GP Out of Hours provision has been de-escalated as a Special Measures concern. The full statement is here. Everybody involved in GP Out of Hours care in North Wales has worked extremely hard to make the required improvements and this is very much recognised and appreciated. Although there is still more to be done, we want to take this opportunity to congratulate everybody involved for their work in reaching this point.
New Special Measures Framework
Following the Cabinet Secretary’s statement on 1st February, the Health Board is moving into the next phase of special measures. A new Improvement Framework is under development and this will run until June 2019, focusing on driving and embedding improvements in the following areas:
Phase 3 Report
The Health Board received and approved for submission to Welsh Government the special measures end of phase 3 report. This report sets out the progress made during the third phase of the special measures improvement framework.
On 1st February the Cabinet Secretary for Health and Social Services provided a written statement updating Members on the outcome of the escalation status review of health organisations between the Welsh Government, Healthcare Inspectorate Wales and the Wales Audit Office in December 2017. He also confirmed additional action being put in place to support the Health Board (BCUHB) under the special measures arrangements.
Phase 2 Report
On 17.11.16, the Board received and approved for submission to Welsh Government a Special Measures End of Phase 2 Report. This sets out the progress made during the second of the three Special Measures phases. Please click on this link to access the Phase 2 report
Phase 1 Report
On 19 May 2016 the Board received a report on the progress made during Phase 1. Key areas of progress include:
Leadership & Governance
· A number of key Board-level appointments have been made including a substantive Chief Executive, Executive Director of Nursing, Executive Medical Director, Director of Mental Health Services and three Independent Members.
· A Board Development Programme is ongoing; this has included self assessments of Board effectiveness.
· Revised committee structure, new Board business standards, Board Assurance Framework and Risk Management Strategy have been approved and implemented.
· The Health Board has implemented a new management structure based on three geographical Area Teams, to improve the effectiveness of the leadership arrangements for Primary Care and Community Services.
· A new system of ward handover safety briefings and senior leadership safety walkrounds has been introduced.
Strategic & service planning
·The Operational Plan key deliverables are to be presented to the Board in May 2016.
·Performance management arrangements have been strengthened by regular accountability meetings and performance reviews for each of the operational areas and directorates.
·The historic backlog of complaints identified previously has been cleared (with the exception of 4 concerns subject to ongoing investigation involving other agencies)
· An Engagement Strategy has been approved
· The Board has established a Strategic Workforce and Engagement Group comprising Trade Union Partners, Independent Members and Officers to improve levels of workforce engagement.
· The Health Board was awarded a Certificate of Good Practice by the Consultation Institute for its Maternity Services consultation.
· A Mental Health Strategy is under development
· The outline business case for the Sub Regional Neonatal Intensive Care Centre (SuRNICC) has been approved by Welsh Government for progression to the full business case stage.
· In April 2016, the Health Board implemented a new model of primary care to deliver services to the Prestatyn community as a result of the local GPs giving notice to terminate their contract.
The Deputy Minister for Health issued a Special Measures Improvement Framework to the Health Board on 29 January 2016, setting out expected improvement milestones over the next two years, divided into three phases:
Phase 1 – November 2015 – April 2016
Phase 2 – May 2016 – November 2016; and
Phase 3 – December 2016 – November 2017
The expectations are that each phase will focus on improvements in the following
· Strategic & service planning
· Mental health
· Maternity services
· Primary care
Healthcare Inspectorate Wales and the Wales Audit office undertook a high-level review of progress after the first four months of Special Measures. As a result of their recommendations, on 22 October 2015 the Deputy Health Minister announced that the Health Board should remain in special measures for the next two years with progress and milestones reviewed every six months.
July - September 2015
100 Day Plans
In response the Health Board initially developed a series of 100 day plans that set out the actions to deliver rapid improvements in the specific areas of concern highlighted by the Minister.
The progress made during this phase is available in a series of newsletters:
The position at the end of the 100 Day Period was reported as follows:
On the 8 June 2015, following a meeting between the Welsh Government, the Wales Audit Office and Healthcare Inspectorate Wales, the Minister for Health and Social Services announced that he had accepted the recommendation that the Health Board should be placed in special measures under the NHS Wales escalation framework.
This reflected the health board’s failure to make sufficient improvement in relation to the long-standing concerns about governance, leadership and other issues which had already resulted in the Health Board’s escalation status being raised to Targeted Intervention.
The measures were designed to provide stability, advice and guidance to the Health Board in discharging its responsibilities.
The Minister set out key areas for tangible improvement as follows:
· Governance, leadership and oversight – the Health Board must implement governance and assurance actions which have been highlighted in a series of reports, including by the Wales Audit Office and Healthcare Inspectorate Wales, and in a review carried out by Ann Lloyd
· Mental health services – the Health Board must implement the mental health plan for North Wales, including actions arising from previous reviews, governance concerns and significantly the recent report into the events at Tawel Fan.
· Maternity services at Ysbyty Glan Clwyd – the Health Board must resolve the outstanding question about the future of consultant-led maternity services at sustainability issues and bring forward plans for the Sub-Regional Neonatal Intensive Care Centre (SuRNICC).
· GP and primary care services, including out-of-hours services – the Health Board must respond to the out-of-hours review and related concerns, which it commissioned.
· Reconnecting with the public and regaining the public’s confidence – the Board must undertake and oversee a listening exercise to establish a different approach to public engagement. It needs to do that rapidly and it needs to listen to what it is told by its local population rather than just informing them of the Board’s point of view.
Following the Minister’s decision, Betsi Cadwaladr University Health Board suspended its Chief Executive with immediate effect. This was a neutral act to enable to enable a new interim accountable officer to be installed. The Minister asked Simon Dean, Deputy Chief Executive of the Welsh NHS and Chief Executive of the Velindre NHS Trust, to assume these responsibilities.
The Board are being assisted by a set of key individuals who are providing expert advice as a required part of special measures. They include:
· Dr Chris Jones, chair of Cwm Taf University Health Board, who is providing advice and support in relation to GP and primary care services, including out-of-hours services;
· Peter Meredith-Smith, the current interim chair of the Board of Community Health Councils and associate director of the Royal College of Nursing in Wales, who is providing expertise in mental health nursing. The mental health 1,000 Lives team will also work alongside Mr Meredith-Smith and the Health Board to ensure there are sustainable improvements in both the culture of care and services;
· Ann Lloyd, a former Chief Executive of NHS Wales, who will provide oversight in relation to governance and accountability.
Ministerial oversight of the special measures arrangements is being led by Deputy Minister for Health, Vaughan Gething.
Whilst the special measures apply to the Health Board, day-to-day services and activities continue as normal.