Digital Health and Care Wales oversight and escalation framework: May 2025

Following an assessment against the NHS Wales oversight and escalation framework in February 2025, Digital Health and Care Wales (DHCW) escalation level is level 3 for performance and outcomes related to major programmes.

This is the first time that DHCW has been escalated.

Level 3 (enhanced monitoring) occurs when Welsh Government has identified serious concerns related to the NHS organisation. Monitoring will be more frequent than that carried out under routine arrangements and may also take a wider variety of forms, including regular interactions and meetings in addition to written progress updates and submission of evidence, including updated action plans and qualitative and quantitative data. The NHS organisation will need to demonstrate that it is taking a proactive response to the escalation and will need to put in place effective processes to address the issue(s) and drive improvement itself. Welsh Government will co-ordinate activity to closely monitor, challenge and review progress.

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 Executive

Whilst the organisation is in escalation:

• normal performance management arrangements will continue through the integrated quality, planning and delivery board (IQPD) and joint executive team (JET) meetings
• the JET meetings in June and October 2025 will serve as formal enhanced monitoring review points
• enhanced monitoring touchpoint meetings will be integrated with the scheduled IQPDs and will be used to examine progress made against the action log, review evidence and agree outputs for inclusion at the Welsh Government led escalation meetings

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
• act as a critical friend and sounding board on existing practices and new developments
• review and provide feedback on developed products
• undertake and share relevant analysis and deep dives of national data
• enable shared approaches to key national issues across Welsh NHS organisations and promote shared learning
• direct the NHS Executive or make alternative arrangements to provide support if required to areas of concern to help the organisation to improve their progress against programme objectives
• appointment of external digital expert to support DHCW on critical enablers relating to digital services
• introduce updated governance to the system to support the delivery of national programmes

The roles and responsibilities of Digital and Health Care Wales are to:

• appoint an SRO
• 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
• to produce an enhanced monitoring plan in response to the areas of concern and commit sufficient resources to ensure that the plan deliverables are achieved
• provide progress reports and evidence against the escalation plan to Welsh Government
• give assurance that there are formal review mechanisms in place within the organisation to monitor and deliver the required improvements

The performance intervention and focus whilst in level 3 escalation covers the delivery of major programmes. 

DHCW will be required to action and demonstrate the delivery of national programmes, and during 2025 to 2026 must agree and deliver the core milestones related to:

• national current and future target enterprise architecture development and design
• Digital Services for Patients and the Public Programme (DSPP), with a focus on delivering the NHS Wales app that supports system recovery and improved patient outcomes
• connecting care to the agreed scope and business case, once agreed
• data architecture, including the National Data Resource and Data Standards
• diagnostics programmes, specifically the Radiology Informatics System Procurement (RISP) and the Laboratory Information Network Cymru (LIMS) programmes and health board deployment
• primary care services, including the ongoing migration to Egton Medical Information Systems from In Practice Systems (Cegedim) VISION, and support to national primary care programme
• digital medicines and prescribing, including electronic prescribing system roll out and development of shared medicines record
• intensive care by undertaking an assessment on the next steps for this programme, and how it should be resourced and led
• the agreement of core milestones for Cancer Informatics Programme, the CANISC replacement

De-escalation criteria

In order for the organisation to be de-escalated, they must achieve:

• delivery of agreed milestones
• programme management, risk and planning through revised approaches and procedures for planning, performance, and risk and programme management agreed and implemented
• good progress against milestones in the action plan related to the recommendations from stakeholder survey