4. Statement by the Minister for Health and Social Services: Special measures at Betsi Cadwaladr University Health Board — One year on

– in the Senedd at 3:33 pm on 20 February 2024.

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Photo of David Rees David Rees Labour 3:33, 20 February 2024


Item 4 today is a statement by the Minister for Health and Social Services: special measures at Betsi Cadwaladr University Health Board—one year on. And I call on the Minister to make the statement. Eluned Morgan

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr, Dirprwy Lywydd. Next week will mark 12 months since I placed Betsi Cadwaladr University Health Board into special measures. Today, I want to take the opportunity to reflect on the last year and to share with you how the health board, despite the ongoing pressures, continues to deliver day in, day out in a really positive way for the vast majority of people in north Wales. 

It’s worth remembering that the health board is the biggest employer in Wales, employing over 20,000 people, serving a population of around 700,000 people, carrying out an average of around 16,000 patient contacts, over 2,000 patient appointments, and around 450 planned procedures every single day. So, I want to acknowledge the excellent work of everyone who works in the health board, and thank them for everything they do to ensure patients are seen and treated safely, compassionately and in a timely manner.

I also want to highlight just a couple of examples of some of the innovations the health board has introduced over the last 12 months. These include becoming the first in the United Kingdom to use artificial intelligence to diagnose breast and prostate cancer. I was also pleased to help launch the new e-prescribing service at a pharmacy in Rhyl back in November, as part of an all-Wales roll-out.

Dirprwy Lywydd, it has been a challenging year for the health board, but I do think the difficult decision to put it into special measures was the right one. And that is because this board is now in a much better position to drive substantial change and improve health services for the people of north Wales.

So, what have we done? Firstly, there has been a focus on rebuilding and stabilising the board. There is now a permanent chair, chief executive and vice chair. The final four independent members will be announced very soon, and this will give the organisation the stability and focus it needs in order to improve. I was pleased to see that Audit Wales recognised a marked improvement in terms of board stability in its recent follow-up report on board effectiveness, and that the dysfunctionality within the board described in its previous report is no longer evident.

As part of the special measures intervention, a small number of independent advisers were contracted to work with the board, and a number of independent reviews have been commissioned into problem areas. Dirprwy Lywydd, I must say that many of the reflections from the advisers, and the reports from the independent reviews, make uncomfortable reading and have exposed some very serious issues that the health board must now address. While it has been encouraging to hear about the improvements that Healthcare Inspectorate Wales has observed through its more recent inspections, Members will be aware that His Majesty’s coroners and the ombudsman have highlighted a number of consistent themes, and I hope the health board has now uncovered all of the key issues that need to be addressed and has structures in place to address these issues.

Audit Wales has also, over the last year, reported on poor financial management and accounting practices. I've discussed these with Members of the Senedd on a number of occasions, and you are all aware that I am unable to comment further as disciplinary processes are still ongoing. But the recent Audit Wales report suggests that the board is responding to the issues identified in their audits of the 2021-22 and 2022-23 accounts, as well as those identified in the Ernst & Young review. It's also worth noting that North Wales Police has decided not to take any further action on the findings of the Ernst & Young report.

Like all other health boards in Wales, Betsi faces significant financial challenges as a result of inflation and austerity measures. We're actively monitoring the health board’s response to these challenges.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 3:38, 20 February 2024


All of this is key to changing the culture within the health board and its organisation. But the key question is: what difference is this making for people living in north Wales? Well, they should take comfort from the fact that performance in the board is improving. The health board has reported a 65 per cent reduction in the number of people waiting more than three years for their treatment to begin, between February and November 2023. The number of those waiting over 52 weeks for their first out-patient appointment has fallen by over 15 per cent in the same period. Also, there has been a 33 per cent reduction in the number of people waiting over eight weeks for their diagnostic tests. I do appreciate that people are still waiting too long, but things are moving in the right direction.

