A retired consultant has criticised Betsi Cadwaladr University Health Board (BCUHB) over high management costs, underinvestment in community hospitals, and the use of expensive external staffing.

Former ear, nose, and throat surgeon Jonathan Osborne FRCS claims BCUHB prioritises management consultants and temporary doctors over patient care, and overcrowding in hospitals, insourcing practices, and unfilled vacancies are driving up costs while failing to improve services.

He said: “We are told the board cannot afford community hospitals but seemingly can afford management consultants. Unfortunate choice of priorities.

“Corridor care in A&E means more nurses are needed. But how many? Betsi executives weren’t content to accept the advice of their experienced consultant leaders to calculate the number, so they solicited well-heeled management accountants to produce a report which, strangely, cited the very same number of nurses as their own senior staff advised! Unfortunately, once the £3 million consultancy bill had been paid, there wasn’t enough money left to pay for them all.

“External doctors are shipped in at weekends to see ‘long waiters’ on outpatient lists. Unfortunately, they lack access to hospital computer systems and cannot order tests, but they can list the patients for surgery, which means the patients need a further review, either to order tests or because the operation listed is either unnecessary or the wrong one entirely. This duplication of resources is expensive, and dangerous.”

“We’ve noted a huge agency staffing bill of £72 million in 2022/23 to cover unfilled medical and nursing vacancies. There has been a staggering £2.3million increase in management salaries in 2023-4, and millions spent on white elephant projects.

“And what are the hidden costs of hospital overcrowding? Operating theatres are standing idle while surgical teams wait for surgical beds to be freed. How are those waiting lists tackled? By paying to send those patients for operations in private hospitals. What is it going to take for Betsi to realise investing in community hospitals will not only help the A&E crisis, but also bring down the bill.”

Health board CEO Carol Shillabeer said the board “recognises the financial and operational challenges we face, and we have been taking firm action to put services on a more sustainable footing”, adding: “Welsh Government asked what additional support the health board needed to accelerate improvement and we have welcomed the announcement of expert assistance to work alongside our teams. This support will not reduce budgets for patient care and is focused entirely on strengthening day-to-day operational performance.

“One solution to relieving pressure in emergency departments is through strengthening community and preventative care. The answer to overcrowded hospitals isn’t simply more beds. Part of the answer lies in helping people to stay well for longer, and for more patients to be able to leave hospital safely and more quickly when medically fit to do so. This is why we are investing in new wellbeing centres, reablement services, and closer working with local partners.

“Since 2023, we have halved agency costs and since September delivered more than 17,500 extra weekend outpatient appointments to ensure patients are seen sooner.”