Final warning for failing health board after nine years of special measures

Wales' largest health board has been given a "final chance" to improve after spending nine years in special measures.

Betsi Cadwaladr University Health Board, which covers all of north Wales, has been under the highest level of oversight due to concerns about care quality, patient safety and leadership.

Due to a lack of progress, the Welsh government said it would take on a more direct role, with an expert panel set to review the situation and report back by the end of October.

Dyfed Edwards, Betsi Cadwaladr University Health Board chairman, said it welcomed the extra support and remained "committed to delivering safe, high-quality care".

On Tuesday, Health Minister Mabon ap Gwynfor warned "all options" were on the table if progress was not at the scale and pace it expected to see.

He added he was "sick and tired" of Betsi being "a byword for dysfunction and declining standards".

Addressing the Senedd, he said there would be "no second chances" for those in leadership positions, while praising staff who he said were "as much the victims of this sorry saga as the patients".

Since 2013 there have been a number of highly critical reports into the health board, with it being placed in special measures in 2015 for the first time.

Last month the health inspectorate reported that Ysbyty Glan Clwyd's A&E needed "significant improvements", less than two years after it came out of special scrutiny for similar issues.

While all emergency departments across Wales were struggling to bring down the numbers of patients waiting longer than four or 12 hours before being admitted, transferred or discharged, two of the worst performing hospitals are in north Wales.

On many key NHS performance figures, Betsi Cadwaladr health board continues to be Wales' worst performer.

Around two-thirds of the 3,694 patients who are waiting longer than two years for planned care in Wales live in this health board area.

Ap Gwynfor said previous arrangements, which relied on the health board identifying and delivering its own recovery, with support alongside it, had not worked.

"This is the board's final chance to demonstrate they can deliver the consistent high standards of care that the people of north Wales deserve," he added.

Within current rules ministers have the option to use emergency powers to remove control from the health board as a last resort.

The health minister has not gone that far, saying board members and the executive team "must take ownership of the long-standing issues".

The move "strengthens expectations" of the health board bosses he said, rather than absolving them of responsibility.

NHS Wales Performance and Improvement has been asked to support the health board with reducing long waits for cancer treatment, tackling ambulance handover delays and two-year waits for planned care.

A team will be set up to make improvements in urgent and emergency care.

There have previously been resignations and replacements within the leadership of the health board.

Ap Gwynfor said there were plans to review the effectiveness of the current escalation and intervention framework for health boards, which he believed had been "shown to be wanting by the chronic issues at Betsi".

The announcement has followed almost a decade of turbulent times for the health board.

In November 2020, the health minister at the time, Vaughan Gething, said "genuine progress" had been made and it was taken out of special measures.

But in 2023 it was placed back in the highest level of oversight following concerns from the Royal College of Surgeons about vascular care and a damning report by Audit Wales citing "dysfunctionality".

At the same time the executive board was replaced.

Last year, former first minister Eluned Morgan, also a former health minister, said governance issues had been sorted, but pressure was being maintained to ensure progress was felt through the whole organisation.

Tuesday's announcement by the Welsh government said Betsi continued to "fall short of the standards that people in north Wales deserve and it is clear that the situation can no longer continue".

Edwards said: "We welcome the opportunity to work collaboratively with the Welsh government and NHS Performance and Improvement to ensure we continue making improvements for the people of North Wales."

The board, we added, remained committed to delivering "safe, high-quality care" and would use independent expertise to strengthen the organisation.

Welsh Labour's interim leader, Ken Skates, said: "The Plaid Cymru government need to outline what they mean by immediate improvements, what the timescale looks like and what happens if those improvements are not met."

Welsh Conservatives leader, Darren Millar, said: "What's been proposed today appears to be more of the same medicine, so I don't think that's going to be the silver bullet that solves the crisis."

Reform's Brycheiniog Tawe Nedd Senedd member James Evans said: "We've seen this all before, how many reviews do we need in the health board, we know what the problems are, we just need to sort it now."