Conversations from the Royal Welsh Show 2017

For the second consecutive year, Inspection Wales partners (Care and Social Services Inspectorate Wales, Estyn, Wales Audit Office and Healthcare Inspectorate Wales) shared a stand at the Royal Welsh show, to engage with the public about our joint and shared working and, to gather the public’s views about the quality of rural services for a future Wales Audit Office report.

I attended on Monday, the first day of the show, and had a number of interesting conversations with members of the public about the work carried out by Inspection Wales partners. As you read this blog, please bear in mind that it represents my account of what I have been told. I have not fact checked what my interlocutors told me. Rather, I have sought to position the issues they raised within a wider context and show how they relate to the work of Inspection Wales partners.

One of my early conversations was with a man who talked to me about plans to regenerate the area of Merthyr town centre around the Pont-y-Cafnau bridge, which is known as the oldest iron bridge in the world [opens in new window]. For him, the end of European Union funding for Wales due to Brexit was a big concern, as it meant the end of a potential source of funding for such regeneration projects.

Brexit is clearly a challenge for the Welsh Government going forward. Under the current round of EU structural funding Wales will benefit from £2 billion of direct funding, and when match funded should, according to the Welsh Government, result in investment of over £3 billion [opens in new window]. The Public Policy Institute Wales finds that Wales has been a net beneficiary from EU structural funds [opens in new window] and that Wales receives substantially more EU funding per head than other UK countries.

In September 2016, the Wales Audit Office reported that the Welsh Government intended to bid for £125 million of EU funding [opens in new window] for elements of the South Wales Metro transport scheme [opens in new window], which has a total estimated cost of around £734 million. The June 2017 Economy, Infrastructure and Skills Committee report [opens in new window] on the rail franchise and South Wales Metre found that Brexit has raised a question mark about the proposed EU contribution, and that ‘while the UK government has provided assurances that it will honour any agreed EU funding commitments up to 2020, it is impossible to argue that this money is secure’.

The same man also talked about what he saw as the ‘wild claims’ being made about the potential economic impact of the proposed Circuit of Wales racetrack; perhaps his interest related to the proximity between his own home in Merthyr and the proposed location of the circuit in Ebbw Vale. I was able to provide him with a copy of the recent Wales Audit Office report on the Welsh Government’s decision to provide over £9.3 million to support initial development of the Circuit of Wales project [opens in new window].

On the same theme of Welsh Government investment in business, I talked to a number of people from north Wales about the April 2014 Wales Audit Office examination of the public funding and closure of the Cywain heritage, rural life and sculpture centre in Bala [opens in new window]. At the time of publishing, the centre and all its facilities were closed. However, I was told that a cafe is now operating at the site.

Wales Audit Office performance auditors undertook a survey about rural services at this year's Royal Welsh Show
Wales Audit Office performance auditors undertook a survey about rural services at this year’s Royal Welsh Show

I also had a number of conversations with people who told me they had used inspection reports by Estyn and Care and Social Services Inspectorate Wales to decide which schools and care homes to use for family members. On a personal level, it felt good to talk to people who were actually using the work of Inspection Wales partners to help them make informed decisions about the futures of their families. I also spoke with people about their experiences of healthcare in Wales, and told them about the role Healthcare Inspectorate Wales plays in regulating and inspecting healthcare services in Wales.

Readers may be interested to note that, although Healthcare Inspectorate Wales does not routinely investigate individual complaints or concerns, it would still like to hear about concerns and it monitors all complaints it receives [opeans in new window]. It uses complaints information as a way of gaining a picture of the overall safety and quality of healthcare services.

About the author

Emma Giles, Inspection Wales Programme Board ManagerDr Emma Giles took over as Inspection Wales Programme Manager in March 2017. Prior to this, Emma was a performance audit lead with the Wales Audit Office.
Emma is an outdoor enthusiast who likes mountain biking and walking.

