Statement by the Cabinet Secretary:
Thank you, Deputy Presiding Officer. I made a statement on 5 June on the progress made in some key areas during the time that this health board has been in special measures, the significant challenges that remained, and plans to work with the health board during the next phase of improvement. My statement today will focus on the progress against those expectations that I set out for the health board in May in the special measures improvement framework.
The framework sets out milestones for 18 months in four key areas: leadership and governance; strategic and service planning; mental health; and primary care, including out of hours. The health board is required to report on progress every six months, and the first report was discussed and agreed at its board meeting held last week.
I met with the new chair and the chief executive for one of their regular accountability meetings with me and the chief exec of the national health service in Wales last Tuesday to discuss the progress made and plans to deliver on the challenges and difficulties that remain.
On leadership and governance, there has been a strong focus on improving board capability. From May to September this year, all the board vacancies were addressed. Mark Polin has been appointed as the new chair, and a new vice chair and independent members appointments have been made. In line with my expectations, an executive director of primary and community care has been appointed to drive the required improvement in this area. A new executive director of planning and performance has also been recruited and will start in post in November.
More robust appraisal and reporting and assurance systems are now being introduced by the new chair to further drive improved good governance. There has also been increased commitment to and impetus on partnership working from the board to support ‘A Healthier Wales’ and the transformation agenda. I was pleased to announce last week support from the transformation fund for a north Wales project across north Wales to help people with learning disabilities live more independent lives and to get the care that they need closer to home. That will involve sharing resources, skills and expertise across health, social care and the third sector.
In relation to finance, the health board remains in a challenging position. However, if the control total set for this year is met, it will represent a real improvement on the previous year. The board are in no doubt that achieving this will require focused action over the latter part of this financial year to deliver the turnaround needed to secure stability and to drive the shift to transformation in its future plan. I announced in July additional funding of £1.7 million under the special measures arrangements to strengthen the management capacity and analysis capability in the turnaround team.
A key expectation of the improvement framework was that the board responded promptly and appropriately to the Health and Social Care Advisory Service—HASCAS, investigation findings and the Ockenden governance review recommendations. I am content that the plans the health board has put in place to implement the recommendations, both with mental health and more widely, are comprehensive and robust, with operational leads identified and being held to account. My focus now is on ensuring that there is rapid progress on implementing these plans.
We are already verifying the progress so far reported by Betsi Cadwaladr in their regular reports, and that is recognised by front-line staff in mental health, and that is in addition to the Healthcare Inspectorate Wales inspection programme, which is also reporting progress. Improvements so far include the confirmation of a new and visible senior management team, appointment of a new mental health nursing director, creation of listening leads across front-line staff and the launch of the 'Today I can’ approach. Furthermore, a stakeholder group has now been created to further test the improvements being made, and I am pleased that some members of the remaining Tawel Fan families have agreed to be part of this group, together with the community health council and other stakeholders.
Recently, I met with a number of Tawel Fan families, when I met them last week. I understand very clearly that a small number of families are not content with the process or the outcome of the HASCAS investigation. However, there was consensus on the need to ensure that the health board reports and action plans are prepared and that they do result in sustainable and meaningful improvements in both mental health services and care of those with dementia across services. My officials have been very clear with the health board on the need to ensure it communicates plans and actions effectively to all staff.
The focus of developments in mental health to date has been around immediate improvements to in-patient services, including environmental works. The health board is also working to assess and improve community services by implementing its mental health strategy, working closely with local authorities, the third sector, service users and the police to deliver local implementation plans. A key focus for the next six months will be to improve and maintain performance against the Mental Health (Wales) Measure 2010 and child and adolescent mental health services targets To support this work, the delivery unit is reviewing demand and capacity and my officials are discussing what further support might be needed in this area to rebalance capacity and demand.
Improvement to engage and involve staff is ongoing, and the results of the NHS staff survey 2018 show positive changes since 2013 and 2016, most notably in staff engagement. That includes an 18 per cent increase from 2013 of staff who say that they are now proud to work for Betsi Cadwaladr.
The strategic and service planning area, including performance, requires acceleration and more focused effort. There has been progress in individual specialist strategies with the sub-regional neonatal intensive care centre—otherwise known as SuRNICC—and primary percutaneous intervention plans implemented, and the vascular surgery plan under way. These plans increase success in recruitment and in delivering specialist services within north Wales for the people of north Wales. Work on other areas, including orthopaedics, needs to be further progressed on a whole-system basis and described more clearly in its plans for service transformation and improvement.
In primary care, the new executive director will provide increased focus to deliver further improvements, working in partnership with clusters. Work is continuing to improve GP out-of-hours services and the health board performance is now more in line with the rest of Wales. The ambition of the health board is now to transform the service model so that it becomes fit for purpose and sustainable.
In this statement, I have noted areas of progress but also outlined the significant difficulties that do remain. I am determined that special measures is not a sticking plaster, but that it delivers sustainable improvement and puts in place the capacity and capability required for the medium and long term. During the next six months, the health board will need to focus on finance, strategic and service planning, especially in unscheduled care and referral to treatment, and delivering on the recommendations from both the HASCAS and Ockenden governance reports.
