North Wales’ crisis-hit health board ‘not run by Welsh Government’

North Wales’ crisis-hit health board is not being run by the Welsh Government, its leaders have been told. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

The current leadership of Betsi Cadwaladr University Health Board has outlined how they will navigate the authority being back in special measures, with another review of vascular services being mooted as part of the plans. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

In February the Welsh Government placed the health board back into special measures because of serious concerns about its performance, leadership and culture. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

This saw the then chair, vice chair and independent members of the board leave to be replaced by interim appointments. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

The board has held its first meeting since Carol Shillabeer took the reins as interim chief executive having been parachuted in from Powys ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Teaching Health Board. Gill Harris, who is the Interim Chief Executive at the Health Board is currently on prolonged sickness absence. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Ms Shillabeer gave a special measures update, saying she has been pleased with the attitude of staff within the health service since her arrival three weeks ago. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“I’ve been really pleased with the response that colleagues have taken and the enthusiasm and motivation with which they’ve applied themselves to this improvement work,” she said. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“It is clear there is a lot to do and the process by which we make the improvements is important to get right, in terms of ensuring we are making firm and sustainable steps on the improvement journey. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“We know that the organisation has unfortunately been either in special measures or targeted intervention for a considerable time and it’s my hope and intention to support wherever I can a sustained improvement that will last a very long time into the future.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Ms Shillabeer said improvement work would take place across three 90-day cycles in which the board can “expect to see quite a change” and a focus on outcomes. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Eight broad areas of concern within the health board are; ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

• Governance and board effectiveness
• Workforce and organisational development
• Financial governance and management
• Compassionate leadership and culture
• Clinical governance, patient experience and safety
• Operational delivery
• Planning and service transformation
• Mental health

A number of independent reviews are to take place, with the first 90-day cycle labelled a “period of stabilisation”. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Although the Welsh Government has deployed a number of independent advisors to support the health board, it has been keen to stress it is not running the health authority day-to-day. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Addressing the board, Olivia Shorrocks, the Welsh Government lead for performance, escalation and intervention said: “I just want to be clear with everybody the Welsh Government are not running the health board. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“There is still a perception that special measures means the Welsh Government are running it but we’re not. We’re here to help, support and advise. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“It’s been a challenging three months for everybody and we’re still uncovering some concerns and issues that we were unsure about and we’re still finding things out. It’s important that we don’t rush these issues, we take our time and understand them.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Ms Shorrocks said there have been examples of good practice and excellent staff performance highlighted already, including the health board’s adult mental health service, the performance of which has improved dramatically in the last few months. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

But there are still many issues to address. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“There is still a lot of noise out there”, she added. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“We’ve had a big focus recently in the press about financial management, issues going around about contract management and procurement, issues raised with the coroner and the ombudsman. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“The health board is under considerable scrutiny, externally and internally.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Ms Shorrocks confirmed the Health Minister meets with the health board at least twice a month, and among the improvements they are looking for is seeing waiting list numbers reduce as well as handover waits. Vascular services are also coming under review again after a damning report published earlier this year. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

She added: “We’re looking to conduct another review I’m afraid of vascular just to give us some assurance against some of the things where we’re hoping to make sure everything is okay. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

“That is going to be kicking off very quickly. There’s still a little bit more discovery to do.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Further recruitment to the board is also set to take place. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

As the current board members noted the report and welcomed future progress updates, interim chair Dyfed Roberts said: “The one thing we must all watch for is that this does not become a process by itself, that it grows ‘factory-like’, but that we have clear focus on outcomes and progress, and we are able to show that clearly in committee and meetings of the board.” ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

By BBC LDRS ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​