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Insight Bulletin - October 2022

Insight Bulletin October 2022

Welcome to the latest edition of the quarterly update from Healthcare Inspectorate Wales (HIW).

HIW's Quarterly Insight Bulletin shares our latest news, summarises key themes we have discovered and outlines significant updates, so together we can achieve our aim of improving healthcare across Wales.

This bulletin is just part of our commitment to better understand our stakeholders’ expectations, proactively engage, and do so regularly, share our findings and report on our activity.

If you work in a service or are involved in running a service, we have recently introduced our new ‘Learning and Insight’ section of this bulletin, to share lessons learnt and drive forward continuous improvement. In this edition, we highlight themes of concern we have uncovered in our work within dental practices across Wales. We ask you…what can you learn from this and take back to your area of work?

Please watch this short animation below which outlines the key role HIW plays in checking people in Wales are receiving good quality, safe and effective healthcare.

Business Update

We have published our latest Annual Report

We have recently published our latest Annual Report for 2021 – 2022 summarising our activity, including the inspection of NHS and independent healthcare services. The report identifies sustained pressure on emergency care following the COVID-19 pandemic, staffing concerns, risks around managing patient safety, and the accessibility of face-to-face appointments. 

The report highlights how HIW have continued to focus on patient safety by challenging healthcare services to look for different ways of working to improve outcomes for patients. Over the 12-month period, HIW continued with a full range of assurance and inspection activities, building on enhanced ways of working and taking action where standards were not met.

During the year HIW undertook nearly 200 pieces of inspection and assurance work and handled over 500 concerns from the public and healthcare staff.

You can read the full report on our website.

Healthcare Inspectorate Wales Annual Report 2021 - 2022

Welcome to our new Director of Strategy and Engagement – Abubakar Askira 

Abubakar joined HIW from Social Care Wales in May 2022. A key focus of Abubakar’s role in HIW is setting the strategic direction for the organisation, building reputation, and ensuring that HIW’s work has the greatest visibility, in order to support improvement in healthcare. He also provides leadership for the following functions - Partnerships, Intelligence, Methodology and Communications. 

Abubakar has over 15 years of experience working in social care workforce development and regulation. His previous role, as Engagement and Development Manager with Social Care Wales involved having oversight of all engagement activities and establishing business systems, which enabled effective use of intelligence gathered through engagement. During the COVID-19 pandemic, Abubakar led on a programme of work aimed at supporting the wellbeing of the social care workforce. 

Of the appointment, Abubakar says: “I’m delighted to be joining HIW, and I look forward to implementing HIW’s new strategy and delivering on our important role of checking that people in Wales receive good quality healthcare.”

Collaboration and partnership working are vital to Abubakar’s role, and over the next few months he is keen to meet and foster close working with partners to ensure HIW delivers a programme of assurance that remains current and helps drive improvement. 

Join Us

HIW is a busy and fast-paced organisation with people at its core. Our organisation is divided into several teams, within each team there are staff with unique roles who work together to check that healthcare services are provided in a way which maximises the health and wellbeing of people.

Take a look at our latest vacancies...

Inspectors - Various

We have a number of roles available in our Inspection team, and we are seeking to recruit individuals who are interested in making a difference. The role ensures a programme of inspection, review and/or regulatory activity is planned, managed and reported in a timely manner and to a professional standard. These roles are due to be advertised soon, please keep an eye on our website.

Intelligence Manager

We are recruiting an Intelligence Manager. The role will perform critical tasks such as gathering and using intelligence to help ensure that HIW activities focus on patient safety and quality and drive improvement in healthcare services across Wales. The post holder will maximise the use of data to help support the risk-based approach to inspection planning, and to provide robust intelligence to inform our work.

The closing date is 24/10/2022 at 16:00 please apply on our website.

Peer Reviewers

Peer Reviewers are health professionals from a range of specialisms from across Wales. They usually form part of a multi-disciplinary team and their knowledge and expertise ensures our work is based on current practice and experience. This helps us to highlight good practice and to reinforce and share healthcare standards within both the NHS and Independent Healthcare Sector for public assurance and improved service for patients. We particularly welcome applications from professionals who are currently in clinical practice.

To apply for these roles and for more information please visit our latest vacancies page on our website.

HIW believes in the value of a diverse and equal workforce. We proactively encourage applicants from all backgrounds in order to represent the communities we serve.

Updated Welsh Language Framework for Health and Social Care


More Than Just Words' is the Welsh Government’s strategic framework to strengthen Welsh language provision in health and social care.

A new More Than Just Words plan 2022-27 was published on the 2 August 2022. Its aim is to support Welsh speakers to receive care in their first language. Healthcare services should ensure they are familiar with their role and their responsibilities against this plan.

HIW has a key role to play under the theme 'Sharing best practice and an enabling approach' and we want our work to lead to better patient experience and improved outcomes across Wales.

Our role is to inspect and drive quality improvement and as part of this, we will consider the extent to which services are delivering their responsibilities in supporting Welsh speakers receiving healthcare.

Activity Update

Escalation and Enforcement Work


Report identifies ‘significant concerns’ at Ysbyty Glan Clwyd’s Emergency Department.Service requiring significant improvement emergency department ysbyty Glan Clwyd

A HIW inspection identified that Betsi Cadwaladr University Health Board did not have adequate arrangements in place within the department to support the delivery of safe healthcare.

HIW completed an unannounced inspection of the emergency department in May this year. This inspection was undertaken to follow up on the significant concerns HIW identified during a previous quality check undertaken in March 2022.

