Plaid Cymru - standing up for Dwyfor-Meirionnydd

Summer like no other

This has been a summer like no other in the world of politics.

We face a series of interlinked crises, from the cost of living to housing - with the expectation that many millions will fall into poverty and even destitution; the UK is facing a deep recession and inflation is running at the highest it has been in forty years; economically, the world looks at the UK as an emerging economy rather than a developed one; and a bloody war is being fought once again in Europe threatening to engulf us all in a nuclear catastrophe.

Whilst all this is going on, our focus has been diverted to what should be nothing more than a side show, an internal Conservative party election to select their new leader. The narcissists convention eventually selected the vacuous Liz Truss as the new UK Prime Minister, who will simply oversee a continuation of disastrous Conservative policies which have blighted so many lives over the past twelve years.

Whilst people in Wales have been distracted by other things, matters of public importance have gone somewhat unnoticed.

Resignation

At the start of September, the Chief Executive of the north Wales Health Board announced her intention to retire from the role having only been in post for eighteen months. A few pleasantries were said on social media, and the press fleetingly gave the story a few column inches - otherwise it was complete radio silence.

Before saying anymore, I should also like to express my gratitude to the outgoing CEO, Jo Whitehead, for the work that she has done over the last year and a half. She inherited a dysfunctional Health Board that had only just been taken out of Special Measures, and let’s be clear – this wasn’t for health reasons but rather political expediency. Mental Health Services was under considerable strain, the rift between the Board and the Ward had not healed, a catastrophic reform of vascular services was underway and moreover, the worst public health crisis in a century was about to strike. So in fairness, she had her work cut out. 

I must confess, having spent the last ten years or so criticising the previous CEO’s, I was increasingly impressed by Jo Whitehead’s management of the Health Board. She struck me as someone who really wanted to understand our communities and wanted to make the health service really work for our communities. I was eager to see what she could achieve, so I’m particularly saddened by her untimely departure.

A week before Jo Whitehead announced her departure, the Health Board published their overdue Annual Report. This has gone completely unnoticed. But it shouldn’t have. We should all be very concerned by what it shows.

It starts with an introduction from the current CEO who paints a picture of the situation the Health Board finds itself in.

Record waiting lists

The NHS in Wales has a delivery framework with 74 measurable outcomes where it is expected that health boards across Wales, well, deliver and meet those set parameters.

The north Wales Health Board (or Betsi Cadwaladr University Health Board as it is more commonly known) saw a decline in performance in nearly half (35) of these measures, ‘The areas of decline mostly related to elected care and unscheduled care.’ The Chief Executive should be thanked for being so candid because having scrutinised the Annual Reports of two of the other Health Boards in Wales, it isn’t clear at all where they stand in relation to achieving the targets set in the National Delivery Framework.

Some 40,000 people in north Wales are having to wait 52 weeks or more for treatment, with an overall 170,000 people waiting for some form of treatment. This compares to over 90,000 waiting for treatment back in April 2020 and around 2,000 waiting over 52 weeks.

It’s abundantly clear that the Covid pandemic is still impacting on our health service.

Pay gap

Whilst the Board is struggling to balance its books, and nurses and other frontline staff are struggling to keep food on the table, the financial accounts tell us that of the 19,355 members of staff working for the Health Board - 669 of them are paid over £100,000. 562 of these are clinical staff, and a further 63 are agency clinical staff. Their agencies must be smiling at the cut they receive! 42 are paid more than £200k (5 of them agency clinical workers), and 1 clinician more than £300k.

There are a further 296 people who are off the payroll but contracted to the Board and who take in over £245 a day. Unfortunately for us, the report doesn’t say how much more than £245 each one is paid.

What was particularly jarring was the paragraph stating that NHS Wales had adopted the minimum wage of £9.50 per hour. I am sure those hardworking staff on the lowest wages struggling with soaring energy costs and trying to wade through the worst cost-of-living crisis in their lifetime will be glad to see their superiors earning so much more than them – whilst nurses continue to fight for better pay.

One welcome development is an explanation of why the number of complaints to the Public Service Ombudsman provided by the Health Board have, historically, been different to the figures provided by the Public Service Ombudsman’s office themselves, with the Health Board numbers showing significantly less number of complaints than the figures provided by the PHO. I and other Senedd Members have raised this issue on the floor of the Senedd, and to her credit the CEO has now provided an explanation:

‘In previous years, the Hearth Board has reported the number of cases where the Ombudsman has raised enquiries and investigations, but not those where the Ombudsman decided not to investigate.’

The Health Board has therefore reported a different and lower figure in its PTR (Putting Things Right) Annual Reports to that reported by the Ombudsman in their Annual Letter. It is acknowledged the difference in reporting criteria may cause confusion. Going forward, the Health Board and Ombudsman will ‘work together to ensure alignment of the reporting criteria across the two reports.’

Worrying

One concerning development is a rise in the number of Never Events. Never Events are ‘serious adverse incidents that (the Health Board’s) systems and processes should ensure are never able to happen’.

This year (2021-22) saw 12 Never Events at Betsi Cadwaladr University Health Board. This is up from 5 in 2020-21, 6 in 2019-20, and 8 in 2018-19. I have written to the Chair and CEO of the Health Board to ask for an explanation for this significant increase, and I seek firm assurances that steps are being taken now so that we never see this alarming number of Never Events again.

Another worrying piece of information was the fact that the Health Board ‘had four judicial review matters open that largely relate to the Healthcare Services in HMP Berwyn.

When the titan prison that is HMP Berwyn was first mooted, many of us argued against the need for such a large prison, and one of our arguments was the significant pressure this would put on local health services.

