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Written Statement: Escalation and Intervention Arrangements


Under the Joint Escalation and Intervention Arrangements, Welsh Government officials meet with the Wales Audit Office and Healthcare Inspectorate Wales twice a year to discuss the overall position of each health board and NHS trust in respect of quality, service performance and financial management. A wide range of information and intelligence is considered to identify any issues and inform the assessment.

It was agreed that the escalation status of each NHS organisation would be published.

The framework has 4 escalation levels:

  • Routine arrangements
  • Enhanced monitoring
  • Targeted intervention
  • Special measures.

The latest meeting took place in December 2019 and the tripartite group considered the position of all organisations since the previous meeting in August 2019. Following the collective discussions, the Minister has received advice from officials to retain all organisations at their current escalation levels.

In Betsi Cadwaladr University Health Board, despite improvements in some areas such as mental health, the health board still faces a challenging improvement agenda. Current performance in planned and unscheduled care, together with the forecast financial position, are of concern and remain key areas in which I expect to see meaningful improvement. There is also a concern there is no agreed clinical strategy in place and I expect further development on this front during the next quarter. A revised improvement framework has recently been published to clarify the progress the health board will need to demonstrate is being made in the outstanding special measures concerns.

With regards to Cwm Taf Morgannwg, the group noted the positive manner the health board had responded to the maternity services and governance concerns it faces in an open and transparent manner, including how it is now engaging with external review bodies. However, the seriousness of the issues and the scale of the challenge that the organisation faces in achieving sustainable change and improvement remain considerable. It was noted that steps had, and continue to be taken to enhance capacity and capability in a number of key areas and a wide range of actions were underway. This included responding to the concerns that have been raised around the culture within the organisation and the need to rebuild patient, public, staff and stakeholder confidence and trust. Ensuring rapid improvements are made in how the organisation responds to patient concerns and complaints will be an essential component of this.

With regards to Swansea Bay, to the group noted concerns around the financial position and the ability of the health board to meet its financial requirements, as well as a deteriorating performance in unscheduled care and planned care.

For Hywel Dda, noting progress over the last couple of years, the group noted the continued challenge around the financial position for the health board to meet its financial obligations, as well as challenges in out of hours provision.

For Aneurin Bevan, there was discussion around the deterioration in performance in both unscheduled care and planned care and having to see clear actions in response of this. These matters will be kept under review as part of welsh Government’s routine monitoring of the Health Board.

The table below shows the previous and current escalation status of each organisation.

OrganisationPrevious status (Aug. 2019)Current status (Dec. 2019)
Aneurin Bevan UHBRoutine arrangementsRoutine arrangements
Betsi Cadwaladr UHB Special Measures Special measures
Cardiff and Vale UHB Enhanced monitoring Routine arrangements
Cwm Taf Morgannwg UHB* Special measures for maternity, targeted intervention for quality and governance Special measures for maternity, targeted intervention for quality and governance
Health Education and Improvement Wales Routine arrangements Routine arrangements
Hywel Dda UHB Targeted intervention Targeted intervention
Powys tHB Routine arrangements Routine arrangements
Public Health Wales NHS Trust Routine arrangements Routine arrangements
Swansea Bay UHB Targeted intervention Targeted intervention
Velindre NHS Trust Routine arrangements Routine arrangements
Welsh Ambulance Services NHS Trust Routine arrangements Routine arrangements

* The previous Cwm Taf UHB was escalated to ‘enhanced monitoring’ at a meeting at the beginning of January 2019. At a meeting in April 2019, it was agreed to raise the escalation status of Cwm Taf Morgannwg to ‘Special measures’ for maternity services following the publication of the Royal College report and to ‘targeted intervention’ for governance and quality.

Following a boundary change in March 2019, Abertawe Bro Morgannwg and Cwm Taf UHBs became Swansea Bay and Cwm Taf Morgannwg UHBs.



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