Image caption Betsi Cadwaladr health board was placed in special measures in June 2015 after a damning report found failings at the Tawel Fan mental health unit at Ysbyty Glan Clwyd

A health board has made "unacceptably slow" progress since it was placed in special measures four years ago, a committee of AMs has concluded.

Betsi Cadwaladr health board has been under partial Welsh Government control since a damning report in June 2015.

An inquiry by the Welsh Assembly's Public Accounts Committee found the situation may have become "normal".

The health board said two services had been taken out of special measures and it was "determined" to improve on this.

A key recommendation of the report is that the health board should bring in external specialists to oversee improvements.

Members made a series of findings, including that Welsh Government interventions had "little practical impact" on the north Wales health board.

The committee also said it had "serious concerns" about the health board's finances - including an increasing deficit which is "significantly worse" than forecast.

The health board's most recent finance report revealed it was overspending by £41.3m.

Image caption Committee chairman Nick Ramsay said there was an "urgent need to transform" the health board's services

Missed patient waiting time targets and a lack of progress improving mental health services were also areas of concern.

Betsi Cadwaladr is the lowest-performing health board in Wales for elective care, unscheduled care and referral for treatment by a GP.

And the report found that demand on services was now higher than four years ago and there were gaps in staffing rotas for accident and emergency departments.

The committee is "deeply concerned" with the situation, its chairman Nick Ramsay said.

"There is an urgent need to transform services across north Wales, delivering financially sustainable services and improved patient outcomes," the Conservative AM said.

"There is a serious risk that special measures may now have become a normal state of affairs."

Mr Ramsay said the committee heard assurances from senior leaders that the health board "now has the right approach".

He added the committee would be "keeping a close eye" on the health board.

The health board's chairman, Mark Polin, and chief executive Gary Doherty defended their record.

"We have demonstrated our ability to turn services around with both maternity services and GP out-of-hours services having been taken out of special measures by the Welsh Government," the statement said.

"We are determined to build on this as we work with our staff and partners to deliver the changes detailed in our plan for the next year and beyond."