Aneurin Bevan University Health Board oversight and escalation framework: February 2026

Following an assessment against the NHS Wales oversight and escalation framework in November 2025, Aneurin Bevan University Health Board escalation levels are as follows:

• Level 4 for finance, strategy and planning
• Level 4 for performance and outcomes related to urgent and emergency care

Level 4 (targeted intervention) is the second highest level of escalation within the NHS oversight and escalation framework. It is applied when organisations have serious problems and where there are concerns that they cannot make the necessary improvements without external support. The Welsh Government will take and co-ordinate action and direct intervention to support the health board to strengthen its capability and capacity in order to drive improvement. It consists of a set of interventions designed to remedy the problems within a reasonable timeframe. The interventions will normally be undertaken by NHS Wales Performance and Improvement directed by Welsh Government. If appropriate, external support will be agreed with the organisation.

Finance, strategy and planning

In September 2023, Aneurin Bevan University Health Board was escalated to level 3 (enhanced monitoring) for finance and planning.

In January 2024, the health board was escalated from enhanced monitoring to level 4 (targeted intervention) for finance, strategy and planning.

In July 2025, the health board was de-escalated to level 3 for finance, strategy and planning.

In December 2025, the health board was escalated from level 3 (enhanced monitoring) to level 4 (targeted intervention) for finance, strategy and planning.

Performance and outcomes

In January 2024, Aneurin Bevan University Health Board was escalated to level 3 (enhanced monitoring) for performance and outcomes related to urgent and emergency care at the Grange University Hospital Emergency Department.

In December 2025, the health board was escalated from level 3 (enhanced monitoring) for performance and outcomes related to urgent and emergency care at the Grange University Hospital Emergency Department to level 4 (targeted intervention) for performance and outcomes related to urgent and emergency care. 

The NHS Wales oversight and escalation framework sets out the process by which the Welsh Government maintains oversight of NHS bodies and gains assurance across the system. It describes the escalation, de-escalation and intervention process, the 5 levels of escalation and the domains against which each health board will be assessed.

During escalation, interventions will be:

• collaborative: we will seek to minimise duplication by working collaboratively with other national committees, groups and programmes
• collective: we will maximise shared knowledge by sharing common approaches, tools, guidance
• impact focussed: we will examine and seek assurance and evidence how organisations are obtaining assurance over delivery and impact of actions
• be undertaken with openness: transparency; and mutual trust and respect between the health board, Welsh Government, and the NHS Performance and Improvement

During the period of level 4 intervention, monitoring and reporting arrangements will include a:

• bi-monthly escalation and oversight meeting chaired by the NHS Wales Chief Executive and a small number of the health board and Welsh Government Executive Team members (this will replace JETs)
• oversight between the Chair and the Cabinet Secretary in line with the Oversight and Escalation Framework
• bi-monthly operational performance and delivery group meeting to support operational improvements across a range of areas

This framework sets out the expectations for de-escalation against each area and domain of escalation. Where possible, these de-escalation criteria are consistent with other health organisations in escalation.

De-escalation will be no more than one level at a time with reduced oversight and intervention at each stage of de-escalation. De-escalation from level 3 (enhanced monitoring) will typically be to level 1 (routine arrangements).

To be considered for de-escalation, an organisation must demonstrate that progress towards the de-escalation criteria is being made.

There are 2 approaches to de-escalation:

• Welsh Government will coordinate activity to closely monitor, challenge and review progress made by the NHS organisation. If the NHS organisation can provide evidence of sufficient and timely improvement, then the Welsh Government and external review bodies will share knowledge to enable them each to consider whether de-escalation of the intervention arrangements placed on the NHS organisation is appropriate. For de-escalation to occur, the NHS body may not have achieved all of the de-escalation criteria, but they will need to demonstrate sustained improvements with a credible improvement plan to maintain improvements.
• De-escalation for those areas with quantifiable outcomes and targets such as performance and outcomes will take place once the de-escalation criteria have been met and sustained for the agreed period of time. If the NHS organisation meets the de-escalation criteria for a specific domain or sub-domain then they will be de-escalated to the next level on the escalation scale. This de-escalation will be automatically triggered outside of the normal escalation cycle and will be confirmed in writing to the organisation. 

