North Wales health board to remain in special measures despite improvements

Betsi Cadwaladr University Health Board has made progress in improving governance and financial management but continues to face significant challenges in urgent care and clinical services, according to a new report marking two years under special measures.

The health board, which serves North Wales, was escalated to special measures (level 5) in February 2023 due to serious concerns about governance, leadership, and performance.

The latest progress report acknowledges positive steps but also highlights key areas still requiring improvement.

On governance, the report states: “Betsi Cadwaladr University Health Board has stabilised and started to put in place the building blocks to become a sustainable organisation over the course of the last 2 years under the current level 5 (special measures) arrangements.”

A new leadership team has been appointed, including a permanent chief executive in 2024, with efforts to strengthen governance structures and financial oversight.

The report notes: “The focus the chair, independent members, chief executive and executive directors are bringing to these areas has made an impact but, as this report highlights, there are areas of continuing fragility, which are linked to operational performance and clinical services, where further improvements are urgently needed.”

However, concerns remain about leadership stability and the long-term strategy.

The Audit Wales Structured Assessment found: “There remains much to do especially in respect of establishing a stable, cohesive and high performing executive team, developing a longer-term strategy and supporting clinical services plan, and ensuring the health board’s organisational structure and operating model is fit for purpose.”

Financial controls have been tightened, and budget management has improved.

The report highlights: “While there are improvements in the health board’s approach to financial management and delivery of savings, significant challenges remain in terms of spending within budget.” Despite progress, the board still faces a substantial financial deficit.

Urgent and emergency care continues to struggle, with ambulance handover times and waiting lists remaining a concern. The report acknowledges: “Performance for urgent and emergency care remains considerably below where we want and expect it to be.”

Planned care has seen improvements, particularly in reducing long waiting times.

The report states: “Between February 2023 and December 2024, the number of planned orthopaedic pathways waiting more than 104 weeks has reduced by 62.7%.”

However, diagnostic waiting times have worsened, with a “15% increase in the number of pathways waiting more than eight weeks for their diagnostic tests over the same period.”

Mental health services have also seen mixed results. Performance for young people has improved, with “91% of assessments completed within 28 days in December 2024 compared to 57.8% in February 2023.”

However, adult mental health services still require improvement, as “performance remains below the target of 80% and must improve.”

Despite ongoing challenges, the report concludes that while the health board remains under special measures, there has been progress:

“Progress has been made in relation to corporate governance, financial control and governance and over the last 12 months the quality management system has begun to demonstrate improved grip and control.”

Speaking about the progress made to date, Health Secretary Jeremy Miles said:

“I want to commend the staff’s commitment and determination to make meaningful improvements to health services for the people throughout North Wales.”

“I have seen first-hand examples of the excellent work taking place, but we know there is more to do to improve the experience of staff, patients and their families.”

“We will continue to support the health board to improve and provide excellent care for North Wales.”

The Welsh Government will continue to monitor the health board’s performance, with further assessments expected to determine when it can exit special measures.