A new report says that governance and accountability in the NHS is currently ‘inherently confused, overly complex and inimical to systematic collaboration'.

Plaid Cymru's spokesperson for health and social care, Mabon ap Gwynfor MS, said: ‘Despite NHS funding accounting for half of the Labour Welsh Government's entire £20bn budget, it simply isn't being used strategically and neither is the NHS being run efficiently.

‘With all seven health boards in Wales in some form of escalation and intervention status, it's clear our NHS needs a change of direction.'

The report identified several shortcomings and proposes the following reforms to strengthen the health service:

• Goals, Priorities and Planning: simplify healthcare planning and ensure more realistic and deliverable targets
• Roles and Accountability: improve accountability by redefining the responsibilities of the Welsh Government and NHS Executive to stop ministers micromanaging the NHS
• Partnership Working: closer working between health and social care through efficient resource-sharing
• Capability and Capacity: increase specialist knowledge of healthcare governance in the civil service to improve public health policies and delivery
• Performance Measurement and Management: greater data collecting on health service performance and clearer criteria for escalation measures
• Public and Patient Engagement: empower the patient voice and promote a culture of welcoming comments and complaints to improve the patient experience and public transparency
• Culture: create standardised rules for senior NHS leaders to ensure that accountability arrangements are met.

Director of the Welsh NHS Confederation Darren Hughes, called for a ‘clear national operating model for the whole health and care system, ensuring clarity and focus on new and existing arrangements, strengthening existing relationships and partnerships, and improving the transparency in how health and social care services are planned, delivered and improved'.

Hughes added: ‘It's also clear there is an opportunity for the NHS Executive to provide clarity and purpose by focusing on translating and supporting government policy into front line delivery to provide a whole-system shift.

‘A key omission from this report is the need for improved whole-system data – to include social care – in order to improve transparency and build a full picture of pressures points across the health and care system.

‘We look forward to continuing to engage with all political parties as they develop their manifestoes in the run up to the 2026 Senedd election.'

A Welsh Government spokesperson said: ‘The health secretary published the Accountability Review and our initial response to it its recommendations a week ago. These will help the NHS to continue in its performance journey, improve timely access to treatment and improve patient care.

‘A new external Ministerial Advisory Group on NHS Performance and Productivity has also been appointed. It will provide an independent review of the existing arrangements in place to support improvements in NHS Wales.'