The Welsh Government has been accused of not "accurately representing the facts" in the Senedd over its decision to take Wales' biggest health board out of special measures just over two years before putting it back into special measures.
Plaid Cymru has published a letter it has received from the public services watchdog, the Auditor General.
In the letter the Auditor General, Adrian Crompton, insisted that he did not advise the then health minister to "de-escalate" the special measures.
Plaid Cymru says that the response shows that Senedd members were given misleading statements by ministers.
The Welsh Government denies the claims, saying in a statement: "The First Minister was clear to the Senedd that decisions around the escalation status of the health board were taken by Ministers alone, on the basis of advice provided by Welsh Government officials.
"This advice was directly informed by an established process including Audit Wales and Healthcare Inspectorate Wales."
Betsi Cadwaladr University Health Board was first placed into special measures in June 2015 in the wake of a mental health scandal at one of its hospitals.
It became the first health board to be put under the measures because of systemic failures across a range of areas.
More than five years later in November 2020, the-then health minister Vaughan Gething announced it would be taken out in what was described as a "very positive step forward" for north Wales.
Ministers said they had received advice from a number of bodies - including Audit Wales - that the health board was no longer a "special measures organisation".
He said, "The chief exec of NHS Wales, Healthcare Inspectorate Wales and Audit Wales have given clear advice that Betsi Cadwaladr should move out of special measures, and that is the basis for my decision.”
But, Plaid Cymru says the letter it has received from the Auditor General shows that that advice was never given.
In a letter dated on 23 March 2023 to the office of the leader of Plaid Cymru Adam Price, Adrian Crompton writes, "In response to your specific question on whether there was advice from me or my staff to the Minister to de-escalate the Health Board from Special Measures at that time, I can be very clear, there was not.
"In the tripartite discussions that were held on Betsi Cadwaladr University HealthBoard in November 2020, the perspective provided by Audit Wales staff was that,whilst there were some positive developments to report, the Health Board was stillgrappling with a number of significant and on-going challenges."
Betsi Cadwaladr University Health Board provides services to more than 700,000 people across Wales and is the largest health organisation in the country.
It has a budget of £1.87bn and employes more than 19,000 people.
It serves people across six counties of north Wales including Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham.
It has since been placed back into special measures which was announced in February after serious concerns were raised about performance, leadership and culture within the health board.
The current health minister Eluned Morgan survived a vote of no confidence amid calls for her to step down over her handling of failings at the health board.
On the day that the health board was taken out of special measures in 2020, Vaughan Gething said:
"The chief executive of NHS Wales, together with Welsh Government officials, Healthcare Inspectorate Wales and Audit Wales, provide advice to me as the Minister. Their clear advice was that this is no longer a special measures organisation. And I should say that the NHS Wales chief executive, Healthcare Inspectorate Wales and Audit Wales do not make choices on their advice to me on the basis of party politics.”
Plaid Cymru’s spokesperson for health and care, Rhun ap Iorwerth MS said, "We now have evidence that Welsh Government received no such advice from the Auditor General. Plaid Cymru, as an opposition party, is duty bound to question this apparent contradiction. We were prepared to give the First Minister fair opportunity to put forward steps to rectify this situation, but the lack of adequate response, and the depth of public interest in the matter means that we have to bring this into the public domain.
"Now, more than ever, upholding the values of integrity, honesty and transparency in public life couldn’t be more important."
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.