Explainer

Welsh NHS: What are special measures and how does it affect your local hospital?

Special measures is a system used across the UK, where a health board, trust or NHS service needs improvement. Credit: PA Images

Wales' biggest health board has been placed into special measures for the second time following concerns about its performance and culture.

When a health board is put into special measures, it is because there are serious concerns with the way it is being managed.

It means that Welsh Government ministers can intervene with the way the health board is run in an attempt to improve matters - and it is not just health boards that can be put under the highest level of escalation.

But what are these powers and does this affect the care you may receive, should you need to go to hospital or your local GP?

  • What are special measures?

Special measures are a variety of extra actions that can be put in place to improve health boards. NHS trusts and some services can also be put into special measures under certain circumstances.

It happens when needed improvements are not being made and there are concerns about the leadership.

It is the highest level of escalation and means that management at the health board need external support.

Actions can involve placing key individuals within the health board to provide support and set milestones of improvement for the health board or trust to meet.

Special measures is a system used across the rest of the NHS in the UK, although escalation decisions are made by devolved governments.

Ysbyty Glan Clwyd, a hospital under the Betsi Cadwaladr health board, was specifically placed in targeted intervention in September 2022.

  • Who decides when special measures are introduced?

The Welsh Government, Healthcare Inspectorate Wales (HIW) and Wales AuditOffice work together to monitor any problems with, and performance of, NHS services.

They advise the Health Minister if a health board, trust or service should be placed in special measures.

A framework is used to decide when a health board, trust or service should be escalated to the next stage of monitoring.

The four levels of escalation:

- Routine arrangements (this reflects normal business)

- Enhanced monitoring

- Targeted intervention

- Special measures (the highest level of concern)

  • How does this affect my local hospital or ability to get medical treatment?

Services run as normal so day-to-day activities will not be affected by special measures status.

People should attend their arranged appointments as the health board will still be delivering services - it will just be receiving extra support to make the improvements required.

  • Who is on charge of the health board when it is in special measures?

The health board will usually continue to run services and ensuring improvements are made to the standards set out.

Maternity and neonatal services

However Welsh Government ministers do have powers to intervene. As a last resort if other measures are not resulting in improvement, they can remove an individual or all members of the management board.

They can also suspend or remove powers or duties from individuals, or put a specified person in charge of a certain area.

  • How long is a health board or trust in special measures for, when is this reviewed?

Every six months, officials meet and escalation statuses are reviewed. However a special request to review outside of this normal bi-yearly process can be made, if a serious problem has arisen.

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