More robust appraisal and reporting and assurance systems are now being introduced by the new chair to further drive improved good governance. There has also been increased commitment to and impetus on partnership working from the board to support ‘A Healthier Wales’ and the transformation agenda. I was pleased to announce last week support from the transformation fund for a north Wales project across north Wales to help people with learning disabilities live more independent lives and to get the care that they need closer to home. That will involve sharing resources, skills and expertise across health, social care and the third sector.

In relation to finance, the health board remains in a challenging position. However, if the control total set for this year is met, it will represent a real improvement on the previous year. The board are in no doubt that achieving this will require focused action over the latter part of this financial year to deliver the turnaround needed to secure stability and to drive the shift to transformation in its future plan. I announced in July additional funding of £1.7 million under the special measures arrangements to strengthen the management capacity and analysis capability in the turnaround team.

A key expectation of the improvement framework was that the board responded promptly and appropriately to the Health and Social Care Advisory Service—HASCAS, investigation findings and the Ockenden governance review recommendations. I am content that the plans the health board has put in place to implement the recommendations, both with mental health and more widely, are comprehensive and robust, with operational leads identified and being held to account. My focus now is on ensuring that there is rapid progress on implementing these plans.

We are already verifying the progress so far reported by Betsi Cadwaladr in their regular reports, and that is recognised by front-line staff in mental health, and that is in addition to the Healthcare Inspectorate Wales inspection programme, which is also reporting progress. Improvements so far include the confirmation of a new and visible senior management team, appointment of a new mental health nursing director, creation of listening leads across front-line staff and the launch of the 'Today I can’ approach. Furthermore, a stakeholder group has now been created to further test the improvements being made, and I am pleased that some members of the remaining Tawel Fan families have agreed to be part of this group, together with the community health council and other stakeholders.

Recently, I met with a number of Tawel Fan families, when I met them last week. I understand very clearly that a small number of families are not content with the process or the outcome of the HASCAS investigation. However, there was consensus on the need to ensure that the health board reports and action plans are prepared and that they do result in sustainable and meaningful improvements in both mental health services and care of those with dementia across services. My officials have been very clear with the health board on the need to ensure it communicates plans and actions effectively to all staff.

The focus of developments in mental health to date has been around immediate improvements to in-patient services, including environmental works. The health board is also working to assess and improve community services by implementing its mental health strategy, working closely with local authorities, the third sector, service users and the police to deliver local implementation plans. A key focus for the next six months will be to improve and maintain performance against the Mental Health (Wales) Measure 2010 and child and adolescent mental health services targets  To support this work, the delivery unit is reviewing demand and capacity and my officials are discussing what further support might be needed in this area to rebalance capacity and demand.

Improvement to engage and involve staff is ongoing, and the results of the NHS staff survey 2018 show positive changes since 2013 and 2016, most notably in staff engagement. That includes an 18 per cent increase from 2013 of staff who say that they are now proud to work for Betsi Cadwaladr. 

The strategic and service planning area, including performance, requires acceleration and more focused effort. There has been progress in individual specialist strategies with the sub-regional neonatal intensive care centre—otherwise known as SuRNICC—and primary percutaneous intervention plans implemented, and the vascular surgery plan under way. These plans increase success in recruitment and in delivering specialist services within north Wales for the people of north Wales. Work on other areas, including orthopaedics, needs to be further progressed on a whole-system basis and described more clearly in its plans for service transformation and improvement.

In primary care, the new executive director will provide increased focus to deliver further improvements, working in partnership with clusters. Work is continuing to improve GP out-of-hours services and the health board performance is now more in line with the rest of Wales. The ambition of the health board is now to transform the service model so that it becomes fit for purpose and sustainable.

In this statement, I have noted areas of progress but also outlined the significant difficulties that do remain. I am determined that special measures is not a sticking plaster, but that it delivers sustainable improvement and puts in place the capacity and capability required for the medium and long term. During the next six months, the health board will need to focus on finance, strategic and service planning, especially in unscheduled care and referral to treatment, and delivering on the recommendations from both the HASCAS and Ockenden governance reports.

The chair and the board are clear on the work needed and are committed to making progress. Welsh Government will work alongside to provide the necessary support and I hope that regional partners and key stakeholders will also play a key role in ensuring improved and sustainable health and care services for the people of north Wales.