Betsi Cadwaladr: NHS health board back in special measures

North Wales' troubled Betsi Cadwaladr Health Board has been put back into special measures by the Welsh government following a damning audit report.

The board had come out of special measures only two years ago.

A total of eleven independent board members also quit on Monday, triggering a row after it emerged the Welsh government had asked them to quit.

Last week Audit Wales said the senior executive team was dysfunctional.

Health Minister Eluned Morgan said she had to act to rectify problems with the health board's performance.

But in a letter, the former independent board members said they had "no confidence" in the Welsh government's grasp of the situation.

They said they had been raising concerns with ministers about the health board and questioned the focus on them, instead of senior executives.

The audit report followed a recent string of failings, including on vascular and emergency services.

Special measures will mean the organisation comes under more direct oversight by the Welsh government, and will see the drawing up of an improvement plan.

Betsi Cadwaladr had already been under "targeted intervention" from the Welsh government in a range of areas, including mental health services.

Plaid Cymru claimed the independent board members had been made "scapegoats", while the Welsh Conservatives said they had no "confidence" the remaining executives will be able to deliver improvements.

As part of the changes Chairman Mark Polin has been replaced by former Gwynedd council leader Dyfed Edwards.

Betsi Cadwaladr is led by a group of executive directors and independent board members.

While executives are responsible for the day-to-day operation of health services, independent board members are there to scrutinise their decisions.

Last week, the Auditor General Adrian Crompton alleged that the executive team suffered from "dysfunctionality and factions".

He said independent members had scrutinised executives publicly, but that was seen as "hostile and inappropriate" by some.

The staff and patients of Betsi have been here before - it's just over two years since the health board was last in special measures.

Many will interpret its return to the status of last resort as a failure by the Welsh government to get to grips with the persistent problems at the board.

Others are asking why the independent board members have been cleared out, when it was the executive leadership that the auditor general recently described as dysfunctional and factional.

The minister says she is taking action to address those problems and clearly hopes that introducing new blood can deliver better working relationships at the top.

Eluned Morgan said in a statement: "I have serious concerns around the performance of the health board and I have not seen the improvement in services I expect for the people of north Wales."

She confirmed to BBC Wales that the government "did ask the independent members of the health board today to consider their positions and they did take that opportunity to resign".

Ms Morgan said the report from Audit Wales had given the Welsh government "considerable cause for concern".

Asked why the independent members were asked to quit, she said the report had made clear "it was not possible... that the independent members could work well with the executives in future to correct the situation".

In a letter to politicians the independent board members said they were "left with no option but to resign as independent members with immediate effect" after a meeting with Ms Morgan on Monday.

"We have no confidence in the Welsh government's grasp of the situation," they said.

Former board members said they had "tirelessly and repeatedly raised issues of concern, both to the health board executives and also to Welsh government officials, and the minister".

The letter outlined that a fraud investigation into £122m allegedly not properly accounted for had followed a review commissioned by the independent members.

"This is under way but has serious implications for other NHS organisations and the government," the letter said.

The members alleged that responsibility for organisational culture, service quality and delivery "have been placed at our door without recognition of the limitation of our powers as independent members".

It added: "We are gravely concerned that the minister's response to the Audit Wales report, and her focus on independent members rather than the operational executive and their delivery, exposes patients across north Wales, and the organisation to significant risk going forward."

Conservative MP for Clwyd West David Jones said: "The letter to the Welsh health minister from the former independent members of the Betsi Cadwaladr health board is incendiary and damning in its criticism.

"These are highly respected people and deserve to be taken seriously. An early response is called for."

Wrexham Conservative MP Sarah Atherton, who trained as a nurse at the town's hospital in the 1990s and returned to work on the wards during Covid, said: "I'm immensely disappointed because what everyone's forgetting here is it's people's lives and well-being that's at stake."

Geoff Ryall-Harvey, chief officer of North Wales Community Health Council, said he was "shocked" that the entire board had resigned.

He said he was "struggling to understand the logic" behind the minister asking the board members to go.

He said Welsh auditors had been asking independent members to be more critical of executives since 2013.

"This board has done that and this is the result," he said.

He questioned whether others will want to take on the jobs in future and said special measures would need to be "different" this time around.

Plaid Cymru's health spokesman Rhun ap Iorwerth said: "Rather than pointing the finger of blame at the board, Welsh government should be looking closer to home."

He added: "The patients and staff of Betsi Cadwaladr deserve better from their government. The least they deserve is an apology, but what we all need is the government to step up and take responsibility for this mess.

"The question is what will it take for the health minister consider her own position in the matter?"

The Welsh Conservatives said: "We welcome the return to special measures, the Betsi Cadwaladr University Health Board should never have been taken out of them in the first place.

"However, we have no confidence that the current executive team will be able to deliver the improvements required. It is extraordinary that such a dysfunctional team is still permitted to lead this organisation."

The health board's Interim Chief Executive Gill Davies said it was "extremely disappointing" that the board was going into special measures, but added: "I acknowledge that more needs to be done at a greater pace to regain the confidence of our staff and our communities". 

She explained that the decision means the board will work "more closely with Welsh government" with the "development of an improvement plan".  

"The arrangements will also involve the creation of a health board turnaround team during the coming weeks", she added.

The Welsh government said a campaign to recruit new independent members will start later this year.

There are four levels of Welsh government oversight for health boards in Wales.

These are, in escalating order: routine arrangements, enhanced monitoring, targeted intervention and special measures.

An entire health board can be in special measures, as Betsi Cadwaladr was between 2015 and November 2020, or just specific departments.

Targeted intervention is a heightened level of escalation that requires significant action on the part of the health board and is accompanied by continued Welsh government oversight.