Six actors at DHCW pull in incompatible directions. Welsh Government wants delivery and political cover; DHCW leadership wants self-preservation; health boards want their own priorities served; clinicians want functioning systems; staff want continuity; auditors want accountability. Every intervention from any one actor is partially countered by the others. The system's net motion is near-zero — which is why twelve months of Level 3 monitoring produced no change, and why Level 4 will produce no change without a structural rebalance of who holds what authority.
What is the policy-resistance trap at DHCW?
Policy Resistance occurs when multiple actors within a system have conflicting goals, and each actor’s actions to achieve their goal counteract the others. The result is stalemate: enormous effort is expended, but the system barely moves.
How It Manifests at DHCW
Six actors are pulling in different directions simultaneously:
| Actor | What they want | What they do |
|---|---|---|
| Welsh Government | National standardisation, value for money | Co-author failure conditions (DPIF cuts, capital refusal, RAG pressure), then escalate for the consequences |
| DHCW Leadership | Self-preservation, empire growth, narrative control | Grow headcount, manage scrutiny, suppress dissent |
| Health Boards | Local autonomy, systems that work | Resist imposed systems, run shadow IT |
| Clinicians | Tools that improve patient care | Ignore or workaround systems that slow them down |
| Vendors | Revenue maximisation | Expand scope, extend timelines, avoid accountability |
| DHCW Technical Staff | Deliver working systems, raise real risks | Raise concerns — and get dismissed |
The addition of DHCW’s own technical staff as a resisting actor is the most telling feature. In a healthy organisation, technical staff and leadership are aligned. At DHCW they are in direct opposition: staff want to deliver and flag risks, leadership wants to control the narrative and suppress risk signals.
DHCW is fighting itself in addition to fighting external resistance. This internal opposition is itself a symptom of absent psychological safety — staff who want to raise risks learn that raising risks produces retaliation (see also L9: Whistleblower Suppression). The resistance is not behavioural friction. It is rational self-protection.
The structural design also locks the resistance in place. Take EPMA: DHCW is measured against EPMA milestones by Welsh Government, but as Evans admitted on the record, “the national EPMA program is a coordinating and knowledge sharing function… Each local organisation has its own EPMA implementation program. They are the accountable delivery body.” DHCW carries the consequences for missing milestones it does not control. Health boards control the implementation but face no equivalent accountability. The actor measured cannot deliver, the actors who can deliver are not measured, and Welsh Government — which set up the gap — escalates DHCW for the result. Resistance is not just behavioural friction between actors. It is engineered into the organisational chart.
Produced By
L2: The Credibility Death Spiral — health boards resist because they don’t trust DHCW to deliver. L7: The Competence Void — leaders without tech experience make decisions that technical staff must then resist. L9: The Whistleblower Suppression Loop — technical staff resistance is punished, driving it underground rather than resolving it.
How is the policy-resistance trap broken?
Align goals by making delivery the only metric that matters for career survival. Currently, loyalty matters more than delivery for career progression at DHCW. Reverse this: tie leadership tenure to externally verified delivery milestones. When every actor’s self-interest aligns with patient benefit, policy resistance dissolves.
The blueprint’s Intervention 1: Competent Leadership targets this trap directly – removing the leadership whose goals conflict with every other actor’s is the only way to align the system and end the stalemate.