Her PhD in Criminology looked at how offenders and criminal justice staff understood fairness, and what these differing perceptions of fairness meant for relationships between staff and offenders.

Working together to deliver the joint review of governance arrangements at Betsi Cadwaladr UHB

The Wales Audit Office and Healthcare Inspectorate Wales (HIW) completed their fourth joint review of governance at Betsi Cadwaladr University Health Board on 29 June 2017.

Cover of the reportThey concluded that ‘while the direction of travel is positive, there is still much that needs to be done’. You can read the report on both the Wales Audit Office [opens in new window] website and on HIW’s website [opens in new window].

However, the purpose of this blog is not to focus on the conclusions reached. Rather, it is based on conversations I had with review team members. Its purpose is to reflect upon their experiences, and in so doing to highlight the benefits of collaboration and identify some factors which contributed  to successful joint working and some potential challenges. What follows might not be ‘rocket science’, but I hope you find this slightly different perspective on audit and inspection interesting.

Joint working added value in a number of ways, particularly communicating to the Health Board the seriousness of the challenges it faces

For the review team members, the very act of the Wales Audit Office and HIW coming together to undertake a joint review is important because it sends a strong message to the Health Board, its partners and stakeholders about the seriousness of the concerns about the governance arrangements at the Health Board.

The message is further strengthened as the 29 June 2017 review was the fourth in a series of joint pieces of work undertaken since 2012. Over that time, the joint HIW and Wales Audit Office reviews of Betsi Cadwaladr have established themselves as authoritative accounts of the progress made by the Health Board in meeting the challenges it faces.

The strength of the message and the authority of the report should increase the likelihood that the Health Board takes actions on the areas of remaining concern, which include that 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.

Drawing upon the relative skills and experiences of HIW and Wales Audit Office staff led to a more comprehensive and whole system perspective about how the Health Board’s processes are working from the experiences of the patient upwards. Broadly speaking, Wales Audit Office staff brought expertise and knowledge about financial matters and governance, and HIW staff brought knowledge about patient care and safety.

‘It sounds cheesy, but successful joint working starts with a willingness to work together and a recognition of the expertise and skills of others’

The absence of shared repository for storing information, which then required the information to be shared by email, was the only issue identified as a challenge.  So to what can the review team ascribe the success of the project? And what advice would they give to others embarking on such joint work? Certainly the success of this piece of joint work lies, to some extent, in the fact that this was the fourth joint piece of work, and so there was a well-established and well understood approach to working together.

One of the team members told me that, while it sounds like a cliché, those embarking on joint working need to begin the journey with a willingness to work with others and a recognition of the skills and expertise which colleagues in other organisations can bring. Also, success was deemed to be about keeping the overall goal in mind, rather than becoming dogmatic about process. At the same time it was important to ensure that project management arrangements were clearly set out and the project was rigorously managed to complete it within agreed timelines.  Clear and frequent communication also seemed a key ingredient to the success of the project. Key elements of the process were jointly delivered, such as fieldwork and reporting to the Betsi Cadwaladr board. This links into an earlier comment about how joint working has helped to communicate to the Health Board the seriousness of the challenges it faces.

Finally, both project leads referred to a future piece of joint working, not between the Wales Audit Office and HIW, but between HIW and the Care and Social Services Inspectorate Wales (CSSIW) on community mental health teams. So watch out for that joint report which is due to be published early in 2018, and for another similar blog on the experiences of the HIW and CSSIW joint review team.

About the author

Emma Giles, Inspection Wales Programme Board ManagerDr Emma Giles took over as Inspection Wales Programme Manager in March 2017. Prior to this, Emma was a performance audit lead with the Wales Audit Office.
Emma is an outdoor enthusiast who likes mountain biking and walking.

Her PhD in Criminology looked at how offenders and criminal justice staff understood fairness, and what these differing perceptions of fairness meant for relationships between staff and offenders.