Health boss claims he is leaving an open and improving organisation

THE departing chairman of Swansea Bay University Health Board believes he is leaving an open and improving organisation compared to the closed and “defensive” one he joined.

Andrew Davies started his role in January 2013. At the end of that year an independent review got under way which found that aspects of the care of frail older people at the Princess of Wales Hospital, Bridgend, and Neath Port Talbot Hospital were “simply unacceptable”.

There were seven key areas of concern. Some areas of exemplary practice were also indentified.

Recalling his early days with what was then Abertawe Bro Morgannwg University Health Board, Mr Davies said: “It was a very closed culture.

“Staff and patients felt unwilling or unable to raise complaints.

“Complaints that were raised were often dealt with in a very negative way.

“As an organisation we were very defensive. There were big problems in the culture.

“My primary responsibility was to create a more open culture.”

Mr Davies said the health board committed itself to acting upon the recommendations of the Trusted to Care report.

Going on prime time television to apologise, he said, was “a very uncomfortable experience”.

Mr Davies said he felt the health board has made big strides since then.

“I believe the quality of services we provide has improved,” he said.

“I’m not saying we get it right every time.

“But we look at the evidence – and we now collect the experience of patients in a way that we didn’t before.”

He said 95% of patients who responded said their experience has been very good.

Some people waiting for urgent orthopaedic surgery at Swansea’s Morriston Hospital might disagree.

It emerged in March that one surgeon at the hospital had a 113-week waiting list. The health board said it was working to reduce referral-to-treatment waiting times, which should not exceed 26 weeks – or 36 weeks for complex orthopaedic cases.

Mr Davies apologised then, and has not changed his tune.

“The long waits are not acceptable,” he said. “But we have made significant inroads. Next year we are confident that these waiting lists will come down.”

Mr Davies is also hopeful that the Welsh Government might take the health board out of the “targeted intevention” category it was placed in three years ago.

This level of minsterial intervention – one below the most serious “special measures” – also applied to two other health boards and was largely the result of a failure to deliver suitable three-year business plans, which address issues such as care quality, workforce and finances.

“My conversations with Vaughan Gething (minister for health) have been very supportive,” said Mr Davies. “We have made significant progress.”

He said the “churn” of board members who lead the organistion – 31 in six years – had stabilised.

Just over a year ago Tracy Myhill was appointed chief executive following the departure of Paul Roberts, who left with a £163,213 payout.

Very little was said about the circumstances of Mr Roberts’ exit at the time.
Mr Andrews declines to venture into the matter.

“It was a mutual decision,” he said.

He is more forthcoming on Mrs Myhill.

“Tracy is a very effective chief executive, and I believe we have a very strong team for the first time in six years,” he said.

Mr Davies arrived at the health board after serving as Swansea West AM from 1999 to 2011, including a decade of ministerial roles.

He said he was instrumental in bringing the graduate medical school to Swansea University’s Singleton campus, and stressed the importance of the health board’s close links with the university.

“The medical school has attracted some top-notch researchers and scientists,” he said.

“Offering (medical) consultants a research or teaching post is really important.

“The research shows that where you have good university links, the care of patients is improved.

“You need to invest in buildings, but it’s people which are crucial.”

Mr Davies said the health board also worked closely with its western neighbour, Hywel Dda University Health Board.

“We have two health boards, but we have one health economy,” he said.

“There are virtually no clinical services, apart from mental health maybe, where we don’t plan, commision or deliver on a regional basis.”

The name change to Swansea Bay University Health Board took place on April 1, coinciding with the transfer of health health services in Bridgend to the neighbouring Cwm Taf University Health Board to the east.

“I wanted to change the name – people know where Swansea Bay is,” said Mr Davies.

But he said costs would be kept down by changing things digitally rather than taking signs down and putting new ones up.

“I think we estimated a maximum of £200,000 (for the name change),” he said.

The smaller boundary, now serving just Swansea and Neath Port Talbot, means a drop in budget of £1.3bn to just under £1bn.

As chairman Mr Davies earns around £69,000 per year. He said the job felt full-time.

There are long-term plans to expand Morriston Hospital – with 55 acres of land acquired for this purpose – but Mr Davies said a new or improved link road would be needed first.

In the shorter term, he said the health board wanted more care to be delivered away from hospitals and in the community.

“It is the holy grail for the NHS,” he said.

“A lot of people don’t need to be in hospital in the first place.”

Welsh Government funding is being provided to establish so-called GP clusters, which include physiotherapy, pharmacy and voluntary services.

Like many people in the health sector, Mr Davies said society was very different to when the NHS was established 71 years ago.

“The major causes of death then were infectious disease, industrial disease and infant mortality,” he said.

Nowadays the average age of a hospital patient in Swansea Bay is 85, and many present with more than one chronic condition.

“People can receive treatment to extend their life, but the quality of life might not be what they want,” he said.

It is difficult territory, and we move on to the dilemma of funding for social care.

Mr Davies said: “A House of Lords report in 2013 said the Government and public bodies were woefully unprepared for the results of an ageing society.

“I think we need a robust conversation about these services – what is the responsibility of the state, and the individual.

“We also need a conversation about end-of-life care. We have become a society which has become uncomfortable about death and dying – previously death was more every day, and people died in their homes.

“The process of death has become medicalised. We need to accept that dying is a natural process.”

Mr Davies, who is an honorary professor, said one thing that had not changed in his view was that people in affluent areas tended to receive better care than those in deprived areas.

He said this was because it was easier to recruit healthcare professionals to affluent areas, and that people living there were usually more adept and confident about fighting their corner for services.

A baby boy born in affluent Mayals, he said, is likely to live 10 to 15 years longer than one born just a mile or two away in Mayhill.

Mr Davies said meetings in Cymmer, near the top of the Afan Valley, about GP access had brought this “inverse care law” home to him.

“A lot of these communities feel they have lost everything,” he said. “The mines have closed, schools have closed.

“For them, the Valleys is a story of loss.”