Damning report describes ‘learned helplessness’ at Welsh health board

Mark Mansfield

One of the largest health boards in Wales has developed a “pervasive culture of learned helplessness”, a damning independent report has found.

Staff morale was described as the “worst it has ever been”, while the assessment found some employees were afraid to speak up about concerns.

Cardiff and Vale University Health Board was also criticised over patient safety, leadership and governance, with assessors concluding its financial problems had been allowed to dominate “at the expense of quality of care”.

The findings come in the same week that Chris Bown, who has more than 35 years of senior healthcare leadership experience, was appointed interim chief executive.

The health board was escalated to Level 4 intervention in 2025 because of concerns over its finances, quality, clinical services, leadership and governance.

The independent assessment, carried out by Dr Pamela Johnston and Professor Em Wilkinson-Brice, involved a review of around 200 documents and engagement with approximately 200 people.

It concluded that clinical governance was “poorly developed”, risk management was underdeveloped and there was an overall failure to hold clinical boards effectively to account.

Assessors also raised concerns over an “excessive number” of Never Events – serious patient safety incidents considered preventable – reported during the previous two years.

They said there was a lack of process for learning from the incidents and taking corrective action to prevent further Never Events.

The report found a culture that was “siloed, quick to blame others and is divided”, while some staff were reluctant to raise concerns because of a fear of negative consequences.

Its conclusions state: “There is poor organisational psychological safety, and in some areas, there is a fear of speaking up compounded by disrespectful behaviours and poor role modelling.”

The assessment also found a lack of clear decision-making and direction from the executive team and said there was no single plan for the organisation understood by staff.

However, it recognised signs of improvement under health board chair Kirsty Williams and highlighted the commitment of staff to providing high-quality care.

Cabinet Minister for Health and Care Mabon ap Gwynfor MS said: “The report identifies concerns across leadership, culture, governance, planning and organisational capability that are unacceptable and must be urgently addressed.

“The report is clear that the health board’s challenges are systemic and long-standing, requiring organisational reset, a single recovery plan, stronger accountability, assurance and cultural change.

“Under this new Welsh Government, we will not allow such issues to continue, and we will robustly hold the health board to account for its performance.”

‘Reset’

The report recommends an organisational “reset” and says a single improvement plan should be finalised and communicated across the health board as soon as possible.

It also says a move away from commissioning further reviews towards “delivery and action of existing plans is crucial”.

Mr Bown has been appointed interim chief executive following the departure of Suzanne Rankin, who is taking up a new NHS role in England.

He said: “I look forward to listening to colleagues across the organisation, understanding their experiences and working together on the opportunities and challenges ahead.

“Cardiff and Vale UHB has many strengths to build on, and I am committed to supporting the organisation as it continues its improvement and transformation journey.”

Mr ap Gwynfor will chair a meeting with the health board in November to review its progress.

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