Dear First Minister: You Inherit a Crisis — Articles — Campaign for Responsible Leadership in NHS Wales

Congratulations to Rhun ap Iorwerth, the new First Minister. To every newly elected and re-elected Member of the Senedd. And to the people of Wales, who voted for change in numbers that ended 27 years of Labour government.

You stood on a platform of transformation. The people believed you. They gave you a mandate — 43 seats where you had 23, a minority government with more support than any alternative. That mandate was earned on a promise to fix public services.

We note that the new governing party voted against a public inquiry into Betsi Cadwaladr in June 2025. We raise it not as an accusation but as a baseline: we will measure this government by whether it does what the last one would not.

This letter is about the scale of what you have inherited — and the cost of failing to match it with action.

What You Inherit

You inherit a system that its own government described, in March 2026, as "complex, data-heavy, burdensome for NHS organisations, lacks transparency and does not drive improvement."

That is not a campaigner's assessment. That is the Welsh Government's own published finding about the system it built and ran for 25 years.

Here is what the data shows:

Every health board in Wales is at Level 3 or higher on the Oversight and Escalation Framework. All seven. This has never happened before.
Betsi Cadwaladr has been in Special Measures for over a decade — the longest intervention in UK NHS history.
Digital Health and Care Wales is at Level 4 — the highest escalation ever applied to a non-health-board NHS body. Every major programme it managed was failing when escalation was imposed.
741,000 open patient pathways. One in four Welsh people waiting for care.
5,300 patients waiting over two years — compared to 182 in England.
Wales is the only UK nation without an Independent Whistleblowing Officer.

These are not inherited problems from a single bad year. They are the accumulated output of a system that has been failing for a generation.

Why It Cannot Fix Itself

The system cannot be reformed by the people who built it. This is not a political statement. It is an observable fact.

The same network of leaders has rotated between the same institutions for 25 years. Four of the most senior national health positions in Wales were filled from a single health board. The person who designed the 2009 restructuring was appointed to chair the 2024 review of why it failed. The inspectorate reports to the government it inspects. The independent patient watchdog was abolished and replaced by ministerial appointees. (See the forthcoming System of Failure article for the full structural analysis.)

The people running the system were raised in the system. They were promoted through the system. They know no other system. When challenged, they respond with the only tools the system taught them: deflect, sanitise, reframe dissent as misconduct, and remove the dissenter.

This is not malice. It is something more dangerous: a culture so deeply internalised that the people inside it genuinely cannot see what is wrong. They have never worked in a system that functions differently. They have never seen what good looks like.

The BMA reports that 50% of SAS doctors in Wales have experienced bullying, harassment, or victimisation. At DHCW — the national digital body — staff burnout runs at 65%. These are not numbers that happen to organisations with healthy cultures. They are the output of a system where dissent is reframed as misconduct and compliance is rewarded with survival.

When a consultant told the most senior civil servant in Wales that DHCW was not changing, the response was: "I don't see your future in digital." When a CEO raised financial crime concerns to the NHS Wales Chief Executive, he described encountering "collusion, bias and bullying." When the Wales Audit Office published a damning report on the digital body, according to an insider with direct knowledge, the response from the top was: "Don't worry about any of this. It'll all blow over."

It did not blow over. Seven years later, every board in Wales is failing.

They have never worked in a system that functions differently. They have never seen what good looks like. And they cannot build what they have never seen.

The Augean Stables

In Greek mythology, Heracles was tasked with cleaning the Augean stables — a task considered impossible because the filth had accumulated for decades and the system that produced it was still running. He did not try to clean the stables stall by stall. He diverted two rivers strong enough to power wash all the dirt.

NHS Wales needs rivers, not brooms.

The temptation will be to make incremental adjustments. To keep the existing leadership in place while adding oversight. To commission another review. To publish another framework. The previous government did all of these things. It produced 25 years of the same results.

The people advising you right now — the Permanent Secretary, the NHS Wales CEO, the executive teams at the health boards, the leaders of the national bodies — are the people who produced these results. They will present plans. The plans will be articulate, well-structured, and informed by the same assumptions that produced the failure. They will recommend strengthening the existing architecture. They will not recommend replacing it, because they are the architecture.

The First Test

Your manifesto commits to a 10-year delivery programme for Digital Health and Care Wales, with the ambition of establishing Wales as a "world leader in digital health innovation."

DHCW is currently at Level 4 — the highest escalation ever applied to a non-health-board NHS body. Here is its record:

Nine flagship programmes under Enhanced Monitoring for delivery failure — enterprise architecture, NHS Wales App, Connecting Care, data architecture, diagnostics, GP migration, medicines, intensive care, cancer informatics. These are the systems every NHS Wales patient encounters. Every one is failing.
Four more programmes killed, paused, or stripped to design-only — including WCCIS (social care) and the national laboratory system.
£600 million of public funding received since April 2021. Total demonstrated return, stated by DHCW's own Director of Finance at the January 2026 accountability meeting: £0.5 million in non-cash time savings from a single system. That is 83p for every £1,000 invested.
£49 million spent on external consultants and contractors — while headcount grew and core funding rose 78% in four years. Budget now approaching £200 million per annum — the highest-funded year in its history, achieved under escalation for delivery failure.
£20.6 million to a single supplier, Kainos, with no per-programme spend breakdown ever published.
Three infrastructure failures in 21 months, including a total NHS Wales network outage in March 2026 that took every service offline for over eight hours. The CEO's warning that a repeat "should be a never event" was deleted from the published minutes.
Its Chief Digital Officer was pushed out. The role went vacant. The independent member who challenged the board was sanitised from the record. The Band 9 engineer who raised protected disclosures was dismissed with a gross misconduct finding designed to make him permanently unemployable.