The roles and responsibilities of Welsh Government are to:

• support a formal structure for reviewing and reporting progress
• signpost relevant best practice guidance and frameworks
• review and provide feedback on developed products
• enable shared approaches to key national issues across Welsh NHS organisations and promote shared learning
• direct the NHS P&I or make alternative arrangements to provide targeted support to areas of concern.
• work with the health board on critical enablers relating to regional planning, clinical services redesign, infrastructure (digital and buildings)

The roles and responsibilities of the health board are to:

• appoint an SRO for escalation and appropriate project leads
• ensure Board ownership and oversight with a clear governance structure, ensure that the board is appraised of the escalation plan and evidence regular progress updates to the board on progress against de-escalation criteria
• produce a level 4 plan in response to the areas of concern and commit sufficient resources to ensure that the plan deliverables are achieved
• provide regular progress reports and evidence against the escalation plan to Welsh Government

The finance intervention and focus whilst in level 4 covers the following areas: 

The health board will be required to action and:

• Demonstrate financial governance and financial control environment mechanisms that are robust, and sufficient assurance is received on their effectiveness by undertaking a review of the financial management arrangements in place against an appropriate best practice framework(s) and developing and implementing an action plan to address any gaps in approach.
• Articulate clearly the drivers of the current deficit to inform a triangulated approach to identify and deliver actions that will improve efficiency, sustainably reduce costs, and maximise the sustainable use of resources.
• Evidence clear policies and processes supporting the identification, delivery and monitoring of all savings schemes and opportunities. This should include having a clear and robust opportunities framework (and pipeline) that contains realistic opportunities to support and manage the short-term challenges being faced, as well as driving the larger-scale transformational changes that will support long-term sustainability.
• Evidence a clear roadmap and key milestones for delivery of a breakeven plan. This should include clear and realistic planning assumptions, which triangulates with the organisation’s longer-term strategic objectives around service delivery, workforce and infrastructure.
• Challenge and stress-test the health board’s plan submission for 2026 to 2027 and identifying opportunities for improvement.
• Set out and deliver an annual plan, with demonstration of a route to achieving a financially balanced plan.

The health board will be required to action and demonstrate financial governance and a control environment through:

• the financial governance framework at the health board that is robust in both design and implementation, including a self-assessment against best practice frameworks
• the financial committee structure; clearly articulated and addresses key risks
• financial reports and supplementary presentations that include the analysis and narrative explanation required to enable management and the board to discharge their duties
• financial controls at the health board that are robust in both design and implementation, including a self-assessment against model frameworks, review implementation of the Standing Financial Instructions, internal audit reviews, or other control reviews
• the finance function that has the necessary capacity and capability to support the needs of the wider organisation
• budgets are set with alignment to the plan and budget management that is effective, with budget holders held to account for delivering their financial plans
• internal monitoring and reporting that are robust (and efficient), with the appropriate level of challenge and supports around divisional performance and delivery, and to inform ongoing board oversight and decision-making
• a developed and deliverable action plan to improve the financial governance and financial control environment

The health board will be required to action and demonstrate understanding of the existing deficit and key drivers and must:

• demonstrate there is a clear understanding of the cost drivers and investment decisions responsible for the growth in deficit across the organisation, including an explicit breakdown by key service area and cost driver
• review prior year investments to assess whether the planned benefits have been delivered
• demonstrate a robust process for challenging underlying deficits reported at local divisional levels
• understand that the drivers and investment decisions responsible for the growth in workforce are well understood, are reviewed for ongoing value and are monitored through the integrated performance report
• ensure integrated performance reports clearly identify and monitor metrics against key activity cost drivers
• provide clarity on any local factors that drive the underlying deficit position that require remedial actions

As a result of the above, there are triangulated approaches to identify and deliver actions to improve efficiency and maximise the use of resources.

