Public Accounts Committee

PAC(5)-31-18 Paper 6

26 November 2018


TITLE:          Betsi Cadwaladr University Health Board Special Measures     Update

DATE:          6 November 2018

BY:     Vaughan Gething, Cabinet Secretary for Health and Social Services


I made a statement on 5 June on the progress made in some key areas during the time the Health Board has been in special measures, the significant challenges that remained and plans to work with the Health Board during the next phase of improvement.

My statement today will focus on progress against the expectations I set out to the Health Board in May in the special measure improvement framework.  The framework sets out milestones for 18 months in four key areas – leadership & governance, strategic and service planning, mental health and primary care including out-of-hours. The Health Board is required to report on progress every 6 months and the first report was discussed and agreed at its Board meeting held last week.

I met with the new Chair and the Chief Executive for my regular accountability last Tuesday to discuss the progress made and plans to deliver on the challenges and difficulties that remain. 

On leadership and governance there has been a strong focus on improving Board capability. During May to September 2018 all Board vacancies were addressed. Mark Polin was appointed as the new Chair and a new Vice Chair and independent members’ appointments made. In line with my expectations, an Executive Director of Primary and Community Care has been appointed to drive the required improvements in this area.  A new Executive Director of Planning and Performance has also been recruited and will start in post in November. 

More robust appraisal and reporting/ assurance systems are now being introduced by the new Chair to further drive improved good governance. There has also been increased commitment and impetus to partnership working from the Board to support delivery of ‘A Healthier Wales’ and the transformation agenda. I was pleased to announce last week support from the ‘Transformation Fund’ for a North Wales project to help people with learning disabilities live more independent lives and get the care they need closer to home. This will involve sharing resources, skills and expertise across health, social care and the third sector. 

In relation to finances, the Health Board remains in a challenging position. However, if the control total set for this year is met, it will represent an improvement on the previous year. The Board are in no doubt that achieving this will require focused action over the latter part of this financial year to deliver on the turnaround needed to secure stability and drive the shift to transformation in its future plan. I announced in July additional funding of £1.7million under the special measures arrangements to strengthen the management capacity and analysis capability in the turnaround team.

A key expectation of the improvement framework was that the Board responded promptly and appropriately to the Health and Social Care Advisory Service (HASCAS) investigation findings and the Ockenden Review recommendations. I am content that the plans the Health Board has put in place to implement the recommendations, both with mental health and more widely, are comprehensive and robust – with operational leads identified and being held to account. My focus now is on ensuring there is rapid progress on implementing these plans. We are already verifying the progress so far reported by BCU in their regular reports is recognised by the frontline staff in mental health – this is in addition to the HIW inspection programme which is also reporting progress. Improvements so far include the confirmation of a new and visible senior management team, appointment of a new mental health nursing director, creation of listening leads across front line staff and the launch of the ‘Today I Can’ approach. 

Furthermore, a stakeholder group has been created to further test the improvements being made. I am pleased that some members of the Tawel Fan families have agreed to be part of this group, along with the CHC and other stakeholders. 

I met with a number of Tawel Fan Families again last week. Understandably a small number of families are not entirely content with either the process or outcome of the investigation, there was consensus though of the need to ensure the Health Board reports and action plans prepared result in sustainable and meaningful improvements in both mental health services and care of those with dementia across services. My officials have been very clear with the Health Board of the need to ensure it communicates plans and actions effectively to all staff. 

The focus of developments in mental health to date has been around immediate improvements to in-patient services, including environmental works. The Health Board is also working to assess and improve community services by implementing its mental health strategy, working closely with local authorities, third sector, services users and the police to deliver local implementation plans. A key focus for the next 6 months will be to improve and maintain performance against the mental Health Measure and CAMHS targets. 

To support this work the Delivery Unit is reviewing demand and capacity and my officials are discussing what further support might be needed in this area to rebalance service capacity and demand. 

Improvement to engage and involve staff is on-going and the results of the NHS Staff Survey 2018 show positive changes since 2013 and 2016 most notably in staff engagement. This includes an increase of 18% from the 2013 survey to 65% of staff proud to say they worked at BCU.

The strategic and service planning area including performance requires acceleration and more focussed effort. There has been progress in individual specialities strategies with the Sub-Regional Neonatal Intensive Care Centre and primary percutaneous intervention plans implemented and the vascular surgery plan underway. These plans increase success in recruitment and in delivering specialist services in the region for the North Wales population. Work on other areas including orthopaedics need to be further progressed on a whole system basis and described more clearly in its plans for service transformation and improvement.

In primary care the new Executive Director will provide increased focus to deliver further improvements working in partnership with clusters. Work is continuing to improve GP out of hours services and the Health Board performance is now more in line with the rest of Wales. The ambition of the Health Board is now to transform the service model so that it becomes more fit for purpose and sustainable.

In this statement I have noted areas of progress but also outlined the significant difficulties that remain. I am determined that special measures is not a sticking plaster and delivers sustainable improvements that puts in place the capacity and capability required for the medium and long term. During the next 6 months the Health Board will need to focus on finance, strategic and service planning especially unscheduled care and RTT and delivering on the recommendations from HASCAS and Ockenden. The Chair and the Board is clear on the work needed and committed to making progress. Welsh Government will be working alongside to provide the necessary support and I hope regional partners and key stakeholders will also pay a key role in ensuring improved and sustainable health and care services for the North Wales population.