Our 2019 joint report highlighted a number of fundamental weaknesses in the Health Board’s arrangements in respect of leadership, strategic focus and scrutiny of patient safety and risk, management of concerns and complaints, and organisational culture. We were concerned that these weaknesses were compromising the Health Board’s ability to identify and respond to problems with the quality and safety of patient care. Our 2019 report made a total of 14 recommendations for improvement.

Our follow-up review found the Health Board has made significant progress in addressing the concerns and recommendations of our 2019 report. It has a stronger strategic focus on quality and patient safety, and there is greater clarity on roles and responsibilities in relation to quality and patient safety compared to 2019.

The organisation’s scrutiny of quality and patient safety has also improved considerably, with greater openness and transparency. There is also greater awareness of risk management across the organisation, and clearer processes in place for identifying, managing, and escalating risks. The Health Board’s concerns and complaints processes are much clearer, and new corporate roles have been created to support implementation and ensure consistency. There is also an improved culture of learning, with a series of arrangements now in place to support the sharing of learning and improvement across the organisation.

There is early evidence of the Health Board’s new operating model supporting further improvements in organisational culture, but further work is required around establishing clear performance monitoring and management arrangements within the new structure.

Staff told us that internal culture is improving, and senior leaders are more visible and accessible. However, they also told us that there are still areas for improvement, particularly in relation to addressing pockets of poor behaviour.