However, there are still fundamental challenges to address, including building a high performing executive team, recruiting substantively to remaining posts on the board, and ensuring the new board demonstrates the unified and effective leadership that is needed to tackle the challenges the organisation faces.

In February 2023, the Auditor General published a report in the public interest that described a worrying level of dysfunctionality within the board at Betsi Cadwaladr University Health Board. The report highlighted a need for immediate action to address fractured working relationships between the health board’s senior leaders that were fundamentally compromising the board’s ability to tackle the substantial challenges the organisation faces.

Following significant changes to the board membership over the last 12 months, and a period of upheaval and churn, the follow-up report that we’re publishing today describes a board that is now more stable.

The dysfunctionality that we described in our previous report is no longer present, and a new substantive Chair and Chief Executive are providing refreshed and focused leadership to tackle the organisation’s challenges. Reliance on interim appointments to senior roles is reducing and action is being taken to strengthen corporate governance leadership arrangements.

However, further action in a number of areas is still needed. Work must continue to build a cohesive and high performing executive team and to move as quickly as possible to a position where the board has a full complement of substantive executive directors and independent members.

Governance structures that were stood down in 2023 following the resignation of the previous independent members need to be built back up and the issues that led to the suspension of staff in the finance team need to be resolved.

Crucially, our report highlights the need for the organisation to develop its internal capacity and resilience to sustain improvement without requiring continual external support.