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Mark Drakeford, Minister for Health and Social Services

First published:
8 January 2015
Last updated:

The findings and recommendations made by Ruth Marks, the former Older People’s Commissioner for Wales, following her independent review of the role and function of Healthcare Inspectorate Wales (HIW), are today being published.

This review, commissioned by the Welsh Government, has provided a timely assessment of whether HIW’s current regulatory and inspection work needed to be reformed and improved. It was important that the review not only looked at HIW itself, but also considered the experiences of, and lessons from, inspectorates elsewhere in the UK as well as taking into account wider related work on audit and inspection and public services reform in Wales and the potential implications of this for the operation of HIW.

In light of this agenda, Ms Marks was asked to develop proposals to inform a future Green Paper setting out the scope of a future Bill, which will be brought forward by the Welsh Government, later this year. She was also asked to make recommendations about any immediate actions she felt should be put in place ahead of any legislative changes which may be required.

In her report, The Way Ahead: To Become an Inspection and Improvement Body, Ms Marks concludes the role and function of HIW is largely fit for purpose. She acknowledges that HIW is a complex regulator, responsible for regulating and inspecting a substantial number and variety of health bodies across the NHS and the independent sector.

Importantly, she reminds us that the delivery of high-quality and safe care cannot be assured by the inspectorate alone – we must accept that healthcare regulation and inspection can only ever be the third line of defence against serious quality failures. The first line of defence is formed by frontline professionals themselves and the second by the boards and senior leaders in our health boards and NHS trusts.

However, the report’s findings and recommendations stress how this third line of defence can be strengthened further. This includes greater collaboration and joint working with other inspectorates and review bodies to help facilitate greater sharing of intelligence and the development of proportionate risk-based inspection programmes.

In particular, the report advocates the need for HIW and the Care and Social Services Inspectorate Wales to work together to develop an integrated inspection framework to scrutinise the performance of health and social care organisations. Ultimately, the Welsh Government will consider whether the two inspectorates will merge in the longer term.

The report also proposes strengthening joint working with community health councils (CHCs), including, CHC members providing the lay element of HIW inspections in the future.

The report focuses on the need for HIW to drive shared learning and promote improvement and proposes it undertakes more thematic reviews as a key vehicle to achieve this. It also recommends steps to develop greater synergy and application of common standards across the NHS and independent healthcare sector.

There are four areas where Ms Marks recommends that consideration should be given to functions being removed from HIW. These include functions relating to the supervision of midwives; carrying out mental health homicide reviews; contributing to the investigation of deaths in Welsh prisons for the Prison and Probation Ombudsman and the assessment of nurse agencies.

Overall the report makes a total of 42 recommendations which are captured under eight key themes. Of these, 25 are directed at HIW, 14 at Welsh Government and three are for joint consideration. These include possible actions to strengthen the independence of HIW.

I would like to thank Ruth Marks for her comprehensive and thorough report. The Welsh Government will consider her findings and recommendations carefully in order to inform any proposals to be brought forward in a Green Paper for future legislation aimed at building and strengthening a culture of continuous improvement and quality for all care provided to people in Wales.

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Assembly returns I would be happy to do so.