Betsi Cadwaladr University Health Board oversight and escalation framework: September 2025

On 27 February 2023, the escalation level of Betsi Cadwaladr University Health Board (BCUHB) was raised to level 5 (special measures). This was in response to serious and outstanding concerns about board effectiveness, organisational culture, service quality and reconfiguration, governance, patient safety, operational delivery, leadership and financial management.

Level 5 (special measures) is the 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.  It consists of a set of interventions designed to remedy the problems within a reasonable timeframe.  Support will always be designed and delivered within the relevant organisational context and specific support needs will be reviewed through regular oversight meetings and additional enhanced oversight arrangements.

Welsh Government will take and coordinate action and direct intervention to support Betsi Cadwaladr University Health Board to strengthen its capacity and capability to drive improvements. 

December 2013

The health board was placed in enhanced monitoring due to concerns about the quality and safety of mental health services and wider concerns around finance, performance against targets, and maternity and GP out of hours services.

November 2014

The health board was escalated from enhanced monitoring to targeted intervention. This was due to concerns relating to significant changes in the financial plan for 2014 to 2015 and concerns about the ability of the organisation to deliver a revised plan, significant concerns around the delivery, safety and quality of the mental health services, management and control of capital schemes, capital planning and capital cash control. In addition, concerns were raised about the performance of the organisation against Welsh Government service performance targets.

June 2015

The health board was escalated from targeted intervention to special measures. There were 5 key areas for improvement: 

• governance
• leadership and oversight
• mental health services
• maternity services
• primary care (especially GP out of hours)
• public engagement

February 2018

Maternity services were de-escalated as a specific special measures concern.

February 2019

GP out of hours services are de-escalated as a specific special measures concern.

November 2020

The health board was de-escalated from special measures to targeted intervention.

February 2023

The health board was placed in special measures (level 5).

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 five levels of escalation and the domains against which each health body will be assessed.

During the escalations, 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
• undertaken with openness, transparency, and mutual trust and respect between the health board, Welsh Government, and the NHS Wales Performance and Improvement (NHSP&I)

Whilst the health board is in escalation:

• normal performance management arrangements will continue through the Integrated Quality, Planning and Delivery (IQPD) meetings and Joint Executive Team (JET) meetings, supplemented by special measures touchpoints
• quarterly special measures meetings will be chaired by the Director General of the Health, Social Care and Early Years Group and Chief Executive NHS Wales, combined with JET meetings where possible
• the chair of the health board will have a regular review meeting with the Cabinet Secretary for Health and Social Care
• regular meetings will take place to ensure progress is made for services of concern
• finance, strategy and planning special measures touchpoint meetings will be agreed with NHSP&I to examine progress against the action log, review evidence and agree outputs for Welsh Government-led escalation meetings
• the Cabinet Secretary for Health and Social Care will publish a regular progress report

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:

• the 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. 

For organisations in special measures, Welsh Government will consider a full de-escalation to level 4 for the organisation when it is satisfied that reasonable progress is being made across all the domains. Alternatively, a partial de-escalation for one or more domains to level 4 may be considered where there is reasonable progress in the domains under review.

The roles and responsibilities of the Welsh Government are to:

• appoint senior support for various aspects of the intervention and a lead SRO
• support a formal structure for reviewing and reporting progress
• signpost relevant best practice, guidance and frameworks
• act as a critical friend and sounding board on existing practices and new developments
• review and provide feedback on developed products
• provide additional analytical capacity to the health board to develop, undertake and share relevant analysis and deep dives of local and national data
• direct NHSP&I to provide targeted support to areas of concern to help the health board to improve its progress against programme objectives including leading on two supportive and integrated assessments to cover operational improvements and quality management and governance
• work with the health board on critical enablers relating to regional planning, clinical services redesign, and infrastructure (digital and buildings)
• enable shared approaches to key national issues across Welsh organisations and promote shared learning

The roles and responsibilities of the health board are to:

• appoint an SRO(s) for the overall escalation and each domain if considered necessary and appropriate project leads
• ensure there is a clear framework in place that provides the board with timely evidence and updates on progress toward de-escalation. The framework should also allow the board to take an appropriate level of ownership and oversight of this area
• agree the special measures plan(s) and commit sufficient resources to ensure deliverables are achieved.
• provide assurance to Welsh Government through regular progress reports
• strengthen the formal review mechanisms to support urgency in delivering confidence and improvement to the overall position

Finance

The finance intervention and focus whilst in level 5 covers the following areas.

