Arrangements for monitoring performance, quality and safety risks across our health system.
Contents
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 Cabinet Secretery for Health and Social Care 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
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.
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.
Level 3
NHS organisations to put effective processes to address issues of concern. Welsh Government will co-ordinate activity, observe, challenge and review progress.
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
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
Level 4 for finance, strategy and planning.
Level 3 for performance and outcomes related to urgent and emergency care pathways at The Grange University hospital emergency department.
Betsi Cadwaladr UHB
Level 5 (since February 2023).
Cardiff and Vale UHB
Level 3 for finance, strategy and planning.
Cwm Taf Morgannwg UHB
Level 3 for finance, strategy and planning.
Level 3 for performance and outcomes relating children and adolescent mental health (CAMHS).
Level 4 for performance and outcomes relating to urgent and emergency care, cancer and planned care.
Hywel Dda UHB
Level 4.
Powys THB
Level 4 for finance, strategy and planning.
Swansea Bay UHB
Level 3 for maternity and neonatal.
Level 4 for finance, strategy and planning.
Level 4 for performance and outcomes.
Public Health Wales NHS Trust
Level 1.
Velindre University NHS Trust
Level 1.
Welsh Ambulance Services NHS Trust
Level 1.
Digital Health and Care Wales
Level 1.
Health Education and Improvement Wales
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.