ELUNED Morgan MS, Minister for Health and Social Services gave Senedd members an update on the ongoing concerns at Betsi Cadwaladr University Health Board,
The Minister said:
” The situation in Betsi is unacceptable and it needs serious work and effort to correct. Services are not as good as they should be, and we are determined to improve the situation for the thousands of people in north Wales who rely on these services.148
Following the tripartite meeting between the Welsh Government, Healthcare Inspectorate Wales and Audit Wales, the NHS chief executive has recommended that the targeted intervention status at Betsi Cadwaladr University Health Board should be extended beyond mental health and governance issues to incorporate Ysbyty Glan Clwyd, focusing in particular on the vascular service and emergency department in Ysbyty Glan Clwyd, and I have accepted that advice. They did not suggest that we put Betsi back into special measures.149
We will therefore ensure that significant new additional external clinical and practical expertise will be put in place to ensure that we embed sustainable change and improvements in the quality of the service. In this way, we’ll be making improvements with the health board rather than doing things to the health board. The decision has been made in line with the escalation framework and reflects serious concerns about the leadership, governance and progress that have been a feature of Ysbyty Glan Clwyd. My decision has been communicated to the chair of the health board.150
Firstly, let me address the issue of governance, leadership and oversight of Ysbyty Glan Clwyd. It’s clear the current challenges facing Ysbyty Glan Clwyd require a focused intervention to support cultural change and promote leadership at all levels. I have therefore instructed Improvement Cymru, the improvement service for NHS Wales, to work with the health board to bring in external clinical and organisational development expertise into the hospital. The aim of Improvement Cymru is to support the creation of the best quality health and care system for Wales, so that everyone has access to safe, effective and efficient care in the right place and at the right time. I want to emphasise that this in no way reflects on the hard work of the staff in Ysbyty Glan Clwyd, but this is a source of external help and support to embed the change that is needed urgently, and we need to do this at pace.151
Secondly, vascular services have been challenged since the service was centralised. This does not mean that the decision to centralise was wrong. Following a series of concerns raised by the Royal College of Surgeons and Healthcare Inspectorate Wales, the health board has responded rapidly and progress has been made in a number of areas, but the service remains fragile. There have been some serious incidents over the last few months and the benefits of the recent changes have not yet been realised. A new clinical leader has been appointed but has yet to take up post. My officials will continue to monitor the implementation of the action plan at least twice a month.152
Thirdly, the emergency department at Ysbyty Glan Clwyd has been designated a service requiring significant improvement by Healthcare Inspectorate Wales. We have made £3 million available to the health board for the local six goals for urgent and emergency care programme. I have instructed clinical leads from the national programme to work closely with the health board to address the concerns identified by HIW.153
Fourthly, mental health. This service is, without doubt, in a much better state than the one that went into special measures. But, while progress has been made, there is still much more to be done, particularly around culture change, and this will take time. Following discussions with the Deputy Minister for Mental Health and Well-being, I’m asking the health board to move with pace to ensure that there is a permanent leadership team in place, and to develop a robust recruitment plan to minimise vacancies and the use of interim staff. We must make this a sustainable service. I have asked Welsh Government officials to commission an independent assessment of the sustainability of the progress that has been made against the various mental health reviews over recent years, and ministerial oversight of these arrangements will be led by the Deputy Minister for Mental Health and Well-being.
Finally, it has become clear that the health board’s current systems are largely reactive. External reviews have pointed to significant gaps in fundamental aspects of clinical service standards. That includes record keeping, incident management, team working, reporting concerns, leadership and morale. Many processes are in place, but there is not sufficient capacity in place and they’re not broad enough to provide systematic assurance in these areas. The health board must become a self-improving organisation, sustained by clinical staff with the skills to practice continuous improvement in their daily work. This focus needs to be evident right through the organisation, from ward to board.
I am asking the health board to do the following things: review current governance, audit and effectiveness capacity and work arrangements with Improvement Cymru to invest in a rapid education and support programme that will be put in place quickly in order to improvement skills. I have also asked the health board to ensure that a senior appointment is made to a director of safety and improvement post. This individual will support the new executive director of nursing to ensure that joint improvements are put in place across the health board. On top of this, the board must do better to connect with and engage with its staff and the public. There have been a series of concerns raised about workforce well-being, cases of harassment, bullying and staff feeling unable to speak out. The board must build on the work it has started in terms of its organisational development, and it must do this quickly. Given the seriousness and exceptional nature of this escalation, these arrangements will be monitored closely and reviewed early to ensure that progress is made. A further tripartite meeting will take place no later than the end of October this year.
Dirprwy Lywydd, this is an extensive and far-reaching set of targeted intervention arrangements for Betsi Cadwaladr University Health Board, and we will review these regularly and robustly over the coming months. Let me be clear that there are pockets of brilliant work being done in Betsi Cadwaladr Health Board. What we need to see now is that that quality is replicated across the whole system, most specifically in Ysbyty Glan Clwyd. But more importantly, this is a set of arrangements that will support the health board on its continuing improvement journey so that the people of north Wales can be proud of their local health service. ”