Written Statement - Update on escalation status review of health organisations and additional support for Betsi Cadwaladr University Health Board

I am updating Members on the outcome of the escalation status review of health organisations between the Welsh Government, Healthcare Inspectorate Wales and the Wales Audit Office in December 2017. I am also confirming additional action being put in place to support Betsi Cadwaladr University Health Board (BCUHB) under the special measures arrangements.

I have agreed with the recommendation from the tripartite meeting of no formal change in escalation levels of organisations at this stage, recognising the higher level of contact and clear expectations in place in respect of the three organisations (Abertawe Bro Morgannwg, Cardiff and Vale and Hywel Dda) still within the targeted intervention category. Six out of the 10 organisations remain in routine monitoring and BCUHB remains in special measures. The escalation status has been updated on the relevant web-page and the individual organisations have received written notification of their current status.

Turning specifically to BCUHB it is evident from the reports that progress has been made against the expectations set out in the special measures improvement framework. Under the leadership and governance area a full executive team is now in place with six new appointments made since it was placed in special measures. Board performance has been aided by an on-going Board Development Programme and a restructured committee structure. Complaints and concerns leadership has now been transferred to the Executive Director of Nursing and Midwifery and this has led to improved clinical oversight, a reduction of more than 50% of the backlog and a material improvement in responsiveness.

Other framework milestones that the Health Board has met include: 

• the agreement on a mental health strategy developed in partnership with involvement of service users; 
• improvements in the ways in which it engages with members of the public; 
• a marked improvement in a number of measures in the 2016 staff survey; and, 
• a successful approach to primary care services in Prestatyn implemented. 

One area of significant improvement from the 2015 position is in maternity services. This has included a reduced reliance on locum/agency rate to 11% (down from 50%); compliance with Birthrate Plus (workforce tool that determines midwifery staffing levels); the re-introduction of pre-registration midwifery students to Ysbyty Glan Clwyd so that all three sites in North Wales are now being fully utilised for training purposes; appointment of a Consultant Midwife to lead improvements in midwife led care; and progress on the development of the SuRNICC. A contract has also been let to support organisational development and improved professional working relationships across the whole maternity service provided by the Health Board. Given the good progress and stability demonstrated across maternity services, this no longer represents a special measures concern and is therefore de-escalated as an issue. I welcome the progress made and the commitment from the staff and teams to meet key milestones.

However, despite the progress in some important areas, the Health Board continues to face significant challenges – in particular it has been disheartening and unacceptable that during 2017/18 issues have escalated in relation to the financial position and some key areas of performance.  This has resulted in the Welsh Government increasing its oversight, including my personal chairing of monthly accountability meetings since July. The Welsh Government continues to work with BCUHB to ensure that services and patients are not adversely affected by the need to improve financial management.  

The Welsh Government, Wales Audit Office and Healthcare Inspectorate Wales at the tripartite meetings held in December also advised on the need for further progress in some key areas and for focussed action under special measures to turnaround the position on finance and performance. In terms of mental health services, all parties recognised that the absence of the Director of Mental Health and Mental Health Nurse Director on extended sick leave had meant the improvements in this area had lost momentum in recent months.    Therefore, there is now an urgent need for BCUHB to embed and build on the new mental health leadership structure and speed up the pace of quality improvement in existing services.   It is important now for BCUHB to urgently rebuild confidence in the safety and sustainability of the existing mental health services, alongside beginning the longer- term transformational change required in the new strategy.

I want to ensure the people of North Wales receive high quality health services. To support the Health Board build on progress made and ensure delivery and improvements in mental health services and in its finance and performance positions, I have agreed a set of interventions to be actioned immediately. These include the appointment of David Jenkins, previous Chair of Aneurin Bevan University Health Board in an advisory role on board governance and performance progress; BCUHB to appoint a Turnaround Director and team to deliver and increase pace on actions; increased primary care leadership and  planning capacity and capability  to be put in place; an action plan progressed to deliver on the Deloitte Review recommendations; additional support to extend management infrastructure in place for mental health team; allocation of £13.1 million committed from within performance funding to improve waiting times and £1.5 million invested in an unscheduled care programme.

The current Health Board Chair tenure ends on the 31 August, 2018 and to ensure we have an appropriate leading time and transition period for a new Chair, I have agreed we will start the recruitment process within the next few weeks.

Tied to the actions are criteria and additional milestones that we expect the Health Board to achieve or progressed by April, 2018:

• A reduction of RTT waiting times by around 50% in the numbers waiting over 36 weeks and progress to continue into 2018/19;
• Sustainable improvement in unscheduled care performance;
• Financial recovery actions to result in the Health Board meeting the £36 million revised forecast at year end and improving into 2018-19;
• Reduction in patient out of area placements; 
• Development of a thematic quality improvement and governance plan for mental health services; 
• A Turnaround Director and team in place and demonstration of increased pace on actions; 
• Director of Primary Care and Community Care in place reporting to the Chief Executive and Board;
• Additional planning support and team in place and evidence on the work to develop a holistic plan and IMTP in partnership; 
• Evidence that clinical leadership is working alongside planning and professional directors on clinical service proposals; 
• Action plan agreed and work progressed to meet the recommendations set out in the Deloitte Review; 
• Team based development programme implemented for the Executive Team; and, 
• Appointment process for the Chair, Vice Chair and 5 independent members initiated and nearing completion. 

Monitoring and oversight of BCUHB by the Welsh Government under special measures will continue at a heightened level. It is important to clarify that under these arrangements the Health Board remains responsible and accountable for its actions and improvements on behalf of its population.  

We will be setting out a revised framework for BCUHB to cover the next 12-18 months with milestones and expectations set out clearly agreed with HIW, WAO and BCU itself. In assessing future progress we are not only looking to ensure they have been met but also that sustainable solutions are in place to maintain progress.