Betsi Cadwaladr in special measures - 12 months on

BCUHB re-entered special measures on February 27, 2023 due to "serious concerns about performance, leadership and culture".

As part of the action, the then chair, vice chair and independent members of the board stepped aside.

Eluned Morgan MS, Minister for Health and Social Services, said: "Next week will mark 12 months since I placed Betsi Cadwaladr University Health Board into special measures.

"I want to take the opportunity to reflect on the last year and to share with you how the health board - despite the ongoing pressures - continues to deliver day in day out in a really positive way for the majority of people in North Wales. 

Eluned Morgan MS

"It’s worth remembering that the health board is the biggest employer in Wales employing over 19,000 people, serving a population of around 700,000 people, carrying out an average of around 16,000 patient contacts, over 2,000 outpatient appointments and around 450 planned procedures every day.

"So I want to acknowledge the excellent work of everyone who works in the health board, and thank them for everything they do to ensure patients are seen and treated safely, compassionately and in a timely manner.

"I also want to highlight just a couple of examples of some of the innovations the health board has introduced over the last 12 months. These include becoming the first in the UK to use artificial intelligence to diagnose breast and prostate cancer.  I was also pleased to help launch the new e-prescribing service at a pharmacy in Rhyl back in November - as part of an all-Wales rollout.

"It has been a challenging year for the health board – but I do think the difficult decision to place it into special measures was the right one and that because of this the board is in a much better position to drive sustainable change and improve health services for the people of North Wales."

Revealing what has been achieved over the past year, Ms Morgan said: "There has been a focus on rebuilding and stabilising the board. There is now a permanent chair, chief executive and vice chair. The final four Independent members will be announced very soon and this will give the organisation the stability and focus it needs to improve.

"I was pleased to see that Audit Wales recognised a marked improvement in terms of board stability in its recent follow-up report on board effectiveness, and that the dysfunctionality within the board described in its previous report is no longer evident.

"As part of the special measures intervention, a small number of independent advisors were contracted to work with the board and a number of independent reviews have been commissioned into problem areas.

"Many of the reflections from the advisors, and the reports from the independent reviews make uncomfortable reading and have exposed some very serious issues that the health board must now address.

"While it has been encouraging to hear about the improvements HIW has observed through its more recent inspections, Members will be aware that His Majesty’s Coroners and the Ombudsman have highlighted a number of consistent themes and I hope the health board has now uncovered all of the key issues that need to be addressed and has structures in place to address these issues.

"Audit Wales has over the last year reported on poor financial management and accounting practices.  I have discussed these with Members (of the Senedd) on a number of occasions and you are all aware that I am unable to comment further as disciplinary processes are still ongoing. 

"But the recent Audit Wales report suggests the Board is responding to the issues identified in their audits of the 2021-22 and 2022-23 accounts, as well as those identified in the Ernst and Young review.  It is also worth noting that North Wales Police has decided not to take any further action on the findings in the Ernst and Young report."

Ms Morgan added: "Like all other health boards in Wales, Betsi faces significant financial challenges as a result of inflation and austerity measures. We are actively monitoring the health board’s response to these challenges.

"All of this is key to changing the culture and organisation of the health board – but the key question is – what difference is any of this making for the people of North Wales?

"Well, they should take comfort in the fact that performance is improving. The health board has reported a 65 per cent reduction in the number of people waiting more than three years for their treatment to start between February and November 2023.

"The number of people waiting over 52 weeks for their first outpatient appointment has fallen by over 15 per cent in the same period and there has been a 33 per cent reduction in the number of people waiting over eight weeks for their diagnostic tests."

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In November 2022 – a few months before the health board was put into special measures - Ms Morgan made an unannounced visit to Abergele Hospital.

She said: "That day – a Thursday afternoon - there was no orthopaedic activity going on - despite the fact that Betsi had one of the longest orthopaedic waiting times in Wales. I was surprised and disappointed to find that the management team and the board was blissfully unaware of the lack of activity – showing their lack of grasp on the situation.

"But today, with huge support from the GIRFT team, Welsh Government and the new board we now see increasing activity at the Abergele site.

"Waiting times for orthopaedic pathways across Betsi have improved, and the number of patient pathways waiting over 104 weeks in November 2023 was at its lowest level since April 2021.  And we expect to see this positive progress continue with the construction of a new orthopaedic hub in Llandudno, which will be completed by the end of this year.

"Pressures in urgent and emergency care continue. Between February and December 2023, there was an increase of over 2,000 monthly attendances at emergency departments in North Wales. The focus on eliminating four-hour handovers, whilst not yet achieved, is resulting in some improvements.  There were 786 handover delays in excess of four hours in December 2023 which is still too many, but this represents a 23 per cent reduction compared to December 2022.

"The challenges facing the vascular services are well rehearsed. I have visited the department on many occasions to monitor progress and I was pleased to see that in June 2023, HIW de-escalated them from a ‘service requiring significant improvement’. 

"An independent assessment against the vascular plan undertaken by the NHS Executive Vascular Clinical Network concluded that the service has improved and now provides a much safer service.

"To give further reassurance, a vascular case note assessment has taken place. The final report is expected in March 2024."

Ms Morgan said despite BCUHB being in special measures for 12 months, there is still "lots to do".

"I set out sustainability conditions for the health board which are still valid and will need to be met before a de-escalation to level four can be considered," she said.

"I will supplement those conditions with clear de-escalation criteria for each of the escalation domains in the coming months. 

"This is undoubtedly an organisation with significant challenges ahead, but it is important that we all collectively support the health board to develop and build a sustainable organisation, capable of delivering the NHS services, which people in North Wales deserve."