Progress at Betsi Cadwaladr University Health Board under special measures: April-June 2024 Update

Mark Drakeford MS, now Cabinet Secretary for Health and Social Care, has circulated an about “progress made under special measures at Betsi Cadwaladr University Health Board” (BCUHB).

BCUHB was again escalated to special measures in February 2023 due to concerns over board effectiveness, governance, patient safety, operational delivery, leadership, and financial management. The new report covers progress made between April and June 2024.

Mark Drakeford said, “Senedd members have been provided with regular updates since Betsi Cadwaladr University Health Board was placed in special measures in February 2023.

“We have published four progress reports to date, and I am today publishing a report which sets out the progress the health board has made between April and June 2024.

“A special measures framework for this phase of the current special measures intervention was agreed between the Chief Executive of NHS Wales and the Chief Executive of Betsi Cadwaladr University Health Board in May 2024. This was presented to the Board at its meeting on 30 May 2024.

“The Welsh Government will continue to work with the health board through our oversight and assurance arrangements to ensure the required improvements related to outcomes, performance, clinical fragile services and quality and safety are accelerated, and that the necessary systems and structures are in place to ensure these improvements are sustainable.

“There is still a lot of work to do, but there are encouraging signs of improvement for people living in North Wales. We will continue to update Members as the work progresses.”

The full report can be found here, with a summary of the points detailed inside it below:

Governance:

• The board has strengthened its governance, with a full complement of independent members and a new Executive Director of Governance.
• A new quality report and citizen experience report are now regularly presented at board meetings.
• Recommendations from a previous review of the Office of the Board Secretary are being implemented, with expected completion by January 2025.

Quality of Care:

• The health board has introduced a Quality Management System (QMS) to address legacy quality issues, starting with vascular and urology services.
• There are improvements in investigating complaints and incidents, with better learning from past cases.
• Nationally reportable incidents (NRIs) are being handled with a focus on rapid reviews and learning dissemination.

Performance and Outcomes:

• Waiting times have improved: 48% reduction in 104-week wait times for orthopaedics, and a 19.9% reduction in diagnostic test wait times.
• Mental health services for under-18s have improved but still fall just short of the 80% target for timely assessments and interventions.
• For adult mental health, performance for interventions completed within 28 days remains above target at 82.4% in June 2024, and there has been an improvement for assessments completed within 28 days at 74.7% in June 2024.
• Despite some progress, urgent and emergency care performance remains a “significant challenge”.

Leadership and Culture:

• Compassionate leadership is being promoted, with senior recruitment in key roles ongoing.
• Organisational learning has been improved, especially in areas like medication errors and patient safety.

Financial Governance:

• The health board ended the 2023-24 fiscal year with a £24.3m deficit, exceeding its target £20m deficit by £4.3m.
• A plan is in place to reduce the deficit to £19.8m for 2024-25 – “This is based on assumed delivery of an annual savings target of £48m”
• The Auditor General raised concerns about financial irregularities, leading to strengthened controls and governance. “The Auditor General has noted that the health board is now strengthening its controls and governance arrangements accordingly. “

Service Transformation:

• A clinical services strategy is being developed for 2024-25, with a focus on sustainability.
• Fragile services like mental health and vascular services are under review, with improvement plans in place.

The report concludes:

The special measures framework provides clarity in our expectations in terms of the priorities and milestones the health board must achieve as we move into the next phase of the special measures escalation.

We continue to work with the health board through our oversight and assurance arrangements, to ensure the required improvements related to outcomes, performance, clinical fragile services and quality and safety are accelerated, and that the necessary systems and structures are in place to ensure these improvements are sustainable.