In November 2022, a few months before the health board was put into special measures, I made an unannounced visit to Abergele Hospital. That day, a Thursday afternoon, there was no orthopaedic activity going on. This was despite the fact that Betsi had one of the longest orthopaedic waiting times in Wales. Now, I was both surprised and disappointed to find that the management team and the board were unaware of the lack of activity, showing their lack of grasp of the situation. But, today, thanks to a great deal of support from the Getting It Right First Time team, the Welsh Government and the new board, we are now seeing far more activity on that site. 

Waiting times for orthopaedic pathways have improved across the health board. In November, the number of patients waiting over 104 weeks was at its lowest level since April 2021. And we expect to see this positive progress continue, as the construction of the new orthopaedic hub in Llandudno will be completed by the end of this year.

Pressures in urgent and emergency care continue. Between February and December 2023, there was an increase of over 2,000 monthly attendances at emergency departments in north Wales. Focusing on eliminating four-hour handovers is resulting in some improvements. In December 2023, there were 786 handover delays in excess of four hours. Although this is still too high, it does represent a 23 per cent reduction compared to the previous year. 

There's been a great deal of talk about the challenges facing the vascular service. I have visited the department on many occasions to monitor progress, and I was pleased to see, in June of last year, that Healthcare Inspectorate Wales de-escalated them from a service requiring significant improvement to a lower status. An independent assessment against the vascular plan by the NHS executive vascular clinical network concluded that the service has improved and now provides a much safer service. To give further reassurance, a vascular case note assessment is in place. The final report is expected in March of this year. 

So, what next? The health board has been in special measures for 12 months, and there is still a lot to do. Last year, I set out a series of sustainability conditions for the board, which are still valid and will need to be met before a de-escalation to level 4 can be considered. And, over the next few months, I will publish escalation criteria for each area. 

Without doubt, the health board faces significant challenges, but it is important that we collectively support the board to develop and build a sustainable organisation, capable of delivering the services that the people of north Wales deserve. Thank you. 

Photo of Darren Millar Darren Millar Conservative 3:43, 20 February 2024

Can I thank you, Minister, for your statement? You'll appreciate that it's a very sobering reminder of the dire situation in the health service in north Wales. It's another year for residents in north Wales with their health board being in special measures, and, of course, it's spent all but two of the last nine years in special measures in north Wales—the longest of any NHS organisation in the whole of the United Kingdom; not an accolade that I want to celebrate, or anybody wants to celebrate.

I do want to put on record the thanks of my constituents and me and the rest of the Welsh Conservatives group to those hard-working staff who work hard day in, day out. But I won't be thanking every employee of the health board, because we know that, unfortunately, some of those employees are still failing people in north Wales. Some of them are former executives that are still in the NHS and ought not to be, frankly. And, for that reason, I won't extend my thanks, unlike you, to everybody at the health board in north Wales. 

There are many people, of course, who are experiencing significant delays in their treatment. There was a briefing that was circulated to Members of the Senedd from north Wales yesterday, by the chair and chief executive of the health board, celebrating the fact that they'd eradicated six-year waits in north Wales for treatments. Six-year waits, can you believe it? So, up until fairly recently, there were people in north Wales still waiting six years for their treatment. In that report as well, it told us that there were still many people in north Wales—hundreds, in fact—waiting for over three years for not just treatment, but for their very first out-patient appointment. We hear a lot of talk about the two-year focus in this Chamber, but what about the three-year focus that some of my constituents are having to face in north Wales? It is truly shocking. And, frankly, we need more regular access to information on this, or else these issues are not going to be dealt with appropriately. I'd like to know how many people are waiting five years, four years, three years, two years, one year, and the rest, because that is the sort of transparency that we need to see.

The other thing in the report, which you didn't completely refer to in your statement today, but the other thing in the information shared by the health board yesterday was that 10 reviews have been undertaken—10 reviews into services, with recommendations. We haven't seen one of them published. Where do we go to see what those reviews are? You've made reference to reviews finding all sorts of horrors that people need to get to grips with today; I haven't seen any of these reviews, nor has anybody else in this Chamber, nor, more importantly, have the public, who pay for these services and have a right to know how those services are performing. So, in spite of the progress that you like to report, I'm afraid I'm still very concerned, and I'd like to see some transparency from this Government so that we can have confidence in the system.

