Cabinet Sub-Committee for North Wales meeting: 5 October 2023

• Rt Hon Mark Drakeford MS
• Lesley Griffiths MS (Chair)
• Mick Antoniw MS
• Rebecca Evans MS
• Vaughan Gething MS
• Jeremy Miles MS
• Eluned Morgan MS
• Hannah Blythyn MS
• Dawn Bowden MS
• Julie Morgan MS
• Lynne Neagle MS
• Lee Waters MS

Leaders of North Wales local authorities

• Cllr Charlie McCoubrey, Conwy
• Cllr Jason McLellan, Denbighshire
• Cllr Gary Pritchard, Anglesey
• Cllr Mark Pritchard, Wrexham
• Cllr Ian Roberts, Flintshire
• Cllr Dyfrig Siencyn, Gwynedd

Other external attendees

• Carol Shillabeer, Interim CEO, Betsi Cadwaladr UHB
• Dyfed Edwards, Interim Chair of the Board, Betsi Cadwaladr UHB
• Lyndsey Rawlinson, Head of North East Operations, Natural Resources Wales
• Keith Davies, Principal advisor to the Designated Landscapes Programme, Natural Resources Wales
• Alwen Williams, Interim CEO of the North Wales CJC / Portfolio Director, Ambition North Wales
• John Parkin, Commissioner, North Wales Transport Commission
• Chris Llywelyn, CEO WLGA
• Aled Jones, Cymen (interpretation)

Officials

• Rebecca Dunn, Head of Cabinet Division
• Jane Runeckles, Special Adviser
• Clare Jenkins, Special Adviser
• Alex Bevan, Special Adviser
• Kate Edmunds, Special Adviser
• Sam Hadley, Special Adviser
• Owen John, Special Adviser
• Phillippa Mawdsley, Special Adviser
• Reg Kilpatrick. Director General, Covid Recovery Local Government
• Tracey Burke, Director General, CCRA
• Catrin Sully, Head of Cabinet Office
• Rhys Morris, Chief Regional Officer – North, Mid and South West Regions
• Christopher W Morgan, Head of Cabinet Secretariat
• Damian Roche, Cabinet Secretariat (minutes)
• Bryn Richards, Head of Regional Planning – North Wales
• Heledd Cressey, Senior Regional Planning Officer – North Wales
• Carys Roberts, Government Business and Operations Executive
• Ceri Christian-Mullineux, Senior Regional Partnerships Manager - North Wales
• Olivia Shorrocks, NHS Wales Performance
• Chris Stevens, Head of Local Government Performance and Governance
• Rhidian Jones, Senior Private Secretary, Minister for Economy
• Lea Beckerleg, WG North Wales Transport Commission
• Simon Pickering, Head of Landscape and Outdoor Recreation
• Tom Cosson, Senior Landscapes and Outdoor Recreation Adviser, Land, Nature & Food

Apologies

• Jane Hutt MS
• Julie James MS

1.1 The Minister for Health and Social Services introduced the item, welcoming the interim Chair and Chief Executive of Betsi Cadwaladr University Health Board to the meeting.

1.2 The committee noted that it was seven months since Betsi Cadwaladr University Health Board had been put back into special measures. This wasn’t a decision taken lightly, but was necessary because of real concerns raised around governance, quality and safety, financial and accounting practices, and performance, amongst others.

1.3 The minister had issued a written statement in July setting out the first quarterly report on special measures arrangements; and provided an oral statement to the Senedd in September, alongside publishing the second quarterly report and agreed priorities for the next 90 days, which was the second cycle of the ‘stabilisation phase’.

1.4 There was no doubt this had been a difficult time for the health board, but there were now real signs of change for the better, albeit there would be a long way to go before confidence could be fully restored in health services across North Wales.

1.5 The minister put on record her thanks to everyone working in the health board for their hard work in difficult circumstances, including intense political and press speculation.

1.6 In terms of measurable impacts, almost 59% of people on waiting lists in North Wales were treated within 26 weeks in July, that being the highest number treated in 6 months since June 2020.

1.7 Since February 2023 there had been a 22% reduction in the number of outpatients waiting over 52 weeks for a first outpatient appointment; and therapy waits over 14 weeks had fallen by 38%; finally, there had been a 38% reduction in the number of orthopaedic pathways over 104 weeks to 1,526, which was now at its lowest level since June 2021.

1.8 In addition, the board had just endorsed a business case for a dedicated orthopaedic hub in Llandudno Hospital and in the interim, Abergele was being used as a regional orthopaedics hub from early September. The first few weeks had been positive with almost 50 patients having operations. Virtual wards had been running and the first ever daycase arthroplasty had been completed.

1.9 Orthopaedic surgical teams at Ysbyty Gwynedd had performed 100 robotically assisted knee replacement surgeries using innovative robotic technology. Ysbyty Gwynedd was the first NHS hospital in Wales to perform robotic knee replacements and last week the first ever daycase robotic surgery was completed.

1.10 Changes at board level included a new interim Chair, and new interim independent members. There had also been considerable change in the leadership of the executive at Betsi including a new interim Chief Executive, a new interim Finance Director and an interim Executive Director of Operations. Changes had also been made to the office of the Board Secretary to support the board.

1.11 Interviews for the new Vice Chair and two independent members had taken place that week, followed by a recruitment campaign for a permanent Chair and additional independent members. The recruitment process for a permanent Chief Executive was also underway.

