North Wales health board faces toughest oversight under new Welsh Government accountability framework from April
The Welsh Government is overhauling how it holds NHS health boards to account from April, with the north Wales health board set to face the most intensive scrutiny of any organisation in Wales under the new system.
Jeremy Miles MS, Cabinet Secretary for Health and Social Care, published a written statement today confirming that the current oversight framework will be replaced with a streamlined, risk-based approach from the start of the 2026/27 financial year.
Under the new arrangements, how often a health board meets with Welsh Government ministers will depend on its escalation level.
Organisations with a strong performance record will have fewer ministerial meetings, what Jeremy Miles described as “earned autonomy.”
Betsi Cadwaladr University Health Board, which covers Flintshire and the rest of north Wales, is the only health board in Wales still in special measures, the highest possible escalation level.
It has been at Level 5 since February 2023.
Under the new framework, the health board will sit at the opposite end of the scale from those gaining earned autonomy, facing the most frequent ministerial oversight of any NHS organisation in Wales.
In a letter published today alongside the statement, Jeremy Miles told BCUHB’s chair and chief executive that more than 5,000 north Wales patients are currently waiting over two years for treatment, with some waiting more than three years.
He described that as “an unacceptable situation” and said he expected “urgent action.”
The letter, written in December following a public accountability meeting with the health board in November, also said cancer performance at BCUHB “has historically been strong but is now the lowest in Wales and has been for most of the past year.”
On urgent and emergency care, Jeremy Miles wrote that the system “is failing hundreds of patients each week.”
Two other health boards saw their escalation levels reduced in February.
Cwm Taf Morgannwg and Hywel Dda university health boards were automatically de-escalated after meeting cancer performance requirements set out in their respective frameworks, Jeremy Miles confirmed today.
The new accountability framework will reduce the number of direct interfaces between Welsh Government and NHS organisations, with NHS Performance and Improvement taking on an operational assurance role between them.
A single shared dataset will be used for all performance reporting under the new system, replacing what the Ministerial Advisory Group on NHS Performance and Productivity had described as a framework that was “complex, data-heavy, burdensome for NHS organisations” and did not drive improvement.
Jeremy Miles said the changes would “strengthen ministerial oversight, focus on outcomes rather than processes, and support a culture of early intervention and improvement.”
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