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Arrangements in place for monitoring performance and quality and safety risks across our health system.

First published:
13 September 2023
Last updated:

In line with the joint escalation and intervention arrangements, meetings take place at least twice a year between:

  • Welsh Government officials
  • Audit Wales
  • Healthcare Inspectorate Wales

They discuss the position of each health board, NHS trust and special health authority in respect of: 

  • governance
  • quality
  • service performance
  • financial management
  • other issues as appropriate

Information and evidence from these meetings is considered further and Welsh Government make recommendations to the Minister for Health and Social Services on future escalation levels.

The escalation and intervention framework sets out how performance is reviewed and risk is assessed risk across the NHS.

There are currently four levels of escalation.

Four levels of governance arrangements

Routine arrangements

NHS organisations are responsible for maintaining appropriate governance arrangements. They need to make sure these are effective, provides quality and safe care. 

Enhanced monitoring

NHS organisations to put effective processes to address issues of concern. Welsh Government will co-ordinate activity, observe, challenge and review progress.

Targeted intervention

Welsh Government, other NHS or external review bodies will work with organisations where serious concerns have been identified. Support may include time limited work such as:

  • mentoring
  • advice from experienced individuals with the necessary clinical or governance skills
  • review work

Special measures

In exceptional circumstances, Welsh Government may find very serious concerns about an NHS organisation. Welsh Ministers may intervene as set out in the NHS (Wales) Act 2006. This may include suspending or removing powers and duties from individual or all members of the NHS organisation’s board. 

These formal powers are a last resort when other intervention is unlikely to succeed.

Escalation status of NHS organisations in Wales

Aneurin Bevan UHB

Enhanced monitoring for planning and finance (escalated from routine arrangements).

Betsi Cadwaladr UHB

Special measures (since February 2023).

Cardiff and Vale UHB

Enhanced monitoring for planning and finance.

Cwm Taf Morgannwg UHB 

Enhanced monitoring for planning and finance.

Enhanced monitoring for maternity and neo-natal (deescalated from targeted intervention).

Enhanced Monitoring for quality and governance, leadership and culture, trust and confidence (deescalated from targeted intervention).

Targeted Intervention for quality issues relating to performance

Hywel Dda UHB

Targeted intervention for planning and finance.

Enhanced monitoring for performance and quality.

Powys tHB

Enhanced monitoring for planning and finance (escalated from routine arrangements).

Swansea Bay UHB

Enhanced monitoring for planning and finance.

Enhanced monitoring for performance and quality.

Public Health Wales NHS Trust

Routine arrangements.

Velindre University NHS Trust 

Routine arrangements.

Welsh Ambulance Services NHS Trust

Routine arrangements.

Digital Health and Care Wales

Routine arrangements.

Health Education and Improvement Wales

Routine arrangements.

Previous escalation status of organisations can be found in written statements.

Additional information

Ministerial summits 

A series of ministerial summit meetings have been held on planned care specialties and services. For more information go to: Ministerial health and social care summits: reports 

Current guidance/framework - NHS escalation and intervention arrangements

Collection for BCU - Betsi Cadwaladr University Health Board (BCUHB) special measures 2023