The health board will be required to take action to strengthen its financial governance and control environment and demonstrate:

• the financial governance framework at the health board is robust in both design and implementation, including a self-assessment against best practice frameworks
• the financial committee structure is clearly articulated and addresses key risks
• financial reports and supplementary presentations include the analysis and narrative explanation required to enable management and board to discharge their duties
• financial controls at the health board are robust in both design and implementation, including a maturity assessment of financial governance arrangements and ensure adequate controls are in place to ensure the success of the changes implemented through the special measures process. Considering if further independent review is required
• all agreed actions and findings from the review of procurement and contract management are implemented
• the finance function has the necessary capacity and capability to support the needs of the wider organisation
• budget holders and managers are held to account for delivering their financial plans and comply with clear schemes of delegation and accountability
• that as a result of the above, the health board continue to develop the scope of the action plan to improve the financial governance and financial control environment

The health board will be required to demonstrate an understanding of the existing deficit and key drivers, and ensure:

• 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
• it has reviewed prior year investments to assess whether the planned benefits have been delivered
• it has a robust process for challenging underlying deficits reported at local divisional levels
• the drivers and investment decisions responsible for the growth in workforce are well understood; are reviewed for ongoing value; and are monitored
• the investment in planned care alongside core funding use, is well understood and triangulated across service provision, activity delivery and workforce
• that 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 focus on the development and realisation of opportunities and ensure:

• it has a clear process and approach across the organisation to support the identification, delivery and monitoring of all savings schemes
• development of 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
• it is translating national opportunities identified through the Value and Sustainability Board into local savings
• it has clear policies and processes in place to enable budget holders and managers to realise and deliver identified savings schemes
• value-based health care principles have been embedded across the organisation

The health board will be required to develop and deliver a clear financial plan and strategy and demonstrate:

• an integrated and triangulated annual plan, with clear and realistic planning assumptions to deliver a (recurrent) breakeven position over the medium-term, with a clear roadmap and key milestones for delivery
• a clear engagement plan to communicate the necessity for financial improvement across the organisation
• a clear approach to implementing a more strategic approach to the allocation and utilisation of resources to deliver improved outcomes for the population over the medium term through a value-based healthcare approach

Aligned to delivery of its financial plan, the health board will be required to demonstrate: 

• it is delivering clear improvement in delivery of the planned financial trajectory (for example, significant progress towards delivery of the Target Control Total), 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, it must meet the criteria set out below:

• the health board must demonstrate improvement and evidence of robust financial governance and a robust financial control environment
• substantial progress to be made in delivering the special measures action plan including actions to improve the organisation’s understanding of the existing deficit and key drivers and development and realisation of opportunities
• annual plan developed with board approval demonstrating a substantial financial improvement trajectory to deliver as a minimum the target control total

Strategy and planning

The strategy and planning intervention and focus whilst in level 5 covers the following areas. 

The health board will be required to demonstrate delivery of improved integrated planning through:

• implementing the recommendations in the independent assessment of integrated planning approach and processes
• undertaking an annual self-assessment against the integrated planning matrix and provide assessment documentation, with a view to achieving a minimum of level 2 on the matrix
• quarterly reporting to board against progress in delivering the annual plan

The health board will be required to submit and deliver an approvable plan and demonstrate:

• delivery of a credible annual plan as a stepping stone towards a full and financially balanced IMTP
• progress in delivering the ministerial targets, accountability criteria and the level 5 (special measures) requirements

The health board will be required to demonstrate progress in:

