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Insight Bulletin - March 2024

Bwletin Arsylwi Insight Bulletin

Welcome to our latest edition of HIW’s Insight Bulletin

Each quarter we share our latest news and highlight the key themes and learning emerging from our work. It is part of our commitment to better understand our stakeholders’ expectations, proactively engage, share our findings and report on our activity.

We believe there is significant value in sharing learning and experiences from our work. We want healthcare services to reflect on our findings and measure their own services against the findings, in order to drive service improvement. We hope the findings illustrated within this bulletin can be transferred between organisations, and across the wider health service to support improvements across the system.

As part of our ongoing commitment to continuous improvement in this edition we take a deep dive into the recommendations highlighted following our review of mental health discharge arrangements, within Cwm Taf Morgannwg University Health Board (CTMUHB).

Following our inspection and assurance work we have published a series of reports, which highlight areas of improvement and good practice, alongside serious systematic and patient safety issues within the NHS and independent health care providers.

Within this edition we also highlight our Annual Report 2022-2023, looking back at our work and key findings over a 12-month period, with 178 pieces of inspection and assurance work carried out.

We reflect on hosting Wales’s first European Partnership for Supervisory Organisations in Health Services and Social Care conference known as EPSO. EPSO is a valuable forum where learning and innovation is shared amongst inspectorates and regulators across Europe and beyond. 

We held our first in-person all staff conference since the pandemic, to reconnect and share lessons learnt. We were joined by inspirational speaker Nazir Afzal OBE, who spoke on inequalities in health care and leadership motivation. 

We hope you find the content within this bulletin informative and insightful.

Your feedback is crucial to us in improving how we communicate and share key messages with you, so please take the opportunity to provide your feedback to us via this survey.

Thank you.

Business Update

Our Latest Annual Report

Healthcare Inspectorate Wales Annual Report 2022-2023

We have published our latest Annual Report for 2022 – 2023 summarising our activity, including the inspection of NHS and independent healthcare services. The report identifies the sustained pressure on healthcare services across Wales, highlighting risks relating to emergency care, staffing concerns, poor patient flow and the accessibility of appointments.

The report highlights how 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.

The 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.

During the year we have undertaken 178 pieces of inspection and assurance work and handled 659 concerns from the public and healthcare staff.

EPSO in Wales

EPSO in Wales

We hosted Wales’s first European Partnership for Supervisory Organisations in Health Services and Social Care (EPSO) conference last October. EPSO’s 35th conference was held at the world-famous 74,000-seater Principality Stadium, in Cardiff, the home of Welsh Rugby. The conference was well attended by Health and social care inspection and regulation professionals from across Europe, Asia, Australia, New Zealand and the Middle East.

The conference was an excellent platform for networking and shared learning on a variety of topics such as the Well-being of Future Generations (Wales) ACT 2015, effective methods of regulation and inspection, including a focus on improvement cultures in health and adult-social care settings.

Take a look at our short highlight video.

Our Commitment to Equality, Diversity and Inclusion

Together with Care Inspectorate Wales (CIW), we will be publishing our joint Equality, Diversity and Inclusion (EDI) strategy this spring. The strategy aims to drive forward improvement and demonstrate our commitment to EDI principles, to address our social responsibilities as regulators and inspectorates to ensure everyone in Wales has access to good quality care.

The strategy will aid better use of intelligence in respect of EDI to inform our regulation, inspection, and assurance work. We in turn will have increased awareness and understanding of EDI, and the actions required to improve the healthcare services provided to diverse communities across Wales.

The joint strategy will also improve links and knowledge sharing, including good practice to improve the quality of care provided by health, social and childcare services across Wales.

We have published our Mental Health Monitoring Annual Report 2022 - 2023

Mental Health Hospitals, Learning Disability Hospitals and Mental Health Act Monitoring Annual Report 2022 - 2023

The report sets out our assurance activity and findings during the period from April 2022 to March 2023, and explores the standards of care being delivered by mental health and learning disability healthcare services across Wales during this time.

Mental health and learning disability services continue to face many challenges that are affecting outcomes for patients. There continues to be severe pressure on in‑patient beds and there are many challenges faced by the health boards and independent providers of care in providing a range of diverse services to vulnerable patients.

