Exclusive: Almost 300 of Wales’ most senior medics met to agree this letter raising concerns about the Cardiff and Vale university health board and the flagship University Hospital of Wales, Heath, Cardiff
Ambulances queuing outside the University Hospital of Wales in Cardiff in November.(Image: Lianne Mcmullen)
This is the full text of the letter sent by the senior consultant body at the University Hospital of Wales, expressing “deep anxiety” about how the health board is being run. You can read the context around the letter here.
Dear Mrs Williams [the health board’s recently appointed chairwoman, Kirsty Williams],
On behalf of all members of the Senior Medical and Dental Staff Committee (SMSC) and the Local Negotiating Committee (LNC), we welcome your appointment as chair of Cardiff and Vale University Health Board.
We look forward to your leadership and to working with you to preserve and enhance the quality of healthcare for the people of Wales.
The SMSC represents all consultants in medicine and dentistry across the Health Board’s secondary care services, encompassing medical, surgical, intensive and acute care, dental, diagnostic, and public health specialties working both locally and regionally.
We meet regularly to discuss issues that directly or indirectly impact patient care. At our most recent extraordinary meeting on 21 October 2025, attended by nearly 300 consultants, a number of serious, long-standing concerns were raised.
The overwhelming majority expressed deep anxiety about the current state of patient care and agreed on the need for urgent action as the current situation is not sustainable.
It was further agreed that these concerns should be formally communicated to the Board and Executive Team, with an opportunity for a written response within two weeks, prior to SMSC writing to the Welsh Government (WG).
Below is a summary of the issues for your and the Executive Team’s consideration:
1. Limited Clinical Engagement in Management
Consultants reported that clinical input is frequently overridden by managerial decisions made without adequate consultation.
Operational management often prioritises non-clinical perspectives, leading to limited and superficial clinical engagement in key decisions that directly affect patient care.
2. Lack of Visible Leadership
There is a growing perception of disconnect between the executive leadership and frontline clinical teams. While relocation of the senior management to Woodland House is not the sole reason, it has contributed to reduced visibility and engagement.
Little has been done to bridge this gap or maintain effective communication with SMSC members. The Executive Team’s reported surprise at issues identified in the recent theatres review is one of several examples cited of limited leadership presence and awareness.
3. Management Approach and Culture
Many consultants described a “firefighting” culture, focused on short-term fixes rather than sustainable solutions. Concerns were raised about the proliferation of middle management, frequent circular meetings without outcomes, and a lack of visible long term strategic direction.
Decision-making appears concentrated among a very small group of senior individuals, which has led to frustration, disengagement, and a perception of exclusion among clinical and even senior leadership teams.
4. Hospital Infrastructure
The deteriorating condition of hospital infrastructure across all sites remains a serious concern. Persistent issues including sewage leaks, water damage, and poor cleanliness continue despite repeated reports from senior clinical staff.
Years of insufficient maintenance and capital investment have compounded these problems, and no clear strategic plan has been shared to address or mitigate the associated risks.
Recent reports that the UHW2 [a long-mooted new hospital] development project may have been paused or cancelled, without any communication to clinicians, are particularly alarming. This uncertainty has heightened concerns about the Health Board’s ability to deliver safe, modern healthcare services.
We would appreciate urgent clarification on whether planning has indeed ceased, and if so, the reasons for this decision. In the medium to long term, progressing with such a development is essential, as continuing operations in the current estates is increasingly uneconomical and unsuitable.
5. Workforce Morale
Morale among consultants and the wider workforce is at an all-time low. High attrition rates, combined with a perception of inaction on staff feedback and wellbeing, are leading to burnout, recruitment challenges, and risks to patient safety.
The manner in which the workforce has been treated in recent years, as highlighted in multiple reviews, has eroded trust and engagement. Proposals from the LNC to the Executive Team have not resulted in any meaningful change.
Decisions made without clinical input have further undermined confidence. Visible, empathetic leadership and active listening, instead of the announcement of already made decisions, are urgently required to rebuild morale and trust.
6. Information Technology (IT)
Reliable IT systems are fundamental to safe and efficient care. Persistent system failures, outdated hardware, and the inability to use digital tools effectively are directly compromising patient care and staff productivity.
A comprehensive review and targeted investment in digital infrastructure are urgently required.
7. Recruitment Freeze
The recent decision to freeze recruitment, following a year-long vacancy freeze, is deeply concerning. The stated aim to reduce the workforce by around 350 posts to release £4.2million by March 2026, with further reductions to follow, was made without consultation with the SMSC or LNC.
Such measures risk exacerbating burnout, disengagement, and poor clinical outcomes. Indiscriminate freezes are an unsustainable response to financial pressures and fail to address the underlying causes of the fiscal crisis.
Evidence from other settings shows that these approaches can lead to unsafe conditions, adverse patient outcomes, and critical external reviews.
8. Funding and Financial Arrangements
The Health Board continues to deliver tertiary and national-level services within an outdated and inequitable funding framework.
The current model fails to capture the complexity and true cost of modern healthcare delivery. Existing Joint Commissioning Committee (JCC) arrangements entrench historical inequities and have not been subject to robust scrutiny.
The lack of a coherent, evidence-based approach to funding tertiary services has left the Health Board chronically underfunded, undermining service quality, infrastructure, and long-term sustainability.
Patients frequently move between Health Boards, yet funding rarely follows them appropriately — and when it does, it seldom reaches the service providing the care.
As a result, the Health Board delivers tertiary and national services for amounts below marginal, let alone actual, cost.
Addressing this imbalance requires urgent action from the Welsh Assembly, working collaboratively with Health Boards across Wales to establish a fair, transparent, and sustainable funding model that reflects the real cost of care.
Concerns were also raised about professional behaviours within some areas of senior and middle management.
The SMSC emphasised that addressing these issues is essential to ensure that all managerial leaders, like clinicians, model professionalism, respect, and accountability.
In Summary
The SMSC firmly believes that the issues outlined above are directly affecting the quality and safety of patient care.
Our purpose in raising them is to ensure that this fundamental principle, patient safety and quality, remains at the heart of all decision making.
We respectfully request that the Board and the Executive Team review these matters and provide a written response within two weeks.
We look forward to working together. As senior clinicians we want to work productively to strengthen the Health Board and to deliver the best possible care for our patients.
Thank you for your attention.
Yours sincerely,
Chair, Senior Medical and Dental Staff committee; Co-chairs, Local Negotiating Committee.
You can read our report on the context around the scathing letter here.
If you would like to contact us about an issue we should be investigating, email us at conor.gogarty@walesonline.co.uk