People in North Wales are suffering, perhaps even dying because the health board responsible for their healthcare has been failing for almost a decade. Despite this national scandal going on for nearly a decade, no-one appears to want to take responsibility for it.
Betsi Cadwaladr University Health Board is the largest public sector organisation in Wales. It has a budget of £1.9bn, covers just under a quarter of Wales’ population and employs 19,000 people.
In 2015 it was put into special measures by the Welsh Government’s then health minister Mark Drakeford, after “institutional abuse” of patients on a mental health ward. Fast forward eight years and Betsi is still in special measures. The intervening years have been a carousel of scandals, reports and high profile issues. You can get more story updates straight to your inbox by subscribing to our newsletters here.
In just the last eight years we have seen:
Eight chief executives
Patients having an “unnecessary amputation”
Members of the finance team deliberately misrepresenting accounts
An amputee needing to be 'carried to the toilet' by his wife after being discharged without a care plan
Clinicians 'possibly working outside the limits of their competence'
£122m of expenditure not being properly accounted for.
Incorrectly recording Covid deaths in the early days of the pandemic
The independent board was forced to resign by the Welsh Government only for one of the newly appointed members to also resign just a week later.
The health board liaised with suppliers to deliberately edit documents before they were sent for auditing.
Almost 1,700 mental health patients wrongly discharged from support services during the pandemic.
Not that the health board was in special measures for the whole eight years. In late 2020, just months before the Senedd election, the Welsh Government took the health board out of special measures which opposition parties labelled as playing politics. However, then health minister Vaughan Gething pointed to advice from the Auditor General for Wales, Adrian Crompton, as underpinning the decision (though Mr Crompton denied he had given any such advice). Fast forward to the start of this year, the health board was back in special measures again after a pretty terrible report from Audit Wales which raised major concerns over "dysfunctionality".
Betsi was established in 2009 with the combining of several trusts and health boards. Staff in other parts of the Welsh NHS have described the health board as a “basket case” to WalesOnline, saying that parts of the health board’s organisation are still divided along those historic lines with each party often using different systems (though the health board’s latest leaders say this is something they are cracking down on).
Despite there being demonstrable incidents where wrongdoing could be argued to have taken place, like altering accounting documents and being unable to account for £122m of missing cash, no criminal charges have been brought. Both Prime Minister Rishi Sunak and Welsh secretary David TC Davies have called on the police to investigate further.
Aside from these incidents there appears to be no accountability for the woeful mismanagement within Betsi. Perhaps nowhere is the dysfunctionality of the health board more apparent than in the case of Lesley Singleton.
Ms Singleton was director of mental health and learning disabilities at the health board at which time it was still under special measures. During this time 1,694 mental health patients were wrongly discharged (though the health board initially wrongly estimated between 200 and 300 people had been affected). The health board's then interim chief executive said discharging the patients was an "error that should not have occurred".
Ms Singleton left Betsi in 2022 only to be appointed by the Welsh Government in spring, 2023, to the new independent board that is supposed to scrutinise the health board's performance and governance (the previous board had been sacked en masse by health minister Eluned Morgan). As she previously sat around Betsi’s board table when she was a director she would be scrutinising decisions she may have herself had a hand in making.
This is not to say that Ms Singleton personally did anything wrong or did her job badly. But there were clearly questions to answer here. These questions were loudly raised by opposition parties and former board members and within a week of taking her new role Ms Singleton resigned.
So what is the Welsh Government’s role in this? As Besti is in special measures, the board overseeing it is appointed directly by Eluned Morgan. Initially the Welsh Government attempted to defend Ms Singleton The Welsh Government issued a statement saying Ms Singleton had worked in the field of mental health for more than 25 years and brought "a wealth of experience", only to then say she has stepped down.
Where does the buck stop?
Who is ultimately in charge? You might think that this is a simple question to answer. The Welsh Government is responsible for health, therefore it is ultimately their responsibility that the largest organisation under their control is often failing the people in their area. Despite going into special measures close to a decade ago, in just the last six months the Welsh Government have seemingly tried to distance themselves from Betsi.
Here are some examples:
- May 24 - Eluned Morgan in the Senedd complaining about being questioned about the health board: “I'm happy to be held to account. I'm held to account on a weekly basis here, very differently, let me point out, from the situation in England, where despite the fact that they have 21 hospitals in special measures equivalent, 21, never, as far as I can tell, has there been a question on the floor of the house in the House of Commons on any one of those, and I am here week after week after week.”
- May 28 - Eluned Morgan saying “it’s not my job” to hold the chief executive to account when asked about why senior staff were still in post despite health board failings: “I think it's really important that people understand how the system works. So I am responsible for the NHS, but I delegate that responsibility to independent boards. I set them parameters, I set them goals, I set them targets. But then I appoint people to those boards to oversee independent organisations, and their job is to run the organisation. It's their job to hold the executive to account. It's not my job. That is why I appoint them. When they fail to do the job that we've asked them to do, holding the executives to account—because it's their job to do that—then I have to step in, and that's what I did.”
