However, I do want to place on record again how acutely aware I am of how difficult this period has been for individuals, families and patients affected by the original concerns. I have received correspondence from a number of the Tawel Fan families and my office is currently agreeing a time for me to meet to with them again, now that all of the reports are in the public domain. I also understand how the staff of the health board must feel about their health board being in the headlines again as a result this report.  My focus is now on moving the health board forward, learning from the past and putting the mistakes of the past behind them to secure real and sustained improvement.

There has been an improvement in mental health services in Betsi Cadwaladr since 2013. However, they still have a long improvement journey ahead of them. In her presentation to the board last week, Donna Ockenden herself highlighted areas of progress and in particular the work of the director of nursing and midwifery on managing complaints, concerns and safeguarding. However, it is important that the local health board more effectively communicate the improvements that are being made in order to rebuild the confidence of their population in their mental health services. I know that the chief executive recognises the need to do this and has now written an open letter that describes recent improvements in mental health services. Those improvements respond to both Donna Ockenden's and the Health and Social Care Advisory Service's recommendations. For example, there is now a completely new management structure in place for mental health services. 

I also know that Healthcare Inspectorate Wales's latest annual report was presented to the board last week. Rightly, it reported that there are still areas of continuing concern, but the report also noted that, overall, patients were happy with the care they received, staff felt supported, and there is good evidence of patient-focused care. It also highlighted that the health board had been open and responsive throughout its involvement with Healthcare Inspectorate Wales and, importantly, that the leadership has strengthened since 2013 and is more effective following fundamental changes to its structure.

Furthermore, the Wales Audit Office’s most recent structured assessment of Betsi Cadwaladr health board pointed to progress being made in addressing previous recommendations, and that strategic planning and operational arrangements are generally effective. However, the pace of this improvement must increase.

Going forward, the new chair will lead a renewed board with the recruitment of a new vice-chair and three independent members. There are also changes in the executive director team, including a recently appointed new executive director of workforce and organisational development, and imminent recruitment of a director of primary care and a director of strategy.

The board agreed at its meeting on 12 July to establish an improvement group to respond to both the HASCAS and Ockenden recommendations. The group will be chaired by the executive director of nursing and midwifery, and will provide leadership, governance and scrutiny of progress against the recommendations. I expect that group to regularly report to the full board. We are continuing to provide further intensive turnaround support for the improvements, with an initial emphasis on supporting improved governance and accountability, focused joint working with clinicians and partners to deliver sustainable improvements, all of which respond directly to issues raised in Donna Ockenden’s report.

It is also important to note progress made in other services, especially maternity services, which were de-escalated from special measures earlier this year. That demonstrates what the health board can achieve with focused leadership and action. But I am under no illusion. I recognise that the review reinforces what we already know about the position of the health board and why it was placed in special measures—it reflects the significant work still to be done.

It has been over four and half years since concerns were first raised regarding the care and treatment on Tawel Fan ward. The publication of Donna Ockenden’s report and the HASCAS investigation marks the end of a lengthy but necessary series of investigations and reviews. As I said earlier, the emphasis must now be on moving forward and increasing the pace of improvement. The staff and the public of north Wales deserve nothing less.