How we will hold NHS organisations in Wales to account.
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The NHS Wales Accountability and Support Framework provides guidance for health boards, trusts and special health authorities on how we hold them to account, and identify and respond to serious concerns in the NHS.
In line with the Framework, meetings take place at least twice a year between Welsh Government, NHS Wales Performance and Improvement (NHSWPI), Healthcare Inspectorate Wales, and Audit Wales.
This process is an evidence-sharing and advisory mechanism to identify issues. The position of each health board, NHS trust and special health authority is discussed against the foundation domain of leadership or well-led, and 4 supporting pillars laid out in the framework of:
- Quality
- Workforce
- Finance and Planning
- Delivery and Performance
Information and evidence from these meetings is considered by Welsh Government prior to making recommendations to the Cabinet Minister for Health and Care on future escalation levels.
There are currently 5 levels of escalation.
Five levels of accountability arrangements
Level 1
This level describes organisations that are broadly on plan, have effective governance arrangements, and can manage variation of care through normal Board and executive arrangements.
They provide Welsh Government with routine assurance, common reporting, and meet at bi-annual accountability reviews.
Level 2
This level is for organisations who indicate emerging risk which is unlikely to be resolved solely through normal routine arrangements, but the organisation has the ability to recover.
Organisations may be offered preventative support and increased oversight.
Level 3
Organisations in level 3 are organisations that are of significant concern against an accountability pillar or domain, or have not secured improvement through level 2 actions.
These organisations receive:
- specific NHSWPI support
- a formal specified escalation framework outlining recovery and de-escalation criteria which is monitored by Welsh Government through quarterly meetings.
Level 4
Level 4 escalation refers to organisations demonstrating serious failure or that are at risk of requiring commissioned intervention to support recovery.
These organisations receive:
- targeted NHSWPI support
- a formal specified escalation framework outlining support, recovery and de-escalation criteria which is monitored by Welsh Government with regular meetings.
Level 5
Organisations in level 5 have demonstrated very serious or complex failure where organisational capability is not enough to recover without intense external intervention.
These organisations receive:
- targeted NHSWPI support;
- a formal specified escalation framework outlining recovery and de-escalation criteria which is monitored by Welsh Government
- as a last resort, use of Ministerial powers as set out in the NHS (Wales) Act 2006
Accountability levels of NHS Wales organisations
Previous escalation status of organisations can be found in written statements.
Aneurin Bevan UHB
Level 4 for finance, strategy and planning, and performance and o9utcomes related to urgent and emergency care.
Current and previous escalation frameworks for Aneurin Bevan UHB can be viewed at:
Betsi Cadwaladr UHB
Level 5 (since February 2023).
Current and previous escalation frameworks for Betsi Cadwaladr UHB can be viewed at:
Cardiff and Vale UHB
Level 4.
Current and previous escalation frameworks for Cardiff and Vale UHB can be viewed at:
Cwm Taf Morgannwg UHB
Level 3 for performance and outcomes relating to planned care.
Level 4 for performance and outcomes relating to urgent and emergency care.
Current and previous escalation frameworks for Cwm Taf Morgannwg UHB can be viewed at:
Hywel Dda UHB
Level 3 for performance and outcomes relating to planned care.
Level 4 for finance, strategy and planning; and performance and outcomes relating to urgent and emergency care, fragile services (including ophthalmology), and Healthcare Associated Infections (HCAIs).
Current and previous escalation frameworks for Hywel Dda UHB can be viewed at:
Powys THB
Level 4 for finance, strategy and planning.
Current and previous escalation frameworks for Powys THB can be viewed at:
Swansea Bay UHB
Leve 3 for performance and outcomes relating to planned care.
Level 4 for maternity and neonatal services, finance, strategy and planning; and performance and outcomes relating to cancer, HCAIs, and urgent and emergency care.
Current and previous escalation frameworks for Swansea Bay UHB can be viewed at:
Digital Health and Care Wales
Level 4
Current and previous escalation frameworks for Digital Health and Care Wales can be viewed at:
Health Education and Improvement Wales
Level 1
Public Health Wales
Level 1
Velindre University NHS Trust
Level 1
Welsh Ambulance Services NHS Trust
Level 1