings in governance and management arrangements.

The high level review examined the progress made against the 24 recommendations made in last year’s report, including the effectiveness of the board, the organisation’s management and clinical leadership structures, quality and safety governance arrangements, the Health Board’s ability to manage it finances and the development of strategic plans for modernisation and reconfiguration of clinical services across North Wales.

Whilst there is evidence of progress against some of the recommendations made in last year’s report, a number of the key challenges identified last year remain and the Health Board still has more work to do before its governance and management arrangements can be seen as fully fit for purpose

Since the original review 12 months ago there have been significant changes in senior personnel at the Health Board with a new Chair, Vice Chair, Chief Executive, Medical Director and Executive Nurse Director being appointed. This has provided fresh impetus and new leadership perspectives in a number of key areas. However, the pace of change has been slowed by the length of time it has taken to replace the Chief Executive.

The review points to progress in the way that board meetings now operate and how board members are supported, and highlights that necessary improvements are being made to infection prevention and control arrangements in the Health Board

However, significant challenges still remain, particularly in relation to providing clarity over the future shape of clinical services across North Wales and addressing the Health Board’s precarious financial position, with a significant deficit already being forecast for the end of the current financial year.

Urgent action is needed to review the Health Board’s organisational structure, to strengthen internal accountabilities for delivering safe and effective services, to improve the timeliness of responses to complaints and serious incidents, and to strengthen the Health Board’s planning capacity.

Chief Executive of HIW, Kate Chamberlain stated: “I am encouraged to see that there has been some progress in tackling the concerns raised in relation to the governance arrangements and procedures at the Health Board. It is clear that there is still work required to ensure that the Health Board can identify, tackle and learn from issues that have arisen in relation to quality and safety of patient care.

While progress has been made, matters such as this will need to be treated with urgency if the Health Board is to rebuild confidence amongst staff, stakeholders and the people it serves.”

Auditor General for Wales, Huw Vaughan Thomas said: “Large scale changes in senior personnel at the Health Board in the wake of last year’s report mean the Board is very much in transition. Despite this there has been progress in addressing our recommendations, most notably into how the board operates and a renewed focus at the top level on quality and safety arrangements.

There are a number of challenges for the Health Board and with a new Chief Executive now in place, the pace at which these key challenges are tackled must increase in particular to address the need to make urgent progress in securing a model of services for North Wales that is clinically and financially sustainable.” 

Archwilydd Cyffredinol yn rhoi amod ar gyfrifon tri o gyrff y GIG yng Nghymru

Heddiw mae Archwilydd Cyffredinol Cymru wedi cymeradwyo’r olaf o'i 10 barn archwilio ar gyfer Byrddau Iechyd ac Ymddiriedolaethau'r GIG yng Nghymru ar gyfer y flwyddyn ariannol 2013-14.

Ac, am y tro cyntaf ers ad-drefnu’r GIG yn 2009-10, mae wedi rhoi amod ar ei farn ar gyfrifon tri Bwrdd Iechyd am dorri eu terfynau gwario cymeradwy – Bwrdd Iechyd Prifysgol Caerdydd a’r Fro, Bwrdd Iechyd Prifysgol Hywel Dda a Bwrdd Iechyd Addysgu Powys.

Dywedodd Archwilydd Cyffredinol Cymru, Huw Vaughan Thomas:

Heddiw rwyf wedi cymeradwyo'r olaf o 10 o gyfrifon y GIG ar gyfer 2013-14 – gyda thri ohonynt yn amodol. Mae hyn yn rhywbeth na welwyd ei debyg yng Nghymru o’r blaen ac yn rhywbeth y byddaf yn sôn amdano mewn mwy o fanylder yn yr Hydref pan fyddaf yn cyhoeddi fy adroddiad blynyddol ar gyllid y GIG.

Mewn blynyddoedd blaenorol, roedd cyrff y GIG nad oedd yn gallu ymdopi o fewn eu hadnoddau ariannol dyranedig yn derbyn cyllid diwedd blwyddyn ychwanegol gan Lywodraeth Cymru. Fodd bynnag, y flwyddyn hon nid oedd yr adran Iechyd wedi dyrannu cyllid ychwanegol i gyfrif am orwario pob un o'r Byrddau Iechyd.

Yn ogystal â’i dair barn archwilio amodol, mae Huw Vaughan Thomas unwaith eto'r flwyddyn hon hefyd wedi adrodd ar ddau Fwrdd Iechyd arall sydd ddim ond wedi llwyddo i weithredu o fewn eu terfynau adnoddau o ganlyniad i dderbyn cyllid ychwanegol gan Lywodraeth Cymru ar ddiwedd y flwyddyn. Y Byrddau Iechyd hynny yw Bwrdd Iechyd Prifysgol Betsi Cadwaladr a Bwrdd Iechyd Prifysgol Cwm Taf.

Mae'r Archwilydd Cyffredinol hefyd wedi adrodd ar fethiannau'r pedwar Bwrdd Iechyd i gael cymeradwyaeth gan y Gweinidog Iechyd ar gyfer eu cynlluniau tair blynedd integredig newydd, yn unol â’r gofyn ers 1 Ebrill 2014 yn sgil Deddf Cyllid y GIG (Cymru) 2014. Y Byrddau Iechyd hynny yw Bwrdd Iechyd Prifysgol Aneurin Bevan, Bwrdd Iechyd Prifysgol Betsi Cadwaladr, Bwrdd Iechyd Prifysgol Hywel Dda a Bwrdd Iechyd Addysgu Powys.

Mae’r materion hyn hefyd yn debygol o gael goblygiadau ar farn archwilio'r Archwilydd Cyffredinol ar gyfrifon cryno GIG Cymru sy'n cael eu paratoi gan Lywodraeth Cymru, pan fydd yr Archwilydd Cyffredinol yn cwblhau ei waith archwilio arnynt y mis nesaf.

Auditor General qualifies accounts of three NHS bodies in Wales

The Auditor General for Wales has signed off the last of his 10 audit opinions for Health Boards and NHS Trusts in Wales for the 2013-14 financial year.

And, for the first time since NHS re-organisation in 2009-10, he has qualified his opinions on the accounts of 3 Health Boards for breaching their approved spending limits – Cardiff and Vale University Health Board, Hywel Dda University Health Board and Powys Teaching Health Board.

Auditor General for Wales, Huw Vaughan Thomas said:

I have today signed off the last of the 10 NHS accounts for 2013-14 – three of which I have qualified. This is unprecedented in Wales and something which I will be commenting on in much more detail in the autumn when I publish my annual report into NHS finances.

In previous years, NHS bodies who were unable to manage within their allocated resources received additional year-end funding from the Welsh Government. However, this year the health department did not allocate additional funds to cover all of the Health Board overspends.

In addition to his three qualified audit opinions, Huw Vaughan Thomas has again this year also reported on two other Health Boards who only managed to operate within their resource limit because of extra funds given to them by the Welsh Government at year-end. They are Betsi Cadwaladr University Health Board and Cwm Taf University Health Board.

The Auditor General has, in addition, reported on the failures of four Health Boards to obtain approval from the Health Minister for their new integrated three-year plans, as required from 1 April 2014 by the NHS Finance (Wales) Act 2014. They are Aneurin Bevan University Health Board, Betsi Cadwaladr University Health Board, Hywel Dda University Health Board and Powys Teaching Health Board.

These issues are also likely to have consequences for the Auditor General’s audit opinion on the summarised accounts of NHS Wales that are prepared by the Welsh Government, when the Auditor General  completes his audit work on them next month.