Written Statement: Betsi Cadwaladr University Health Board

On 7 June 2022, I outlined the ongoing concerns I had about Betsi Cadwaladr University Health Board following patient safety, governance and assurance issues highlighted through a number of serious incidents and inspections. I extended their targeted intervention status to incorporate a wider range of services including:

• Ysbyty Glan Clwyd – patient safety, governance, leadership, operational oversight, clinical safety governance including record keeping, incident management, team working, reporting concerns, and consent
• Vascular services
• Emergency department at Ysbyty Glan Clwyd

Unfortunately, the improvement that I and the people in North Wales had hoped for has not happened, and last week Audit Wales presented their review on Board Effectiveness highlighting their concerns that the Board is dysfunctional and a barrier to further progress. 

Every day thousands of people across north Wales are receiving an excellent service by the NHS but there is a lack of consistency when it comes to quality, safety and efficiency. Correcting this will be at the heart of changes that will need to be made. I know that we also have thousands of dedicated health board workers who may be concerned at these developments, but I would like to reassure them that their day-to-day services and activities will continue and will not be immediately affected by special measures status. I am making some fundamental changes to help ensure people living in North Wales can be confident they will receive safe, timely, high-quality care.

I have today informed the board I am taking special measures with immediate effect. This significant decision comes after the tripartite group of Healthcare Inspectorate Wales, Audit Wales and Welsh Government officials met in November 2022 and January 2023 to specifically discuss concerns about the service delivery, quality and safety of care and organisational effectiveness at Betsi Cadwaladr University Health Board. 

My decision today is made in line with the NHS escalation framework and reflects the serious and outstanding concerns about board effectiveness, organisational culture, service quality and reconfiguration, governance, patient safety, operational delivery, leadership and financial management.

I have had discussions with the Chair, Vice Chair and independent members of the Board and they have agreed that it is time for them to step aside. I would like to thank them for their efforts in leading the organisation during a time of unprecedented challenge.  A new team is needed to lead the organisation.

I have made a number of direct appointments to ensure board stability over the coming 12 months. The new team – to be led by Dyfed Edwards, a former leader of Gwynedd Council and the deputy chair of the Welsh Revenue Authority, supported by three Independent Members– will undertake the statutory roles of the board chair, vice chair and independent members.

They will review executive leadership arrangements and take the necessary decisions for improvement. I will be seeking their guidance before formally recruiting new independent members to the board later in the year.   

At the heart of the work to develop and build a sustainable organisation, capable of delivering the NHS services, which people in North Wales deserve, will be the appointment of a new permanent chief executive. The incoming Chair will lead the recruitment of an individual with necessary vision, leadership and drive to re-build the confidence of the workforce and the public.

We will also create a health board intervention and support team, which will report directly to the new chair and chief executive and will work alongside the board. Their work will be focused on the key areas of challenge, including leadership, culture, operational performance, improving the emergency departments and service configuration, including vascular services.

The health board intervention and support team will:

• Provide specialist advice and oversight about board governance and board effectiveness.
• Offer mentoring and support to the board.
• Provide specialist HR support to the new chair and the board to review the organisational structure and portfolios and quality assure the underpinning systems and processes.
• Increase the capacity and expertise in clinical service planning within the organisation and develop and embed the clinical plan.
• Provide substantial support to improve operational performance and deliver the transformational change needed. There are immediate operational and delivery priorities, governance processes to improve and manage, estate risks to mitigate and a recovery plan to develop.

We will work with the health board to finalise an improvement plan, setting out the key milestones. I expect to see a health board, which:

• Has strong, compassionate leadership supported by robust and effective governance systems.
• Provides safe, high-quality, urgent and emergency and planned care services, with a clear plan for the development and sustainable delivery of these services across North Wales.
• Delivers services that improve the health of the population and works to reduce heath inequalities, in partnership with the public and local partners.

I know this announcement will be concerning, but I want to reassure people in North Wales and the thousands of people working for the health board that day-to-day services and activities will continue, with an increased focus on quality and safety.

I am making this statement to Members today, so they are aware immediately of my decision. I will make an oral statement to the Senedd tomorrow.