Although our work allowed us to observe some examples of good practice across different aspects of service delivery, significant improvement was often required, and there was a large degree of variability in the quality of care delivery.

Deprivation of Liberty Safeguards (DoLS) Annual Report 2022-23 Published

Deprivation of Liberty Safeguards Annual Monitoring Report for Health and Social Care 2022 - 23

Together with Care Inspectorate Wales (CIW) we have joint responsibility for the monitoring and reporting of Deprivation of Liberty Safeguards (DoLS), and each year we publish an annual report on the applications received by health boards and local authorities.

Key findings include a rise in the number of applications received by local authorities and health boards and long delays in allocating, accessing and authorising applications.

Inspector Training Following OFSTED Incident

As an inspectorate and regulator, we have reflected on the Prevention of Future Deaths report issued by the coroner relating to Ofsted. Ofsted is the Office for Standards in Education, Children’s Services and Skills. Ofsted inspects services providing education and skills for learners of all ages. Ofsted also inspects and regulates services that care for children and young people.

It is within HIW’s ethos that our inspection and assurance work is a supportive process, designed to help drive and inform improvement. Integral to this approach is positive and constructive engagement with staff throughout the inspection process. Given the similarities of roles and functions, we have worked together with Care Inspectorate Wales (CIW) to develop bespoke training for our inspectors in recognition of the issues identified by the coroner.

This training will focus upon enabling inspectors and teams to recognise signs of distress arising from inspections, and how to deal with these circumstances including how to deliver difficult messages whilst supporting mental health and wellbeing.

HIW hopes that taking these steps will enhance the way that it delivers its functions and improve the experience for those who are inspected.

Activity Update

Caution issued to provider using unregistered laser services

Following a recent criminal investigation, Healthcare Inspectorate Wales (HIW) invoked its legal powers due to a breach of the Care Standards Act 2000.

It follows evidence of a service providing aesthetic laser treatments at a clinic in Cardiff without registration. 

A caution was issued after the setting was found to have been operating whilst unregistered.

As the regulator of independent healthcare services in Wales, we are committed to taking action when standards are not met. When an independent healthcare provider does not comply with the regulatory requirements, we will take action. 

Providers of independent hospitals, clinics and medical agencies are required to register with HIW.


Already registered and want to tell us that something has changed?

If you are registered with us and you need to change the remit or scope of the services you provide, or the responsible person for your setting has changed please ensure you notify us as soon as possible.

To make changes to your registration please visit our website for full details and the relevant documentation.

Assurance and Inspection Activity

We inspect NHS services and regulate independent healthcare providers against a range of standards, policies, guidance, and regulations to highlight areas requiring improvement. Following our inspection and assurance work we will publish a report outlining our findings and recommendations.


Changes to Publication Handling

Our publication policy sets out our intention, for certain types of inspection, to provide details of inspection findings to the media and other key stakeholders, in advance of publication and under embargo. We will follow this process for inspections of Emergency Departments and Maternity Services, regardless of whether the inspection findings were positive or negative. This process will also be used for other types of inspection where there are findings of a significant nature. The introduction of this process meets HIW’s strategic commitment of driving system and service improvement within healthcare.

To find out more:

Inspection Reports

As part of our continued commitment to driving forward improvement through smarter working, a decision has been made to cease the publication of a separate public summary report post-inspection. This will help to streamline our processes for efficiency and to optimise our resources. We will continue to provide a full inspection report with an improved executive summary at the beginning of the report.

Spotlight Case Study - Inspectors find immediate improvement is required at a specialist mental health hospital in Wrexham

Alwen Ward and Brenig Ward Ty Grosvenor Mental Health Hospital

We conducted an announced inspection of the independent mental health hospital, Tŷ Grosvenor in Wrexham. The service provides specialist care for men over the age of 18 with mental health conditions and/or personality disorders.

Through our concerns process, we received a report of the hospital having inadequate procedures in relation to the management of medication. Following a subsequent inspection of the hospital, HIW placed Tŷ Grosvenor into its Service of Concern process in November 2023. This process is part of HIW’s Escalation and Enforcement procedures which aim to ensure that rapid action is taken when there are significant service failures, or when there is an accumulation of concerns about a healthcare setting.