You made reference to the fact that the coroners' reports and the ombudsman's are regularly raising concerns about treatment in north Wales. You said, in addition, that North Wales Police have decided not to take any further action on the findings of the Ernst & Young report into accounting irregularities, but we know that there are still people suspended, we know that there were findings of false accounting, we know that there were individuals, including in the NHS Wales Shared Services Partnership, who were covering up documents and circumventing the proper governance arrangements around the letting of contracts. Frankly, it's shocking that not one single person appears to have been sacked as a result of those failings in the organisation. 

You made reference to Llandudno. I'm very pleased to see that Llandudno is going to be getting an orthopaedic hub. Of course, most of that activity at the moment, or a great proportion of it, is being undertaken in Abergele, at Abergele Hospital, which you said that you visited some time ago and were shocked to find that not all of the beds were occupied. I too was shocked just a few weeks ago, when I visited, and just one bed was occupied in that hospital. And my staff were shocked as well, this weekend, when they went to visit a member of their family and just two beds were occupied in that whole hospital. That does not seem as though you're sweating the resources to get rid of those overly long orthopaedic waits in the way that we need to. So, I do not accept your complacency on that front.

You talked about the problems we're having in emergency care. Of course we're having problems in emergency care in north Wales, because we know that we need a new minor injuries unit in Rhyl, which you haven't bothered building in spite of the fact that it was promised 10 years ago. So, can you give us an update on that too?

And then, finally, if I may, there was a patient safety report attached to some board papers that were recently published. It has been reported in the media today that one of the things that that report highlighted was concern about oxygen administration for patients, with staff not correctly connecting oxygen supply and that having catastrophic consequences for some patients. And it wasn't just one isolated incident, there have been further patient incidents as well. Can you tell us what action is being taken to ensure that those things do not happen? And can you tell us also what the actual outcome was? What was the catastrophic outcome? Have people died? Have people lost cognitive ability as a result of this lack of oxygen? We need to know, and I think the public deserves to know. In addition, that report—

Photo of David Rees David Rees Labour 3:48, 20 February 2024

No, you've done a lot of questions and I've been very flexible. We've got more Members to ask questions and we have got quite a few going.

Photo of Darren Millar Darren Millar Conservative 3:49, 20 February 2024

I appreciate that. This is the final question. 

Photo of David Rees David Rees Labour

And short please, Darren.

Photo of Darren Millar Darren Millar Conservative

It is. That report also makes reference to an audit of urology services, in which a search of offices was undertaken and they found, and I quote

'100+ radiology reports, internal referrals, histology reports and tertiary centre letters have been identified that have not been reviewed or actioned', over 300 of them in total, with referrals going back to March 2023 that have not been triaged. And one final point here, on this—

Photo of David Rees David Rees Labour

Darren, you are pushing it. Darren, please, I think you need to ask the question. 

Photo of Darren Millar Darren Millar Conservative

I appreciate that time is of the essence, but a minute's worth of time in order to hold the Minister to account for the failings in north Wales surely is appropriate. This is the one—

Photo of David Rees David Rees Labour

Darren. Darren. No, I'll stop you here. You've had six minutes in which you've had—

Photo of David Rees David Rees Labour

—an opportunity to put questions to the Minister

Photo of Darren Millar Darren Millar Conservative

And I've tabled many questions.

Photo of David Rees David Rees Labour

You've spent a lot of time because you want to make points. One final question, please, and it must be a question, or I'll close it.

Photo of Darren Millar Darren Millar Conservative 3:50, 20 February 2024

It is a question. They also identified that there was a backlog of 1,133 letters dictated by clinicians that have not been issued. Now, can I ask you, Minister, why is it that when constituents of mine, and I, and other Members in this Chamber representing north Wales, have made countless complaints about urology services in recent years, that that has been allowed to happen while this organisation is in special measures, because it's unacceptable?

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Wel, diolch yn fawr. I did make it very clear that there is still a long way to go in relation to Betsi, and we're only in year 1, and actually there has been, I think, quite a long road travelled in the right direction, but I make no apology on behalf of the board that they recognise that there is a long way to go.

