Desired level of improvement at special measures health board has not been reached, concludes committee

An inquiry, by the National Assembly for Wales’s Public Accounts Committee, found there had not been the desired level of improvement at Betsi Cadwaladr University Health Board (BCUHB) since it was put in special measures in 2015.

The Governance Review of Betsi Cadwaladr University Health Board: Lessons Learnt was published today (May 24). 

The committee felt that the Welsh Government’s interventions have had little practical impact. 

The report stated: "We share the frustrations of the people of North Wales at the pace of change and believe that both patient input and clinical engagement in delivering change has not been as effective as it could be.

"We are pleased that recent board appointments have refreshed the leadership at BCUHB, but it is too early to gauge impact and it is imperative that the Board collectively, with active support from the Welsh Government, now makes rapid and demonstrable improvements.

Last December, relatives of Tawel Fan patients were left “distraught” after the HASCAS investigation rejected claims of institutional abuse or neglect

"Overall, we remain deeply concerned about the slow pace of change and limited improvement given that nearly four years have passed since the Health Board was put into special measures.

"Demand on services is now even higher than four years ago and there are gaps in staffing rotas for accident and emergency departments, requiring changes to workforce models and using a more multidisciplinary team approach. However, we recognise that significant change takes time because of the sheer range of changes required across the entire health and social care system in North Wales.

"The need to reshape BCUHB’s services is well understood but progress remains unacceptably slow. There is an urgent need to transform provision across North Wales, delivering financially sustainable services and improved patient outcomes.

"There is scope to learn from others in order to improve performance and we encourage the Board to work with other Health Boards, particularly from those who are performing well, in order to learn and develop better practices."

Serious concerns have been raised over BCUHB’s financial performance, missed patient waiting time targets and the lack of progress improving mental health services.

The health board’s most recent Finance Report for March 2019 revealed that the Health Board was overspending by £41.3 million and "alarmed” was expressed that the financial deficit has increased and is significantly worse than forecast.

Nick Ramsay, chair of the Public Accounts Committee, said: “Progress is in dealing with problems is unacceptably slow. There is an urgent need to transform services across north Wales, delivering financially sustainable services and improved patient outcomes.

“Although there have been many changes to the board and plans in place for improvement, we remain deeply concerned. There is a serious risk that special measures may now have become a normal state of affairs.

“The financial deficit seems to be getting worse, waiting times do not appear to be improving and following historic failings and current shortcomings in mental healthcare we are concerned that the Board is not acting quickly enough to improve services.

“The Committee has heard assurances from senior leaders that it now has the right approach to deliver improvements and that it now needs time and space to achieve this.

“As a committee, we will be keeping a close eye on developments at the Health Board and urgent action should be taken for us to see the much needed turnaround that the people of north Wales and the hardworking NHS staff deserve.”

The committee met families affected by issues on the former Tawel Fan ward at Ysbyty Glan Clwyd, to listen to their concerns. They aired concerned over the pace in which the Health Board is acting on recommendations to improve mental health services.

A recommendation has been made to the board that they considered bringing in specialist external turnaround expertise and that in future, any commissioned reviews into failings are established independently of the health board in question.

In a joint statement, Betsi Cadwaladr University Health Board Chairman Mark Polin and Chief Executive Gary Doherty said: “We welcome the Committee’s recognition of the progress we have made and remain resolved to achieve further improvements. We continue to focus on delivering the transformational change needed to provide modern, sustainable services for the people of North Wales.

“We have demonstrated our ability to turn services around with both maternity services and GP Out of Hours services having been taken out of Special Measures by the Welsh Government.

“We are determined to build on this as we work with our staff and partners to deliver the changes detailed in our plan for the next year and beyond. This includes a financial review, which will report this summer. We continue to work with representatives of the Tawel Fan families to drive forward improvements across our mental health and wider services.”