Implementation Roadmap — Our Solution — Campaign for Responsible Leadership in NHS Wales

Reform blueprints are easy to write and hard to implement. We know this. We also know that the absence of a concrete timeline is the most common excuse for inaction — "we agree with the direction, we just need more time to plan." DHCW has been planning for five years. It is time to act.

This roadmap sets out what must happen immediately, what must be achieved in Year 1, and what the five-year transformation path looks like. Every item is specific, time-bound, and verifiable. There is no room for "we're working on it" — either the action has been completed by the stated date, or it hasn't.

The First 90 Days: Crisis Stabilisation

The first 90 days are about stopping the bleeding, establishing independent oversight, and creating the foundations for sustained reform. These actions require Welsh Government direction — DHCW's current leadership cannot be expected to reform itself.

Days 1-30: Governance and Leadership

Announce the Independent Technical Advisory Panel (ITAP) — Welsh Government publishes the terms of reference, begins recruiting panel members, and sets a date for the panel's first assessment. Target: panel operational by Day 60.
Initiate the CEO search — Welsh Government engages an executive search firm to begin an open, international search for a new DHCW CEO. Current CEO placed on garden leave or reassigned to a transition role. Interim leadership from outside DHCW appointed for the transition period.
Publish all outstanding data — DHCW directed to publish within 30 days: all programme costs and status, all contracts above £25,000, off-payroll headcount and total cost by band, and all board papers from the past 24 months. No excuses for delay — this data exists within DHCW's systems.
Appoint an Independent Freedom to Speak Up Guardian — External appointment, reporting to Welsh Government. Immediately available to receive disclosures from current and former staff.

Days 30-60: Assessment

Portfolio triage — The ITAP conducts a rapid assessment of all nine major programmes, classifying each as Continue, Pause, or Terminate. Published report with recommendations.
Commission the independent cyber security assessment — Engage the NCSC or NCSC-approved provider. Assessment begins within 60 days.
Baseline psychological safety assessment — Independent administration of Edmondson's instrument to all staff. Results published.
DDaT role mapping initiated — External consultancy maps all DHCW roles at Band 8a and above to DDaT role families. Draft mapping published for staff consultation.

Days 60-90: First Reforms

ITAP publishes its first programme assessments — The portfolio triage results are published. At least 3-4 programmes should be paused to bring the active portfolio within manageable bounds.
Mandatory transparency regime takes effect — DHCW begins publishing programme dashboards, contract registers, and off-payroll data monthly. Format and content requirements defined by the ITAP.
Board competence review — Independent assessment of current board members against the new competence requirements. Where gaps are identified, a recruitment timeline is published for new appointments.
Procurement reform announced — Open source by default policy published. Mandatory exit strategy requirements for all new contracts. Contract values above £500,000 published.

Year 1: Foundation Building

Year 1 builds the institutional structures that enable sustained reform. The crisis stabilisation actions of the first 90 days create breathing room; Year 1 uses that space to embed new ways of working.

Q1-Q2 (Months 1-6)

New CEO appointed and in post. Clear mandate, published objectives, Personal Accountability Statement signed.
ITAP fully operational. First round of formal service assessments completed for all active programmes. Published reports.
DDaT framework adopted. All roles Band 8a and above mapped. New job descriptions use DDaT competencies. Published on DHCW website.
NHS Service Standard adopted. All active programmes assessed against the 17-point standard. Remediation plans for gaps.
FHIR UK Core mandate published. No new system procurement without FHIR compliance. Conformance roadmap for existing systems initiated.
Staff Digital Council elected. First meeting held. Annual "State of Technology" report commissioned.
First four-nations comparison commissioned. Audit Wales engaged. Methodology defined. Data collection begins.

Q3-Q4 (Months 7-12)

Legacy remediation budget ring-fenced. Minimum 25% of technology budget allocated. First quarterly spend report published.
Cyber security assessment completed. Summary report published. Critical vulnerabilities identified and remediation initiated.
Digital pay supplement framework published. Benchmarked against GDS, NHS England, and market rates. Implementation begins for new hires.
First annual NHS Staff Survey results published. Benchmarked against NHS England comparators.
Blameless post-mortem practice embedded. At least 5 post-mortems published for significant incidents or programme failures.
API catalogue — Phase 1. Discovery completed. All existing APIs catalogued. Developer portal launched with documentation for first 10 APIs.
WGLL digital maturity baseline completed. DHCW and all Health Boards assessed. Results published.
First FTSUG annual report. Published and presented to Senedd.
First annual four-nations comparison published. Presented to Senedd.

