Report exposes deep-rooted issues and fractured relationships within North Wales Health Board Executive Team

A report by the Auditor General for Wales has highlighted deep-rooted issues with working relationships at the most senior levels of the Betsi Cadwaladr University Health Board.

The report suggests that the breakdown in these relationships is compromising the organisation’s ability to tackle the numerous challenges it is facing.

The Health Board is currently dealing with demands on its services, while also trying to address long-standing concerns over the quality, performance, and safety of a number of specific services.

The report shows that fractured working relationships within the Executive Team are preventing the Board from working effectively, leading to a lack of confidence from the board’s Independent Members in the team’s ability to tackle the challenges that the Health Board is facing.

The report also notes that the heavy reliance on interim posts within the senior management structure is still evident, which points to ongoing difficulties in securing the senior leadership capacity that the Health Board needs.

The Health Board has invested in an extended program of externally facilitated board development work to try and address the challenges it faces.

However, this work was partly affected by the need to respond to the pressures of the pandemic and has not been successful in building the more integrated and effective approach to board working that is needed.

The report suggests that the organisation needs senior leaders on its board and in particular, its Executive Team members, to demonstrate a unified and cohesive approach that drives the immediate and longer-term actions that are necessary.

Working relationships between Independent Members and the Executive Team need to be built on respect, trust, candour, clear accountability, and constructive challenge.

They also need to be rooted in clear agreement on the level of risk that the board is prepared to tolerate in respect of the quality and safety of services.

Adrian Crompton, the Auditor General for Wales, stated, “The findings from my review of board effectiveness at Betsi Cadwaladr University Health Board are extremely worrying.”

“It is clear that there are some deep-seated problems with working relationships within the board.”

“These problems need to be resolved as a matter of urgency to provide confidence to the public and wider stakeholders that the Health Board has the leadership it needs to effectively tackle the significant challenges it faces and to provide safe and effective care to the people of North Wales.”

“The Welsh Government will need to use the current Escalation and Intervention Framework to support the urgent improvements that are necessary.”

Chair of the Health Board, Mark Polin, welcomed the report and its observations, and he confirmed that the board is committed to implementing the recommendations. He said:

“As Chair of the Health Board, I welcome the report and the observations and recommendations set out by Audit Wales.

“I can confirm the Board’s commitment to taking the recommendations forward, and we will work collaboratively with Welsh Government and Audit Wales in doing so.

“The Health Board has been aware of the majority of the issues raised in the Audit Wales report, which partly informed a decision to commission a bespoke Board development programme with the Kings Fund to address Board effectiveness and relationships in 2020.

“It is most disappointing that previous internal interventions have not resulted in necessary improvements in relation to an effective Board, which is what the patients and population of north Wales deserve in order to deliver and receive safe and effective services.

“The Board will receive the report and a proposed action plan, to be developed in consultation with Welsh Government and other key stakeholders, at the March Board meeting, but the required responses will commence immediately.

“In this regard a number of actions are already in train to address some of the serious matters identified in the report, with progress having been made in relation to key areas such as the Chief Executive Officer recruitment, which is underway with our chosen recruitment partner.”

Commenting on the report, Welsh Conservative Shadow Minister for North Wales, Darren Millar MS said: “It’s no wonder that the NHS in North Wales is in such turmoil, and that the failings in the Betsi Cadwaladr University Health Board have gone on for so long.”

“The NHS in North Wales needs an executive team that is focused on delivering improvements in patient care and preventing people coming to harm, not one that is rowing with itself or afraid of scrutiny.”

“The Welsh Government must urgently intervene to ensure a total clearout of this dysfunctional executive team, without the eye-watering payoffs we’ve seen in the past, and support the chair of the Health Board to appoint a new and capable team as soon as possible.”

The Betsi Cadwaladr University Health Board is responsible for the delivery of health services in North Wales and has a budget of over £1.3 billion.

The organisation provides a wide range of health services, including hospitals, community services, and mental health services.

The Health Board covers a population of over 700,000 people and is one of the largest employers in North Wales, with around 16,000 staff.