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Shared reflections ahead of the winter period - Joint HIW and CIW Letter to all Health Boards, NHS Trusts and Local authorities

The Chief Executives of Care Inspectorate Wales and Healthcare Inspectorate Wales, Gillian Baranski and Alun Jones, have jointly written to the chief executives of local authorities, health boards and NHS trusts across Wales to share some of the key issues that have arisen in their work over the past six months. It is clear that issues highlighted will need to be tackled both nationally and locally and the intention is that they will be considered in planning and improving for what will no doubt be a challenging winter period for the health and social care system in Wales.

The letter highlights a number of areas including the importance of easy and timely access to personal protective equipment and to COVID testing, as well as training in infection prevention and control. The inspectorates also emphasise that people receiving health and social care, or their families or advocates, must be involved in decision-making about that person’s care. Recognising that health and social care staff have been stretched and the effect that a difficult period such as this can have on staff wellbeing, senior figures are urged to support and encourage staff to speak up.

The full text of the letter is included below.


To Chief Executives of all Health Boards, Trusts & Local Authorities in Wales

2 October 2020

Dear Chief Executive

Shared reflections ahead of the winter period

This past year has been an unprecedented period for health and social care services in Wales. Public services have risen to meet the challenge posed by the coronavirus pandemic. It has been positive to note improved partnerships between health bodies and local authorities, working together, with agility, towards the common goal of ensuring the impact of the pandemic can be managed.

As all organisations look to reflect and learn from their response to the pandemic over the past 6 months we have worked together as inspectorates to consider and share some of the most significant issues from our own work and those that have been raised with us. These issues need to be tackled both nationally and locally and our hope is they will be considered in planning and improving for what will no doubt be a difficult winter period for the health and care system. These are:

  • The importance of a rights-based approach, ensuring people receiving social and health care, and their families or advocates are involved in decision making. This includes recognising the benefits of robust advance care planning processes, including ensuring that decisions or considerations of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), are taken on an individual basis and in the best interests of the person


  • Recognising, and minimising as far as possible, the impact that not being able to see family and friends has on the mental well-being of many people


  • The importance of having a co-ordinated communication strategy that minimises duplication and clearly highlights key issues and changes to guidance


  • Ongoing access to infection prevention and control training and support


  • Ensuring easy access to sufficient personal protective equipment (PPE), with clarity about its use


  • Ensuring easy access to testing with timely turnaround of results


  • The importance of support networks for managers and care workers recognising the isolation of the many small providers in Wales


  • The importance of continuity of staffing because of increased risk of agency staff transmitting the virus if they are working across different services


  • Recognising that providers are partners in care, especially in relation to hospital discharge, as are family members for many people. Acknowledging successful discharge occurs with coordinated communication, essential timely discharge planning and the receipt of detailed and timely discharge information. Taking appropriate steps and measures across the health and care sector to ensure that the care sector, receives adequate and timely input from primary care, in particular from GPs


  • Ensuring the safe and timely transfer of patients by ambulance, whether these patients require hospitalisation from a care home setting, or discharge from hospital back into care settings.


We recognise the resilience of staff working in health and social care services has been stretched and supporting their well-being in the coming months is vital. As part of this, we reiterate the importance of supporting and encouraging staff to speak up about what is working well and when they have concerns.

We will continue to use information and concerns raised by people working in, or using heath and care services, to inform our work. It is the intention that our own activities in the forthcoming year will focus on many of the aspects included in this letter.

We will also continue to work jointly as inspectorates to highlight any emerging issues as early as possible, to positively contribute to the ongoing management of the pandemic.

Yours sincerely


Alun Jones                                                                        Gillian Baranski

Interim Chief Executive                                                    Chief Executive

Healthcare Inspectorate Wales                                       Care Inspectorate Wales


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