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

Betsi Cadwaladr University Health Board submitted earlier this month its report on progress under the first phase milestones and expectations set out in the special measures improvement framework. The report was discussed on June 8 at a tripartite meeting of senior Welsh Government officials, the Wales Audit Office and Healthcare Inspectorate Wales. 

The tripartite meeting noted the progress made in a number of areas and highlighted where focus is needed to deliver on the next phases to provide assurance that the improvement is sustainable and demonstrating visible outcomes.

I have visited North Wales regularly during the past 12 months to meet staff, patients and partners. I was in Ysbyty Gwynedd last week and I continue to be impressed with the effort and commitment shown by staff. They recognise that changes are needed and have risen to the challenges special measures has presented. 

Areas the tripartite group noted had made some significant progress included maternity and primary care and out-of-hours services.
In maternity services, the health board has stabilised the service through the successful recruitment of medical and midwifery staff to reduce the vacancy rates and make the service more robust. It has also recently successfully appointed a midwifery consultant to lead work on normality in childbirth. The public consultation process undertaken last summer provided a comprehensive report on views and concerns of the public and stakeholders to aid the Board decision in December on how to maintain safe maternity services across the three major hospital sites. The conduct of this important public consultation was awarded the Consultation Institute Certificate of Good Practice. The outline business case for the Sub Regional Neonatal Intensive Care Centre (SuRNICC) – a state-of-the-art unit to care for very sick and premature babies has been approved and the timetable is on target with the full business case to be submitted to the Board in July. This will help provide the best possible standards of care and clinical outcomes for mothers and babies across North Wales. The health board under its plans for phase two will however need to focus on improving the cultural and clinical leadership within maternity services which was set out as one of the improvement criteria.
Good progress has also been made with regard to the milestones in primary care and out-of-hours services noting the specific concerns on the latter. New arrangements have been put in place to improve the operational delivery of out-of-hours services with a strong focus on recruitment and out-of-hours has been more resilient and better performing over this last winter period. In the east area, 10 new GPs and two new nurse practitioners have been recruited and the rota fill rate is now at 90% compared to the previous 60-70%. A new innovative model of primary care is being implemented in Prestatyn that to date has received positive feedback from patients and staff. In the next phase the health board will need to build on this work, developing its primary care clusters, and identifying new ways of retaining and recruiting GPs and other primary care workers and making best use of their time and expertise to deliver services which are sustainable and accessible locally.
Looking at the criteria for leadership and governance, there is also evidence of progress. Recent recruitment to the senior team has demonstrated that the health board is attracting individuals with experience and a track record. The new Chief Executive – Gary Doherty - started in post on 29 February; the new Director for Mental Health, Andy Roach, whom I met last week, started in post this month; the new Nursing Director – Ms Gill Harris - is to start in the next few weeks; and Dr Evan Moore the new Medical Director will commence in post in early September. This will bring additional capacity and capability to the leadership team, building on progress made and Area Director arrangements.

New independent members have also joined the Board and the board development programme is on-going supported with advice from Ann Lloyd, a former Chief Executive of NHS Wales. The Board has approved a revised risk management strategy and reviewed and completed the implementation of a new committee structure. The effectiveness of these new arrangements will be monitored in phase two. I expect to see further improvement in this critical area.

Positive early steps have been taken in re-connecting with the public, and the health board has worked hard to arrange and attend events to involve and engage staff, partners and public. Its engagement strategy and stakeholder and local partnership working within the area teams show promise, but these developments now need to demonstrate more clearly the outcomes and benefits realised as a result of these actions. I want to see more progress in developing the vision and strategy for health for the people of North Wales. I need to be assured about the sustainability of the regional partnership approach with stakeholders, especially to driving forward the mental health strategy work. Further improvements in managing concerns and complaints are important to strengthen public confidence in the work of the board. I expect to see more substantial development in these areas by the autumn. 

The tripartite group, in their discussions, recognised the significant scale of mental health services in North Wales and the efforts which will be needed to improve them. It is important to note the early steps taken, with the support of Helen Bennett, during the past few months to build new governance arrangements and improve compliance with the mental health measure. The appointment of the new Mental Health Director reporting directly to the Chief Executive is pivotal. I expect to see progress on transforming the service in the next 6-12 months, especially on the development of the longer-term strategy and more immediate assurance on implementation of recommendations from HIW reports including shared learning across North Wales. 

The Health and Social Care Advisory Service (HASCAS) continues to undertake the work to ensure a full and rigorous investigation in relation to the care of individual patients on the Tawel Fan ward. Donna Ockenden is also carrying out, in parallel, a comprehensive review of governance arrangements in the period leading up the closure of Tawel Fan. The health board is committed to engaging and supporting the Tawel Fan families and the Chair and Chief Executive continue to meet with a group on a monthly basis. 

I confirmed last October the health board would remain in special measures for two years and the advice, as expected at this phase in the improvement journey clearly supports this position. The improvement framework I published in January sets out the expectations and milestones for the next six months for phase two – up to the end of October 2016 -and October 2017 for phase three. The health board has made progress on a number of fronts but still has work to do especially in transforming mental health services and developing a clinical strategy for the future that is sustainable and affordable. Welsh Government will continue to provide support and work with the health board to deliver the improvements expected.
It is essential people in North Wales have confidence in the delivery of their health services. As a government, we are committed to engaging with people throughout North Wales on the future of the health service in the region to ensure it delivers improved outcomes.