A damning occupational health and safety report has revealed how a “lack of structure and systems poses risk of serious harm” for Betsi Cadwaladr Health Board staff.

The report, presented to the board’s meeting on Thursday, highlighted “serious concern over the management of key areas” concerning staff safety.

It said the failures have left the board open to “enforcement action, prosecution and fines for the most serious offences” and calls for a “fundamental shift in the safety culture”.

Despite a catalogue of faults in how it manages health and safety, violence on health board premises is following a worrying trend.

Almost 4,000 incidents of violence and aggression were logged on its systems last year.

Of those,  2,257 incidents were classed as “affecting staff” – up from 2,175 the previous year and from 1,776 in 2017-18.

There were 719 staff injured as a result of those incidents up to April 2020, an increase of 10% on the previous year.

It emerged the board had engaged more security staff at general hospitals during the pandemic and is considering engaging more.

However a study, which was instigated by the health board after concerns were raised at a board meeting last year, exposed a catalogue of worrying practises.

The areas of concern highlighted within the report included:

During the 2019 – 2020 there were 3,983 incidents of violence and aggression recorded compared to 3,752 incidents the previous year

2,257 incidents of violence and aggression towards staff in 2019-20, up 85 on the year before

RIDDOR accidents (those reportable to the Health Safety executive) had increased from 97 in 2018-19 to 110 the following year

Abuse of staff by patients increased from 15 the previous year to 20 in 2019-20

Injuries caused by physical or mental strain more than doubled to 19 between April 2019 and April 2020

Effective security provision within BCUHB remains a significant challenge but

Audits identified 15 pieces of legislation where the board was deemed to be non-compliant, 13 where it was partially compliant and just three where it was fully compliant across the organisation

Health and safety training not being completed at all levels

Concerns over stress management systems and mental health support

Concerns regarding fire safety, risk assessment and evacuation

Concerns about Legionella disease management

Plus concerns about asbestos management, lone working systems and management and control of substances hazardous to health

Sue Green, Betsi Cadwaladr’s executive director of workforce and organisational development, said she’d raised concerns last year.

She said: “People had been trying to cope with health and safety by fire-fighting.

“I brought a report in saying we needed to start again from scratch and that it was likely to take some time and we needed to implement a much more systematic and structured programme of improvement.”

She said they embarked a review of where the board was “warts and all” across the board’s 18,000 members of staff and multiple sites.

She said taking such a systematic approach was the only was to give assurance to the board they were meeting “statutory and moral requirements” to assure the safety of patients staff and visitors to its sites.

Vice chairman of the board, Lucy Reid, said the board couldn’t provide “positive assurance” about health and safety procedures but said work to develop systems had been hit by the coronavirus pandemic.

She added: “It’s a level of assurance that we now know what the problems are.”

The report said:  “The overall impression of safety management systems was that OHS performance had become fragmented, with central control taking responsibility from sites, and limited overall evidence of training, good quality risk assessments and safety management systems being implemented.

“Clear lines of responsibility and accountability are not being evidenced in a number of service areas.

“The lack of structure and systems poses risk of serious harm to individuals who work for the health board and others who may be affected by its work activities.

“The risk leaves the health board open to enforcement action, prosecution and fines for the most serious offences.

“A fundamental shift in the safety culture is needed to improve safety outcomes for staff, visitors, patients, contractors and volunteers.”

The report says that plans are in place and work has gone on to recruit health and safety representatives and put staff through training on workplace risks.

It said it provides a clear plan and framework for action to “firstly identify hazards and place suitable controls in place” but it will require funding.