Madam,

Your Leader writer in your edition of 30 May is correct; the Betsi Health Board situation is a worry. But should we have any expectation of an improvement?

On my count, seven special measures advisors have come, and mostly gone, since Betsi went into special measures. As I recollect, only one, Ann Lloyd, former head of the NHS in Wales, has left a clear audit trail, written in her 2015 report “Targeted Intervention, Jan/Feb 2015”.

She described the challenge that the Betsi Board faces succinctly. “Adopt an outline plan that defines improvement proposals that fit inside a £1.3 billion financial resource envelope”. No-one has ever assessed if it was, or is, possible to produce improvements within this £1.3 billion financial resource envelope.

Mrs Lloyd’s credentials as a special measures advisor were that she could demonstrate successes in turning around English NHS organisations. A key technique was the US “Buddy” good practice transfer. This is based on finding a similar organisation in population size, geographic spread, healthcare planning and service delivery responsibilities,etc, which is recognised as successful and to transfer the successful techniques to the underperforming health body.

At the 2015 Betsi AGM, I asked questions about applying the “Buddy” technique to Betsi. Mrs Lloyd was present. AGM Minute A15/5.4 records my intervention. The chair, Dr Higson, said that he was interested in finding a “Buddy” for Betsi, perhaps from Scotland.

Subsequently, I learnt that NHS Wales had determined that Betsi was unique in its size, geographic spread, healthcare planning and service delivery responsibilities, etc. There is no comparable successful model that Betsi could “Buddy” with and learn from.

Recently First Minister Mark Drakeford has said that he keeps under review whether to take action to break up Betsi. Many informed healthcare management practitioners consider that the break-up is long overdue.

When Betsi was formed, minister Edwina Hart faced challenges from critics that Betsi’s size and scale was too large to succeed. Surely the failings of 2009-13, and the subsequent four years floundering in special measures, is sufficient evidence that the critics were correct.

Yours etc, Tom Brooks, Borth-y-Gest, Porthmadog.

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