1.12 These appointments formed part of a long-term process, with the plan to ensure the right people were in place to provide leadership for the organisation.

1.13 An independent assessment of patient safety issues had been commissioned, in response to concerns raised by His Majesty’s Coroners and the outgoing board members. This was now with the health board for action and the NHS Executive would be working with the board to ensure quality and safety governance systems and procedures responded to the issues within a set timeframe.

1.14 Concerns remained about mental health services across North Wales and an assessment of mental health inpatient facilities had been commissioned to ensure all reasonable risks were identified and managed. The assessment had been broadly positive, with some concerns highlighted, which the health board were addressing.

1.15 Another key concern had been around vascular services, but whilst the decision by Healthcare Inspectorate Wales to de-escalate vascular services from a service requiring significant improvement earlier this year was encouraging, concerns remained, and the NHS Executive would be undertaking further work with the Health Board in the coming months.

1.16 The governance and financial accounting issues noted by the Board and highlighted by Ernst and Young and Audit Wales were challenging, but the Chair and Chief Executive were working hard to understand what happened, ensure there were no further issues to expose and to embed new processes within the health board to prevent them happening again.

1.17 Many planned care services continued to be challenged and the Welsh Government had emphasised to the health board that sustainable plans for ophthalmology, urology, oncology, dermatology, orthodontics and plastics should be developed in this next phase of special measures, alongside plans for ensuring that very long waiting patients were treated.

1.18 Improvements had been seen in urgent and emergency care performance, although it was recognised there was a long way to go, supported by the NHS Executive and the national six goals programme.

1.19 The committee noted that stability to deliver as an organisation was key to its future success, and a clear work programme with an outcome-focused approach had been agreed upon. A programme of culture change was underway at the health board and this would be complemented by consistent messaging, stronger accountability and engagement. All of this would take place whilst focusing on the immediate issues faced by health services in North Wales.

1.20 The point was made that local authorities also had a role to play in ensuring stronger engagement with communities about where investment was going and improve partnership working with the health board, and to this end there were already LA representatives on the health board, and the Chair would be attending public scrutiny meetings at LAs in future.

1.21 The committee discussed the lessons learned from previous periods spent in special measures and whilst it was acknowledged there wasn’t one straightforward answer as to why the Health Board found itself in the same situation again, there was a commitment from all parties to hold each other to account going forwards and work together for the benefit of the people of North Wales.

1.22 The Chair thanked the interim Chair and Chief Executive for their presentation and noted that health was a standing item for the committee and would be returned to periodically as the situation developed.

2.1 The Chair set out the Welsh Government’s ambition to designate a new National Park in North East Wales, which was a significant undertaking. It was vital that all views of those who could be impacted were considered as part of the development work.

2.2 To that end, the government had commissioned Natural Resources Wales to take forward a programme that included detailed assessment, consideration of the evidence, engagement and consultation. This would inform a final decision on any new designation.

2.3 The committee noted the focus was centred on the Clwydian Range and Dee Valley Area of Outstanding Natural Beauty but was considering a wider landscape area, and that establishing a designation required sufficient evidence of natural beauty and outdoor recreation opportunities.

2.4 A series of engagement events were taking place in late 2023, with statutory consultation to follow in 2024.

2.5 Early engagement with the Welsh Government, Local Authorities, Eryri National Park and Corporate Joint Committees amongst others had taken place, with the emerging themes being around affordable housing, agricultural policy, funding and energy interfaces.

2.6 The committee welcomed the proposals and noted the future work programme.

3.1 The Chair welcomed John Parkin from the North Wales Transport Commission and asked the Deputy Minister for Climate Change to introduce the item.

3.2 The committee noted that Lord Burns’ final report was due out in the next few months, following publication of the interim report earlier in the year.

3.3 It was noted that recent headlines about electrification of the North Wales mainline by the UK government did not contain any specific timeline, would more than likely take over 10 years to deliver and would far exceed the reported £1 billion funding. Expectations would be raised without adequate delivery and the only meaningful way forward for the Region was through the Burns report.

3.4 It was reported that significant work would be needed to upgrade Chester Station prior to any electrification of the North Wales mainline, including a phased programme of signalling and track work.

3.5 The Chair thanked the North Wales Transport Commission for its presentation.

4.1 The Chair welcomed Alwen Williams, interim CEO of the North Wales CJC and Portfolio Director for Ambition North Wales to the meeting and invited her to update the Committee on latest developments.

4.2 The Committee noted there was a long history of collaborative joint working between regions in North Wales over the previous decade, and the Economic Ambition Board, now branded as ‘Ambition North Wales’ was a good example of the potential for joint working.

4.3 It was the intention to move the NWEAB governance arrangements into the CJC, and consideration was being given as to how the CJC could be branded as a continuation of the EAB and its good work, in the context of a strengthened corporate framework.

4.4 There was good potential for the use of enhanced powers provided to the CJCs to deliver more for North Wales.

4.5 In terms of practicalities, both the Chair, Dyfrig Siencyn, Gwynedd and Vice-Chair, Mark Pritchard, Wrexham were in place. The CJCs budget had been set and it had met eight times, with the interim CEO in place for two days per week currently.

4.6 A number of sub committees had been established, Welsh Language standards adopted with additional support from Cyngor Gwynedd, along with the pension fund from the LA.

4.7 There were some initial teething issues relating to staff retention, but these would be resolved shortly.

4.8 The Committee thanked the interim CEO for the update.

Cabinet Secretariat
October 2023