Doctors 'lose confidence' in Betsi Cadwaladr Health Board
Senior doctors at one of the biggest hospitals in north Wales have lost confidence in their local health board, BBC Wales can reveal.
Consultants at Ysbyty Gwynedd in Bangor warn they lack faith in the ability of managers to make the changes needed to provide good care for patients.
They say the Betsi Cadwaladr board's internal structures are "not fit for purpose" amid patient safety concerns.
The board says it will be holding discussions with clinicians.
The consultants laid out their concerns in a letter - seen by BBC Wales - to the chair of the assembly's public accounts committee.
Speaking to BBC Wales, Dr Tony Roberts, chair of the Gwynedd consultants specialist committee, said senior doctors were particularly concerned that management failings could put patients at greater risk.
"Many consultants who've worked here for the past 30 years say they've never known it so bad," he said.
"Specifically there are problems in terms of infection rates and mortality rates - they're higher than they have been.
"There are numerous untoward incidents reported [by consultants].
"Some patients aren't on the right wards, others who need to be in hospital aren't getting in. We're also uncertain about how the organisation is reporting untoward incidents.
"When consultants bring up difficulties and say things aren't working, they've been told to shut up and pressure has been brought to bear in a whole series of ways to try and stop them saying things have gone wrong."
Dr Roberts blamed a breakdown of communication between management and senior doctors.
The consultants' letter comes on the day AMs on the public accounts committee will hear evidence from the health board's senior managers following a recent damning official report into mismanagement.
The joint report by the Wales Audit Office (WAO) and Healthcare Inspectorate Wales (HIW) led to the resignation of Betsi Cadwaladr health board's chair and chief executive.
It highlighted huge failings in leadership and it found there had been a breakdown in the relationship between the health board's chair and chief executive.
Shadow Health Minister Darren Millar, chair of the Welsh assembly's public accounts committee, said AMs would be seeking answers from senior managers about how they would address the concerns highlighted in the report.
He said they would also want to know how the board would rebuild relationships with the consultants who "clearly don't have any confidence that the changes that have already taken place at the health board are sufficient".
Dr Mark Lord, consultant histopathologist at Ysbyty Gwynedd, insists concerns raised in the report came as no surprise to senior clinicians.
"Myself and my colleagues are very upset," he said.
"They're very worried that the management of the health board isn't sufficiently strong enough to give them a safe place to treat their patients.
"In addition there's been an increase in Rami (risk adjusted mortality index) - an indicator of excess or unexpected deaths. Until last year Rami at Ysbyty Gwynedd had shown a steady progressive decline.
"But over the past few months it's started to increase and the at the last count was 122 which is quite significant."
A Rami of over 100 indicates a hospital has more deaths than should be expected.
The health board says it intends to discuss the concerns with the senior doctors.
A spokesperson for Betsi Cadwaladr University Health Board said: "We acknowledge receipt of the letter submitted by consultant medical staff at Ysbyty Gwynedd to the public accounts committee.
"The board will be considering its response at the July board meeting and issues of the need for urgent action, structure of the organisation and the emphasis on local site management will be part of that response.
"We will be holding discussions with clinicians as we move forward to address the issues within the report."
The Welsh government said it also will meet the consultants.
A spokesperson said: "Arrangements are in hand to provide the board with strong transitional support until a new chair and chief executive are in place.
"The views of the consultants will be considered by both the transitional and permanent team.
"The director general of NHS Wales, David Sissling, intends meeting with consultants in north Wales later this week to discuss the issues raised."
The Welsh government is currently in the process of appointing replacements to take over from the chair of the health board Merfyn Jones and chief executive Mary Burrows.
They anticipate the process could take more than eight weeks.