• developing the organisation’s clinical services strategy within an agreed timeline
• demonstrating how the clinical services strategy is driving decision-making across the organisation

The health board will be required to demonstrate progress in regional service delivery and:

• review the learning from the orthopaedic intervention from Welsh Government and NHSP&I, demonstrate effective partnership working to deliver a regional orthopaedic model that benefits the populations of each respective organisation
• deliver on the Llandudno orthopaedic business case
• scope and develop regional opportunities for ophthalmology services across the region
• scope and develop regional opportunities for urology services across the region
• agree the long-term sustainable vision for vascular services

De-escalation criteria

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

• submission of an approvable annual plan in line with the NHS Wales planning framework
• evidence of improving integrated planning across the organisation which supports the development of a coherent and deliverable annual plan
• board clarity on the strategic vision for the organisation
• evidence of a clear roadmap and implementation of the health board’s multi-professional clinical services plan
• deliver commitments set out within the annual plan, particularly in relation to the ministerial priorities.
• sustained improvements in delivery of the plan throughout the year
• achieve level 2 across all aspects of the health board self-assessment against the planning maturity matrix

The performance and outcomes intervention and focus whilst in level 5 covers the following areas.

The health board will be required to establish a baseline and agree improvement plans for service delivery and take action to:

• undertake a current situation report to highlight the baseline and opportunities. This will be repeated at agreed milestones to provide assurance to Welsh Government and the board that progress is being made or where further interventions are required.
• review, for assurance purposes, progress the health board has made against previous external and internal reviews and implementation plans with a performance lens.
• consolidate previous performance reviews and improvement plans into one core document, reducing the risk of duplication, with the intention of adding value to a clear way forward.
• 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.

The health board will be required to implement improvement plans and demonstrate:

• improved urgent and emergency care performance to ensure that patients access safe, timely and clinically effective urgent and emergency care services, reducing waiting times, delays and improving quality
• improved access to planned care with reduced waiting times in line with national requirements
• improved the timeliness of access to cancer services and demonstrate improved compliance with the suspected cancer pathway, prioritising improvement in the most at-risk tumour sites
• reduced the cancer backlog to agreed levels and site-specific plans are in place for tumour sites of concern
• implementation of an agreed outpatients transformation plan that supports a move towards the requirements of the planned care programme
• delivery of activity in line with agreed trajectories and implement any necessary changes where performance falls below trajectory
• how the health board responds and handles concerns, complaints, incidents and patient experience feedback related to UEC.

The health board will be required to work with national programmes and respond to external reviews and take action to:

• work with and implement the recommendations from national programmes including but not limited to Strategic Programme for Primary Care, Six Goals for Urgent and Emergency Care, Planned Care Improvement and the National Diagnostic and Endoscopy Programmes
• support the implementation and realisation of the GIRFT opportunities as highlighted through the programme reviews
• develop and implement an integrated approach to theatre scheduling and management, working with the GIRFT programme to develop and embed the agreed theatre reporting metrics on a bi-weekly basis
• implement agreed plans in response to the GIRFT speciality reviews and recommendations
• ensure a prompt response to any HIW unannounced inspections, Audit Wales and Royal College recommendations, developing and completing action plans that demonstrate sustainable evidence

The health board will be required to demonstrate improved communications and engagement and take action to:

• ensure there are plans in place for all long-waiting patients with a clear communication strategy and appropriate support to keep them well
• implement the requirements of the three Ps policy for planned care
• ensure that patients are clear where they can and should access support, signposting away from emergency services
• ensure that the benefits of new pathways such as straight to test, primary care management, self-management and see on symptoms pathways are communicated effectively

