Welsh language in healthcare inspections: Insights and progress

HIW has a direct role in supporting the delivery of two actions in the More Than Just Words Action Plan, these are :

• Action 10 : Taking account of the Welsh‑language workforce planning guidance in our work.
• Action 38:   Ensuring the active offer is embedded within our inspection activity and directing underperforming organisations to support and advice.

We have integrated Welsh language workforce planning considerations into our inspection methodology. This includes a bank of questions embedded across all inspection workbooks, covering Welsh language skills, communication needs, and accessibility.

Inspection questions cover:

• Are Welsh‑speaking staff identifiable?
• Are staff supported to develop Welsh‑language skills?
• Does workforce planning consider Welsh‑language need in the service?

We routinely review bilingual communication practices, signage, materials, and staff identification. We also check whether services ask and record patients’ preferred language, which is a recurring weakness.

Inspection questions cover:

• How is language preference established?
  • Is written information available bilingually?
  • Is the Active Offer visible and proactive?
  • Are Welsh speakers identifiable to patients?
  • Are translation/interpretation services used appropriately?

Our findings feed into formal recommendations and follow‑up monitoring.

Good Practice:

Inspectors found that patients were routinely asked about their language preference, helping to support more personalised care. Staff were confident in using Welsh, and its use in day-to-day interactions contributed to a more positive experience for patients.

Communication was consistently respectful and inclusive, with Welsh used appropriately between staff and patients. Bilingual information materials were also available, ensuring patients could access important information in their preferred language.

Areas for improvement:

There was limited evidence of senior-level assurance and oversight of Welsh language provision, indicating that governance arrangements require strengthening. Welsh language support was not consistently embedded, with a lack of clear systems and processes to ensure a standardised approach.

In addition, visual cues, communication aids and identifiers such as Iaith Gwaith badges were inconsistent or lacking, making it difficult to identify Welsh-speaking staff. There were also limited numbers of Welsh-speaking staff, and the Active Offer was not routinely implemented. Overall, clearer and more robust systems are needed to identify and support patients’ language needs, including improved identification at admission, better access to interpretation services, and stronger workforce development to support Welsh language skills and embed the Active Offer.

Good Practice:

Welsh-speaking staff were clearly identifiable through the use of Iaith Gwaith lanyards, and bilingual information was consistently available to support patients. Translation services were also used where required, ensuring patients could access care in their preferred language.

Communication was respectful, supportive and person-centred, with patients’ language needs actively recorded and considered. There was strong evidence that Welsh was used naturally in interactions, with patients able to communicate confidently in Welsh and access bilingual information throughout their care.

Areas for improvement:

There was limited evidence that Welsh was routinely used, and the Active Offer was not clearly promoted or consistently monitored across services. In some cases, it was not evident how patients’ language preferences were recorded or used to inform care planning, and feedback suggested that communication could be more consistent.

Additionally, not all Welsh-speaking staff were easily identifiable, as Iaith Gwaith badges were not consistently worn, reducing the visibility of Welsh language provision. Overall, improvements are needed to strengthen the promotion and monitoring of the Active Offer, ensuring greater consistency in communication, and reinforcing expectations around the visibility of Welsh-speaking staff.

Good Practice:

Bilingual information and translation support were provided across a number of services, helping to ensure patients could access care in their preferred language. Welsh-speaking staff were available or easily identifiable in some settings, supporting clearer communication and improving patient experience.

In stronger examples, patients’ language preferences were actively recorded and used to inform care. The Active Offer was more proactively embedded in these services, with evidence of well-developed accessibility measures and a consistent approach to supporting Welsh language needs.

Areas for improvement:

The Active Offer was found to be weak or inconsistently applied across a number of services, with limited evidence that patients’ language preferences were routinely recorded or used to inform care. This lack of consistency suggests that Welsh language needs were not always systematically considered in service delivery.

There were also gaps in the visibility and availability of Welsh language provision, including limited bilingual signage and inconsistencies in information materials. Some services had few or no Welsh-speaking staff, reducing opportunities for patients to communicate in Welsh. In addition, reliance on informal translation methods in some cases posed risks to the quality and accuracy of communication, highlighting the need for more robust and reliable support arrangements.

Good practice:

There was strong visibility and integration of the Welsh language in several services, with bilingual signage, and Welsh routinely used in interactions. In other settings, Welsh-speaking staff were available, and some bilingual materials were in place, helping to support patient choice and access to care in their preferred language.

Areas for improvement:

Language preferences were not consistently recorded across a number of services, indicating that patients’ communication needs were not always systematically identified or considered. The Active Offer was also found to be weak or absent in several cases, often linked to limited bilingual signage and a lack of visible Welsh language provision.

In addition, there were gaps in the availability of printed bilingual materials and inconsistencies in staff training to support Welsh language needs. Overall, these findings highlight the need for a more consistent and structured approach to recording language preferences, strengthening the Active Offer, and improving both the visibility of Welsh language provision and staff capability.

From September to December 2025, we launched our Strategy 2026–2030 consultation. Over 12 weeks we received over 1,300 responses.

The consultation responses reflected a deep call for improving healthcare in Wales. Alongside recognition of staff who provide dedicated, compassionate and person‑centred care, respondents shared clear views about the challenges they face in accessing healthcare services in Welsh, reporting inconsistent access to Welsh medium care, with the Active Offer not reliably delivered in practice. 

While many staff go above and beyond to communicate in Welsh, wider system issues such as shortages of bilingual staff, low confidence, and uneven training means that lived experience frequently falls short of standards. 

People strongly linked language choice to dignity, clarity and person-centred care, and expressed a desire for clearer consideration of Welsh language within inspection, reporting and workforce planning. They emphasised that meaningful improvement requires more consistent, practical Welsh language provision across services.

Across our inspection work, there is clear evidence of compassionate care and pockets of good Welsh language practice. However, Welsh language provision remains inconsistent and too often reliant on individual staff rather than embedded, systematic approaches.

Our Strategy consultation reinforced this, highlighting uneven access to Welsh-medium care, inconsistent delivery of the Active Offer, and barriers such as limited bilingual capacity, low confidence and variable training. Respondents also called for HIW to be more visible, confident and proactive in addressing Welsh language issues, recognising its importance to dignity, understanding and safety.

This also means raising the profile of Welsh language in our assurance work, improving how we report and follow up on findings, and ensuring our staff understand the practical importance of More than Just Words.