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Written Statement - Betsi Cadwaladr University Health Board: special measures update

Vaughan Gething, Deputy Minister for Health

Following the tripartite meeting of senior Welsh Government officials, the Wales Audit Office and Healthcare Inspectorate Wales on October 22, I issued a Written Statement, stating that Betsi Cadwaladr University Health Board would remain in special measures for two years, with progress and milestones to be reviewed every six months.
In considering the next steps for Betsi Cadwaladr University Health Board – the first NHS organisation in Wales to be put into special measures – we have drawn on the experience of NHS England, where a number of NHS trusts are in special measures. The English experience has highlighted the importance of providing the right support at the right time. It is also clear that organisations need time to achieve a successful and sustainable turnaround.

We have discussed what further support is now needed with Simon Dean, Betsi Cadwaladr University Health Board’s interim chief executive, Peter Higson, the health board’s chair and with the three independent advisers – Ann Lloyd, Dr Chris Jones and Peter Meredith-Smith – to enable the health board to build on the progress made during the first four months of special measures and put it on a sustainable footing for the longer term.

Appointing a substantive chief executive is key to securing strong and permanent leadership for the health board. The process for recruiting an individual with the necessary vision, leadership and drive to continue to rebuild the confidence of staff, the public and stakeholders is underway. Mr Dean – who I would like to thank for his continued hard work and dedication since he took up the post of interim chief executive – will continue to play a pivotal role in the health board, supporting the transition to the new chief executive. He will return to his substantive role as deputy chief executive of NHS Wales within the Welsh Government in due course.

We are putting together a health board improvement team to ensure the chief executive has both the capacity and capability to make the necessary improvements to the areas identified under special measures. The team will report to the chief executive and will work alongside independent board members and the executive team in the key areas of governance, strategic planning, mental health, primary care and reconnecting with the public.

Ann Lloyd, a former chief executive of NHS Wales, will continue to provide oversight and finalise board governance work, including work on behaviours; the development of the board assurance framework and a review and restructuring of the committee structures.  

Betsi Cadwaladr University Health Board has not yet produced a comprehensive three-year integrated medium-term plan. The improvement team will therefore include specialist planning and strategy expertise to build on the skills and capacity within the organisation in this area. This will accelerate the development of a strategy to deliver high-quality, safe and sustainable health services for North Wales.
Improving mental health services continues to be a key priority for the health board under special measures. A strategic review of current services, followed by a new vision and longer-term strategy is now needed. This must be developed in close partnership with service users, stakeholders and local people.

To accelerate the development of this strategy and help with the public engagement about the future of mental health services, external consultants with a proven track record in this area will be brought in. Support will also be provided by the 1,000 Lives team and Public Health Wales to ensure the plans are aligned with our national strategy Together for Mental Health and draw on best practice from across Wales and elsewhere. 

The health board will appoint a new director of mental health services who will report directly to the chief executive. Jenny French, an experienced mental health divisional lead nurse, from Aneurin Bevan University Health Board and previously a nursing officer in Welsh Government is joining the improvement team as the senior mental health and learning disabilities nurse for Betsi Cadwaladr University Health Board.  Jenny will start work in North Wales within the next few weeks.

The work to develop a new mental health governance framework will be taken forward by Helen Bennett, a former mental health nurse director at Cardiff and Vale University Health Board. Helen, who is currently working part time for Hafal, will bring extensive clinical expertise, along with experience from working with the Ombudsman in Wales as well as the voluntary sector. I am grateful for Hafal’s support in making this happen.

We will also provide additional project management capacity to support both the HASCAS and Donna Ockenden work, in relation to the failings in care identified on Tawel Fan ward, at Ysbyty Glan Clwyd. 

Peter Meredith-Smith, associate director of the Royal College of Nursing in Wales, will continue to provide advice to the Welsh Government about progress on mental health.  He will now focus on ensuring the health board keeps pace with the Wales-wide child and adolescent mental health services improvement programme until he returns to the RCN in the spring.

Healthcare Inspectorate Wales and the Wales Audit Office, in their review of progress under special measures, were clear the out-of-hours primary care services work led by Dr Chris Jones, chair of Cwm Taf University Health Board “appears to have been a catalyst for a greater appreciation of how to develop more consistent and coherent primary and community services across North Wales”.

The improvement team will include people with the right skills to support the health board to make further improvements to primary care and ensure it makes best use of its share of the national £40m primary care fund. Dr Jones will review progress in December.

The health board has started the process of reconnecting with its staff and the public – it must now develop a longer-term plan which shows how it will continue to engage with and listen to staff, patients, the public and key stakeholders. The improvement team will provide additional resources and support to help the health board achieve this.

The improvement team will be established during the next few weeks and will work with the health board and the Welsh Government to finalise an agreed improvement plan, setting out the key milestones to be achieved at the six-month reviews.
In outlining the future arrangements for special measures at Betsi Cadwaladr University Health Board, over the next two years, I expect to see a health board which:

  • Has strong leadership and robust governance;
  • Provides safe, high-quality mental health services;
  • Offers safe and sustainable out-of-hours primary care services and has a plan for the development of primary care and community services in North Wales;
  • Has demonstrated an ability to deal with difficult and challenging service issues in partnership with its staff and the public and has a clear clinical strategy for the long-term development of services across North Wales.

To tackle the challenges and deliver sustainable outcomes the continued support, dedication and energy of the health board staff and the North Wales public will be critical. 

I will provide a further update on progress and the support arrangements in due course.