A blueprint without a route to adoption is a wish. This page names the decisions, the decision-makers, and the instruments — and what the first ninety days look like, because a 36-month reform survives politically only if it pays something visible up front.
The decisions and who owns them
| Decision | Owner | Instrument |
|---|---|---|
| Commission the independent forensic review (I1) | Cabinet Secretary for Health | Ministerial direction, with Audit Wales cooperation |
| Mandate data publication (I2) | Welsh Government / Senedd | Directions initially; permanent duties need regulations or a Senedd Act |
| Reconstitute the board; reset leadership | Welsh Government | Digital Health and Care Wales (DHCW) is a Special Health Authority — Welsh Government holds establishment and appointment powers |
| Re-scope DHCW to a standards body (I4) | Welsh Government | Amendment to the establishment instruments and a new remit |
| Multi-year programme envelopes (I5) | Welsh Government finance | Budget process; no primary legislation required |
| Reform-the-funder discipline (I6) | Senedd PAC + Welsh Government | PAC inquiry, Audit Wales examinations, published RAG audit trail |
The striking fact in that table: most of the Digital Blueprint for NHS Wales needs no new law. The monopoly was made by executive instruments, and executive instruments can unmake it. Statute is needed where discretion must be permanently removed — the publication duties — and that is precisely why Radical Transparency asks for it.
The window
A new Senedd term began in 2026. New terms write programmes for government; programmes for government fund what is already worked out. This blueprint is the worked-out version. The ask, in programme-for-government language: an independent forensic review of national digital delivery, statutory transparency for NHS Wales digital bodies, and a standards-based delivery model — reform cost £5–15M, first-year savings larger.
The first 90 days
Announcements buy a week; delivery buys the next month. Five moves, all cheap, all fast, all visible:
- A live public status page for national clinical systems — uptime and incidents, published as they happen. Costs almost nothing; changes the transparency default overnight.
- Transcript-fidelity minutes from the next board meeting onward — the anti-sanitisation protocol, started voluntarily before statute compels it.
- Publish the contract register above £100K, including the values never before stated in a public forum.
- Name the independent digital expert appointed under escalation, publicly, with their reports published.
- One clinician-visible fix per health board, chosen by the board’s clinicians, shipped inside 90 days by the future embedded teams working in pilot form — the down payment on “DHCW delivered what they promised,” which the monitoring framework treats as the single most important signal.
Who else moves
The Cabinet Secretary decides; others make the decision easier. PAC can open the Reform-the-Funder workstream on its own authority. Audit Wales can examine Welsh Government decisions as causally upstream of DHCW outcomes. Health board chairs can request the capability standard and joint-procurement vehicles. The Royal Colleges can put their December 2025 finding on the record annually until the boundary harms stop. Each actor’s move is independently useful; together they make the central decision close to inevitable. That is distributed oversight doing its work before the reform even starts.