Betsi Cadwaladr: NHS leadership dysfunctional, report says

Betsi Cadwaladr governs NHS services for north Wales, including at Ysbyty Gwynedd in Bangor

The leadership of Wales' largest health board is dysfunctional, a damning report from the spending watchdog has said.

Auditor General Adrian Crompton wants urgent Welsh government intervention after finding "fractured working relationships" at the top of Betsi Cadwaladr, which covers north Wales.

Several board members have shown "signs of emotional distress", he said.

Health Minister Eluned Morgan said the findings gave her "serious concerns".

Mr Crompton said the problems were "fundamentally compromising" the health board's ability to deal with "the significant challenges" it faces.

The health board said it would take immediate action ahead of an action plan to be submitted to its board in March.

In response, the Welsh Conservatives called for "a total clear out of this dysfunctional executive team".

Plaid Cymru said Betsi Cadwaladr University Health Board (BCUHB) could not serve people in north Wales effectively "in its current form".

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Betsi Cadwaladr is led by a board of executive directors and independent members.

Mr Crompton said evidence presented to Audit Wales "points to dysfunctionality and factions" within the senior executive team, and "the whole team is not united around the interim chief executive".

The report said "clear and deep-seated fractures within the executive team that are preventing that team from working effectively".

The health board has been dogged by a series of problems in recent years. In 2022 Health Minister Eluned Morgan placed the board into "targeted intervention" for vascular and emergency services.

But she stopped short of placing the board into special measures - a status it had for five years to November 2020 which saw the board under direct Welsh government control.

Auditor General for Wales Adrian Crompton said the leadership of Betsi Cadwaladr is dysfunctional

Mr Crompton said independent members of the board were losing confidence in the executive team, leading to examples of "challenging public scrutiny of the executive".

That was seen as "hostile and inappropriate" behaviour by some.

"Given the extent of the problems, it is understandable that several board members we interviewed showed visible signs of emotional distress, giving us concern about their wellbeing," Mr Crompton wrote.

Churn within the senior leadership team "has not helped," it said, with the health board without a substantive chief executive after four different chief executives since 2019.

The report said the situation was "unlikely to be resolved without some form of intervention". It said the Welsh government will need to use the current "Escalation and Intervention Framework" to support urgent improvements.

Under the framework ministers could choose to put the health board in special measures.

However Mr Crompton does not make a specific recommendation to do that - Audit Wales said that would be a matter for ministers and officials.

Mr Crompton added: "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."

Welsh Conservative's spokesman for north Wales Darren Millar said the "Welsh government must urgently intervene to ensure a total clear out of this dysfunctional executive team, without the eyewatering 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".

Plaid Cymru health spokesman Rhun ap Iorwerth said the report raised "further fundamental questions" about the board.

He said he did not believe the board "in its current form can serve the people of north Wales effectively. We need a fresh start".

Chairman of the Senedd Public Accounts and Public Administration committee, Mark Isherwood, called the report "shocking".

"Yet again we find that a breakdown in relationships between the health board's senior leaders has compromised its ability to move forward. This is simply not good enough," he added.

Labour Health Minister Eluned Morgan said she had "serious concerns" about the report into the leadership of Betsi Cadwaladr health board.

But she refused to be drawn on whether she would re-implement special measures.

"It's a conversation that certainly we will have to have with the health board, and obviously I'll need to take a little bit of time to consider what actions we need to take," she told BBC Wales.

Board was aware 'of majority of issues'

Mark Polin, chairman of BCUHB, welcomed the report and said it had been "aware of the majority of the issues raised in the Audit Wales report".

"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."