Hospitals

How we inspect

We inspect NHS hospitals in different ways, these include:

• Single department or ward inspections: A detailed review of one department or ward to understand the quality and safety of care provided.
• Multi-ward inspections: Visits to several wards and departments within a hospital to identify broader themes or issues.
• Multi-hospital inspections: Visits to undertake assessments across multiple hospitals within a health board to evaluate governance and service delivery. 

What We Assess

During inspections, we consider how services:

• Comply with healthcare regulations and legislation
• Meet the Health and Care Quality Standards 2023
• Comply with Welsh Government strategy, policy and legislation
• Adhere to professional standards and guidance relevant to their area of care.

Our NHS hospital inspections are usually unannounced to help achieve the following:

• Realistic view of day-to-day operations - Unannounced inspections provide a more reflective view of how services operate on a typical day, without the opportunity for staff to prepare or change routines. This helps HIW assess whether high standards are consistently maintained.
• Increased accountability - Knowing that inspections can happen at any time encourages hospitals to maintain continuous compliance with regulations and standards, rather than preparing only for scheduled visits.
• Improved patient safety - By observing services in their natural state, inspectors are more likely to identify genuine risks to patient safety or lapses in care that might otherwise not be seen during a planned inspection
• Enhanced credibility and public trust - Unannounced inspections demonstrate HIW’s independence and impartiality, reinforcing public confidence that healthcare services are being held to account transparently and fairly.
• Opportunity to hear unfiltered patient and staff feedback - Patients and staff are more likely to provide authentic feedback during unannounced visits, as the environment is less staged and more reflective of their everyday experiences.
• Early Detection of Systemic Issues - These inspections can help uncover underlying problems in hospital culture, staffing, or leadership that may not be visible during a prepared inspection.

Each hospital inspection is carried out by a team comprising at least one HIW inspector - who leads and manages the process, an external peer reviewer with relevant professional expertise, and a patient experience reviewer. The external peer reviewer offers an independent clinical perspective, while the patient experience reviewer engages with individuals receiving care to gather first-hand accounts of their experiences. This collaborative approach ensures that inspections reflect both professional standards and the real-life experiences of patients.

After the Inspection

Following an inspection:

• We publish an inspection report on our website
• Services may be required to make improvements and submit an improvement plan to us
• We may take further action if serious concerns are identified.

We continue to monitor services using information from inspections, the public, engagement with healthcare staff, and other organisations.

If you would like a copy of our inspection workbooks please contact HIW.Inspections@gov.wales quoting which type of inspection workbook you require.