And these programmes are not failing because of underfunding. They are failing because the people leading DHCW have no documented record of delivering digital programmes at scale.

The Leadership Gap

The CEO's career path, reconstructable from public sources, runs through information management and patient records administration — not technology delivery. She holds a "Professor of Practice" title awarded by the University of Wales Trinity Saint David — DHCW's training partner and MoU counterpart. The title was awarded at the same ceremony where she signed the partnership agreement with the university.

Three executive board members hold the same honorary title from the same institution. None has a doctoral degree. None has peer-reviewed publications. None went through a governed academic appointment process. The titles paper over the gap between the careers they had and the roles they were given.

The Executive Director of Strategy is a historian by training who spent 15 years in Welsh Government, where he co-authored the national digital health strategy — A Healthier Wales. He then left government and joined DHCW to implement the strategy he had written. He now reports on whether his own plan is succeeding. The author wrote the brief, implemented the brief, and evaluates the brief. This chain has never been subject to independent assessment.

The Medical Director was appointed through a "protected list" — as an internal candidate, the role was offered to him first with no open application process. He has no digital delivery background. He terminated the Director of Digital at another health board for posting about open architecture on Twitter.

This is not a leadership team that failed despite having the right skills. It is a leadership team that was never equipped to succeed — appointed through a closed network, credentialed by their own partners, and protected from scrutiny by the system that produced them.

This is the organisation your manifesto asks to make Wales a world leader in digital health innovation.

The Choice

Your 100-day plan already promises an audit of all health data sources. That is welcome. But the test is not whether you commission the right review. The test is whether you allow DHCW's current leadership to write the 10-year plan before that review reports.

If they do, the people who produced the failure will have designed the future. The new government will have inherited the circle — and closed it tighter.

Your likely Health Minister, Mabon ap Gwynfor, already knows the pattern. On 3 December 2025, he stood in the Senedd and asked Jeremy Miles about the Donegan case — citing the Velindre Trust annual report directly: "Governance concerns have been raised by the Trust in relation to Shared Services. Is the Welsh Government aware of these concerns, and, if so, what actions has the Government taken?" He received no meaningful answer. He now has the power to demand one.

Darren Millar — who told the previous First Minister the system "absolutely stinks" and called for police investigation — is still in the Senedd. He will be watching too.

What Patients Need From You

The patients of Wales — the 741,000 people on waiting lists, the families who lost someone at Betsi Cadwaladr, the staff too afraid to speak up — do not need another framework. They need five things:

1. New leadership from outside the circle. The Senedd's own committee found appointments come from "the same pool of people, usually clustered around Cardiff." The pool must be broken open. Bring in leaders who have run successful health systems elsewhere — people who know what good looks like because they have built it, not because they have read about it in a strategy document written by the people who failed.

2. An independent NHS Wales inspectorate. Healthcare Inspectorate Wales is part of the Welsh Government. It inspects the services run by its own employer. In England, the CQC operates as an arm's-length regulator. Wales needs the same. An inspectorate inside the government is not an inspectorate. It is a department.

3. An Independent Whistleblowing Officer. Scotland has one. England has the National Guardian's Office. Wales has a framework document with no enforcement mechanism, signed by the head of the system the concerns are about. Staff who raise concerns in NHS Wales lose their positions — every documented time, without exception. An independent officer with statutory powers to receive disclosures, investigate retaliation, and publish findings is not optional. It is the minimum.

4. External review of every senior appointment. Establish a Welsh Public Appointments Commissioner with statutory powers. Every NHS chair, every chief executive, every board appointment — subject to independent scrutiny. The closed pool that produced a system where the architect reviews her own architecture must be opened.

5. Commission an independent culture review within 100 days. Not by the people inside the system. Not by the inspectorate that reports to the government. An external, independent review of leadership culture across NHS Wales — with the power to interview staff confidentially, examine retaliation complaints, and publish findings without ministerial approval. The culture will argue that it does not need reviewing. That argument is the culture.

The people of Wales voted for change. They did not vote for the same system with a different logo.

Every day that the existing leadership remains in place without external oversight is a day that the system of failure continues to operate. Every framework published without enforcement is a framework that protects the people it should scrutinise. Every appointment made from the same pool is an appointment that closes the circle tighter.

The stables have been accumulating dysfunction for 25 years. The rivers are available. The question is whether the new government has the will to divert them.

The patients of Wales will be waiting.

Rose Davies CareNHS

CareNHS invites the new First Minister and the incoming Health Secretary to respond to the matters raised in this letter. If received, we will publish their response in full. Contact: carenhs@carenhs.org