NHS in Wales
The Welsh government develops a framework of policy and strategy, as
well as annual requirements for NHS performance. Local health boards are
responsible for planning for their local services. They put together a threeyear
Integrated Medium Term Plan, which is reviewed annually, and where
levels of reassurance are sufficient, Health Boards are rewarded with three-year
financial allocations and a measure of freedom in expenditure within the threeyear
period. The Welsh government is also in charge of emergency planning
and business continuity for NHS organizations.
Beyond this, the Welsh government is looking to change the planning
arrangements across public services. The Well-Being of Future Generations
Act (passed by the Welsh Assembly in March 2015) places a statutory duty on
public sector organizations to improve the economic, social and environmental
well-being of Wales in accordance with the sustainable development principle.
It will establish a Future Generations Commissioner for Wales, to monitor
and assess the achievement of the well-being objectives set by the specified
public authorities. Planning across public services (including health) will be
carried out by Public Services Boards (PSBs), whose aim will be to improve the
economic, social and environmental well-being of their area in accordance with
the sustainable development principle. The Act places Public Services Boards
and well-being plans on a statutory basis to create better alignment between
Health systems in transition United Kingdom 27
national and local well-being goals. The well-being plan must include objectives
designed to maximize each Health Board’s contribution within its area to the
achievement of the well-being goals. Each Public Services Board must also
review and amend its local well-being plan and produce annual progress reports.
Health and Social Care in Northern Ireland
The Northern Ireland Executive creates spending plans for the health department,
and the Department of Health, Social Services and Public Safety of Northern
Ireland handles planning for personnel, estate management and emergency
planning. The Strategic Investment Board (SIB) works with the Office of the
First Minister and Deputy First Minister to create a ten-year funding envelope
(budget). The health department helps the Strategic Investment Board in its
investments and thus has a say in the envelope, which is what it uses to plan.
The Health and Social Care Board and the Public Health Agency work together
to determine what services are required. This is an example of the emphasis
placed on intersectorality in the Northern Ireland health system (see Section 2.6).