COVID-19 response and our approach to assurance and inspection

During the COVID-19 pandemic, it is our continued commitment and goal at Healthcare Inspectorate Wales (HIW) to check that people in Wales are receiving good quality care, which is provided safely and effectively, in line with recognised standards. We recently published a position statement that sets out the principles that underpin our approach during this period and the actions we have has taken in response to the outbreak. It also sets out how we are adapting our approach to delivering our functions as we move through the pandemic, and as restrictions are eased, to ensure it is both proportionate and appropriate.

Over the past few months we have been considering new ways of working which will give us flexibility and agility in delivering our role over the coming year and I am now at a point where I can share more detail of this approach.

We are planning and refining our routine work programme on an ongoing basis and will be piloting our new way of working for the three month period from August to October. Towards the end of this period we will evaluate the approach to ensure it is appropriate and is meeting its aims and objectives.

I’m acutely aware that we have had to move quickly to adapt as an organisation and this has not allowed us to engage with you about our approach in the way I would have wished. That said, our core role of checking whether standards and regulations are being met continues to be central to our approach. The new methodology and inspection approach will allow us to deploy our resource in a more agile way, responding to specific risks and issues whilst taking account of revised operating models during the pandemic.

A key feature of our new approach will be the use of a three-tiered model of assurance and inspection that reduces the reliance on onsite inspection activity as our primary method of gaining assurance.

Tier 1 activity will be conducted entirely offsite and will be used for a number of purposes but, at this stage, primarily where issues cannot be resolved via our standard concerns process and where the risk of conducting an onsite inspection remains high. Tier 2 will introduce a combination of offsite and limited onsite activity, whilst Tier 3 will represent a more traditional onsite inspection.

We always reserve the right to conduct a full inspection at any time, but we expect the majority of our work to be Tier 1 throughout August and September. For this activity, where work is announced, there will be a shorter lead in time (at least 7 working days), a smaller inspection team with most of the assurance work being completed through a request for information, and a follow-up phone or video call with key personnel. Following a short period of factual accuracy checking, there will be a written summary and, where required, an improvement plan. We will publish the summary report as soon as possible after the activity has taken place and the accuracy checking has been completed.

This approach will enable us to seek assurance from services at a time when on-site inspection visits are far more challenging for both healthcare settings and ourselves. It also provides an incremental approach that in future will provide more flexibility by offering a wider range of methods for conducting our work.