- May 9 - Mark Drakeford was asked about the fact there were no prosecutions for fraud within the health board: “If the Member has concerns about the decision reached by NHS Counter Fraud Service Wales, he must take up those concerns with them. I am not responsible for them, nor should I be, and I cannot be expected to answer questions about how or why they came to their conclusion. They do that entirely independently and entirely of their own volition.”
- May 28 - Eluned Morgan again speaking about the power to dismiss the executives, said: “I do not have the power to dismiss executives. They have rights; they have employment rights. I do not employ them; I cannot dismiss them. That is the reality of the situation. So I'm not sure what exactly you want me to do. Do you want me to directly employ all 105,000 people who work [there]? I do not have the powers, even under special measures, to sack people who work directly for the health boards. I think it's really important that people understand that I do not have those powers.”
This is not to mention that both Mark Drakeford and Vaughan Gething said that the decision to take the health board out of special measures in late 2020 was down in part to advice from the auditor general, despite the auditor general himself saying he never issued any such advice.
Of course there is merit in some of the Welsh Government’s points. Mark Drakeford isn’t responsible for decisions made by NHS Counter Fraud. Eluned Morgan can also not directly dismiss senior executives. She clearly wants to do so as seen in her response to Plaid leader (then health spokesman) Rhun ap Iorwerth on May 28. She went on to say: “One of the reasons I want to look at the accountability mechanisms is because I don't have the levers that I think that I require to make the kind of interventions that I think are necessary. So that is something that I will be looking at and already I've approached a few people to help me in that task.”
But this begs the question of why it is only now, eight years after the health board went into special measures and presumably over a decade since it started failing patients, that the Welsh Government are seeking the tools to actually hold the health board accountable?
Plaid Cymru leader Rhun ap Iorwerth said he believed that the Welsh Government were actively failing to take responsibility for the health board. Mr ap Iorwerth said: “By putting Betsi in special measures, Welsh Government effectively runs the health board.
“The value of government intervention is that they are able to orchestrate action ‘as they see fit’ – but when we have a health minister who openly avoids taking responsibility, saying it’s ‘not her job’ to ‘have a grasp of things’ and denies she has the levers to ‘make the kind of interventions that I think are necessary’ then one has to question what Welsh Government hopes to achieve through these special measures.
“Health is devolved to Wales and Betsi Cadwaladr is in the highest level of targeted government intervention – if Welsh Government is refusing to take ownership of this, then who will?”
Plaid have repeatedly called for the health board to be broken up to try and make it more manageable and improve the culture. Rhun ap Iorwerth MS added: “Questions about the board’s structures and leadership have damaged this health board for so many years with most of its time in existence having been in some level of Government intervention.
“Welsh Government must accept that the time has now come for a more fundamental consideration of how services are configured across north Wales. Government say reorganisation would be disruptive, but so is the current mess. They should, as a minimum, look at the options. It’s not that we WANT reorganisation, but that we genuinely believe we need a fresh start.
“The fact we’re talking about a huge board split into East, Centre and West already indicates it’s too big and unwieldy, and it’s failing to look after the people in its care. But at the very least we need an inquiry that can look transparently and forensically at what has happened in Betsi’s past, so we can make plans for its future - for the future of those staff working in it and the patients dependent upon it.”
The big question - when is this ever going to get better?
Ultimately, one thing matters to the people of North Wales above all when it comes to this issue - when is their health service going to be up to scratch? WalesOnline approached health minister Eluned Morgan saying: "It is not unreasonable for people in North Wales to ask when will they have a health service in North Wales which is up to standards? Will it be months, years, or not until the next Senedd election in 2026?"
In reply to this, Ms Morgan said it would not be quick. "I think we've got to be clear," she said. "This is not going to be a short term fix. This is going to take a while, we need to make sure that the people who work for the health board understand the changes that need to be made. We do need to think about a new culture in the health board, we need to make sure that performance measures are improved. So our team here in Welsh Government are trying to hold the hands of the people who are responsible for delivering for the people of North Wales - that is the health board themselves.
"We do not directly, as a Welsh Government, provide health services. It is the health boards that deliver those services. So we've now put in new independent members to change the way that the the top of the organisation works. My understanding is that there's been a real change in terms of tone and relationships, the top of the organisation, but that now needs to filter through to the rest of the organisation. There's a lot of work to be done in Betsi Cadwallader, and this is not going to be something that we're going to be able to turn around overnight."
It is worth noting two things here. Firstly, the Welsh Government is not taking responsibility for the health service in North Wales, they are merely "holding the hands" of the people who are, The second is that the health minister is going all in on the "change is finally happening" line.
The new independent board are entirely her selections. Whether or not she believes the Welsh Government is ultimately responsible for the delivery of health care in the north, the success and failure of Betsi going forward lays with her. There is no hiding, there is no-one else to point to now.
Commenting to WalesOnline, Carol Shillabeer, Betsi Cadwaladr’s interim CEO, said: “The current challenges across the whole of the NHS in the UK are well described and these exist in North Wales too. There are, however, additional challenges the NHS in North Wales and the Health Board is experiencing and the special measures re-escalation provides an opportunity to tackle these with the intervention and support of advisers. The board and staff across the organisation are committed to making improvements and whilst some of these will take time, we are already making good progress in a number of priority areas in our initial 90-day special measures response."
