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HIW Winter update

As we head into what will be a difficult winter period for healthcare services across Wales it is timely to provide an update on our approach and activity over the coming months.

Winter Update

Assurance and inspection programme

Our position with regard to our assurance and inspection programme remains unchanged in that it is driven by risk, whilst also seeking to support the response and recovery of healthcare services from the pandemic. Our commitment to keep the situation under review and use the right blend of offsite and onsite assurance work to deliver our role is also unchanged. With a range of indicators showing increased pressure on healthcare services due to COVID-19, broader respiratory conditions and pressure across the system, we will continue to risk assess every piece of work and engage with services where appropriate. Further to this, and in recognition of feedback and reflection on recent inspections, we will now move away from unannounced inspections for ‘green’ and elective, scheduled pathways. We will provide around 24 hours’ notice for these inspections with the intention of ensuring our teams have time to communicate with staff and allow time for arrangements to be put in place for the inspection. Our expectation is that this will be the approach for all inspections that fall into this category, however, we must still reserve the right to operate in a fully unannounced way where we determine there to be an extremely high risk to patient safety as a result of the way a service is operating.

We are very aware that difficult decisions will need to be made locally over the course of the winter period given the extraordinary demand and systems context within which healthcare services are operating. We will be careful to ensure that this is clearly understood as part of our assurance work and in our reporting.

Where we do need to conduct onsite work, we have implemented a number of measures to reduce the risk of COVID 19 transmission from our inspection activity and to ensure that our staff are protected from COVID-19. I would, therefore, expect the presence of our inspectors to be treated as essential and similar to that of visiting professionals rather than members of the public.

National Reviews

National and local reviews continue to form a key part of our assurance work. Our review of Welsh Ambulance Services Trust (WAST): Review of Patient Safety, Privacy, Dignity and Experience whilst Waiting in Ambulances during Delayed Handover was published last month. It is clear from our work that a significant number of whole system activities are either planned or underway with a view to addressing improvement in the delivery of urgent and emergency care services. We look forward, however, to receiving a co-ordinated, system response to the specific recommendations falling from our work. We are in contact with Wales’ Chief Ambulance Commissioner about the response and will support improvement where possible.

The fieldwork has been completed for our National Review of Mental Health Crisis Prevention in the Community. The report is scheduled for publication in December 2021 and we will engage with you on our findings in the normal way.

We have commenced a National Review of Patient Flow (Stroke Pathway), and are currently finalising the terms of reference. A stakeholder advisory group is currently being convened to help steer the work. We aim to share findings as part of our series of Quality Insight Bulletins before concluding with a national report published late autumn 2022.

We will publish our Mental Health Act Annual Report 2020-21 on 10th November 2021. Following a significant number of quality checks and inspections, the report covers a number of key areas in relation to general mental health provision and those specific to the administration of the Act. 

We recently supported CIW in carrying out a national review of early help, care and support and transition for disabled children in Wales. Working together enabled consideration of how people are being supported seamlessly across both health and social care services. The review identified positive practice, learning points and areas for improvement for consideration by local authorities, local health boards and their partners. The final report is due to be published at the end of November 2021.

Service of Concern implementation and HIWs future strategy

Contributions to our work and how we develop as an organisation are much appreciated, particularly at such a busy time. Following a period of consultation we intend to launch our new NHS Service of Concern process on 15 November 2021. We have carefully considered all comments received and made any amendments we felt necessary or appropriate to the process which will be made available on our website.

The most significant change relates to how a service being managed through the Service of Concern process is described. In externally facing communications and for the purpose of our website, it is our intention to describe any such service as a ‘Service Requiring Significant Improvement’ rather than a Service of Concern. In addition, our website will include an explanation of the reasons underpinning this determination. We believe that this is a more constructive way to describe services and support any necessary improvement, with Service of Concern being a term reserved for the process rather than the outcome of the process.

Finally, following an initial engagement on HIW’s future 3 year strategy we have worked to refine our priorities to ensure we keep pace with changes in healthcare provision and focus on the quality of healthcare provision for people and communities as they access, use and move between services. We will share our priorities again before finalising them and publishing our new strategy in March 2022.