The chair and the board are clear on the work needed and are committed to making progress. Welsh Government will work alongside to provide the necessary support and I hope that regional partners and key stakeholders will also play a key role in ensuring improved and sustainable health and care services for the people of north Wales.
Response from Janet:
Yes, and thank you for allowing me to speak. Cabinet Secretary, it's fair to say that over the past 12 months in particular, I've been extremely vocal. It's not wise for anybody to stand up in this Chamber and just pontificate or use anecdotal information here. When I speak, I speak clearly from what I receive coming into my office. And I can tell you, my casework file is—[Interruption.] There's no let-up in the number of complaints and the type of serious complaints that are coming in as regards this particular health board. Now, you'll be aware, no doubt, of my constituent, where it's just only been announced—. Can I carry on?
Seven hours ago today, one of my constituents, sadly, has passed away, through waiting for an ambulance for over four hours and bled to death. A 37-year-old constituent. That is just one of many people that I'm dealing with. Another lady, who had a very bad fall in Conwy, waited three hours for an ambulance then waited for 10 hours for treatment. She was taken to Llandudno hospital, and then, such was her bleeding on her leg, and it was a replacement knee joint, they had to cut her jeans off her, 10 hours later. So, she wrote to the chief executive. To date, she wrote to the chief executive in July. I followed it up, asking him where the response was, in August. We're now in November—no response.
We have dozens and dozens of complaints. You know, because sometimes, I get very frustrated because my constituents come to me in all good faith and they say to me, 'Janet, we don't want to get anyone into trouble, we don't want to criticise, we just want the people at the top running things to know just how bad things are', and they don't receive any response.
And I just find, if a chief executive or anybody working within a senior management team cannot put pen to an e-mail, a standard response even saying, 'I'm very sorry to learn of your experiences, but your information coming back helps us to improve the service'—. There's nothing like that. I've asked Gary Doherty, I've asked Andy Scotson, and, you know, things are so bad for my constituents that now we have a weekly phone session with a member of my staff to go through all the cases where they are just massively delayed.
I had an e-mail when I was sat in Plenary about four weeks ago. An elderly gentleman has been waiting four and a half years for a hip operation. He's in agony. He said he finds it hard getting out of bed. These are people who are not being supported by care. He lives alone. He just needs—. He's been told by the doctor, his GP, he's been told by his consultant he needs a hip operation. Luckliy, as a result of him contacting me, they are now prioritising him some treatment. So, please God that he gets his operation, and I think it's going to be fairly imminent.
But people are coming to me, and I want them to, but there's an awful lot of people out there who are not coming. There has not been any improvement, honestly, Cabinet Secretary, as regards their complaint processes.
Now, I know that the senior management team—
The senior management team—. Yes, it's quite noteworthy the number of new staff that have been taken on, but the old staff are still there. So, you've got this ballooning, ballooning, ballooning management team, and yet, Llandudno hospital have had to close wards—they can't get staff. There has been no improvement in the short or medium or long-term planning in terms of attracting nurses. Have you seen the number of vacancies now for nurses in the Betsi Cadwaladr health board? Things may be better on paper in some areas, but, frankly, as an Assembly Member, my workload is no less and the distress to my constituents, if anything, is growing. So, all I would say to you is you do need to look more at some of the other things.
But, the point that Michelle Brown made earlier, and also Helen made too, about—you can't guess when you might take this board out of special measures. It's been there the longest it's ever been in any of the four parts of the United Kingdom, three years and counting. You mentioned in June 18 months and you're still saying 18 months. So, it looks almost like it'll be the next election before we even consider it.
Can you just tell this Senedd and the Members here when you yourself, as a Cabinet Secretary, as a Minister in a Government of a nation, when do you see this health board coming out of special measures? But, more importantly, when do you envisage that being a situation where real improvements have been made? I will always have a casework load, I appreciate that, but when will we as AMs and my constituents and your patients actually say, 'Do you know what? Things have improved'? Just tell us a timescale, please.
Reply from the Cabinet Secretary:
On the individual cases that you mentioned, I can't comment, but I'm not going to try and say that extreme long waits for treatment are acceptable. I've made very clear that they're not and there's a need for improvement not just in north Wales, but in every other part of our healthcare system if people wait too long. I rehearse again that the ombudsman has said objectively the complaints system is improving. That may not be seen in your casework file, but that is what the ombudsman himself has said objectively.
On your question about a timescale, it's essentially the same question and the same answer I gave to Helen Mary earlier. The improvement framework that I published previously goes up to September 2019. I will not give a timescale for when special measures will end because it must be on the basis of the objective advice and assessment we get from Healthcare Inspectorate Wales and the Wales Audit Office that sufficient and sustained progress has been made and the health board should come out of special measures.
If I do as you urge me today, then it might be convenient for me or somebody else in the Government, but it may be entirely the wrong thing to do for people who work in our health service and people who rely upon it. I will do what is right for the health service, even if it means that you and I must agree to disagree.