Agenda item

To receive a presentation by the Chief Executive of Betsi Cadwaladr University Health Board.

The Chair welcomed Ms Jo Whitehead, the Chief Executive of the Betsi Cadwaladr University Health Board to give a presentation to the Committee.

Ms Whitehead thanked the Committee for inviting her to the Committee.  She gave a brief summary of the background regarding Betsi Cadwaladr University Health Board being put in special measures by Welsh Government in 2015 until November 2020; following an independent review by the regulators the Health Board was moved into targeted intervention thereafter.  She noted that four broad themes were identified for the Health Board to improve over a period of time as follows:-

·      Mental Health service provision (adults and children services)

·      Strategic direction (planning and performance)

·      Leadership (ability to make service change and the culture of the Board)

·      Engagement (engaging with the people of North Wales, patients, staff and partner organisations)

As Welsh Government is experienced in targeted intervention in Health Boards a ‘maturity matrix’ is to be incorporated within improving indicators and self-evaluation.  Quality assurance is a theme across the ‘maturity matrix’ which apply to the four broad themes as noted above.  The ‘maturity matrix’ requires the Health Board to gauge as to where they consider their performance levels from 0 -5 in respect of i.e. patient experience, able to respond to the covid pandemic (test and trace, vaccination, patients care and support for patients with long covid), patients waiting times for treatment, unplanned care (urgent appointments), mental health services and sustainability of services provided into the future.  It is important to be able to sustain the 3 main sites at Ysbyty Gwynedd, Glan Clwyd and Wrexham Maelor as there are recruitment difficulties and retention of staff.   A ‘Stronger Together’ approach is to be undertaken which entails engaging with staff of the Health Board to ascertain the challenges faced by staff on a day-to-day basis.   Ms Joe Whitehead further referred to the ‘maturity matrix’ and as to how the Health Board has scored its performance level from 0-5.  She noted that an improvement range of 1 was scored by the Board as it considered that it is performing ‘good in part’ but more work is needed improve the services offered as was for all the 4 broad aim of the Health Board.  The Chief Executive of the Betsi Cadwaladr further said that independent partner organisations were of a view that more work was needed in terms of stability of the Health Boards Senior Leadership Team and to enable staff to raise concerns in a transparent way and that the Board is clinically lead.

She further referred to the mental health care for Child Mental Health Services and the transition from paediatric to Adult Mental Health Services and Older Age Mental Health together with prevention services within the Mental Health area.  The Health Board has identified that substantial work is required to improve the performance of these services.  Working in partnership with organisation is paramount i.e. local authorities Social Services, Education and the third sector. 

The Committee were afforded the opportunity to ask questions regarding the above:-

·           Councillor R Ll Jones as the Authority’s Older People’s Champion raised concerns that a Psychiatrist only visit the psychiatric ward on a weekly basis for patients over 65 but there a Psychiatrist available at a daily basis for the under 65 year olds.  He also referred to the untidy state outside the psychiatric unit.

The Chief Executive of the Betsi Cadwaladr Health Board responded that she accepted the comments as regards to the Psychiatrist vising the site on a weekly basis and would look into the matter together with the comments as regards to the un-kept conditions outside the psychiatric unit. 

·           Reference was made to the 4 broad identified areas of improvement and questions were raised as to whether these were areas that have been identified as the least performing areas of services within the Health Board and whether it was the Health Board or Welsh Government that had identified these 4 areas of improvement required.  Questions were further raised as to whether the scoring matrix are adequate to challenge the performance of the services afforded and whether pier assessments is needs to be implemented in assessing the service.

The Chief Executive of Betsi Cadwaladr University Health Board responded that the 4 identified/weak areas for improvement were highlighted by Welsh Government, Audit Wales and the Health Care Inspectorate Wales who are the independent organisations who have been monitoring the services of the Health Board.  Both Audit Wales and Health Care Inspectorate Wales advice the Health Minister with regard to moving the Health Board from special measures into targeted intervention in November 2020 and will continue to monitor the Health Board on the progress made and against the maturity matrices.  The Health Board is currently in the process of appointing a third party independent organisation who will also provide the Board with assessments of progress in order for the Health Board to make the necessary investments to improve the services for the people of North Wales in respect of health care in the future and the delay to planned surgical operations due to the covid pandemic. 

·       Questions were raised as to whether the Health Board intends improve its IT procedures with regard to patients notes.

The Chief Executive of the Betsi Cadwaladr responded that the Health Board is considering its digital provisions to improve services and to invest in appropriate technology for staff provision and benefit patients care.

·           Reference was made that the Betsi Cadwaladr University Health Board covers a large proportion of population and geographical areas; questions were raised as to whether it would be appropriate to separate the Health Board into smaller divisions.

The Chief Executive of the Betsi Cadwaladr responded the University Health Board is the largest in Wales and one of the largest in the UK.  She expressed that the Board must consider the clinical services that are currently been offered in England and offering such services in North Wales.  She accepted that personal patient care is also important to the individual and to enable the health care provision locally to provide patient care.  She further said that attracting the Medical Sciences School to North Wales is paramount to enable local students to be able to study in the local area and potentially applying for posts in the Betsi Cadwaladr University Health Board once qualified.

·       Questions were raised as regards to partnerships working with outside organisations and the improvements needed within Social Services provision.

The Chief Executive of the Betsi Cadwaladr responded that she considered that good working relationship exists between both the Health Board and Social Services and both the Board and the local authority are able to challenge each other on patient centred care and specifically to statutory duties and financial constraints.  During the pandemic, changes have been needed to be made in respect of the services provided by the Board in partnership with partner organisations such as the local authority. 

·           Questions were raised whether the Health Board, whilst focusing on improvement as regards being transferred from special measures, that patients focus is being lost when people are awaiting surgical procedures and patients with cancer. 

The Chief Executive of the Betsi Cadwaladr University Health Board referred to the challenges during the covid pandemic and having to hold virtual consultations and at present there are 42,000 patients awaiting surgery.  She noted that discussions are currently taking place with Welsh Government to increase staffing capacity within the Health Board to address the covid backlog. The Health Board’s cancer performance in treating patients is currently the best in Wales.

·           Reference was made to the problems in recruiting GP’s for surgeries in Holyhead and concerns by patients due to the lack of communication between the Health Board and the patients of two surgeries in Holyhead.  However, it is understood that two part-time GP’s have been appointed to start in August and another full time GP starting in January in Hwb Iechyd Cybi but concerns were expressed that it has taken two years to appoint to the GP posts.  It was also expressed that the Penrhos Stanley Hospital is having difficulties in recruiting nursing staff and health care assistants are having to cover duties of trained nursing staff and also there is a shortage of Care Assistants to support patients within their own homes.  

The Chief Executive of Betsi Cadwaladr University Health Board responded that she is aware that patients are awaiting clinical discharge from the hospitals but there is a lack of care facilities for patients within the communities and for rehabilitation.  The Health Board is currently considering ways of encouraging staff who work in community hospitals and also for care assistants to apply for cadetship and apprenticeships to enhance their nursing careers.  She further noted that there is a national problem with the recruitment and retention of GP’s and clinical staff.