Recent events have brought Betsi Cadwaladr University Health Board (BCUHB) sharply into public focus. In February 2023, Audit Wales published Betsi Cadwaladr University Health Board – Review of Board Effectiveness which highlighted significant concerns about the management of the health board. As a result of this review on 27 February 2023, the Welsh Government announced it was placing the health board in special measures - the highest level of escalation under the NHS Wales Escalation and Intervention Arrangements - with immediate effect.
This article summarises some of the background and chronology relating to the health board to provide some context for this decision.
BCUHB is the largest health organisation in Wales, with a budget of £1.87 billion and a workforce of over 19,000. It delivers health care services to more than 700,000 people across the six counties of north Wales. There have been calls – rejected by Welsh Government - for the health board to be broken up.
Concerns about BCUHB date back to its earliest years following NHS reorganisation in 2009. Some of the subsequent chronology is set out on the BCUHB website and in the Fifth Senedd’s Public Accounts Committee (PAC) report Governance Review of Betsi Cadwaladr University Health Board: Lessons Learnt (May 2019).
The timeline below isn’t intended to be comprehensive, but summarises key events affecting BCUHB since initial concerns were raised in 2012.
|
Date |
Events |
|
During 2012 |
Healthcare Inspectorate Wales (HIW) and Wales Audit Office (WAO) identify concerns regarding BCUHB’s governance arrangements. |
|
June 2013 |
WAO and HIW publish the outcome of their joint review of governance arrangements, highlighting issues around governance, strategic leadership, and the clinical and financial viability of BCUHB’s service model. |
|
During 2013 |
Serious concerns about the quality and safety of mental health care provided on Tawel Fan Ward at Ysbyty Glan Clwyd lead to the closure of the ward in 2013. Alongside wider concerns around finance, performance against targets, and maternity and GP out of hours services, this resulted in BCUHB being placed under enhanced monitoring (the first level of intervention) by the Welsh Government in December 2013. |
|
December 2013 |
The Senedd’s Public Accounts Committee (PAC) publish a report into “The Governance Arrangements at Betsi Cadwaladr University Health Board” which echoes many of the WAO and HIW concerns. |
|
September 2014 |
An independent adviser Donna Ockenden publishes her initial investigation report into Tawel Fan ward which detailed patient safety concerns that constituted “institutional abuse”’. BCUHB mental health services were the subject of other reports; from the Health Board and Health and Social Care Advisory Service and a further review of patient care on Tawel Fan Ward and older people’s mental health services by Donna Ockenden, both in 2018. The Holden Report, (concerning the Hergest mental health ward - at Ysbyty Gwynedd) was completed in 2013 but wasn’t published by BCUHB until 2021. |
|
November 2014 |
BCUHB moves from enhanced monitoring of mental health services to the whole organisation being under targeted intervention (the second level of intervention). |
|
June 2015 |
BCUHB is placed in Special Measures (the highest level of intervention) - the first time the Welsh Government had used this level of intervention with a Welsh health board. There were five key areas for improvement; governance, leadership and oversight; mental health services; maternity services; primary care (especially GP out of hours); and public engagement. |
|
February 2016 |
The Fourth Assembly PAC reports on progress against its 2013 report, making recommendations to improve health board governance and performance management at BCUHB and across Wales. |
|
February 2018 |
Maternity services are de-escalated from special measures, followed by GP out of hours services in February 2019. |
|
During 2019 |
In May 2019 the Fifth Assembly PAC reports again on BCUHB governance examining concerns about mental health services, and the level of support and intervention provided to the health board by Welsh Government. The PAC recommends the provision of additional turnaround expertise, the publication of reports by health boards, and ensuring the independence of reviews into failings within any health board. The report also noted that PAC would maintain a watching brief over progress and that “it is simply unacceptable that BCUHB, as the largest NHS body in Wales, has been in special measures for nearly four years to date”. |
|
November 2020 |
Health Minister, Vaughan Gething announces that BCUHB would be de-escalated from special measures to targeted intervention with immediate effect. This was to be supported by ”strategic assistance” including a further £82m per year over three-and-a-half years. The Health Minister notes that the health board had shown “genuine progress, but also insight and acceptance of areas for ongoing action and improvement”. There has been recent controversy on the rationale behind this de-escalation. |
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March 2021 |
The Welsh Government publishes the Targeted Intervention Framework, indicating the areas for improvement expected of BCUHB. |
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January 2022 |
Concerns around BCUHB Vascular Services are raised in reports from Royal College of Surgeons, prompting ongoing work to improve the quality of services and patient care. |
|
March 2022 |
The Sixth Senedd’s Public Accounts and Public Administration Committee (PAPAC) undertakes follow-up work on governance issues in BCUHB. It raises several concerns and makes a commitment to continue to closely monitor issues there. |
|
February 2023 |
Audit Wales publishes Betsi Cadwaladr University Health Board – Review of Board Effectiveness. The Welsh Government announces it is returning BCUHB to special measures with immediate effect, removing the Chair and Independent Members from the Board and appointing a new Chair along with a health board intervention and support team. |
|
May 2023 |
Carol Shilabeer, Chief Executive of Powys Teaching Health Board is appointed as BCUHB Interim Chief Executive. The recruitment process for a permanent Chief Executive is underway following the departure of the previous postholder in October 2022. There has been significant turnover in the Board’s executive team, and since 2019 there have been four different Chief Executives - on either a substantive or interim basis. |
Article by Paul Worthington, Senedd Research, Welsh Parliament