De-escalation criteria

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

• 55% performance against the suspected cancer pathway (SCP) target maintained for four consecutive months
• 98% of open outpatient pathways waiting less than 52 weeks and maintained for four consecutive months
• continuous improvement to ensure that 97% of open pathways are waiting less than 104 weeks and maintained or improved for four consecutive months
• continuous reduction in the number of patients delayed by 100% for their follow up appointment.
• 75% of patients waiting for a diagnostic test to be waiting less than 8 weeks maintained for four consecutive months
• 80% of patients waiting for therapies to be waiting less than 14 weeks and maintained for four consecutive months
• continuous reduction of ambulance handovers over one hour of at least 17% maintained over four consecutive months
• median time from arrival at an emergency department to assessment by a senior clinical decision maker should not exceed 60 minutes
• continuous monthly improvement towards achieving no more than 10% of patients waiting over 12 hours at each individual site and across the health board
• continuous reduction of 5% in pathways of care delays for 3 consecutive months and then maintained for four consecutive months
• 65% of LPMHSS adult mental health assessments undertaken within 28 days from the date of receipt of referral for four consecutive months (Part 1a)
• 65% of adult therapeutic interventions started within 28 days following an assessment by LPMHSS for four consecutive months (Part 1b)
• 65% of adult health board residents in receipt of secondary mental health services who have a valid care and treatment plan for four consecutive months (Part 2)
• 75% of LPMHSS mental health assessments for people aged under 18 years undertaken within 28 days from the date of receipt of referral for 4 months (Part 1a)
• 60% of therapeutic interventions for people aged under 18 years started within 28 days following an assessment by LPMHSS for four consecutive months (Part 1b)
• 75% of health board residents aged under 18 years in receipt of secondary mental health services who have a valid care and treatment plan for four consecutive months (Part 2)

The above metrics, and monthly reports will form the basis of an assessment by the Welsh Government and NHSP&I as to the confidence levels of the health board’s ability to maintain and sustain improvements.

Clinical services

The clinical services level 5 (special measures) focus will alter over time as it is likely that other services may have areas of concern during the timeframe of the level 5 (special measures) escalation. The initial focus will cover the following areas of concern:

• vascular
• dermatology
• plastics
• urology
• orthodontics
• orthopaedics
• ophthalmology
• oncology
• mental health

For each service, there will be a summary document setting out the issues of concern, expectations and de-escalation criteria. 

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must:

• evidence that the health board has the appropriate mechanism to understand the drivers behind a fragile service through the triangulation of key data points, including staffing levels, staff and patient feedback, concerns, incidents, stakeholder feedback (HIW, AW, HM Coroners, Royal Colleges, HTA, MHRA, Llais), mortality reviews, duty of quality and candour, infection prevention and control, performance, clinical and medical leadership
• meet for each clinical service evidence:
  • whether staff have all the information they need to deliver safe care and treatment to people?
  • how are people's care and treatment outcomes monitored and how do they compare with other similar services?
  • how does the service make sure that staff have the skills, knowledge and experience to deliver effective care, support and treatment?
  • how well do staff, teams and services work together within and across organisations to deliver effective care and treatment?
  • how consent to care and treatment is sought in line with legislation and guidance?
  • clear and effective processes for managing risks, issues and performance
  • strong clinical leadership, with an effective integrated improvement plan, project management structure and effective transformation support
  • effective response to recommendations from the Royal Colleges, HIW and other reviews are discharged and either verified or delivered or scheduled for delivery within the health board's longer-term improvement plan
• evidence that the board is sighted on clinical services and has a robust response to these issues that is being addressed by the health board

Governance

The governance intervention and focus whilst in level 5 covers the following areas:

• compliance with legislative requirements
• responding to and working with regulators effectively
• effective and timely response to internal audit reports and where necessary, implementation of internal audit recommendations
• effective and timely response to Audit Wales reports including the annual structured assessment and the review of board effectiveness, and where necessary implementation of external audit recommendations.
• effective and timely response to HIW and Royal College reports
• improving and strengthening the governance and assurance framework and decision-making processes across the health board. Ensuring that policies, procedures and other written control documents meet statutory requirements and reflect good practice
• clarity of roles and remit of the committees, the Executive and the board with clear escalation and reporting processes in place
• implementation of a Board Development Framework that seeks to address learning and development gaps and needs to improve the board’s overall effectiveness

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must demonstrate:

