Healthcare Inspectorate Wales calls for safe, dignified, and effective health care
Healthcare Inspectorate Wales (HIW) has today published its Annual Report for 2024–2025, offering a clear and independent assessment of healthcare services across Wales. The report draws attention to a system under sustained pressure, where dedicated staff continue to deliver good care in difficult conditions, but where risks to patient safety persist, and improvement is not always sustained.
Over the past year, HIW received 743 concerns, marking a 21% increase from the previous year and a 102% rise since 2019–20. Alongside this, 120 whistleblowing disclosures were made, up 36%, pointing to deeper issues in leadership, governance, and organisational culture. These figures reflect the growing urgency and complexity of the challenges facing healthcare in Wales.
HIW carried out 163 inspections across NHS and independent healthcare services, informed by the voices of 3,407 patients, carers and members of the public, and 1,657 staff. These insights continue to shape HIW’s priorities and ensure that scrutiny is focused where it matters most.
The NHS in Wales: A System at a Crossroads
Inspections of GP practices, emergency departments, maternity units, and mental health services reveal a system stretched to its limits. Staff are working under immense strain, often in environments that are not fit for purpose. The report identifies recurring risks and a concerning pattern of previously identified issues resurfacing.
Emergency departments where patients wait in corridors, maternity units compromised by staffing gaps, and mental health wards with unresolved safety risks are not isolated incidents, they are symptoms of wider systemic strain. Welsh Government’s Six Goals for Urgent and Emergency Care programme is targeting many of the root causes of these system challenges, increasing access to same-day emergency care, improving discharge processes, and supporting a home-first philosophy. Whilst it is encouraging to see that urgent care delivery is being reshaped, patient demand continues to be high, with this often impacting on patient experience.
While services often respond positively to scrutiny, action taken is not always sustained. The report calls for sufficient resources, effective local leadership, and robust governance to ensure high standards are not only achieved but maintained.
Mental Health: A National Priority
Mental health services continue to face long-standing and significant challenges. Notably, 36% of mental health inspections triggered immediate assurance or non-compliance processes. HIW remains deeply concerned about the condition of the estate in many NHS mental health facilities. For mental health patients, the physical environment is not a superficial issue it is central to the delivery of effective and therapeutic care. The report calls for urgent investment and a national commitment to improve environments of care.
Independent Healthcare: Expanding, But Not Always Ready
The independent healthcare sector in Wales continues to grow, with 60 new services registered this year, reflecting increasing demand and diversification, particularly in cosmetic procedures, laser treatments, private dentistry, and GP services.
However, with growth has come risk. In 2024/25 HIW issued more urgent enforcement actions in the independent sector than ever before. Many involved smaller providers entering the market without a clear understanding of their legal responsibilities or the standards required to keep people safe. The independent healthcare sector is evolving, and it is concerning that there are an increasing number of emerging services which fall outside the scope of the current regulations and therefore HIW’s remit.
Regulation That Drives Improvement
HIW’s regulatory activity in the independent sector in 2024–2025 has been fair and decisive. We have suspended unsafe services, escalated serious concerns, and launched criminal investigations into unregistered providers. At the same time, HIW has supported services to improve through targeted monitoring, guidance, and follow-up.
This year, HIW conducted 50 dental inspections, resulting in nearly 600 recommendations for improvement. In addition, 18 clinical reviews of deaths in custody were carried out to assess the equivalence of care in prison settings.
The report makes clear that HIW’s role is not only to challenge poor practice, but to highlight good practice and help the system improve. However, unsafe care must not be tolerated whether delivered by the NHS or an independent provider. Everyone in Wales deserves the same standard of safety, dignity, and respect.
Alun Jones, Chief Executive of HIW, said:
“This report is not just a record of our work - it is a challenge to the system to do better.
We have seen environments that are unsafe and systems that are being stretched to their limits, but we have also seen staff delivering exceptional care in difficult conditions.
Everyone in Wales deserves safe, dignified, and effective healthcare, and HIW will continue to challenge, support, and drive improvement wherever it is needed most.”