BETSI Cadwaladr Health Board has made improvements, but still needs to do more to address concerns, a report by Healthcare Inspectorate Wales and the Wales Audit Office has found.

The joint report looks into the health board’s management, service changes and financial handling after it was put into special measures in 2015 following a highly critical report from HIW and WAO in 2013.

While the follow-up report said there had been improvements across a range of areas in the health board, there are still several issues which have not been addressed, including a plan for how clinical services should be reorganised and how to address the board’s financial problems.

It says: “It shows the health board is moving in the right direction. Leadership has been strengthened, the board is working more effectively and a fundamentally different organisational structure has been established. Moreover, the imposition of special measures is clearly helping to focus attention on the specific areas where concerted action was required.

“However, several of the most pressing challenges that we identified in 2013 continue to remain evident, some four years after our original report.

“Crucially, the health board has yet to develop a clear plan for how clinical services in north Wales should be reshaped to ensure that they are clinically and financially viable. This is something that must be driven forward by the health board with pace and urgency, but also in a way that properly engages all relevant stakeholders.

“Whilst the direction of travel is positive, there is still much that needs to be done. Energetic, brave and visible leadership will be increasingly needed in order to continue to build on the progress that has already been made.”

The report warns that more work is needed to draw up plans for the future of services, as well as addressing recruitment challenges to help mitigate the board’s financial issues.

Part of the work carried out has seen the board offer assurances that each of the board’s three main hospitals will have an emergency department and medical and surgical team.