Troubled Betsi Cadwaladr University Health Board (BCUHB) will remain at level 5, the highest level of special measures.

Despite some improvements “significant challenges remain” for BCUHB.

Wales’ largest health board has “by far the largest proportion, and the longest waits, in Wales,” a health report states.

The board was placed back under the control of the Welsh Government in February 2023.

Prior to that, it was under the highest level of Welsh Government special measures from the summer of 2015 to November 2020.

This followed concerns about board effectiveness, organisational culture, service quality and reconfiguration, governance, patient safety, operational delivery, leadership and financial management.

The health board has more than 19,000 staff and serves more than 700,000 patients in hospitals across Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham, and manages a budget of £1.87 billion

It coordinates the work of 96 GP practices, and NHS services provided by 78 dental and orthodontic practices, 70 optometry practices and opticians and 145 pharmacies in North Wales

Escalation levels are considered at least twice a year.  Measures are imposed if a board or trust fails to meet expected standards of care and needs external support to improve.

A letter to the board’s chief executive, Carol Shillabeer, from NHS Wales CEO Judith Paget CBE on 15 July, confirmed the board would remain under WG oversight.

“I am writing to you to confirm that following a recent assessment, the escalation status of your organisation will remain unchanged at level 5 (special measures),” it states.

“We will continue to hold quarterly special measures assurance board meetings to monitor progress against the agreed special measures framework and de-escalation criteria.”

Ms Shillabeer, in a chief executive report for July 2025, noted “the Welsh Government report indicates there has been steady and measurable improvement made across key areas including leadership, governance, clinical quality, and financial management over the past two years”.

However Ms Shillabeer, in her report, acknowledged “significant challenges remain – especially in planned and urgent and emergency care, which will require additional focus during the coming months.

“The priority is to improve operational grip and control, agree and implement a new operating model, improve performance and build the necessary foundations for sustainable, system wide improvement.”

Welsh Government noted that the board had “made many changes” over the last two years, she added.

“Year one had seen improvements in corporate governance, financial governance and performance, and board leadership, while year two has seen a focus on quality and safety, with the board responding to many legacy issues in an open and transparent manner.”

“This year, the focus is on reducing the number of long waits and the overall size of the waiting list – bringing it back to pre-pandemic levels – and tackling outpatient appointments-in the most challenged specialities, as well as taking action to improve waiting times for urgent and emergency care services.

“This is a priority for the health board as it has by far the largest proportion, and the longest waits in Wales,” Ms Shillabeer said.