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Nurse chief exec of troubled board aims to ‘calm the waters’

The nurse who was recently appointed chief executive of a troubled NHS Wales health board has outlined her plans to get the service back on track.

Betsi Cadwaladr University Health Board, which covers all of North Wales and serves more than 700,000 people, was placed into special measures in February due to concerns about the quality, safety and efficiency of its services.

“It is a high-profile organisation for all the wrong reasons; I came here to help stabilise it”

Carol Shillabeer

This followed a previous period in special measures between 2015 and 2020.

Key members of its executive board stepped down and there were concerns about the number of nursing vacancies, organisational culture and leadership effectiveness.

At the time, Welsh health minister Eluned Morgan said she had “serious concerns” about the performance of the health board, and the lack of any signs of improvement.

Carol Shillabeer, a registered nurse of more than 30 years, joined Betsi Cadwaladr earlier this year as interim chief executive, and will formally take on the role permanently in the new year.

Speaking exclusively with Nursing Times, she was confident the health board was on the road to improvements, but acknowledged there was still a significant way to go.

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“If anyone types Betsi Cadwaladr into Google, they’ll see a turbulent history, a revolving door of leadership, and many other headlines,” said Ms Shillabeer.

“It is a high-profile organisation for all the wrong reasons; I came here to help stabilise it.

“When I joined [as interim chief executive], the previous executive board was mostly gone, a new one had to be developed, and my job has been to stabilise the organisation, calm the waters a little and then really focus on things which would help make a difference here.”

Her comments came shortly after the board’s interim chair said it could take a decade to get Betsi Cadwaladr back up to standard.

Ms Shillabeer said quality and governance issues remained the ones which stuck out to her, and that she had the following five priorities:

  1. Establish a functioning executive board;
  2. Develop a strategy to ensure “we aren’t living every day the same”, to allow forward planning and genuine improvements, not just crisis management;
  3. Improving leadership culture with better engagement from the top of the board to its roughly 19,000 staff, including many nurses;
  4. Improving access to health for the board’s served population, care outcomes and in particular the welfare of unpaid carers;
  5. Turning the board into a “self-improving organisation”.

She said of these: “I think we’re making progress so far, I really do. There are days when it’s one step forward and two steps back, but it must feel like that in every organisation.

“We have a real buzz about greater focus on being able to improve things.”

Ms Shillabeer said that she has tried to be a visible leadership presence early on in her job by taking on clinical shadowing shifts, and added there was “motivation and commitment” from staff to improve the quality of care at the health board.

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One issue facing all Welsh health boards, including Betsi Cadwaladr, is finances. In September, all seven of them were placed into some form of escalated financial monitoring by the Welsh Government.

This, health minister Ms Morgan said recently, was done to support the boards to improve their financial planning, and to make “difficult decisions” in order to balance the books.

Asked about the financial situation at Betsi Cadwaladr, Ms Shillabeer said she was wary about the difficulties it faced – but also that it is a “difficult financial environment” in which to run a health organisation such as hers.

“As a health board, we have a lot of duties: a duty to plan, a duty to break even,” she continued.

“All of these have to be managed in balance, and every single NHS organisation is facing difficulties: inflation, and a cost of living crisis – and we’ve also had the recent industrial action.

“I think positively, though, that it’s often when we have no money that we can find we are our most innovative and creative. Rather than always looking for more money, we can design with what we have for now.

“That will work up to a limit, but we do know the pressure of recovering from the pandemic – and we weren’t necessarily on a stable footing before that.”

Ms Shillabeer, who was previously chief executive of Powys Teaching Health Board where she formerly served as chief nurse, further said she was “delighted and honoured” to join Betsi Cadwaladr.

She added: “In the short time I have already been here I have seen a strong commitment from colleagues and partners alike to make improvements and give the people of North Wales the services they expect and deserve.

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“There has been a lot of change here in recent years and I am confident we will build the right leadership and culture to provide the stability and confidence we need to take the organisation in the right direction.

“I did a talk at a conference a few weeks ago, and the title I was given was ‘The limitless opportunities as a nurse to CEO’; it helped me to reflect on how many opportunities there are for nursing and nurses now, both in the NHS but outside of it.”

Dyfed Edwards, chair of Betsi Cadwaladr, added: “I am really pleased that Carol has chosen to take on the role as our chief executive and welcome her to the health board on a permanent basis.

“I have had the opportunity to work with Carol since May and believe her strong track record of leadership, organisational development and partnership working make her the right person to get this health board where it needs to be.

“Carol has already made a significant impact since joining us on an interim basis and this appointment provides us with the stability we need to continue delivering improvements for our communities, staff and partners.”

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