Systemic problems at health board are unacceptable, says health minister

Wales' health minister has said concerns raised in a damning report into a health board were "unacceptable and must be urgently addressed".

An independent assessment into Cardiff and Vale health board raised concerns about leadership, culture, governance, planning and organisational capacity.

Mabon ap Gwynfor said the Welsh government would "not allow such issues to continue" and would "robustly hold the health board to account" but added there was "no more money from the government to fund improvements".

Chris Bown, interim chief executive of the health board said: "We are committed to listening, learning and taking action."

The report was commissioned after the health board was put at the second highest level of oversight and escalation by NHS Wales in June 2025 - one below special measures.

Written by independent advisors Prof Em Wilksinson-Brice and Dr Pamela Johnston, it focused on the root causes of existing problems - particularly critical were the findings on leadership and culture within the organisation.

The next phase of the intervention will consider how to resolve the issues raised.

The report stated "there is a lack of positivity, direction setting and clear decision-making" by the executive team.

It said the "financial narrative has been allowed to dominate the agenda at the expense of quality of care" and there was a "failure to focus on patient outcomes as the primary metric of success".

Staff reported a "widely held belief... that there is not the management capability to transform services" within the health board.

The report spoke of a failure to "reset" after Covid - where many experienced staff retired and there was a "management capability gap in the workforce".

There was a "pervasive culture of learned helplessness" within the health board and a "lack of pace and urgency even when confronted with serious issues", it continued.

It added there was a "lack of challenge" because people did not want to be unkind and a "background of insular, hierarchical and old fashioned views".

Staff were interviewed anonymously for the report and described a "longstanding culture [over decades] of tolerance of poor behaviours including incivility, disrespect and poor team working, with a failure to tackle thee even when a whole team is negatively affected".

Among the findings was a "digital immaturity" which "significantly hampers the progress" of the health board.

It said evidence shared with the advisors of "at least one manual process" where a patient was not followed up because a piece of paper posted under a door was lost.

There was a frustration expressed that as well as its local responsibilities, the health board provides highly specialised care for the wider population of Wales, and hosts the Major Trauma Centre for the country, but that contribution was not recognised in the funding model.

There was a "lack of agreement and communication for plans for the estate" - referring to crumbling hospital infrastructure and there was a "cultural disappointment and loss of faith in the pride many once felt" working for the health board.

In terms of governance, the advisors found the board "lacks rigour" and "risk management is poorly understood", as well as "quality and safety not universally prioritised".

HR policies were singled out as being "variably implemented" with accountability needing to be improved at all levels.

The report also raised concerns about plans already in place to address the problems in the health board, saying while there was a "plethora of high-level strategic intent documents often described as plans", there was not a "common understanding" across the health board of "what constitutes a plan" and the "execution and implementation" of those plans was lacking.

It acknowledged improvements had been made at board and governance levels since the appointment of a new chair and it emphasised the health board had examples of "excellent care".

Ap Gwynfor said the health board's challenges were "systemic and long-standing, requiring organisational reset, a single recovery plan, stronger accountability, assurance and cultural change.

"We expect them to deliver within the envelope they have and we expect the health board to make sure they deliver on the improvements recommended in the report at pace."

He acknowledged the criticism about the condition of the health board's estate saying it was "fair" and the priority was to "ensure the money that we have got works as hard as possible in improving those backlogs"

Bown, who only started in the role on Monday, said the health board took the findings "extremely seriously and recognise that there are a number of areas requiring improvement - these must be addressed at pace".

"There are multiple changes we need to make. I'm confident that we can improve our financial management and use that money more effectively.

"I'm confident that we can shift that dial on culture and although that will take some time, we've got to start somewhere. It's entirely possible," he added.