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Insight Bulletin - Spring Update 2022

Insight Bulletin March 2022 - Magnifying glass on purple background

Welcome to the new Insight Bulletin 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, regularly proactively engage and report on our activity.

Read on to find out what we have been up to recently.

Activity Update

Approach to our work

Following the move to alert level 0 across Wales on 28 January 2022, we resumed all routine NHS onsite inspections and continued to risk assess every piece of planned assurance and inspection work. Our work programme for independent healthcare settings and dental practices remained unchanged.

We would like to thank NHS teams and independent health providers and staff for their continued commitment over this time, and for continuing to engage positively with our work despite other pressures.

Planning our programme for 2022-2023

We have recently completed our planning for the 2022-2023 inspection year.

Our planning process is risk based and complex, taking information from many areas. We analyse:

  • National and local level intelligence
  • Known specific risks to patient safety
  • Review of previous inspection results
  • Current/emerging risks in the sector.

In the independent healthcare sector, we also consider our statutory responsibilities and how we will meet our targets for inspection frequency.

We prioritise our assurance and inspection work, to ensure our resources are directed at areas where there is significant risk to patient safety. We also consider where we can make the most impact. For example, a review of a service may take more resources, but our recommendations for improvements could have a greater positive impact on patients. Our full inspection and review plan is thoroughly challenged and scrutinised through our internal governance mechanisms.

Escalation and Enforcement Work

HIW uses legal powers

Following a recent criminal investigation relating to an unregistered service, HIW has issued a simple caution for a breach of section 11 of the Care Standards Act 2000.

As the regulator of independent healthcare services in Wales, HIW is committed to taking action when standards are not met. In order to ensure that patients receive safe effective care HIW will take action when an independent healthcare provider does not comply with the regulatory requirements.

If you have information about an unregistered healthcare provider in Wales please let us know by using our online form.

If you are thinking of providing a health service in Wales and are not yet registered with us, you may be required to register with us before providing services. You can register either as an individual or as an organisation.

We have produced guidance which will help you to decide whether you need to register with us. This is provided as a general guide only. Healthcare services are provided in a number of different ways and by a variety of healthcare professionals. Where there is any doubt that registration may be required, you are advised to contact HIW for advice by completing and submitting a Registration Query Form.

More information can be found on our website.

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Service Requiring Significant Improvement – Vascular Services Betsi Cadwaladr University Health Board

As of 21/02/2022 we have designated Vascular Services at Betsi Cadwaladr UHB as a Service Requiring Significant Improvement.

The Royal College of Surgeons Clinical Record Review Report, published on 20 January 2022, identified a number of concerns that indicate a risk to patients using the vascular service.

These concerns relate to:

  • Poor Multi-Disciplinary Team (MDT) working
  • Poor documentation and record keeping
  • The quality of clinical care.

The Service Requiring Significant Improvement designation enables us to plan and deliver future activities necessary to gain assurance about the quality and safety of care in that service. We will be working with the health board to ensure improvements are made in a timely manner. This status will be updated once HIW is satisfied that necessary improvements have been achieved.

More information relating to this can be found on our website.

Assurance and Inspection Programme Update

Since December 2021 we have published over 60 reports from our assurance and inspection work to a range of services from laser clinics to inpatient mental health hospitals and emergency departments. Of note amongst this were two Emergency Department inspections which clearly highlight not just individual patient safety issues, but how pressures on the wider system are affecting patient flow through hospitals, and so placing significant demand on Emergency Departments. Our full reports can be accessed on our website. 

Our reports

All published reports can be found on our website - Find an inspection report

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

New Reporting Style

We have concluded a project to implement a new reporting style for onsite inspections. This new approach will be implemented in April 2022, and will involve publishing a public summary and a full detailed report for the setting. We have also reviewed how we report to remove unnecessary duplication.

Methodology Updates

There has been ongoing work to develop and enhance current methodologies.

We have developed a new methodology which will be used for onsite mental health inspections and we are in the process of developing a new methodology which we will use to explore the quality of GP practices.

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National Review of patient flow – Stroke Pathway

We are currently undertaking a National review to assess the impact on patients of any delay in assessment or treatment. We are using the stroke pathway to assess the quality of a patient’s journey. We want to understand what is being done to mitigate any harm to those awaiting care and how the quality and safety of care is being maintained throughout the stroke pathway.

If you, a family member or friend have suffered a stroke within the last few years, please complete our short survey.

Your experience will help us to identify good practice and improvements where required, to provide better care for patients in Wales.

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

A range of information sources considered by HIW have indicated concerns around mental health services within Cwm Taf Morgannwg University Health Board (CTMUHB). We have therefore decided to undertake a local review which will aim to examine the quality of mental health services provided by CTMUHB.

Read our terms of reference on our website.

We have now published our National Review of Mental Health Crisis Prevention in the Community.

HIW explored the experiences of people who access care and treatment, to understand how services help them to manage their mental health conditions and prevent crisis. The review also considered how GPs and other NHS services across Wales provide safe and effective care to help prevent mental health crisis, and what third sector organisations do to support this.

Some of the key findings from the report:

Inefficiencies in process – HIW’s review found that referral processes can be complex, leading to potentially lengthy waiting times, during which individuals lack sufficient support.

Committed staff - Those working within healthcare, emergency and third sector services and across Wales are committed and dedicated to providing support and care to people with mental health needs.

Business Update

Strategic Plan 2022-2025 Published

Today 31 March 2022 marks the launch of our new strategic plan for 2022 – 2025. It has been developed through consultation with our own staff, with stakeholders and members of the public.

Alun Jones Interim Chief Executive said:

'Our vision for the next three years recognises that we must remain an agile organisation, one which is able to adapt our work and use our resources most effectively to deliver our goal: to be a trusted voice which influences and drives improvement in healthcare. We will consider the quality of healthcare as it is delivered to people as they access, use and move between services. We will need to work collaboratively with others, harnessing the insight, understanding and expertise they bring, in order to help us consider a whole-system approach and deliver against our goal.'

Our goal as an organisation over the next three years is:

To be a trusted voice which influences and drives improvement in healthcare

Our priorities

  • We will focus on the quality of healthcare provided to people and communities as they access, use and move between services.
  • We will adapt our approach to ensure we are responsive to emerging risks to patient safety
  • We will work collaboratively to drive system and service improvement within healthcare
  • We will support and develop our workforce to enable them, and the organisation, to deliver our priorities.


We have been very busy on the recruitment front. This includes recruiting over 20 new Peer Reviewers in a variety of specialisms in preparation for our 2022-2023 inspection and review programme. In addition, we have recruited a number of new staff to the organisation to fill vacancies in our Inspection team, Strategy & Engagement team, and Registration team.

Our inspection team have also had a recruitment drive underway over the last quarter, taking on new inspectors at both Healthcare Inspector and Senior Healthcare Inspector grade. Our Senior Healthcare Inspectors lead our more complex inspections, such as hospital wards and mental health units. Our Healthcare Inspectors lead our inspections of dentists, GPs and laser clinics. They also support our Senior Healthcare Inspectors on the more complex inspections. Our inspectors have a wide variety of backgrounds, many are registered nurses from different disciplines, but all have strong inspection/regulatory experience.

We’ve launched on LinkedIn

HIW is now live on LinkedIn, connect with us and find out about our latest job vacancies. We’ll also bring you snapshots of current news and important updates. Whether you’re looking for a job vacancy, more information about HIW or want to stay connected with us, please do follow our LinkedIn page.

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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