• a vision, credible strategy and supporting plans to deliver organisational priorities which are underpinned by a culture of quality, sustainable care
• governance and assurance systems are in place with performance (quality, resource, activity and outcomes) issues escalated appropriately through clear structures and processes with effective board oversight and a clear performance and delivery framework that drives improvement
• effective oversight and scrutiny being consistently provided by the board or the appropriate committee with clear evidence, recommendations, risks and opportunities outlined in committee and board papers
• an effective risk management framework for identifying, recording and managing risks across the organisation. The board and the relevant committee is sighted on the organisation’s strategic risks and areas of concern on a regular basis
• processes ensure the board and the relevant committees are provided with regular reports on performance to maintain an appropriate level of oversight and so they can scrutinise effectively
• regular self-assessment against the agreed governance framework to identify risks and opportunities and ensure continuous improvement

Leadership, capability and culture

The leadership, capability and culture intervention and focus whilst in level 5 covers the following areas.

The health board will be required to stabilise its workforce and structure and take action to:

• review the scope and breadth of responsibilities, review the effectiveness of the structure to deliver high quality, safe care and experience for patients and their families and carers
• review key medical, nursing and allied health professional gaps and capacity for all clinical groups making recommendations for the future
• focus on strategic workforce planning and maximising the skills of its current staff
• develop and implement an effective approach to recruitment and retention to help ensure a high quality sustainable and flexible workforce
• ensure all parts of the organisation are clear on accountability and expectations at all levels to ensure successful delivery. Empowering effective decision-making and a constant focus on performance improvement
• support the development of a policy for job planning for consultants, SAS doctors and where appropriate for other senior clinicians

The health board will be required to demonstrate effective leadership and development and take action to:

• ensure the culture and tone set by the organisation’s leaders is inclusive, open and transparent
• ensure ongoing development of leadership and management skills at all levels and professions to strengthen scrutiny and assurance and management maturity
• ensure clinical leadership is visible and effective, there is leadership development support in place, and the consultant body as a whole is actively engaged in driving forward service improvement
• complete a review of multi-professional clinical leadership at all levels, including capacity and capability
• assess multi-professional working arrangements
• support more junior staff to take on leadership roles
• identify change champions
• strengthen local leadership models

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must demonstrate:

• succession and development plan are in place to ensure adequate capacity and capability in all areas of the organisation
• a clear organisational structure led by an effective and complete executive team with the leadership capacity and capability to deliver high quality, sustainable care
• effective leadership programme is in place to support ongoing development of leadership and management skills at all levels and professions to strengthen management maturity
• continued embedding of a values and behaviours framework throughout the organisation.
• mechanisms are in place to ensure lessons learned are recorded, communicated and used to drive improvements
• improved staff engagement in NHS Wales surveys
• plans are in place and being implemented to reduce the number of interim and agency staff
• a culture of listening, learning, and improving is embedded throughout the organisation based on early and rapid triangulation and resolution of issues from a variety of sources, including patient, user and staff feedback

The quality of care intervention and focus whilst in level 5 covers the following areas.

The health board will be required to demonstrate improved clinical governance and take action to:

• review current systems and procedures to ensure high quality care, consistent with the Duty of Quality guidance
• review data surrounding incidents, complaints, Datix, never events to establish any patterns and investigate the extent to which learning is taking place across the organisation
• undertake an overall review and assessment of clinical governance
• assess clinical staff capability and overall wellbeing
• review the quality management system linking quality control, assurance, planning and improvement, to include the management of complaints, incidents, claims, safeguarding and other related activities in line with agreed guidelines
• review how patient experience and staff feedback is being used to support quality management.
• review safeguarding arrangements
• ensure there are standard operating procedures for undertaking and responding to:
  • clinical risk assessment
  • mortality and morbidity reviews
  • incident reporting, investigations and learning
  • coroner’s requests and inquests
  • capability and capacity issues
  • record keeping
  • understanding consent, as well as the fundamentals of care practice 

