Betsi Cadwaladr University Health Board will come out of special measures, more than five years after initially being placed under them.
Health minister Vaughan Gething made the announcement to AMs on Tuesday, saying that the health board will now be moved to 'targeted intervention' - one step down from special measures.
He said evidence submitted by the health board showed "progress over recent years", specifically in the areas that were of most concern.
The north Wales health board was first put under the measures in June 2015 in the wake of a mental health scandal at Ysbyty Glan Clwyd in Rhyl.
It became the first health board to be put under the measures because of systemic failures across a range of areas, not just mental health.
Special measures are the highest level of escalation a health board can be put under when there are concerns they are not improving adequately.
The practical implications of this can mean an 'improvement framework' is set out and the health board or trust has to regularly provide updates on their progress. It can also mean individuals on the health board's board have powers removed or suspended.
When was the health board put into special measures?
On June 8 2015, it was agreed by the then Welsh health minister, Mark Drakeford, that Betsi Cadwaladr University Health Board should be put under special measures following "long-standing concerns about governance, leadership and other issues".
The kinds of measures the health board was initially put under focussed on improving a range of areas like maternity services at Ysbyty Glan Clwyd, governance, GP and mental health services.
The Chief Executive of Betsi Cadwaladr at the time, Trevor Purt, was also suspended. He went on to resign in 2015.
The health board had already been placed under 'targeted intervention' in 2014.
How did we get here?
The decision to place the health board into special measures came after a damning report into the Tawel Fan mental health ward at Ysbyty Glan Clwyd, which found evidence of "institutional abuse". Several staff members at the psychiatric unit were reported amid claims patients were being treated "like animals".
In 2018, another report into the Tawel Fan mental health unit found "no evidence" to suggest patients suffered from abuse or wilful neglect but did find failures of systems and governance across the care system.
This included "unacceptable" standards in adult and dementia services, where patients often did not receive the right care in the right place at the right time - which led to distress, loss of dignity, delays, compromised care and treatment.
In 2019, the health board's GP Out of Hours provision and maternity services at Ysbyty Glan Clwyd were taken out of special measures but a report by the Public Accounts Committee earlier that same year found progress in general had been "unacceptably" slow.
The report claimed that Welsh Government support had been "insufficient" and that actions "had little practical impact" on changing the health board's performance. Welsh Government argued that progress had been made in "key areas".
In May this year, the health board was forced to apologise after it was revealed that they had wrongly discharged almost 1,700 mental health patients.
Betsi Cadwaladr health board came under even more scrutiny this year for its handling of mental health services after ITV News saw a leaked copy of the Robin Holden report from 2014.
The report was commissioned after staff on the Hergest mental health unit, which is situated within Ysbyty Gwynedd in Bangor, blew the whistle over management and patient safety concerns. The full report details how staff were "very intimidated" and feared for their patients lives.
In August 2020, Jo Whitehead was appointed as the new Chief Executive of Betsi Cadwaladr health board - she is due to take up the role in January 2021.
Why is the health board being taken out of special measures now?
Today, health minister Vaughan Gething announced that Betsi Cadwaladr would be taken out of special measures.
No other health organisation in the UK has spent as long in special measures than Betsi Cadwaladr has.
Mr Gething said: "I have decided that Betsi Cadwaladr University Health Board will come out of special measures with immediate affect.
"The escalation status of the health board has now moved to targeted intervention."
He added that "a wide range of evidence and intelligence" was considered by, Welsh Government ministers, Audit Wales and Healthcare Inspectorate Wales before coming to the decision.
At a meeting between the three groups earlier this month, more evidence submitted by the health board was reviewed. Mr Gething said this "demonstrated further progress over recent years, including in the areas that had originally been designated as special measures concerns".
The "clear" recommendation to the health minister from that meeting was "that the escalation status of the health board should change".
In a statement, Mr Gething also said: "Throughout the pandemic the organisation has worked hard to play its role in caring for people affected by the virus.
"During what has been an unsettling time for public health across the world, I’m pleased to announce this positive news for North Wales and NHS Wales.
"I want to thank everyone at the health board who has contributed to improving services."
How have others reacted to the news?
Other political parties have questioned the move and whether genuine improvements had been made to warrant the de-escalation.
Welsh Conservative health spokesperson, Andrew RT Davies MS said: "Concerns over governance and delivery of services for the people of north Wales are as pertinent today as when the health board entered special measures under the stewardship of this health minister in 2015.
"I’ve heard of miraculous recoveries, but not like this, not when services have been so bad for so long."
Plaid Cymru were also surprised by the decision. Shadow Minister for Health, Rhun ap Iorwerth MS said: "After 5 and a half years of special measures, patients can be forgiven for being sceptical about what today’s announcement will actually mean in terms of improvements to services.
"Plaid Cymru believes that the board’s problems are chronic and structural, and that major changes are still required."