Just when it comes to staffing in the health board, obviously this is something that is a decision for the board, and I do think it's important that we're absolutely clear about accountability here, because there does seem to be, once again, confusion about where accountability lies. I set out the parameters for what is expected to be delivered, but then I pass on that responsibility to the health board. Now, clearly, when they're under special measures, we have a far more vigilant approach in terms of what they need to deliver, but it is still the responsibility of the health board to deliver and not the responsibility of the health Minister in the Welsh Government.

Now, just when it comes to disciplinary processes, obviously I can't comment on some of the ones that are still ongoing, which is very frustrating, but that is the situation, that the disciplinary processes in relation to some of the financial issues are still ongoing, I'm afraid, and we do have to follow due process.

When it comes to performance, you're absolutely right that there is still a long way to go. The fact is that I am monitoring this incredibly carefully. I have fortnightly meetings to monitor waiting lists in Wales; I know exactly how many people are on what lists, in what health boards, so I am monitoring it in absolute fine detail. I think it's really important that, actually, the fact that those waiting lists, the longest waiting lists, have come down not just in Betsi, but the whole of Wales, have come down, is because of that absolute focus that I and the Welsh Government have put on that.

Just in terms of reviews, I think, certainly, there's more transparency, and an example of the transparency is the fact that you mentioned the issues relating to oxygen administration. The fact that the health board is being open about it and transparent is a big shift from where we've seen things in the past. The health board have confirmed that they're investigating one catastrophic outcome related to no flow of oxygen, but I'm unable to give any more detail than that included in the report due to the confidentiality concerns.

When it comes to urology, the health board have identified administrative processes that resulted in information not being shared between specialities and GPs in a timely manner, and work has already taken place to review this information to ensure it's still appropriate in every case. Any patients affected by this are, I understand, being contacted.

When it comes to the situation in relation to pressures, I get frustrated as well when I see beds that are empty, but, actually, having lots of beds full all the time is not a prize. I think we've got to be clear about the fact that, actually, I'm very unapologetic about the fact that I would like to see more care happening within the community. The fact is we've got significantly—significantly—more beds per head of population than they do in England, and also—[Interruption.]

Photo of David Rees David Rees Labour 3:54, 20 February 2024

One minute, Minister. Darren, I would like to hear the Minister's response, and you're continually trying to speak over her, so please let the Minister respond to the many questions you raised in over the time you had. Minister.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

If you look at what GIRFT recommends—the Getting It Right First Time experts in the field—what they say is, actually, we should be doing far more day-case surgery. So, it's a sign of success if you've got fewer patients, because it means that they're being more efficient in terms of their day-case surgery.

And then, just when it comes to the Royal Alexandra Hospital, the health board have decided that they wish to review their proposals for this site, and they're doing that in partnership with local authorities. I believe that the plans will include a minor injuries unit, intermediate care beds and integrated care, and I'm waiting for a new proposal that I can consider.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 3:55, 20 February 2024


I'll be as brief as possible. Betsi Cadwaladr is my health board, and my loved ones are reliant on the workforce there to support and heal them in periods of ill health. And let's be clear: the workforce there are dedicated people and they do excellent work in very difficult circumstances. And that's why the disappointment about the board's failures is so much greater, because it's not just the patients who are being let down, but also the workforce. But it would be unfair to say that this was only a board failure. It is also a failure on the part of this Government and previous Governments: a failure in failing to identify the weaknesses earlier; a failure in failing to tackle the weaknesses when they emerged; and a failure in failing to put a clear programme in place to improve the situation when needed.

The Government, of course, is happy to blame Westminster for failing to fund Wales adequately. This is of course true, but the evidence shows that this Government is not lifting a finger to try and secure a better financial settlement, and it's unlikely that the Starmer Government will provide financial fairness for Wales. But the truth in the case of the north Wales health board, as with the health service as a whole, in all honesty, is that there is a much deeper problem here that needs to be tackled. And that is not a financial problem, but as I have pointed out here many times, it's a cultural problem.

