Written Statement: Betsi Cadwaladr University Health Board Special Measures – one year progress report

On 27 February 2023, I placed Betsi Cadwaladr University Health Board into special measures as a result of serious concerns about board effectiveness, organisational culture, service quality and reconfiguration, governance, patient safety, operational delivery, leadership and financial management.

I have provided Members with regular updates throughout the past 12 months, and have published three reports, setting out the progress made during each quarter of the current special measures arrangements.  I am today publishing the fourth progress report, which reflects on progress made over the first 12 months of special measures, lessons learned and improvements and challenges that have been identified.

The health board has also published its own reflections on its response to special measures over the past 12 months.

There are indications that the health board is making improvements: 

• Performance is starting to improve. There has been a 65% reduction in the number of people waiting more than three years for their treatment to start between February and November 2023.
• The number of people waiting over 52 weeks for their first outpatient appointment has fallen by over 15% in the same period and there has been a 33% reduction in the number of people waiting over 8 weeks for their diagnostic tests.
• Waiting times for orthopaedic pathways has improved, and the number of patient pathways waiting over 104 weeks in November 2023 was at its lowest level since April 2021.  This positive progress will continue with the construction of a new orthopaedic hub in Llandudno, which will be completed by the end of 2024.
• 91% of GP practices in North Wales were achieving 100% of the Access Standards in March last year and Welsh Government has taken a number of steps within the new General Medical Services Unified Contract to make our expectations on access a mandatory contractual requirement.
• The recent Audit Wales follow-up report on Board effectiveness highlights Board stability and better working relationships. 
• An expanded post-anaesthesia care unit at Wrexham Maelor Hospital for people who need specialised care after surgery.
• An eight-bed respiratory support unit has opened in Ysbyty Glan Clwyd to support people with respiratory issues who need regular observations, but do not need high dependency care.
• Cutting-edge laser surgery is being used to remove kidney stones; and the orthopaedic team at Ysbyty Gwynedd has performed over 100 knee replacement surgeries using robotic technology. I was also pleased to learn that doctors in training have ranked Ysbyty Gwynedd’s Emergency Department as the best place to train in the United Kingdom.
• Wrexham Maelor Hospital is the first in Wales to use a new procedure – a cutting-edge laser – to remove bladder tumours or suspicious areas - this will improve people’s outcomes and experience.
• A new stroke rehabilitation centre has opened in Llandudno General Hospital to ensure patients have the best chance of a good recovery after having a stroke. 
• A “straight to test” pilot approach has been introduced so patients have an mpMRI test sooner after being referred for diagnostics on suspicion of cancer. People are seen more quickly, undergoing an MRI scan around 18 days after a GP referral. 
• The decision by Healthcare Inspectorate Wales to de-escalate vascular services from a ‘service requiring significant improvement’ last June was encouraging.  The subsequent assurance assessment by the NHS Executive also indicated that the service is making the required improvements and I look forward to the outcomes of a further case notes review, which is due to report in March.

Following an open public appointment process and in accordance with the Governance Code on Public Appointments, I can confirm the appointment of four independent members as well as the trade union independent member to the health board. The board now has a full complement of independent board members.

The four independent members are Karen Balmer, Clare Budden, Christopher Field and Rhian Watcyn Jones, and Billy Nichols is the trade union independent member.

Last year, as part of the special measures framework, I set out a number of sustainability conditions for the health board. These remain valid and will need to be met before the health board can be considered for de-escalation to level four (formerly known as targeted intervention). 

In the coming months, a clear set of de-escalation criteria will be developed and agreed in partnership with the health board to ensure there is a common understanding of priorities and clarity about my expectation for immediate and sustainable improvements. This will be published once agreed. 

I will continue to keep Members updated.