There are huge problems facing HMP Berwyn as it is, not least the turnover of staff – which incidentally we also warned about. A recent report into the prison noted, ‘…there continued to be staff shortages, which affected the delivery of some key services in health care, purposeful activity, and resettlement and release.’

See article: https://www.leaderlive.co.uk/news/21219737.report-raises-concerns-staffing-issues-hmp-berwyn/

I personally know several members of staff who have left employment at the prison after a short time working there, and the stories that I have heard are truly frightening. Seeing as HMP Berwyn is not a prison that serves north Wales, the cost of Health Service provision to HMP Berwyn should be borne by the Ministry of Justice.

Another worrying statistic is that of staff sicknesses. In 2021/22 the average working days lost was 14. This compares to a little over 10 days back when the Health Board was first set-up in 2009/10.

The workforce has grown since the Board was formed in 2009/10, from being 16,000 to now having over 19,000 people on their books. But that growth does not account for the massive increase in the numbers of days lost to sickness.

Back in 2009/10 the Board noted that they had a total of 244,262 days lost. By this year, that number had ballooned, increasing by 2/3rds to 377,736. Much of that might be attributable to Covid-19. However, it was over 300,000 days lost in the pre-Covid period, 2019/20. This tells us a lot about the enormous pressures and stresses that health providers are under in this part of the world.

Financial management

The other problem which has plagued the Health Board since its formation is that of financial management. The Board has a statutory duty to breakeven over the three-year period, 2019-2022, however it has failed spectacularly, recording a huge deficit of £38m.

In fact, the auditor notes that the Health Board had exceeded its cumulative revenue resource limit of £4,922 million by £79.485 million. That is to say that over a three-year rolling period they are allowed to spend a little short of £5bn on revenue expenditure, and they overshot this by…wait for it, nearly £80m!

We in Plaid Cymru have long called for the re-structuring of the Board, or at least for the option to be considered. The stock response from the Welsh Government has always been that now is not the time for a costly re-structuring exercise. This weak, perennial response shows itself to be completely meaningless when you consider the massive overspend that the Health Board regularly accumulates, and this after many years of being in Special Measures and subject to numerous interventions which brought in a load of additional money. I recently asked the Welsh Government, ‘How much additional funding has Betsi Cadwaladr University Health Board received since 2015 as a consequence of being in Special Measures and targeted interventions?’. The answer was eyewatering:

The additional funding received by Betsi Cadwaladr University Health Board is detailed in the table below.

N.B. Funding to 2019/20 inclusive of support for performance funding and winter planning provided to BCUHB from national programmes.

That’s a grand total just shy of £300m. I must admit that it seems odd to me that the figures show a massive increase in the 2020-2022 years, suggesting that it was Covid related. But that’s not what I asked. Regardless, the pre-Covid sums shows tens of millions of pounds being ploughed into the Health Board on top of writing off tens of millions of overspend in previous years. For instance, in the three years immediately before the pandemic, 1 April 2017 – 31 March 2020, they had recorded a cumulative deficit of £118.8m. The irony is that the Board have only managed to record small surpluses in the last two years, after seeing cumulatively hundreds of millions of pounds extra pumped in to cope with the Covid-19 crisis.

The Board also failed in a second key financial duty, which is ‘to prepare and have approved by the Welsh Ministers a rolling three-year integrated medium-term plan’. They failed to have a plan in place.

Assurance rating

Finally, and of greater concern, is the report’s Risk Assurance. Auditors only gave the Board a Limited Risk Assurance. For clarity, out of the four tiers of risk assurances, a Limited Risk Assurance is the third level, with Substantial Assurance being the best, then Reasonable Assurance, Limited Assurance, and finally No Assurance.

Every other health board in Wales were given an overall Reasonable Assurance, with a few areas given limited assurance and needing attention.

It was also concerning to read that following an un-announced visit by Healthcare Inspectorate Wales (HIW) to the Hergest Mental Health Unit in Bangor, they found that urgent remedial action was required. It is disappointing, to say the least, that Hergest again finds itself lacking, and following the incidents of the last few years it would be expected that the Unit would have improved significantly and by now be an exemplary unit. The problems with delivering high quality mental health care continues to plague this particular health board, which is a surprise because the front-line staff that I have met are second to none. There is clearly a deeper problem that needs to be resolved, urgently – in the interests of both patients and staff.

Other areas noted were the Emergency Department at Ysbyty Gwynedd and there were similar but major concerns around Ysbyty Glan Clwyd Emergency Department, with HIW finding additional areas of concerns ‘relating to patient safety’, from those already documented.

They also highlighted the Vascular service. This is no surprise and is particularly infuriating. The report notes, ‘HIW issued Service requiring significant improvement status to the service, due to indications of significant risks to patients using the vascular service.’ This is simply not acceptable and is a problem entirely of their own making.

The CEO herself ends the annual report admitting that ‘there are processes requiring significant improvement in relation to patient safety and compliance assurance’.

Act now

What is abundantly clear is that this behemoth, this titanic of a health board is unwieldly and dysfunctional and much like Brexit - finishing off three Prime Ministers, this Health Board has had the better of four Chief Executives. Who will be next to take on this unruly beast?

We cannot continue like this. It’s not fair on the people of north Wales to have to live with such insecurities and anxieties around health service provision. We deserve better than this. The Government must now, as a matter of urgency, look at the structure and provision of health services across north Wales, particularly so in rural communities, and carry out a root and branch review. They need to put all options on the table, despite how unpalatable they might be and model their effectiveness, then take the bull by its horns and implement the best option with no delay. Bold steps are required. The people of north Wales cannot wait any longer. We cannot afford to lose further confidence in our health services. I urge the Government to act now.