I therefore welcome the recent report by the auditor general showing that progress has been made over the last 12 months since the board was once again placed in special measures, but this, of course, reflects the folly of the Government's decision to move the board out of special measures in the first place. But one swallow doesn’t make a summer, and it's clear to me that these structural weaknesses remain; the gulf between the board and the workforce on the ground remains. This dates back to the original restructuring, and a series of chief executives have failed to address this fundamental weakness.

But before doing anything fundamental, you have to have an entire board in place. So, I wonder whether the Minister can tell us when she expects all appointments to have been made to the board. This instability that there has been at board level, involving not only the independent members but chief officers as well, has led to a lack of accountability and a failure to take responsibility. We have seen senior members being brought in to work there without any understanding of the area and being unwilling to even put down any roots in the area. The constant change in managers that has taken place at Betsi Cadwaladr—this incessant churn—has contributed to the sense of instability in the board and has created an unclear picture in terms of the lines of accountability.      

What's frightening is that, as far as I know, neither the Government nor the Minister have set any criteria for de-escalation. What is the strategy for improving the situation, and how can the board know that they are moving in the right direction without those criteria for de-escalation? So, I would be grateful to the Minister if she could set out clearly for us today what the criteria are for de-escalation, so that the board can put a strategy in place. Furthermore, will the Minister commit to stating who will contribute to the decision to de-escalate and who will make that final decision? After all, we don't want to end up in the same place as we were before, with the Government taking the board out of special measures due to political imperatives and against the advice of specialist bodies.

Finally, of course, there are constant pressures on the board, such as waiting lists, the rurality of the region, demographics and so forth, which are proving to be challenging. But I would like to know what the Minister's vision is for health service provision for north Wales. What does the Minister believe are the challenges and the needs of people in north Wales? What work has she done to identify these, and in identifying them, to put the right benchmarks in place in order to achieve that vision, so that the board knows which actions need to be taken in order to improve the service? I wonder whether the Minister could enlighten us on that. Thank you.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:00, 20 February 2024


Thank you very much. You're quite right to focus on the fact that the workforce in Betsi is crucially important, and they are there to ensure that healthcare is provided to the people living in north Wales. There are over 20,000 people working for the health board, which in itself means that it touches upon all aspects of society.

The previous board had struggled to get a grip of the situation. I think that's a fair comment. The fact that the current board has taken a different path, that the atmosphere has changed, that people don't fear speaking out any longer—. I think that cultural problem that previously existed—. There is still a long way to go, but I do think that we are on the right track in that regard. I know that compassionate leadership is crucially important, and I know that people are coming in to provide training for the board in that area. 

I know that Plaid Cymru is always interested in talking about restructuring. What I want to see is that we focus on what's important to people on the ground, and I think what they want to see is improved performance and they want to ensure that everything is safe. 

In terms of what's happening in terms of the board, there are four people still to be appointed as independent members to the board. I am waiting for those recommendations to arrive in my inbox, and I expect that to happen over the next few days. Then, hopefully, that will mean that we are in a position to have a full complement in terms of the board. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:02, 20 February 2024

I think it's probably worth setting out that there have been lots of very new appointments to key positions. We've got a new chief executive, of course, but there is also a new interim finance director, a new interim executive director of operations, a new interim chief of staff, a new interim executive director of public health. There have been changes made to the office of the board's secretary, and there's a new director of corporate governance who is going to start in April. It sounds like lots of those are interim, but this is a necessary first step. We need to stabilise the ship, get people in place. Obviously, we have to go through a formal process to now make sure that those interim appointments go through the correct process. 

In terms of what the de-escalation conditions are, we set out the sustainability conditions, and that was referenced in the oral statement that I made previously. These include things like setting out strategic vision, integrated performance and quality, culture change, structures and delivery, effective and functioning board, a responsive organisation, a learning and improving organisation, stronger leadership and engagement, programme management, clinical leadership, strengthened clinical services, improved access, outcomes and experience. 

What's going to happen now is that I'm going to supplement those sustainability conditions with clear de-escalation conditions in the coming months, but I want to do that with the board so we all are agreed on what is necessary to do. And then, of course, we'll go to the normal approach, which is the tripartite approach. HIW, AW and the Welsh Government will make recommendations, and I will determine when is the correct time for people to come out. Thank you.  

