Further to an update from the Cabinet Secretary for Health and Well-being on the progress of Betsi Cadwaladr University Health Board, under the special measures intervention of the Welsh Government, the Assembly Member for Aberconwy, Janet Finch-Saunders AM, has expressed her concern at the lack of progress in vital areas and against Key Performance Indicators.
Janet said:
“The Cabinet Secretary speaks proudly of his achievements in reducing waiting times for patients, but he has twisted the figures on this. Yes, the number of patients waiting over 36 weeks has gone down since December, but the fact is that under the Welsh Government’s interventions, the latest figures for those waiting this long are actually 34% higher than when the Board was initially taken into special measures!
“This includes a 24% increase in the number of patients waiting longer than 53 weeks, and a jump from 0 to 41 for patients waiting over 105 weeks! Many of these will be those waiting for orthopaedic treatment – with some having recently faced delays of up to 130 weeks for a knee or hip operation.
“Despite having raised this repeatedly with the Cabinet Secretary and the Board, it is a real concern to note that in setting their targets for April – September next year, the requirement to provide "Evidence of continual sustainable improvement on RTT with no patient waiting longer than 36 weeks for treatment" expressly excludes orthopaedics from this target.”
ENDS
Notes
Board papers available here: http://www.wales.nhs.uk/sitesplus/documents/861/Agenda%20bundle%20Health%20Board%207.6.18%20Public%20V1.0.pdf [See pages 12-46]
Statistics available here: https://statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-Hospital-Waiting-Times/Referral-to-Treatment/patientpathwayswaitingtostarttreatment-by-month-groupedweeks
March 2018: % change in no. if patients waiting over 36 weeks for treatment since Jun 2015: 34.07
March 2018: % change in no. if patients waiting over 36 weeks for treatment since Dec 2017: -45.36
- In June 2015, 0 patients were waiting over 105 weeks.
- In December 2017, 36 patients were waiting over 105 weeks.
- In March 2018, 41 patients were waiting over 105 weeks.
Statement available here: www.senedd.tv, and www.record.assembly.wales
In full:
STATEMENT
BY
THE WELSH GOVERNMENT
TITLE
Update on Betsi Cadwaladr University Health Board
DATE
5 June, 2018
BY
Vaughan Gething, Cabinet Secretary for Health and Social Services
In my statement on the 1 February I confirmed, following the review by Welsh Government, the Wales Audit Office and Healthcare Inspectorate Wales under the escalation and intervention arrangements, that Betsi Cadwaladr University Health Board would remain in special measures.
This week marks 3 years in special measures for Betsi Cadwaladr University Health Board. I want to update Members today on the progress made in some key areas during this period, the significant challenges that remain and plans to work with the Health Board during the next phase of improvement.
Under the special measures arrangements we have provided support to stabilise and recover the position in key areas of concern. This has included areas outlined for immediate action in 2015 – governance, leadership and oversight, mental health services, maternity services at Ysbyty Glan Clwyd, reconnecting with the public and primary care including out of hours services. More recently steps have been required in finance and some performance areas.
This support has involved a higher level of scrutiny and oversight, appointing key advisers to work alongside the Board on leadership & governance, mental health services and primary care and the NHS Wales Delivery Unit providing targeted support. During the first two years an additional £10 million of funding was provided to support actions in key areas, including mental health and maternity services. In the past 12 months investment to reduce waiting times has included a £1.5million commitment towards the unscheduled care programme and over £10 million additional support in planned care resulting in a 45% reduction in people waiting over 36 weeks compared to the end of December 2017.
Update reports from the Health Board and the Wales Audit Office and Healthcare Inspectorate Wales reviews, did during the first two years, evidence progress against the milestones and some evidence of recovery. The recent report from HASCAS into the care and treatment provided on the Tawel Fan ward also reported on some recent progress including key areas of work detailed in the dementia strategy and patient and carer support.
One of the substantive reasons BCU was placed in special measures in 2015 related to major concerns in maternity services at Ysbyty Glan Clwyd. Due to the hard work of the staff and support provided, this is a service area we have seen significant improvements in over the past three years. Following advice from the review under the escalation and intervention arrangements, I announced earlier this year that it was de-escalated as a special measures issue.
Progress has also been made in other areas including the management of complaints and concerns with improved clinical oversight under the leadership of the Executive Director of Nursing; in developing and delivering the Mental Health Strategy in partnership with users and partners; improved performance in delivering Mental Health (Wales) Measure 2010 targets, restructuring the mental health team and board governance processes.
