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Arrangements for monitoring performance, 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
  • leadership, capability and culture
  • performance and outcomes
  • finance, strategy and planning
  • quality of care
  • fragile services
  • 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 oversight and escalation framework sets out how performance is reviewed and risk is assessed across the NHS.

There are currently five levels of escalation.

Five levels of governance arrangements

Routine arrangements (level 1)

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

Area of concern (level 2)

Welsh Government will meet with the NHS organisation to explore the nature and extent of the concern. The NHS organisation will be expected to respond to these concerns.

Enhanced monitoring (level 3)

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

Targeted intervention (level 4)

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 (level 5)

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 providing targeted support, 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

Targeted intervention (level 4) for planning and finance.

Enhanced monitoring (level 3) for performance and outcomes related to urgent and emergency care at The Grange hospital.

Betsi Cadwaladr UHB

Special measures (level 5) (since February 2023).

Cardiff and Vale UHB

Enhanced monitoring (level 3) for planning and finance.

Cwm Taf Morgannwg UHB

Enhanced monitoring (level 3) for planning and finance.

Enhanced monitoring (level 3) for maternity and neo-natal (de-escalated from targeted intervention).

Enhanced monitoring (level 3) for quality and governance, leadership and culture, trust, and confidence (de-escalated from targeted intervention).

Targeted intervention (level 4) for quality issues relating to performance.

Hywel Dda UHB

Targeted intervention (level 4).

Powys THB

Enhanced monitoring (level 3) for planning and finance.

Swansea Bay UHB

Enhanced monitoring (level 3) for maternity and neonatal.

Enhanced monitoring (level 3) for planning and finance.

Targeted intervention (level 4) for performance and outcomes.

Public Health Wales NHS Trust

Routine arrangements (level 1).

Velindre University NHS Trust

Routine arrangements (level 1).

Welsh Ambulance Services NHS Trust

Routine arrangements (level 1).

Digital Health and Care Wales

Routine arrangements (level 1).

Health Education and Improvement Wales

Routine arrangements (level 1).

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

Additional information

Ministerial summits

A series of ministerial health and social care summit meetings have been held on planned care specialties and services.

Oversight and escalation framework

The revised oversight and escalation framework provides guidance for health boards, trusts and special health authorities on how we identify and respond to serious concerns in the NHS.

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