A consideration of escalation and special measures in NHS Wales

Abstract

This article examines the escalation process for NHS bodies in Wales and explores the effectiveness of this mechanism as a means of improving performance. Two case studies of health boards that have been subject to special measures are included. The central role of Welsh government in the decision-making process, the length of time a number of organisations have been in ‘escalation’ and the opaqueness of the decision-making criteria used to de-escalate health boards are highlighted. The author discusses potential issues regarding accountability within NHS Wales and whether the eventual establishment of an NHS Executive will address this. The article will also look at how the size and complexity of Welsh health boards may negatively affect their manageability and, if so, whether these matters need to be considered by NHS England as it shifts towards integrated care systems.