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Written Statement - Betsi Cadwaladr University Health Board – Special Measures Update

Vaughan Gething, Deputy Minister for Health

On June 14, I provided an update on the action taken by the Welsh Government and Betsi Cadwaladr University Health Board after it was placed in special measures. I committed to provide a further statement to Assembly Members at the start of the new term.

Work has been ongoing over the summer in each of the five areas highlighted as part of the special measures –governance, leadership and oversight; mental health services; maternity services at Ysbyty Glan Clwyd; GP and primary care, including out of hour services and reconnecting with the public in North Wales.

A series of 100-day plans, commissioned by Simon Dean, Betsi Cadwaladr University Health Board’s interim chief executive, have been put in place across the health board. Among the changes introduced as a result are the appointment of an extra 27 midwives, following a recruitment drive, and all the key milestones in the GP out-of-hours services plan have been delivered.

The health board has held a series of events to engage with and listen to the public in North Wales in a variety of community settings, including live web chats; high street “have-your-say” days in Bangor, Llandudno, Rhyl and Wrexham; meeting community groups and having regular meetings with the community health council. It has also held more than 40 listening events and 11 open-door forums with NHS staff.
The three key individuals appointed to support the special measures work have met board members and staff; visited and reviewed services; assessed the actions undertaken as part of the 100-day plans and monitored how the health board is responding to the requirements set under special measures.

Work on governance and accountability, supported by advice from Ann Lloyd, former chief executive of NHS Wales, has included the board effectiveness review; the first phase of re-developing the board assurance framework and putting in place robust processes to oversee future capital projects. 

Peter Meredith-Smith, associate director of the Royal College of Nursing in Wales, who is providing advice and support on mental health services, has outlined his initial findings and recommendations for action. His initial work has focused on the three main hospitals – Ysbyty Gwynedd, Ysbyty Glan Clwyd and Wrexham Maelor – and has included older people’s mental health units; liaison psychiatry services and Mental Health Act implementation. 

There have been some improvements to mental health and learning disability management capacity, including the establishment of a mental health strategic coordination group; the recruitment of an experienced interim director and better use of the support being made available to the health board from the 1,000 Lives team. However, further action is needed, including the development of a mental health and wellbeing strategy; strengthening the capacity and capability of the divisional management team and the governance and leadership function for the services. 

Dr Chris Jones, chair of Cwm Taf University Health Board, has outlined his initial reflections about primary care services and has said that with encouragement, leadership and direction significant progress can be made. He has spent time visiting services – in and out of hours – and talking to staff to help him understand the challenges in more detail.

Dr Jones is positive about the opportunity the health board has to develop a robust primary care strategy which meets the needs of the local population. He will outline recommendations for further action later this month. 

The health board has engaged with the organisation Impact Innovation to support team development and to reform the working culture in the maternity unit at Ysbyty Glan Clwyd. It is also advertising for a consultant midwife. 

The health board is currently consulting with its staff and the public in North Wales about temporary changes to maternity services. 

Special measures must provide a sustainable foundation for Betsi Cadwaladr University Health Board into the long term and give confidence to people in North Wales about the board’s ability to provide high-quality health services.
The health board’s escalation status will be subject to continuous review under the escalation framework arrangements. While I expect to see further and ongoing progress, I want to make it clear the health board will remain in special measures for the foreseeable future.

Healthcare Inspectorate Wales and the Wales Audit Office will start a formal review of progress under special measures this month and a tripartite meeting with Welsh Government officials will be held in mid October to discuss their findings. I will update Assembly Members after that meeting.