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Audit Wales - Urgent action needed to tackle dysfunctionality within the board at Betsi Cadwaladr University Health Board
Breakdown in working relationships within the board is fundamentally compromising its ability to tackle the numerous challenges the organisation faces
The current situation is unlikely to be resolved without some form of intervention to establish a more collegiate and unified Executive Team and wider board, according to a report by the Auditor General for Wales issued yesterday.
Betsi Cadwaladr University Health Board is currently facing unprecedented challenges from demands on its services and long-term concerns over the performance, quality and safety of a number of specific services. In such circumstances, it is vital that the board works in a cohesive and unified manner to drive the improvements that are needed.
However, concerns about working relationships at the most senior level in the Health Board have led the Auditor General to undertake an urgent review of board effectiveness. These concerns are on top of the issues we have already reported on regarding significant errors in the Health Board’s 2021-22 accounts.
Our work on board effectiveness has found fractured working relationships with the Executive Team that are preventing it from working effectively. This, together with concerns about the pace of change and the quality of assurances provided have eroded the confidence of the board’s Independent Members in the Executive Team’s ability to collectively tackle the challenges the Health Board faces. The frustration Independent Members have experienced has led them to publicly challenge Executive Team members in a way that is perceived by some to be hostile and inappropriate. This has adversely affected working relationships and functionality within the wider board and created further divisions between Independent Members and some of the Executive Team.
Churn within the senior leadership team has not helped the situation. The organisation again finds itself without a substantive Chief Executive, with four different Chief Executives having been in post since 2019. A heavy reliance on interim posts within the wider senior management structure is still evident and points to on-going difficulties securing the senior leadership capacity that the Health Board needs.
The Health Board has invested in an extended programme of externally facilitated board development work to try and address the challenges it faces. However, this work was partly affected by the need to respond to the pressures of the pandemic and has not been successful in building the more integrated and effective approach to board working that is needed.
It is doubtful that the Health Board can make the necessary improvements without external intervention and the Welsh Government will need to use the current Escalation and Intervention Framework to support the urgent improvements which are necessary. In doing so, the findings from this review will need to be considered alongside those of other reviews in response to serious concerns, and which may lead to specific actions in their own right.
The findings from my review of board effectiveness at Betsi Cadwaladr University Health Board are extremely worrying. It is clear that there are some deep-seated problems with working relationships within the board. 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.
Adrian Crompton, Auditor General
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