The health board will be required to action and demonstrate development and realisation of opportunities and must:

• have a clear process and approach across the organisation to support the identification, delivery and monitoring of all savings schemes
• develop a comprehensive opportunities framework with a constant pipeline of opportunities and establish clear roles and responsibilities for developing opportunities into saving schemes and subsequent delivery of these saving schemes
• translate national opportunities identified through the Value and Sustainability Board into local savings.
• have clear policies and processes in place to enable budget holders and managers to realise and deliver identified savings schemes
• demonstrate how the health board uses value based health care principles across the organisation through specified services and pathways

The health board will be required to action and demonstrate a clear financial plan and strategy through:

• an integrated and triangulated plan, with clear and realistic planning assumptions to deliver a breakeven position, with a clear roadmap and key milestones for delivery
• a clear engagement plan to communicate the necessity for financial improvement across the organisation

The health board will be required to action and demonstrate delivery of a plan through:

• a clear improvement in the planned financial trajectory to deliver a breakeven position, including further progress around identification and delivery of recurring opportunities

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must meet the criteria set out below:

• demonstrate that there are robust financial governance and robust financial control environment in place with risks minimised
• make substantial progress in delivering the level 4 action plan, including actions to improve the organisation’s understanding of the existing deficit and key drivers and development and realisation of opportunities
• demonstrate a clear, credible and deliverable annual plan and route to achieving financial balance

Strategy and planning 

The strategy and planning intervention and focus whilst in level 4 escalation covers the following areas:

The health board will be required to action and demonstrate delivery of milestones within the approved plan and must:

• show evidence of improved integrated planning across the organisation to develop an approvable IMTP, providing a route map towards the health board’s longer-term ambition
• deliver a credible annual plan as a stepping stone towards a full and financially balanced IMTP
• make good progress in delivering the ministerial targets, delivery expectations and enabling actions (as set out in the NHS Wales Planning Framework), accountability criteria and the level 4 requirements

The health board will be required to demonstrate how the delivery of a clinical strategy and plan is supporting:

• future planning and investment decisions
• decision making across the organisation

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must meet the criteria set out below:

• submission of a balanced and credible 3 year medium-term plan or acceptable annual plan in line with the current planning framework
• evidence a clear roadmap and implementation of the health board’s clinical services plan
• increase Welsh Government’s confidence in delivery based on an assessment against an agreed planning maturity matrix
• delivery of commitments set out within the annual plan

Urgent and emergency care 

The performance and outcomes level 4 intervention and focus for urgent and emergency care (UEC) covers the following areas: 

The health board will be required to action and demonstrate sustainable services and must:

• ensure that recovery and improvement plans are in place and that agreed priorities are being implemented, in accordance with evidence-based practice and national requirements
• improve unscheduled care performance to ensure that patients access safe, timely and effective unscheduled care services, reducing waiting times, delays and improving quality
• deliver activity in line with agreed trajectories and implement any necessary changes where performance falls below trajectory
• deliver the UEC enabling actions in the 2025 to 2028 planning guidance
• demonstrate how the health board responds and handles concerns, complaints, incidents and patient experience feedback related to UEC
• assess declared BCIs, including reasons why, actions taken, and lessons learnt
• ensure that patients are clear where they can and should access support, signposting away from emergency services

The health board will be required to action and demonstrate working with national programmes and respond to external reviews and must: 

• work with and implement the recommendations from national programmes including but not limited to Community by Design, Six Goals for Emergency Care and the National Diagnostic and Endoscopy Programmes
• support the implementation and realisation of GiRFT and the national programme reviews opportunities
• develop a prompt response to any HIW unannounced inspections, Audit Wales and Royal College recommendation, developing and completing action plans that demonstrate sustainable evidence

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must meet the criteria set out below:

• continuous reduction of ambulance handovers over an hour of at least 11% in three consecutive months and maintained for three months (based on agreed baseline)
• continuous improvement towards no-more than 7% of patients waiting over 12 hours at each individual site and across the health board
• median time from arrival at an emergency department to assessment by a clinical decision maker should not exceed 60-minutes
• continuous reduction in delayed pathways of care of 5% for three consecutive months and then maintained (based on agreed baseline)