Year 1 Success Criteria

By the end of Year 1, these conditions must be met:

Active programme portfolio reduced to maximum 4 major programmes
All active programmes assessed against NHS Service Standard
Independent oversight fully operational (ITAP, FTSUG, Senedd Panel)
Transparency regime in full operation (monthly programme dashboards, contract register, off-payroll data)
Baseline measurements established for all benchmarking metrics
New CEO in post with published Personal Accountability Statement
At least one legacy system remediation programme in active delivery

Years 2-3: Delivery and Transformation

Years 2-3 are about demonstrating that the new model works — delivering programmes to higher standards, closing the gap with the rest of the UK, and building public confidence.

Programme delivery

At least 2 programmes pass formal service assessments and move to Live.
Benefits realisation reports published for first completed programmes.
Sunlight Rule triggers first automatic reviews of any programmes exceeding 3-year mark.
Portfolio expanded cautiously — only after demonstrated delivery capacity.

Technical transformation

FHIR UK Core compliance achieved for at least 3 national systems.
API catalogue covers all major national systems with developer sandbox.
Welsh Health Data Exchange architecture defined and first connections established.
NHS England shared components — at least 2 adopted (NHS Login, NHS Design System) with Welsh language support.
No national system running on a platform out of vendor support for more than 12 months.

Culture

Psychological safety scores improve measurably from Year 1 baseline.
NHS Staff Survey results within 10% of NHS England comparator organisations.
FTSUG reports declining retaliation indicators.
Staff Digital Council publishes second annual "State of Technology" report — tone should be measurably more positive.

Benchmarking

Four-nations comparison shows measurable progress in at least 4 of 6 metric areas.
WGLL digital maturity scores improve for DHCW and majority of Health Boards.
Personal Accountability Statements reviewed — directors meeting commitments retained; directors failing commitments face capability review.

Year 2-3 Success Criteria

By the end of Year 3:

Wales has delivered at least 2 digital health services to Live that pass independent assessment
FHIR UK Core interoperability is established between at least 3 national systems
The four-nations gap has narrowed measurably in programme delivery and interoperability
The culture metrics show sustained improvement
Public confidence — measured through annual public survey — has improved

Years 4-5: Maturity and Sustainability

Years 4-5 are about embedding the new model as the permanent way of working — not a reform programme, but business as usual.

Goals

Digital maturity parity: Wales achieves WGLL scores comparable to the top quartile of NHS England organisations.
Full FHIR UK Core compliance across all national systems.
Welsh Health Data Exchange operational — all Health Boards connected, patient access to data logs available through NHS Wales App.
Sustainable talent pipeline: Voluntary turnover below UK digital public sector average. DDaT career pathways operational. Off-payroll reliance reduced by at least 50% from baseline.
Standing scrutiny normalised: The Senedd Digital Scrutiny Panel, ITAP, FTSUG, and Staff Digital Council are established institutions — not reform artefacts.
Public accountability normalised: Programme dashboards, benchmarking, PAS reviews, and post-mortems are routine — not exceptional.
The reform programme ends — because the reforms have become the way the organisation operates. Not because a ministerial statement declares victory, but because the evidence demonstrates it.

What Success Looks Like

Five years from now, we want to live in a Wales where:

A hospital doctor can see a patient's complete digital record — GP notes, medications, referrals, test results — through a single, standards-based interface, without logging into four separate systems.
A GP can send an electronic prescription that reaches the pharmacy instantly, as it does in England, Scotland, and Denmark — not through a paper-based process that hasn't changed in decades.
A patient can access their own health records, book appointments, and manage their care through an app that actually works — not one that has been "mired in delay, non-delivery."
An engineer who spots a problem can raise it without fear — and be thanked, not fired.
A director who fails to deliver faces real consequences — and a director who succeeds is recognised and retained.
A Senedd Member can look up, in real time, how much any DHCW programme has cost, whether it's on track, and who is responsible.
The people of Wales can be confident that their digital health infrastructure is safe, modern, and led by people who care about outcomes rather than optics.

None of this is radical. All of it is achievable. Every element has been implemented successfully in at least one comparable organisation. The only thing standing between Wales and a competent digital health service is the will to demand it.

This roadmap is our demand.