Written Statement - Governance Arrangements at Betsi Cadwaladr University Health Board

I wish to update Assembly Members on the range of actions which have been taken by the Welsh Government following the joint Wales Audit Office/Healthcare Inspectorate Wales report on Governance Arrangements at Betsi Cadwaladr University Health Board.

Whilst the report does make sobering reading, it also provides reassurance that the national oversight, inspection and supervision arrangements were able to detect and respond to the emerging situation in Betsi Cadwaladr Health Board.  From the outset of the WAO/HIW review my officials have held regular meetings with WAO and HIW and have been working to assist the Health Board on a range of performance, governance and quality and safety issues.  Therefore, much of our support to deal with the Review’s recommendations was either already in place or planned prior to the Review’s publication.

Turning to the details of Welsh Government current support for the Health Board, I have already announced that David Jenkins, Chair of Aneurin Bevan Health Board, will be providing assistance to the Health Board until a new Chair is in post.  This arrangement has already commenced and we have already advertised for a replacement Chair. This process will be completed within the next two months.   The advertisement for the Vice Chair will be placed very shortly.

In addition, David Sissling, Chief Executive of the NHS, has ensured arrangements are in place to provide support to the Executive Team and the wider organisation to increase the team’s capacity to respond to the Review recommendations.   This support is being provided by  

• Paul Roberts, Chief Executive of Abertawe Bro Morgannwg University Health Board, 
• Richard Bowen, Director of Planning at Aneurin Bevan Local Health Board 
• Bruce Ferguson, recently retired Medical Director at Abertawe Bro Morgannwg University Health Board

Each of the above will provide sufficient time to assist the Board to implement the review recommendations. Paul Roberts will be spending 3 or 4 days a week on site.  In doing this work, the individuals will have the support of both myself and David Sissling.  They will carry our authority to take the actions required to see the Board through this transitional period. This support team will remain in place until at least the early autumn but we will extend this period of support if necessary

Furthermore, the Chief Medical Officer has requested Public Health Wales to continue to provide support to the Health Board to ensure infection control systems are robust through monthly progress monitoring.  At the present time PHW's Welsh Healthcare Associated Infection team are working with BCU to replicate the epidemiological analyses that were undertaken in Ysbyty Glan Clwyd across the other two sites at BCUHB.  This work should be completed in the next couple of months.  The PHW team are also providing advice and support to the Executive Nurse Lead on infection control issues.

The Health Board has also engaged the services of Professor Brian Duerden, formerly the Inspector of Microbiology at the Department of Health.  Professor Duerden is an expert in infection prevention.  He will review relevant procedures and produce recommendations for improvement.  The terms of reference for his work are to:

1. Provide evidence based timely advice to the Health Board on the appropriateness and robustness of its governance and management arrangements for health care associated infections, in particular C. Difficile.
2. To identify all opportunities to strengthen these arrangements so that the incidence of infection is reduced and the board is able to identify and take appropriate action as early as possible should an outbreak occur.

The Health Board expects to receive an initial report from Professor Duerden by the end of July.  To further strengthen their response in this area, the Health Board has already appointed an external specialist Nurse Consultant in infection control.

The Health Board has been advised for some months to appoint a Chief Operating Officer, a Senior Clinical Leader and Turnaround experts and I understand this process is now well advanced.  The Health Board are also working with an external consultancy to secure support on planning and financial matters.

My Officials are also providing support on a day to day basis to members of the Executive Team and Board as required.  The Chief Medical Officer and Chief Nursing Officer for Wales are already working closely with the Acting Medical Director and newly appointed Director of Nursing as well as the BMA and RCN to strengthen clinical engagement.  This is an important area – we need to ensure all staff in the Health Board feel a part of and play a part in the processes of improvement.

It is clearly vital that the Board maintains a focus on matters of quality and safety.  In order to ensure that this takes place strengthened surveillance arrangements have been put in place in this area and I am receiving regular reports on a range of key indicators.

The Health Board itself now needs to draw on this support and take urgent and sustained action in relation to resolving the issues in relation to:

• Board governance, information and support
• Clinical governance, leadership and engagement
• Planning systems, including for service change processes
• Performance and quality and safety management arrangements

A formal review of the Board’s progress will be undertaken across all these areas at the end of September and I will update Assembly Members at that point.

Finally I would, once again, like to pay tribute to the professionalism and commitment of NHS staff at the Health Board.  It is a difficult time but they will, I know, continue to rise to the challenge and deliver high standards of care to the people of North Wales.