Competent Leadership

This is the intervention that makes every other intervention possible.

1. Commission an independent forensic review of DHCW’s recruitment practices, vendor procurement decisions, and programme delivery — conducted by reviewers from outside the NHS Wales ecosystem, with statutory Audit Wales powers.
2. Mandate publication of all whistleblowing data, disciplinary proceedings, staff leavers analysis, and contract values — remove DHCW’s discretion to suppress this information.
3. Require independent skills audits of all executive and director-level roles — measured against verifiable competency frameworks used by comparable organisations.
4. Establish a protected reporting channel for DHCW staff to raise concerns directly to Audit Wales or Welsh Government, bypassing DHCW management entirely.
5. Set hard, externally-verified delivery conditions tied to leadership tenure: if specific programmes do not reach specific adoption milestones by specific dates (not self-reported), leadership is replaced. Not reshuffled. Replaced.
6. Conduct patient safety triage — independent clinical safety review of every live national system with documented incident history: WPAS (documented patient-safety risk), eMPI (patient record mixups), WCCG (running on unsupported technology for 8+ years against repeated technical staff warnings), WICIS (“effectively still on pause”), RISP (global worklist issue threatening cross-Wales image viewing), PSBA-class shared infrastructure, and the data-centre estate. Pause systems where the safety case is unsupported. Publish findings.
7. Reset the non-executive board — replace the executive and audit the non-executive board against published competency criteria. Sub-committees that produced zero corrective actions across eighteen consecutive months — the Performance and Delivery Committee from May 2024 to May 2025 — must be reconstituted with technical NEDs. The departures of Rowan Gardner, Simon Jones, and Ruth Glazzard between 2025 and 2026 removed the sharpest governance voices on the board; the reset must replace them with people capable of asking the questions Gardner asked.
8. Disclose the patronage pipeline — full audit of declarations of interest across DHCW history, examining the instances where directors recorded “nil” on the register while interests were, in fact, held. The ABUHB CEO succession (three NHS Wales CEOs from one health board, through a long-running patronage pipeline) is examined for its bearing on appointments at DHCW.

Why first: Every subsequent intervention depends on leadership that is competent, accountable, and committed to delivery over self-preservation. Implementing transparency dashboards under leadership that blocks websites and suppresses data is futile. Embedding clinical teams under leadership that overrides technical experts is futile. And no intervention lands while the cultural prerequisite is inverted — the record is unambiguous. The eight actions above run in parallel from Month 0 — none can wait.

Who does what