THE head of NHS Wales has delivered a blistering rebuke to Hywel Dda University Health Board, ruling that it has breached its legal duty after failing to produce a credible plan or bring its finances under control.

In a letter dated July 23, NHS Wales chief executive Jacqueline Totterdell said the board had failed statutory planning and financial requirements and had not met the test for de-escalation. Her conclusion was stark: Hywel Dda has no agreed or supported annual plan.

The scale of the crisis is laid bare in papers presented to the board. Hywel Dda plans to overspend by £41m this year, but its gross forecast is £62.2m. That figure relies on £21.2m of hoped-for savings which have yet to be confirmed.

Its underlying deficit stands at £68.8m — an improvement from £81.5m in April, but still branded “unsustainable” in the board’s own documents. Of a £42.8m savings target, just £21m has been identified, leaving a £21.8m black hole. Only £5.1m of those savings are recurring.

The board’s risk register gives financial sustainability the maximum danger score of 25 out of 25.

Paging Doctor Mabon art
(Cambrian News)

It is not the first warning from the NHS chief. In June, Ms Totterdell said Hywel Dda lacked sufficient grip on its biggest challenges and showed “a clear lack of ambition to deliver”. She also raised patient-safety concerns after two “never events” involving nasogastric feeding tubes, saying it was concerning that lessons had not been learned after the first incident.

Hywel Dda has now used its highest internal escalation level for the first time, placing two divisions with combined budget gaps of £24.6m at Level 4. Externally, finance, planning, urgent and emergency care, fragile services including ophthalmology, and healthcare-associated infections also remain at Level 4.

Against that backdrop, board papers show approval for three new planning posts costing £310,971 a year as an “exception to financial governance”, while acknowledging the appointments will worsen the financial position.

Campaign group Protect Bronglais Services said it was “absolutely astonished” the crisis had received so little attention. It accused senior management of continuing failure and questioned how a proposed £20m overhaul of stroke services could be justified while the board’s finances were in such peril.

PBS also challenged Health Secretary Mabon ap Gwynfor to explain how the Welsh Government would deliver its pledge to make Bronglais a “hospital of rural excellence” and protect its stroke unit. The group said repeated requests for answers had gone unanswered, adding: “His silence on both fronts is positively deafening.”

“Given their more than parlous financial state, what is the Welsh Government's response to this deficit?,” spokseperson Lisa Frances said. “How does this latest report affect Hywel Dda's attempt to drive forward their plan for a so-called reform of services? Moreover how does the estimated cost for all of this (changes to Stroke services) at £20m fit into the situation. “

The breach raises fresh questions over whether Hywel Dda can press ahead with sweeping service reforms while its plan remains unsupported and its finances are at breaking point.