The health board will be required to demonstrate improved management of complaints and healthcare associated infections (HCAIs) and take action to:

• undertake oversight of the PTR process including PTR compliance, inquests and claims management, complaints and serious incidents and external investigation processes
• implement a recovery plan to ensure complaints are responded to in line with Welsh Government targets
• stabilise the increased trajectory of cases of HCAI and demonstrate evidence of continuous improvement accompanied by a strong QI approach and plan that has oversight and monitoring by Quality Safety and Experience Committee and Board

The health board will be required to demonstrate improved planning and service management and take action to:

• reassess the clinical strategy and support the immediate development of a clinical plan to lead future planning and investment decisions
• review the models for agreed services including clinical leadership, capability, regional and service configuration options
• assess patient risk within the ophthalmology pathway, assess whether the clinical risk is being well managed and options for an improved clinical model
• review and strengthen commissioning arrangements including the development of standard operating procedures for external providers to ensure continuity of care for patients to agreed standards
• review the clinical approach for regional delivery models

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, they must demonstrate:

• an integrated and effective quality management system operating throughout the organisation.
• stabilisation of the increased trajectory of cases of HCAI and evidence of continuous improvement accompanied by a strong QI approach and plan that has oversight and monitoring by Quality, Safety and Experience Committee and Board
• the health board to have a clear improvement plan based on a root cause analysis to address the issue of hospital onset HCAIs, including:
  • C-Diff: reduce the number of hospital onset infections by 15% and maintain for 4 months (from a baseline of the average number of cases in quarter 3 of 13 cases to no more than 11 per month)
  • E-coli: reduce the number of hospital onset infections by 15% and maintain for 4 months (from a baseline of the average number of cases in quarter 3 of 10 cases to no more than 8 per month)
• 68% of complaints that had final reply (Reg 24)/interim reply (Reg 26) to be closed within less than 30 working days of concern received maintained for 3 months
• effective response from the health board to external reports and reviews including those from Audit Wales, Public Services Ombudsman, Royal Colleges and HIW resulting in sustainable improvements
• demonstrate how service user and staff experience and involvement is being used to improve quality processes and inform service development across the organisation
• demonstrate the progress made against implementing the requirements of the Duty of Candour and Duty of Quality including the embedding of the Care and Quality Standards throughout the organisation from board to service area delivery
• oversight of safeguarding arrangements to ensure the board has sufficient, meaningful assurance that the organisation is delivering against its safeguarding statutory responsibilities
• use of national clinical audit and outcome review programme and Value in Health dashboards to support quality improvement and address unwarranted variation in care (including the use of patient and staff feedback to influence service design)

Health boards are responsible for the health of the population within their geographical area. They are responsible for planning, developing and securing the delivery of primary, community, in-hospital care (hospital) services and specialised services for their areas. These services include dentistry, optometry, pharmacy and mental health services.

They are also responsible for: 

• improving physical and mental health outcomes
• promoting wellbeing
• reducing health inequalities across their population
• commissioning services from other organisations to meet the needs of their residents

The population health and prevention intervention and focus whilst in level 5 will require the health board to:

• implement a robust plan for primary care transformation making full use of community opportunities, urgent primary care centres
• develop the health board approach to GMS managed practices
• have robust plans in place to support fragile GMS practices and contingency plans for the disproportionately high number of single-handed practices
• re-procure and make contract awards for terminated GDS and PDS dental contracts.
• establish the community dental service facility at the Bangor Dental Academy
• develop a clear plan for the commissioning of tier 2 dental services across North Wales

De-escalation criteria

In order for the health board to be de-escalated to the next level of intervention, it must demonstrate:

• demonstrate that primary and community care is supported by strong clinical leadership, at board and Executive level, an effective integrated improvement plan, project management structure and effective transformation support
• evidence of improved activity within community opportunities, urgent primary care centres.
• a clear strategy and plans for GMS managed practices fragile GMS practices and community dental provision
• all GDS and PDS dental contracts are in place with a clear plan for the commissioning of tier 2 dental services across North Wales