Photo of Jack Sargeant Jack Sargeant Labour 4:05, 20 February 2024

Minister, thank you for your statement this afternoon. It’s one year on since the return of the health board to special measures, and residents in Alyn and Deeside, and in north Wales, understandably want to see the change on the ground. However important the changes at the top are, at board level—and they are crucially important, as you’ve described—they mean less to them than how easy is it to get a GP’s appointment, how easy is it to get a dental appointment, or how long they and their loved ones are waiting on the list for treatment. So, with that in mind, what more can you update the Chamber on with regard to the progress on those issues, the issues on the ground? And also, can you reassure us again today that the priorities of my constituents and myself remain the priorities of you and the Welsh Government? Diolch.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr. I think you're absolutely right—it's all very well that we need to change the culture at the top, we need to change the organisation, but, actually, what is it that matters to the public? What they want is access on time to a service that they require. That’s why I’m really pleased that, actually, in terms of general practice, not just in Betsi but across Wales, what we have now is a new approach to access to GPs—and let’s not forget that 90 per cent of people access the NHS via primary care and GPs.

Ninety-one per cent of practices in north Wales were achieving 100 per cent of access standards by 31 March last year, so I think that is something that is commendable. So, things are improving. You may have noticed—I’ve certainly noticed in my postbag—that the volume of complaints in relation to GP access has come down significantly. There is still a way to go. Eight per cent of practices even in north Wales still need to comply with that. We’re building on investment in digital infrastructure and there's additional investment in staff resources across the whole of Wales. So, I’m hopeful that that 8 a.m. bottleneck has gone.

In terms of recruitment, we’ve got to make sure we focus on recruitment of GPs to those surgeries. I’m very pleased that a recruitment campaign meant that Wrexham and Flintshire have seen a number of posts being offered to five clinical lead GPs and 18 salaried GPs recently. So, things are improving there, and I think that’s encouraging more to come to Wrexham and Flintshire. I think the introduction of permanent salaried GPs will provide that important continuity of care that your constituents are keen to see. 

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative 4:08, 20 February 2024

I just want to put on record that I stand by every single word that my colleague Darren Millar has said today. As north Wales Members, and for me as the Member for Aberconwy, not only do we read the very negative reports that have come from some shocking stuff; I had to raise only the other week about dirty suction equipment, and that was in a report from well over a year ago. Of course, now it has gone back into special measures. We were all very much of the opinion, ‘Will anything change?’; I have to be honest, I have seen a difference in terms of engagement, but it’s a little too little, really.

I want to put on record my thanks to the new chair that has been appointed—rather than interim, he's now the chair—Dyfed Edwards, because he has been absolutely excellent. When we get an emergency situation that we get no response from, he responds and he acts, and we get results. But it shouldn’t be the chairman’s role to automatically have to do this. There should be a mechanism that works within the board.

I’ve got patients now who’ve been waiting four years for orthopaedics. The chief exec told me herself six weeks ago that AS1 and AS2 uncomplicated cases—people who haven’t got other issues, who just need the orthopaedic operation—would be dealt with now very quickly in Abergele, but I haven’t seen any improvement to the numbers of patients that I have waiting.

Photo of David Rees David Rees Labour 4:09, 20 February 2024

You need to ask your question now, Janet.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative

So if you could just comment on that. But I want to record my thanks to Dyfed Edwards. Thank you.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Thanks very much. I'd like to put on record my thanks to Dyfed Edwards as well. I think he's shown real leadership in what is a very difficult situation. He's made it clear that he's there to listen and he's engaging with communities, and there's a real difference, I think, in the way that he's communicating with the public. So, I would like to add my thanks to Dyfed Edwards, and the rest of the board as well. I meet with Dyfed regularly—I have monthly meetings with him; I had the latest one this morning—just to monitor progress, just to make sure if there's anything else that we can do to help. Because he has got to take responsibility, he's still in charge, but I am there to stand by him, if he needs that.

