Welsh NHS trapped in doom loop, former minister and health board chief warn

NHS Wales is trapped in a damaging "doom loop" that forces health leaders to spend their time producing reports rather than actually improving patient care, according to warnings issued by a former Welsh Government minister and an ex-health board chief executive. According to Nation, Lee Waters and former Hywel Dda chief executive Steve Moore have published a joint paper titled From Escalation to Improvement alongside Tim Daley and Victoria Ford of Swansea-based consultancy Perago.

The report argues that the current system of administrative intervention has lost its original purpose. An escalation process originally designed to flag exceptional concerns has instead become an unyielding routine. According to the authors' analysis of all seven Welsh health boards, every single board has faced some level of escalation ranging from additional monitoring to special measures. Nation reported that the paper was written with Tim Daley and Victoria Ford, and explicitly notes that Perago and Mr Moore’s advisory business provide the exact type of external improvement support recommended in the findings.

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The Welsh Government defended its record by pointing to the introduction of the Accountability and Support Framework. According to the Welsh Government, this framework was introduced precisely to address the issues raised in the paper by shifting focus away from process and reporting toward improvement and measurable outcomes, while maintaining appropriate accountability for performance and public resources. Despite this, the authors warn that more and more patients will migrate to the private sector if performance is not gripped quickly, pointing to a slow unravelling of the social contract underpinning the NHS.

The paper specifically cautions against breaking up the Betsi Cadwaladr University Health Board, arguing that such a move would be counterproductive. Betsi Cadwaladr has remained under intervention at varying levels since June 2015, leaving special measures before returning. Instead, the authors argue that Betsi should become the first test case for a different approach featuring realistic timescales and targeted leadership support. Furthermore, the analysis highlights a combined health board deficit of £199 million, which occurred despite a real-time increase in revenue funding during the previous year.

To break the cycle, the authors propose reducing national performance measures from 53 to fewer than ten, establishing a single reporting channel, and publishing clear, measurable conditions for health boards to leave government intervention. Waiting lists are put forward as the immediate priority, managed through a national programme led by chief executives and medical directors. Mr Waters emphasised that these initial steps require no new legislation, funding settlements, or structural reorganizations, relying instead on practical delivery and clinical collaboration.

What happens next depends on the implementation of the Welsh Government's Accountability and Support Framework, which the paper acknowledges offers an opportunity for change provided it is properly executed by health boards and ministers alike.