Since 2015 there has also been a continued investment in the estate and the services to ensure improved access and healthcare for the people of north Wales, with a number of these having been or due to be completed.

The major ongoing significant refurbishment work, involving over £160 million of capital investment on the Ysbyty Glan Clwyd site, is due to be fully completed in December this year, and the sub-regional neonatal intensive care centre, otherwise known as the SuRNICC, on the site is due to fully open this summer. Capital funding of almost £14 million has been provided to redesign, extend and improve the emergency and urgent care department in Ysbyty Gwynedd. Investments have also been made in two modular theatres at Wrexham Maelor Hospital and for environmental improvements to mental health wards as part of the drive to improve standards of care.

I recently announced £2.2 million of funding to convert a theatre at Ysbyty Glan Clwyd to a hybrid theatre capable of performing complex vascular surgery. That will bring benefits for patients, and is already increasing the attractiveness of the health board in terms of recruitment of consultants, with five vascular consultants successfully appointed and improvements in surgical training.  

It's not only in hospital settings that capital funding is making a difference, of course. Investments in primary care are supporting priorities to improve population health across north Wales, reduce health inequalities and provide care for people closer to home. Over £14 million has been provided to develop integrated health and social care centres in Flint, Blaenau Ffestiniog and Tywyn that provide a range of integrated, co-located, health, social care and third sector facilities.

However, despite the investment and progress in some key areas, significant challenges remain, as reported in the Deloitte review findings and, indeed, the HASCAS report. They both highlighted continued concerns on governance, clinical leadership and service redesign. In the last 12 months, the Welsh Government has escalated the level of intervention in finance and some areas of performance due to substantial concerns on referral to treatment waiting times, unscheduled care and financial planning and management. I am intensely concerned with the decline in performance in these areas, and generally exasperated with the pace of progress by the health board on the milestones set for the first part of this calendar year and the continued lack of clarity on its plans for the future.

I was always very clear that the transformation at Betsi Cadwaladr would require a significant culture change to working in partnership, both externally and internally. This will require ongoing focus on board-to-ward engagement and a move from an underlying resistance to consistency in clinical practice in a variety of service settings, with strong professional oversight and clinical leadership. To deliver improved outcomes for its population, the health board needs to work in a systematic way, in partnership as one organisation at a local and regional level, and to play a full part on a national level.   

During my regular visits and contact with the health board, I continue to be impressed by the commitment and hard work of staff to deliver quality patient care in a challenging environment and in the context of high-level negative reporting and attention. I take seriously the well-being of our NHS staff. Whilst sickness levels in Betsi Cadwaladr have been lower than the all-NHS Wales position for a number of years, and it is delivering a range of initiatives to support staff, we will continue to engage with the health board and trade unions on how we can better support our staff.

To ensure the health board delivers on its short and medium-term expectations swiftly, whilst also planning and undertaking transformational change, I published on 8 May this year the special measures improvement framework. This sets out milestones for the next 18 months in four key areas: leadership and governance; strategic and service planning; mental health; and primary care, including out-of-hours. I expect visible progress before the summer on the framework expectations, including a reduction in waiting times, responses to the recommendations set out in the HASCAS and Ockenden reports agreed and being actioned, recruitment to key positions completed, the additional capacity and capability required in place, and turnaround actions having a positive impact.  

To support the improvements and drive forward the work in the short and medium term, the Welsh Government will provide more intensive support, with a team to work alongside the health board, and additional resources to further improve waiting times. This will include additional system leadership, turnaround and operational capacity support. We will also be increasing the NHS delivery and finance delivery units interventions to include individual unit members providing focused support on plans, intelligence and best practice. Advisory support will also continue under the special measures arrangements. 

The intensive support will initially be directed towards supporting improved governance and accountability, focused joint working with clinicians and partners to deliver substantial improvements, especially in planned and unscheduled care, delivery on financial turnaround and working towards developing an integrated medium-term plan for 2019-2022. Adviser support will include continued guidance on leadership and governance from David Jenkins and Emrys Elias on assuring the development and delivery of the thematic quality improvement and governance plan for mental health services.

The next phase of the improvement journey will be led by a new chair from 1 September, following the appointment of Mark Polin, who will bring clear direction and leadership. He will lead a renewed board, with the recruitment of a new vice-chair and three independent members, and changes at the executive level, including a recently appointed new executive director of workforce and organisational development, and the imminent recruitment of a director of primary care and a director of strategy.

I will continue to hold regular accountability meetings with the chair and chief executive and I will attend the board meeting this Thursday to discuss progress. I will set out my clear expectations of the board to lead and deliver sustained positive change.