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.

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