HIW inspection highlights serious patient safety and governance concerns at Ysbyty Glan Clwyd Emergency Department

The inspection, which took place over three days in May 2026, found an emergency department operating under sustained and significant pressure. During the inspection, HIW identified several immediate assurance concerns that required urgent action by the health board. These related to waiting area safety, paediatric emergency care, medicines and equipment management, and safeguarding oversight. 

An exceptionally high number of patients, relatives and carers shared their experiences with HIW, with more than 660 survey responses received. Their feedback highlighted long waiting times, overcrowding and challenges relating to privacy and dignity, while also recognising the compassion and professionalism of staff.

Inspectors also identified significant concerns regarding leadership, governance and organisational culture. Staff described low confidence that concerns raised would result in meaningful action, limited confidence around the visibility and responsiveness of senior leaders, and a disconnect between governance processes and frontline experience. It was particularly concerning that inspectors found longstanding risks, including overcrowding, corridor care, delays in patient flow, workforce pressures and risks to patient dignity, had become normalised despite being recognised through governance arrangements, incident reporting, staff feedback and previous scrutiny.

Following the inspection, HIW designated the department as a Service Requiring Significant Improvement (SRSI), the highest level of escalation available under HIW’s Service of Concern process. The department was previously subject to SRSI arrangements between May 2022 and August 2024. This latest inspection found that several longstanding concerns remained evident and that improvements made during the previous period of escalation had not been sustained.

While HIW recognises the significant pressures facing urgent and emergency care services across Wales and the wider UK, this decision was not based on service pressure alone. It reflected concerns about whether leadership, governance, accountability and oversight arrangements were sufficiently effective in identifying, escalating, managing and reducing known risks to patients and staff.

Inspectors found that patients with high clinical risks were not always moved promptly to monitored clinical areas. Oversight of patients in the waiting area was not sufficiently reliable, and patients did not always receive regular clinical monitoring, timely pain relief, food and drink, support to use the toilet, or updates during prolonged waits.

In the paediatric emergency area, inspectors identified safety concerns requiring immediate action. These included occasions when the children's area was left unattended while patients were present, the absence of paediatric trained nurses, weaknesses in security arrangements, emergency equipment not being readily available and safeguarding documentation not being easily located.

Inspectors also identified weaknesses in medicines management and equipment safety systems. These included expired equipment, missing emergency equipment and inconsistent completion of safety checks. Wider concerns related to safeguarding, patient records, workforce pressures and the care of vulnerable patients. 

Equality and access concerns were identified, including issues relating to age, disability and other protected characteristics or vulnerabilities. Inspectors found inconsistencies in the Welsh language Active Offer and in how patients' language preferences were identified and recorded. 

Despite these findings, inspectors recognised the commitment and professionalism of staff working in exceptionally challenging circumstances. Patients consistently praised staff for being caring, compassionate and respectful. Inspectors also found strong teamwork, effective multidisciplinary working and examples of patient-centred care. 

Further positive findings included effective support from discharge and wellbeing services, which helped support patient comfort, dignity and flow where possible. The department was generally clean and well maintained, and staff demonstrated a good knowledge of infection prevention and control practices.

HIW has continued to engage closely with Betsi Cadwaladr University Health Board through its Service of Concern process. The health board has engaged positively and has provided detailed improvement plans in response to the concerns identified. 

While a range of actions has been taken, the seriousness and breadth of the findings mean that substantial and sustained improvement is still required. The health board must maintain momentum, organisational focus and effective leadership to drive the necessary changes across patient safety, service delivery, governance and organisational culture.

A follow-up visit to the Emergency Department took place on 24 and 25 August 2026 to check progress on the immediate concerns identified during the original inspection. Inspectors found improvements in staff wellbeing and engagement, patient flow, safety huddles, paediatric governance, security, and the management of medicines and equipment. However, challenges remain in waiting-room oversight, reducing delays in gaining specialist input following medical and surgical referrals, and ensuring recent improvements can be sustained. While positive progress has been made, continued focus and accountability will be needed to ensure these improvements are maintained.

HIW’s enhanced monitoring and follow-up activity will focus not simply on whether actions have been completed, but on whether they are delivering measurable improvements, reducing risk and making a sustained difference to the experience of patients and staff. HIW will continue this enhanced oversight until it is assured that the required improvements are effective, embedded and sustained.

HIW’s role is to identify concerns and ensure services take the action needed to improve and provide safe care. Patients who need urgent or emergency care should continue to attend the department. 

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

People attending emergency departments should be able to expect safe, timely and dignified care, particularly when they are at their most vulnerable. While we recognise the significant pressures facing urgent and emergency care services, this inspection identified serious concerns about patient safety, patient flow, leadership, governance and the effectiveness of the arrangements in place to identify, manage and reduce risks to patients and staff.

We recognise the professionalism, compassion and commitment shown by frontline staff working in exceptionally challenging circumstances. However, this inspection found that previously identified improvements had not been sustained and that several longstanding concerns remained evident. The recurrence of these issues raises important questions about the effectiveness of the arrangements in place to identify, manage and reduce risk.

While our follow-up visit in August found signs of progress, these improvements must now be sustained over the longer term. Through our Service of Concern process, we will continue enhanced monitoring and follow-up activity. We will consider not only whether actions have been completed, but whether they are making a measurable difference and delivering sustained improvements in safety, quality and experience for patients and staff.