Although the health board has remained under special measures since 2023, this year’s annual report from Healthcare Inspectorate Wales shows that its problems are not exceptional. 

Problems still remain for Betsi Cadwaladr University Health Board, which was placed in special measures – the highest level of escalation – in 2023. The eighth progress report to be published since the escalation to special measures finds that although some improvements have been made, it finds that “fragility, quality and consistency of service delivery” continue to be of real concern across a number of services. 

In a written statement to the Senedd, health secretary Jeremy Miles said that “significant challenges remain in terms of planned care and emergency care performance”.

The health board must focus on making urgent and sustainable improvements to waiting times for planned care and to urgent and emergency care. “This must be a priority as it has by far the largest proportion of – and the longest waits – in Wales,” he added. 

But rather than a one-off, the problems that beset the health board are symptomatic of the broader problems that face healthcare in Wales. 

The need for improvement

The eighth progress report – which covers July to September – emphasised that the expected improvements in operational delivery are still not being realised. 

The special measures improvement plan set a clear expectation that the overall size of waiting lists and the number of long patient waits for planned care would be substantially reduced and brought back to pre-pandemic levels. It is also expected that the health board would tackle the large number of outstanding outpatient appointments in the most challenged specialities and take action to improve waiting times for urgent and emergency care services.

The health board has received £15.7 million to support improvements in planned care over the next year. This includes funding to support reductions in total waits, outpatient waiting times, cataract and diagnostic waits.

But the report says that although there had been a 44% drop in reducing the longest waits between December last year and March, “that rate of improvement has not been maintained”. 

At the end of July, there were 5,399 pathways waiting more than 104 weeks across 15 specialities.

The report also singled out cancer performance, traditionally strong at the health board. “Over the past 18 months, this has not been maintained,” it says, showing a 55% performance against the 62-day suspected cancer pathway target. 

Emergency department performance also remains “a significant challenge”. 

The health board’s performance against the four-hour emergency department waiting time target fell to 57.6% in August, which was 7.7 percentage points worse than performance in August last year. Ysbyty Glan Clwyd reported the worst four-hour emergency department waiting time performance of any Welsh emergency department, with just 34.2% of people admitted or discharged within four hours. 

“Significant and urgent improvement is still required,” the report concludes. 

Growing urgency

The report on Betsi Cadwaladr University Health Board came as Healthcare Inspectorate Wales (HIW) released its bleak annual report, which chief executive Alun Jones calls “a challenge to the system to do better”.

Over the past year, HIW said that it had received 743 concerns, which was a 21% increase on the previous year and a 102% rise since 2019. Alongside this, 120 whistleblowing disclosures were made, up 36%, which points to deeper issues in leadership, governance and organisational culture. These figures, it said, reflect the growing urgency and complexity of the challenges facing healthcare in Wales.

Inspections of GP practices, emergency departments, maternity units and mental health services reveal a system stretched to its limits. Staff are working under immense strain, often in environments that are not fit for purpose. The report identifies recurring risks and a concerning pattern of previously identified issues resurfacing.

“It’s crucial now that the Welsh government sees that all roads lead back to safe staffing in the fight to save the NHS,” commented Nicky Hughes, associate director of nursing at the Royal College of Nursing Wales. 

Emergency departments where patients wait in corridors, maternity units compromised by staffing gaps and mental health wards with unresolved safety risks are not isolated incidents, they are symptoms of wider systemic strain, the report says. 

While services often respond positively to scrutiny, action taken is not always sustained. The report calls for sufficient resources, effective local leadership, and robust governance to ensure high standards are not only achieved but maintained.

“This report from Healthcare Inspectorate Wales HIW paints a stark but accurate picture of a health service under sustained pressure,” said Hilary Williams, Royal College of Physicians vice president for Wales.