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Annual Report finds sustained pressure on healthcare services across Wales

Today, 6 December, Healthcare Inspectorate Wales (HIW) has published its annual report for 2022-2023. The report summarises all of our activity, including the inspection of NHS and independent healthcare services.

Healthcare Inspectorate Wales Annual Report 2022-2023

Our findings outline the sustained pressure on healthcare services across Wales, highlighting risks relating to emergency care, staffing concerns, poor patient flow and the accessibility of appointments.

We have continued to focus on patient safety through our inspection and assurance work by challenging healthcare services to look for different ways of working to improve outcomes for patients. Healthcare staff engaged well with our inspections and worked constructively to tackle any issues highlighted. Our annual report sets out how we carried out our functions across Wales, seeking assurance on the quality and safety of healthcare through a range of activities. This includes inspections and review work in the NHS, and regulatory assurance work in the independent healthcare sector. The report provides a summary of what our work has found, the main challenges within healthcare across Wales, and our view on areas of national and local concern.

Our findings show unrelenting pressure on healthcare services across Wales, and whilst there are initiatives in place to help support healthcare services cope with increasing demand, our work during this year did not find evidence of these making a clear and significant difference to services at the front line. Whilst patients may well have been satisfied with the staff providing their care, they were not satisfied with the long waits and difficulty in getting treated by services in a timely manner. Whilst staff continued to describe their passion for working with people and supporting people with their care, they were not satisfied with the immensely pressured environments of work they found themselves in on a daily basis.

Our work within NHS hospitals has highlighted the issue of poor patient flow, with intense daily pressures around patient admission and bed management. Within Emergency Departments across Wales, we have noted overcrowding, long waits for triage and long waits for treatment, plus ongoing delays in being admitted into the most appropriate beds. Within General Practice and Dentistry, access to NHS services remains a matter of real concern to patients.

Our work within mental health services has found delays in treatment, in particular when patients with a diagnosis and a care and treatment plan are moving from one part of the service to another.

The independent healthcare sector often cares for some of the most vulnerable patients in Wales, dealing with high levels of risk and complex needs. Our work has sought to challenge the sector to ensure that the standards and quality provided are in line with their regulatory responsibilities so that they provide a quality service to patients.

During the year we have undertaken 178 pieces of inspection and assurance work and handled 659 concerns from the public and healthcare staff. Three key themes have arisen from our concerns monitoring service, which takes calls and information from members of the public. These are difficulties in accessing a regular dentist and receiving dental care, difficulty in getting an appointment with a GP and difficulty in accessing mental health services. This feedback from members of the public is highly concerning and is an early warning of future public health challenges which must be heeded.

Whilst the responses received to our staff questionnaires indicated low staff morale, including challenges around staffing numbers and high demand for services, this did not generally seem to impact on the experience patients had of staff.

In providing an independent view of healthcare services, we seek to contribute to an understanding of the risks and challenges that are preventing services from operating effectively and impacting on the quality of care being delivered to patients. Many settings were issued with improvement plans following our findings and recommendations, which continue to be followed up on in order to ensure robust action is taken to improve outcomes.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said:

“Now, more than ever, healthcare in Wales needs continued innovation, and a vision and understanding of what works and what does not. In these challenging times, HIW has a clear role to play in providing independent assurance on the quality of healthcare services, highlighting what good looks like and providing challenge where standards are not being met.

Our work has once again illustrated the sustained pressure on healthcare services across Wales, highlighting risks relating to emergency care, staffing levels, poor patient flow and the accessibility of appointments. Through our work we have once again seen a highly skilled and committed workforce, delivering care with compassion and innovation. The workforce of the NHS remains its biggest asset and is central to navigating the challenges that lie ahead.”

Annual Report 2022 - 2023