Since 2015 there has also been a continued investment in the estate and services to ensure improved access and healthcare for people in North Wales, with a number of these having been or due to be completed.
The major on-going significant refurbishment work, involving over £160million investment on the Ysbyty Glan Clwyd site is due to be fully completed in December this year and the Sub Regional Neonatal Intensive Care Centre (SuRNICC) on the site is due to fully open this summer. Capital funding of almost £14 million has been provided to redesign, extend and improve the Emergency & Urgent Care Department at Ysbyty Gwynedd. Investments have also been made in two modular theatres at Wrexham Maelor Hospital and for environmental improvements to mental health wards as part of the drive to improve standards of care.
I recently announced £2.2 million of funding to convert a theatre at Ysbyty Glan Clwyd to a hybrid theatre capable of performing complex vascular surgery. This will bring patient benefits and is already increasing the attractiveness of the Health Board in terms of recruitment of consultants, with 5 vascular consultants successfully appointed and improvements in surgical training.
It is not only in hospital settings that capital funding is making a difference. Investments in primary care are supporting priorities to improve the health of the people of North Wales, reduce health inequalities and provide care for people closer to home. Over £14 million has been provided to develop integrated health and social care centres at Flint, Blaenau Ffestiniog and Tywyn Memorial Hospital that provide a range of integrated, co-located, health, social care and third sector facilities.
However, despite the investment and progress in some key areas, significant challenges remain as reported in the Deloitte Review findings and the HASCAS report. They both highlighted continued concerns on governance, clinical leadership and service redesign. In the last 12 months the Welsh Government has escalated the level of intervention in finance and some areas of performance due to substantial concerns on referral to treatment waiting times, unscheduled care and financial planning.
I am intensely concerned with the decline in performance in these areas, and exasperated with the pace of progress by the Health Board on the milestones set for the first part of this calendar year and the continued lack of clarity on its plans.
I was always very clear that the transformation at Betsi will require significant culture change to working in partnership both externally and internally. This will require on-going focus on board to ward engagement and a move from an underlying resistance to consistency in clinical practice in a variety of service settings with strong professional oversight and clinical leadership. To deliver improved outcomes for its population the health board needs to work in a systematic way in partnership as one organisation at a local and regional level and play a full part on a national level.
During my regular visits and contact with the Health Board, I continue to be impressed by the commitment and hard work of staff to deliver quality patient care in a challenging environment and the context of high level negative reporting and attention. I take seriously the wellbeing of NHS staff. Whilst sickness levels in Betsi has been lower than the all NHS Wales position for a number of years and it is delivering a range of initiatives to support staff, we will continue to engage with the health board and trade unions on how we can better support people.
To ensure the Health Board delivers on short and medium term expectations swiftly whilst also planning and undertaking transformational change, I published on the 8 May the special measures improvement framework. This sets out milestones for the next 18 months in four key areas – leadership & governance, strategic and service planning, mental health and primary care including out-of-hours.
I expect visible progress before the summer on the framework expectations including a reduction in waiting times, responses to the recommendations set out in the HASCAS and Ockenden reports agreed and being actioned, recruitment to key positions completed, the additional capacity and capability required in place and turnaround actions having a positive impact.
To support the improvements and drive forward the work in the short and medium term, Welsh Government will provide more intensive support with a team to work alongside the Health Board and additional resources to further improve waiting times. This will include additional system leadership, turnaround and operational capacity support. We will also be increasing the NHS Delivery and Finance Delivery Units interventions to include individual unit members providing focused support on plans, intelligence and best practice. Advisory support will also continue under the special measures arrangements.
The intensive support will initially be directed towards supporting improved governance and accountability, focused joint working with clinicians and partners to deliver substantial improvements especially in planned and unscheduled care, delivery on financial turnaround and working towards developing an agreed IMTP for 2019-2022.
Adviser support will include continued guidance on leadership and governance from David Jenkins and from Emrys Elias on assuring the development and delivery of the thematic quality improvement and governance plan for mental health services.
The next phase of the improvement journey will be led by a new Chair from the 1 September, following the appointment of Mark Polin who will bring clear direction and leadership. He will lead a renewed Board with the recruitment of a new Vice-chair and three independent members and changes at the executive level including a recently appointed new Executive Director of Workforce and OD and imminent recruitment of a Director of Primary Care and a Director of Strategy.
I will continue to hold accountability meetings with the Chair and Chief Executive and I will attend the Board meeting this Thursday to discuss progress. I will set out my clear expectations of the Board to lead and deliver sustained positive change.