Aneurin Bevan University Health Board oversight and escalation framework: August 2025

Following an assessment against the NHS Wales oversight and escalation framework in July 2025, Aneurin Bevan University Health Board escalation levels are as follows:

• level 3 for finance, strategy and planning
• level 3 for performance and outcomes related to urgent and emergency care at the Grange University Hospital

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 issues and drive improvement itself. Welsh Government will co-ordinate activity to closely monitor, challenge and review progress.

Finance, strategy and planning

In September 2023, Aneurin Bevan University Health Board was escalated to level 3 (enhanced monitoring) for finance and planning.

In January 2024, the health board was escalated from enhanced monitoring to level 4 (targeted intervention) for finance, strategy and planning.

In July 2025, the health board was de-escalated to level 3 for finance, strategy and planning.

Performance and outcomes

In January 2024, Aneurin Bevan University Health Board was escalated to level 3 (enhanced monitoring) for performance and outcomes related to urgent and emergency care at the Grange University Hospital Emergency Department.

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
• undertaken with openness, transparency, and mutual trust and respect between the health board, Welsh Government, and the NHS Wales Performance and Improvement

Whilst the health board is in escalation:

• Normal performance management arrangements will continue through the integrated quality, planning and delivery board (IQPD) and joint executive team (JET) meetings.
• Formal assessment of progress against the escalation criteria will be undertaken at the bi-annual JET meetings will be chaired by the Director General of the health, social care and early years group and Chief Executive NHS Wales.
• The monthly IQPD meetings led by Welsh Government will be utilised to ensure effective ongoing oversight against the concerns related to performance and outcomes domain. This will incorporate the monthly oversight for urgent and emergency care.

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:

• 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. 

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 Performance and Improvement or make alternative arrangements to provide targeted support to areas of concern to help the health board to improve their progress against programme objectives
• work with the health board on critical enablers relating to regional planning, clinical services redesign, infrastructure (digital and buildings)

The roles and responsibilities of the health board are to:

• appoint an SRO for all areas of escalation
• 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
• produce an escalation intervention 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 health board to monitor and deliver the required improvements

Finance

The finance intervention and focus, whilst in level 3, covers 5 areas: 

• financial governance and control environment
• understanding the existing deficit and key drivers
• development and realisation of opportunities
• clear financial plan and strategy
• delivery of the financial plan

The health board will be required to action and demonstrate financial governance and control environment through:

• financial reports, including the analysis and narrative explanation required to enable management and board to discharge their duties, for example through feedback or self-assessment approaches
• integrated performance reports that clearly identify and monitor metrics against a comprehensive selection of key workforce and activity cost drivers
• the Internal Audit work programme that continually encompasses and reports on control environment and financial governance arrangements

The health board will be required to action and demonstrate understanding the existing deficit and key drivers and must:

• demonstrate 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
• review prior year investments to assess whether the planned benefits have been delivered
• implement a robust process for challenging underlying deficits reported at local divisional levels
• understand the cost drivers and investment decisions responsible for the growth in specific areas, to include particular focus on workforce and non-pay

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 action and demonstrate development and realisation of opportunities and must:

• translate national opportunities identified through the value and sustainability board into local savings schemes
• have a clear process for the development and delivery of strategic opportunities to support the health boards sustainability

The health board will be required to action and demonstrate a clear financial plan and strategy through:

• an integrated and triangulated 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

The health board will be required to action the delivery of the financial plan and must:

• deliver the planned breakeven position for 2025 to 2026, including further progress around identification and delivery of recurring opportunities to support a balanced 3 year plan

De-escalation criteria

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

• sustain improvement in minimising the underlying deficit, controlling identified key cost drivers and realising savings
• develop, approve and deliver a deliverable and balanced 3 year medium-term plan
• delivery of financial balance

Strategy and planning

The strategy and planning intervention and focus whilst in level 3 escalation covers the following areas.

The health board will be required to action and demonstrate delivery of milestones within the approved plan and must:

• deliver a credible and financially balanced IMTP
• make good progress in delivering the ministerial targets, enabling actions, accountability criteria and the enhanced monitoring requirements

The health board will be required to demonstrate how the delivery of a clinical strategy and must: 

• demonstrate how plan is driving decision making across the organisation

De-escalation criteria 

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

• deliver the milestones and actions within the 3 year medium-term plan
• evidence a clear roadmap and implementation of the health board’s clinical services plan
• increase Welsh Government’s confidence in delivery based on an assessment against an agreed planning maturity matrix

Urgent and emergency care at the Grange University Hospital

The performance and outcomes level 3 intervention and focus for urgent and emergency care (UEC) at the Grange University Hospital covers the following areas.

The health board will be required to action and demonstrate sustainable services and must:

• 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
• ensure patients can access safe, timely and effective unscheduled care services
• deliver activity in line with agreed trajectories and implement any necessary changes, where performance falls below trajectory
• demonstrate how the health board responds and handles concerns, complaints, incidents and patient experience feedback related to UEC (assessment of declared BCIs, including reasons why, actions taken, and lessons learnt)
• deliver the UEC enabling actions in the 2025 to 2028 planning guidance
• ensure that patients are clear where they can and should access support, signposting away from emergency services

The health board will be required to action and demonstrate working with national programmes and respond to external reviews and must:

• work with and implement the recommendations from national programmes including, but not limited to, the:
  • strategic programme of primary care
  • 6 goals for emergency care
  • national diagnostic and endoscopy programmes
• support the implementation and realisation of the GIRFT and the national programme reviews opportunities
• develop a prompt response to any HIW unannounced inspections, Audit Wales, and Royal College recommendation, and developing and completing action plans that demonstrate sustainable evidence

De-escalation criteria

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

• a 3 month continuous reduction of at least 15% in each month (from the November 2023 baseline of 859) for ambulance handovers over an hour
• continuous monthly improvement towards achieving no more than 5% of patients waiting over 12 hours
• a median time from arrival at an emergency department to assessment by a clinical decision maker should not exceed 60 minutes and maintained for 3 months

The enabling metrics for de-escalation are:

• a 3 month continuous reduction of at least 5% in each month (from the November 2023 baseline) in the number of people admitted as an emergency who remain in hospital over 21 days since admission
• a 3 month continuous reduction of at least 5% in each month in pathways of care assessments issues (from the November 2023 baseline)