Every failure documented on this site was, at some layer, a people failure that structure produced: the wrong leaders selected, the right engineers underpaid and overloaded, seven health boards left without digital muscle of their own. The people plan fixes the structure. Four parts: pay that matches the market, a professions framework that makes careers real, a pipeline that grows Welsh talent, and a minimum digital capability standard for every health board.
Pay the market rate — and say so in the advert
DHCW advertised its Head of Software Engineering at Band 8c (£71–82k) — well below market for the responsibility. That single line item is the recruitment strategy in miniature: price the role below the people who could do it, and the people who could do it don’t apply.
The fix is not heroic. NHS England ran commercial-recruitment ranges for digital roles for a decade; Scottish Government Digital publishes its pay strategy. Wales adopts the same instrument: a published digital pay framework, benchmarked annually against the UK market, applied to the standards body and available to health boards for embedded-team roles. Where Agenda for Change bands cannot reach the market, the framework says so and pays the supplement openly — a published, criteria-based Digital Recruitment and Retention Premium, not a workaround.
Selection is externalised for senior roles: commercial health-tech recruiters, published criteria, external panels — the machinery Flip the Model specifies, made permanent.
A professions framework
Engineers at DHCW had no ladder that valued staying technical. The successor adopts a digital professions framework — the UK Government Digital and Data profession model, adapted for Wales — with dual tracks: individual-contributor careers that reach senior levels without becoming managers, and management careers assessed on delivery. Capability assessments, not tenure. Published role profiles for every level, so the gap between a job and its pay is visible before it becomes a grievance.
Grow the pipeline
Wales does not have to import everyone. It has computer-science-strong universities, an apprenticeship system, and a health service people want to work for when it works.
- Degree apprenticeships and a graduate scheme. A national NHS Wales digital graduate and apprenticeship intake — cohort hiring, two-year rotations across the standards body and embedded teams, run with Health Education and Improvement Wales and the universities.
- Returners and career changers. Structured returnships for experienced engineers; conversion pathways for clinicians into clinical informatics (Clinical Leadership and Safety).
- Embedded teams as the destination. The most attractive engineering jobs in Welsh healthcare should be inside health boards, shipping software clinicians use that week. Six pilot teams under Flip the Model become the recruiting brand.
The board capability standard
Federation’s honest cost: seven health boards must be capable customers, and today they are not. The blueprint does not wish this away — it standardises it. Every health board meets a published minimum digital capability standard:
- An accountable executive digital leader (CDIO) on the board.
- A clinical informatics function — CCIO and clinical safety officers per the clinical safety chapter.
- Procurement capability certified against the national standards — with the option to buy this as a shared service.
- An embedded delivery team, or a shared one: smaller boards such as Powys pool teams and procurements by choice, through joint vehicles — cooperation as a board decision, not a national mandate.
- Published delivery metrics, same schema as the national dashboard.
The standards body assures the standard; Audit Wales audits it. Boards that cannot yet meet it get funded support to reach it — not an exemption from it.
The comparators’ lesson is unambiguous: Denmark’s regions and Estonia’s providers are competent buyers because their systems required them to be. Wales’ current system requires the opposite — helplessness by design, because the monopoly does everything. End the monopoly and you must build the capability. This is that plan.