The inspection uncovered multiple issues requiring immediate assurance due to issues of non-compliance around the application of the Mental Health Act, including incorrect recording of medication being administered to patients.

We continued to engage with Elysium Healthcare, the management company of Tŷ Grosvenor to seek further assurances, and in January 2024 we were satisfied adequate improvement had been made. The hospital was then de-escalated as a Service of Concern.

Latest highlight publications include:

All published reports can be found on here: Find an inspection report.

Want to find out when HIW reports are due to be published? Take a look at our Publication Schedule.


We publish a range of national and local reviews every year. 

Our reviews help us to evaluate how healthcare services in Wales are delivered.

Joint review of child protection arrangements (JICPA) in Powys

Powys County Council Powy teaching health board dyfed powys police report of joint inspection of child protection arrangements


Together with (HMICFRS) His Majesty's Inspectorate of Constabulary and Fire & Rescue ServicesCare Inspectorate Wales (CIW), and Estyn, we carried out a joint inspection on the multi-agency response to abuse and neglect of children in Powys.

The report highlights the benefits of partnership and multi-agency working. Action was usually taken within appropriate timescales, with support and protection in place to meet children’s needs. 

However, the report  also makes some recommendations for improvements such as enabling children to take a more active part in decision making forums and the need to simplify systems for recording safeguarding information.

All Wales Review of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decisions

The aim of our review is to consider the practices in place when DNACPR decisions are applied to adult patients (over the age of 18), and whether patient views and considerations are respected. The scope of the review will seek to answer the question- “Are DNACPR decisions being respectfully communicated to patients and those close to them, and are they clearly recorded and communicated between healthcare professionals”.

The review will conclude with the publication of a national report in spring of 2024.

How are services supporting the mental health needs of children and young people in Wales?

We are leading a joint review with Care Inspectorate Wales (CIW) and Estyn to explore how healthcare, education and children’s services support the mental health needs of children and young people in Wales.

The aim of the joint review is to consider whether children and young people are receiving timely and effective support for their mental health needs. The review will conclude with the publication of a joint national report in the autumn of 2024.

The report will highlight key themes and areas of good practice and will make recommendations where required improvements are identified throughout the review. 

Learning and Insight

Sharing Learning and insight to improve Healthcare

Reviewing Mental Health Discharge Arrangements

In March 2023, HIW published its report following a review assessing the quality of the discharge arrangements in place within Cwm Taf Morgannwg University Health Board (CTMUHB) for adult patients discharged from inpatient mental health services to the community.

The report made 40 recommendations for improvement, and considering the review’s findings, we wanted to understand whether the issues identified were replicated throughout other mental health services across Wales. Therefore, we asked all health boards to consider the report and provide a response to the recommendations.

HIW received responses from all health boards and analysed the information and supporting evidence. There was variability in the quality and detail of responses, and it is our intention that this exercise will inform our ongoing assurance activity in relation to mental health services. The most significant issue that requires strengthening relates to communication and clinical record management system, to maintain a safe discharge and ongoing safe and timely care.

For further reading on the issues identified from the health board responses, please visit our Learning and Insight section.

Join Us!

We are recruiting for Second Opinion Appointed Doctors (SOAD)

The Mental Health Act 1983 introduced the SOAD Service as a safeguard of the rights of patients detained under the Act who either refuse the treatment prescribed by the Approved Clinician or are deemed incapable of consenting.  From November 2008, the amended Mental Health Act introduced additional safeguards relating to Supervised Community Treatment and Electroconvulsive therapy (ECT). 

The SOAD is an independent Consultant Psychiatrist appointed by HIW to undertake this statutory function on behalf of Welsh Ministers, and only ‘becomes’ a SOAD when appointed to give an individual second opinion.  HIW is responsible for the appointment of SOADs and the SOAD service. 

Full details of the vacancy and details of how to apply can be found here: Second Opinion Appointed Doctor (SOAD) | Healthcare Inspectorate Wales (

The closing date for applications is the 30th April 2024.

Have Your Say

We want your views! Head over to our website where we have a range of patient surveys now open, and we welcome your views.

All open surveys can now be found on our surveys page.

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