Quarterly update (overview): Betsi Cadwaladr University Health Board special measures, discovery phase

Eight domains

• Governance, board effectiveness and audit.
• Workforce and organisational development. 
• Financial governance and management.
• Compassionate leadership and culture.
• Clinical governance, patient experience and safety.
• Operational delivery.
• Planning and service transformation.
• Clinically vulnerable services.

Conditions for sustainability

• Clear strategic vision.
• Cultural change journey.
• Effective board.
• Strong leadership and engagement.
• Clinical leadership.
• Strengthened clinical services.
• Integrated performance and quality.
• Accountability.
• Responsive.
• Learning and improving organisation.
• Strong programme management.
• Improved access, outcomes and experience.

• Focus on understanding core issues across the organisation.
• Six Regulation 28 reports.
• One Schedule 5.
• Health and Safety Executive prosecution confirmed.
• Grievances/disciplinaries.
• Performance overview.

• Support for the Office of the Board Secretary in place.
• Rapid review: Office of the Board Secretary.
• Review of interim appointments.
• Scoping of patient safety issues.
• Review of mental health reviews. 
• Mental health inpatient safety impact assessment.
• Orthopaedics sustainability.
• Elimination of 4-hour handover wait.
• Vascular assurance assessment.

• Establishment review commenced.
• A scoping programme to assess the effectiveness and implementation of the new operating model is underway.
• Workshops with local medical council and local staff-side partnerships are being arranged. 
• A review of wellbeing, engagement and workforce policies is underway.
• Review of interims appointments commenced.

• Clinical governance review scope is being agreed.
• Interim assessment in relation to concerns around patient safety underway. 
• His Majesty's Coroner and Public Safety Ombudsman Wales rapid reviews.
• Learning and reporting programme structure in place.

• Six independent members in post.
• Four committees have taken place.
• Two board meetings and two workshops taken place.
• Five independent advisers in place.
• Discussions underway regarding a further three independent advisors.
• Support for operational grip embedded in the health board.
• Interim CEO in place and recruitment for a new CEO commenced.
• Changes made to the Office of the Board Secretary.
• Rapid review of Office of the Board Secretary structure and remit underway.

• Welsh Government has commissioned direct support.
• Focus on elimination of 4-hour handover and orthopaedic delivery. 
• Workshops held on orthopaedics and regional treatment centres.
• Urgent and emergency care summit.

• Mental health inpatient safety assessment took place in April.
• A review of previous mental health reviews started.
• Oversight on vascular services and assurance assessment taking place.
• Harm review on those waiting for plastic (dermatology).
• A clinical leadership conference of senior medical leaders held in April.

• Preliminary review of cultural leadership led by Health Education and Improvement Wales.

• Detailed deep dive into the reasons for the forecast financial deficit. 
• Options for efficiencies noted. 
• Value based approach in development.
• Financial controls and governance.
   

• Draft annual plan. 
• Areas of opportunity highlighted. 
• Revised plan to be submitted at the end of June is in development. 
• A Board workshop held to understand the challenges and options.
• Planning and financial delegations in development.