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 | 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 blueprint 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.