Our inspectors concluded that there was a lack of improvement to an acceptable standard in relation to the concerns identified in March 2022. As a result, HIW designated the emergency department in Ysbyty Glan Clwyd as a Service Requiring Significant Improvement (SRSI) on 9 May 2022. Furthermore, the May inspection identified several additional areas of concern relating to patient safety.

The onsite inspection in May highlighted the emergency department was experiencing a period of unrelenting demand on its services. HIW noted the highly pressured environment for staff, who were working above and beyond in challenging conditions. However, HIW found that the health board was not fully compliant with many of the Health and Care Standards, and highlighted significant areas of concern, which could present an immediate risk to the safety of patients.

These concerns were around the effectiveness of arrangements for assessing, monitoring, observing, and escalating unwell or deteriorating patients. HIW also noted that the quality of the nursing documentation fell far short of the required standard and found evidence of poor management of health and safety risks, such as unsecure access and exit from the paediatric area. Infection prevention and control procedures were also insufficient.

As a consequence, HIW was not assured that the processes and systems in place were sufficient to ensure that patients consistently received an acceptable standard of timely, safe and effective care.

HIW highlighted areas which required immediate action be taken in order to keep patients safe. HIW has urged the health board to carefully consider all findings from this review and undertake action to reduce the potential for significant harm to patients and to embed all improvements into practice.

The SRSI designation currently applied to the emergency department enables us to plan and deliver future activities necessary to gain assurance about the quality and safety of care in that service.

Ongoing Reviews

National Review of Patient Flow - Stroke Pathway

Ineffective and inefficient patient flow can have a significant impact on the quality and safety of patient care. As a result, HIW are undertaking a national review of patient flow.

To assess the impact of patient flow challenges on the quality and safety of patients awaiting assessment and treatment, we will be focusing our review on the Stroke pathway. We want to understand what is being done to mitigate any harm to those awaiting care, as well as understand how the quality and safety of care is being maintained.

The planning of the review commenced in autumn 2021, and the field work began in March this year. Throughout our review we will consider how the NHS in Wales addresses peoples’ access to acute care at the right time and if care is received in the right place, by people with the right skills, through to timely discharge. We aim to publish the review report early next year.

Review of Discharge Arrangements for Adult Patients from Inpatient Mental Health Services in Cwm Taf Morgannwg University Health Board

Following an assessment of information from a range of sources which indicated significant concerns around mental health services in Cwm Taf Morgannwg University Health Board (CTMUHB), we made the decision to undertake this review. The focus is to explore the quality and safety of discharge arrangements of adult patients from inpatient mental health units, back into the community.

The review started in January 2022 and will progress into late summer, with the report to be published later in the year.

Local Review of the Vascular Service, Betsi Cadwaladr University Health Board

In line with our NHS service of concern process, in February 2022 we designated the Vascular Services at Betsi Cadwaladr University Health Board as a Service Requiring Significant Improvement (SRSI).

We have therefore decided to undertake a local review within the health board’s vascular services, which will examine the progress made by the health board in relation to each recommendation highlighted in the Royal College of Surgeons report, to gain assurances on patient safety and the quality of care being provided.

We aim to publish the findings of the review early next year.

Learning and Insight

Dental Care

Following recent assurance work HIW has repeatedly reported on a number of issues within dental practices across Wales, in particular within independent healthcare services. Whilst a variety of issues were reported, some key themes have emerged through our inspections and quality checks. In some circumstances we have needed to ask the practices to take immediate action to reduce risks to patient safety.

We want to highlight these common themes, and we hope this is helpful for you and your staff in thinking about how we can all contribute to making dental care safer and more effective.

The areas of concern we have found during our assurance work were:


  • A poor standard of cleanliness in decontamination areas. In some practices HIW Inspectors uncovered ineffective decontamination processes, including inadequate cleaning of instruments and ineffective use of ‘dirty/clean’ pathways.
  • We reported inappropriate storage of items in clinic and decontamination rooms such as food and cleaning materials, including high numbers of clinical fridges containing non-clinical items such as food and out of date medication. Practices should ensure there are procedures in place to reduce the risk of contamination and to support good standards of infection prevention and control.
  • There were numerous examples of practices not undertaking audits of their work. Audits offer an opportunity to review the consistency and quality of care and treatment that is provided to patients and are a quality improvement tool, which can provide many benefits and support better practice. 
  • A number of practices did not have a system in place which ensured all risk assessments were being kept up to date. We noted that some fire risk assessments were out of date and fire drills were not being carried out and evidenced. Risk assessments are an important management tool, which helps to keep patients and staff safe and should be reviewed and updated regularly to reduce risks.
  • Inspectors highlighted the poor maintenance of first-aid kits, emergency drugs and resuscitation equipment – some included out of date items posing a significant risk to patients.


  • The majority of dental practices needed to improve their documentation when recording staff training and evidencing that all staff had completed mandatory training sessions.
  • Annual appraisals, clinical supervision and staff meetings were often overlooked. We recognise these aspects have been challenging to maintain at times during the COVID-19 pandemic, but practices must continue to prioritise this to support their staff.


  • Through our assurance work, inspectors did note practices had out of date or incorrect information on informative literature including patient care leaflets. Practices should conduct regular audits of materials to ensure the information available to patients and staff is relevant and accurate.

Dental Practices should ensure they take account of the above findings, considering whether they can apply any of this learning to their service to improve the quality and safety of care and treatment that is provided.

Have Your Say

We carry out surveys when we want your views on particular topics.

We have a range of staff and patient surveys now open and we welcome your views on any of the topics.

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

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