Wales' biggest health board has been placed into special measures following "serious concerns about performance, leadership and culture", the health minister has announced.
Betsi Cadwaladr University Health Board was placed into special measures following a series of problems in 2015 - and was taken out in 2020.
The whole board has been removed of their positions.
Health Minister Eluned Morgan said: "I have serious concerns about the performance of the health board and I have not seen the improvement in services I expect for the people of north Wales."
The health board is responsible for the delivery of health care services to more than 700,000 people across the six counties of north Wales - Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham.
What are special measures?
Special measures refer to a range of actions which can be taken to improve health boards or trusts and specific NHS services in exceptional circumstances.
It is the highest level of escalation and happens when a health board or trust is not making the improvements expected and there are concerns that the leadership and management require external support to respond to the serious concerns identified.
The Welsh Government then has the power to suspend or remove duties from individuals of the board which are described as a "last resort" and will normally only be used if other intervention is unlikely to succeed.
Ms Morgan said the former leader of Gwynedd Council Dyfed Edwards and the deputy chair of the Welsh Revenue Authority has been appointed as the new Chair of the board to ensure "stability" - adding her will "focus on renewing the leadership and culture of the Health Board which will support its workforce to provide safe and effective services for the people of north Wales."
Dyfed will be supported by Gareth Williams, Karen Balmer and Rhian Watcyn Jones as interim independent members of the Board.
Former chief executive Jo Whitehead retired from her position at the end of last year and the Welsh Government said it will recruit for the post immediately.
The health board will also be supported by an intervention and support team.
Eluned Morgan added, "I have informed the Board that I am putting the organisation back into Special Measures with immediate effect.
"This significant decision is made in line with the escalation framework. It reflects serious concerns about the performance of the organisation, about its governance, and issues with leadership and culture that are holding back progress.
“I recognise that the health board has had significant challenges for a number of years and has worked hard to overcome these challenges. But now is the time for new leadership to deliver the improvements that are needed.”
Following calls by opposition parties for Eluned Morgan MS to "consider" her position, she told ITV Cymru Wales that she doesn't intend to leave her role.
Welsh Conservative Shadow Minister for north Wales, Darren Millar MS said problems at the health board had gone on for so long, it was no surprise Betsi Cadwaldr UHB was being put into special measures.
He added: “The NHS in North Wales needs an executive team that is focused on delivering improvements in patient care and preventing people coming to harm, not one that is rowing with itself or afraid of scrutiny.
“The Welsh Government must urgently intervene to ensure a total clear out of this dysfunctional executive team, without the eyewatering payoffs we’ve seen in the past, and support the chair of the Health Board to appoint a new and capable team as soon as possible.”
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Responding to the news, Plaid Cymru spokesperson for health and care, Rhun ap Iorwerth MS, said the health board's leaders were being made "scapegoats".
He added: “Rather than pointing the finger of blame at the Board, Welsh Government should be looking closer to home. This is as much a failure of ministerial leadership as it is leadership within Betsi Cadwaladr UHB. This all happened on Labour’s watch.
“The people in the north of Wales have witnessed damning report after damning report about their health service. They’re the ones that have been suffering under this dysfunction, incompetence and chaotic mess at hands of Labour Welsh Government.
“The patients and staff of Betsi Cadwaladr deserve better from their government. The least they deserve is an apology, but what we all need is the government to step up and take responsibility for this mess. The question is what will it take for the Health Minister consider her own position in the matter?”
Meanwhile the Liberal Democrats described the leadership of Betsi Cadwaladr UHB as “dysfunctional”, and added that it needed "a completely fresh start".