The other thing, just in relation to orthopaedics—I know you're delighted to see that development in Llandudno—is that orthopaedic waits are reducing. We have seen an improvement in the over 36 week, over 52 week, over 104 week and over 156 week waits, and we have, since February, seen a 15 per cent reduction in the number of outpatients waiting over 52 weeks for a first appointment. So, things are improving. I think it's really important to recognise that, because people are working really hard, they're trying to turn this ship around, and it's really important to give praise where that is merited.

Photo of Sam Rowlands Sam Rowlands Conservative 4:11, 20 February 2024

Thank you, Minister, for your statement today. Minister, you referenced, in your statement, the report from Audit Wales, which came out last week, and you referenced it in responses today as well. It did make for a sobering read and it shows there's still much to do. While there is a level of improvement, there's much, much more to be done to give the people I represent in north Wales the health service that they deserve.

The report talks of fundamental challenges that still face the health board, and you referenced some of these in your response to Mabon ap Gwynfor a moment ago. There are references to substantive appointments, the need for a cohesive and unified board, the need to deal with personnel issues. This, to me, points to significant issues within the management structure that still haven't been fully fixed. Granted, it does take time, but we are a year down the track.

In amongst all of this, in the bigger picture of things, there are real people—patients, a stretched workforce, residents that I'm elected to represent. They've been waiting a long time for these issues to be fixed—not just this past year, but for years and years beforehand. So, I wonder, Minister, if you have a date in mind as to when you expect to be satisfied that my residents have the right level of access to healthcare in my region.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:13, 20 February 2024

Thanks very much. I think you're right to draw attention to the fact that the Audit Wales report recognised that there are still challenges, but I think it's really important that they also recognise that substantial change has been made and the board is in a far more stable position. They concluded that the dysfunctionality within the board, which was described in the previous report, is no longer evident, and that working relationships amongst senior leaders are far more positive. It hasn't made any new recommendations to the health board, because it felt that the actions that were still needed are already included in the overall improvement plans that the health board has already got in place. 

I think it is important also to set out that the vast majority of people in north Wales are getting a really good service, and we mustn't lose sight of that. I just quoted to you the statistics in terms of access to GPs. Those are stunning statistics, and I think it's really important, because 90 per cent of people get their access to the NHS via those initial contacts with GPs and primary care. I'm not saying that all is perfect—it's far from perfect. There is a long way to go. There's a huge need to drive up that improvement in performance, in quality and in safety, and those are the things that I've asked them to really focus on.

Photo of Gareth Davies Gareth Davies Conservative

Diolch, Dirprwy Lywydd, and thank you very much for your statement this afternoon, Minister, on the 12-month anniversary of you placing Betsi Cadwaladr University Health Board back into special measures, and, indeed, the changes to the structure and the personnel of the board.

You briefly mentioned in your statement sustainability conditions that the health board will need to meet in order to achieve a de-escalation to level 4, which I can only assume is a move away from special measures if improvements are made in the future. So, can you describe, Minister, the specific, qualifying criteria that Betsi Cadwaladr will have to display and meet in order to eventually exit special measures in a way that is safe, sustainable and in the best interests of patients and the 20,000 people that the health board employ across north Wales? And I understand, obviously, the complexities and the logistical issues in coming out of special measures, but surely that has to be the goal and the overarching ambition here? We need to see a timeline of events because we've had enough of the scandal and the perennial crises. It's time for tangible action, delivery and results, and as you say in your statement, Minister, it's what the people of north Wales deserve.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:16, 20 February 2024

Thanks very much. Well, I think I covered some of that answer in response to Mabon, which was the listing of the sustainability conditions that I've already set out: strategic vision, performance and quality and culture change. So, there was a long list that I read out earlier. But what I have also said is that I'm going to be supplementing that sustainability condition with a clear de-escalation condition that I will agree with the health board in the next few months. So, that is coming. We're not ready for it yet, and what I'm not going to do is to give you any random date for when the board is going to come out of special measures. That is not the approach that we're taking. They will come out of special measures when they're ready to come out of special measures, not before.

Photo of David Rees David Rees Labour


Thank you, Minister.