North Wales health board ‘too large’ to run effectively, says Senedd Member

Questions have been raised over whether the health board responsible for running NHS services in North Wales is “too large”.

It follows vascular services at Betsi Cadwaladr University Health Board being designated as “requiring significant improvement” by Health Inspectorate Wales (HIW).

Health officials in the region have come under fire in recent months after a “damning” report by the Royal College of Surgeons, which raised serious questions about the quality and consistency of vascular care.

It led to Health Minister Eluned Morgan issuing a “clear warning” for vascular services to be improved within the next three months or the board could face “further escalation measures”.

Following news of the HIW measures, Ynys Môn MS Rhun ap Iorwerth has raised doubts over whether the health board is sustainable in its current structural form.

During a Senedd session held yesterday, the Plaid Cymru MS said: “The announcement and the statement by Healthcare Inspectorate Wales is sobering.

“HIW has put this escalation measure in place because the Royal College of Surgeons report identified a number of concerns that we believe indicate a clear risk to patients using the vascular service.

“Now, vascular patients have been put at risk because of poor management, just as mental health patients’ lives have been put at risk through a number of scandals within the same health board.

“I repeat my call today: put vascular services in Betsi Cadwaladr University Health Board in the highest possible level of special measures you have, and do so with the patient in mind.

“I don’t want reorganisation any more than the minister does, but this again smacks of a health board that is too large, too unwieldy to be run effectively, and too distant from the people it serves.

“Episode after episode, such as the one we’re discussing today, mean that the redesigning of health services across the north has to be left on the table.”

The service of concern process for the NHS was introduced in November 2021.

It is used when significant service failures are identified, or when there is an accumulation of concerns about a service or setting.

The intention of the process is to support improvement and learning, both for the service in question, and across NHS services more broadly.

Further explaining the status on its website, HIW said: “The service requiring significant improvement designation enables us to plan and deliver future activities necessary to gain assurance about the quality and safety of care in that service.

“We will be working with the health board to ensure improvements are made in a timely manner.

“We will then consider whether the service can be de-escalated and removed from this process.”

Responding to Mr ap Iorwerth’s comments, the Health Minister did not specifically say whether she would support a re-organisation of the health board.

However, Eluned Morgan stressed that she understood vascular services in the region were not good enough.

She said: “I’ve said, and I’ll say it again, that the vascular services and the services offered in Betsi are not at an acceptable standard.

“I did issue a written statement on February 3 following that report by the Royal College of Surgeons, and it was very disappointing to find that there were some really fundamental and basic things that were not being done.

“Deficiencies in care, record keeping, consent taking, following up, all of these things that you would assume are basic things that happen in every department within the care service.

“I have made it clear that they’ve got three months to address these issues, and that has started already, and it’s very clear to me that I will be receiving monthly updates from the health board.

“If significant progress has not been made in those three months, I will require escalation measures or oversight, and we will convene a special tripartite meeting to consider that.”