A Healthcare Inspectorate Wales (HIW) report has found that health services in Wales are “stretched to the limits” with staff “working under immense strain, often in environments that are not fit for purpose.”

In its annual report for 2024/25 released on 16 October, HIW said the more than 150 inspections it carried out during the year showed the extent of issues within the healthcare system in Wales.

It showed mental health services that were not fit for purpose, emergency departments where patients wait in corridors, and maternity services where staffing issues are leading to compromised safety.

The HIW inspections of GP practices, emergency departments, maternity units, and mental health services “reveal a system stretched to its limits,” the report said.

The report “draws attention to a system under sustained pressure, where dedicated staff continue to deliver good care in difficult conditions, but where risks to patient safety persist, and improvement is not always sustained.”

“Staff are working under immense strain, often in environments that are not fit for purpose,” the HIW report outlined.

The report identifies “recurring risks and a concerning pattern of previously identified issues resurfacing,” HIW identified.

“Emergency departments where patients wait in corridors, maternity units compromised by staffing gaps, and mental health wards with unresolved safety risks are not isolated incidents, they are symptoms of wider systemic strain,” HIW said.

“Welsh Government’s Six Goals for Urgent and Emergency Care programme is targeting many of the root causes of these system challenges, increasing access to same-day emergency care, improving discharge processes, and supporting a home-first philosophy,” it added.

“Whilst it is encouraging to see that urgent care delivery is being reshaped, patient demand continues to be high, with this often impacting on patient experience.

“While services often respond positively to scrutiny, action taken is not always sustained.”

The report calls for sufficient resources, effective local leadership, and robust governance to ensure high standards are not only achieved but maintained.

Mental health services “continue to face long-standing and significant challenges”, the report found, with 36 per cent of mental health inspections triggered immediate assurance or non-compliance processes.

HIW said it “remains deeply concerned about the condition of the estate in many NHS mental health facilities.”

“For mental health patients, the physical environment is not a superficial issue it is central to the delivery of effective and therapeutic care,” HIW said.

The report calls for urgent investment and a national commitment to improve environments of care.

The report finds that the independent healthcare sector in Wales continues to grow, with 60 new services registered this year, reflecting increasing demand and diversification, particularly in cosmetic procedures, laser treatments, private dentistry, and GP services.

“However, with growth has come risk,” the report said.

“In 2024/25 HIW issued more urgent enforcement actions in the independent sector than ever before,” it said.

“Many involved smaller providers entering the market without a clear understanding of their legal responsibilities or the standards required to keep people safe.

“The independent healthcare sector is evolving, and it is concerning that there are an increasing number of emerging services which fall outside the scope of the current regulations and therefore HIW’s remit.”

HIW’s regulatory activity in the independent sector in 2024–2025 has been “fair and decisive”, the regulator said

“We have suspended unsafe services, escalated serious concerns, and launched criminal investigations into unregistered providers,” the report outlines.

“At the same time, HIW has supported services to improve through targeted monitoring, guidance, and follow-up.

This year, HIW conducted 50 dental inspections, resulting in nearly 600 recommendations for improvement.

In addition, 18 clinical reviews of deaths in custody were carried out to assess the equivalence of care in prison settings.

The report says that HIW’s role is “not only to challenge poor practice, but to highlight good practice and help the system improve.”

“However, unsafe care must not be tolerated whether delivered by the NHS or an independent provider,” HIW said.

“Everyone in Wales deserves the same standard of safety, dignity, and respect.”

The report says that over the past year, HIW received 743 concerns, marking a 21 per cent increase from the previous year and a 102 per cent rise since 2019–20.

Alongside this, 120 whistleblowing disclosures were made, up 36 per cent, “pointing to deeper issues in leadership, governance, and organisational culture,” the report said.

“These figures reflect the growing urgency and complexity of the challenges facing healthcare in Wales,” HIW said.

Alun Jones, Chief Executive of HIW, said the NHS Wales “is at a critical juncture”, but the “challenges are not new”.

“We have seen emergency departments where patients wait in corridors, maternity units where safety is compromised by staffing gaps, and mental health wards where serious patient safety risks remain unresolved.

“What remains a significant concern is the recurrence of issues we have previously identified.

“There is no doubt at all that healthcare services respond well to the challenge that HIW provides. “However, action taken is not always embedded or sustained.

“Sufficient resources and effective local leadership and governance are the key to sustaining high standards in healthcare.”

Mr Jones said that Mental Health services” continue to face significant and, in many cases, long standing challenges.”

“We continue to be concerned about the condition of the estate in many NHS mental health services,” he said.

“This is not a new issue.

“It has been a recurring theme across our inspections for several years.

“Some facilities remain so outdated and degraded, that they would not meet the standards required for registration as independent mental health providers.

“Some of these environments are not conducive to therapeutic care.

“They fall short of providing the safety, dignity, and therapeutic stability that people need to recover and feel supported.”

Mr Jones said that “strategic investment in mental health services is essential” and called for “urgent investment in mental health care across Wales, and a national commitment to improve service access and delivery.”

HIW published its Annual Report for 2024-25 on 16 October, which it says offers a “clear and independent assessment of healthcare services across Wales.”

HIW said the report “draws attention to a system under sustained pressure, where dedicated staff continue to deliver good care in difficult conditions, but where risks to patient safety persist, and improvement is not always sustained.”

HIW carried out 163 inspections across NHS and independent healthcare services in 2024/25, informed by the voices of 3,407 patients, carers and members of the public, and 1,657 staff.

“These insights continue to shape HIW’s priorities and ensure that scrutiny is focused where it matters most,” the report said.

“This report is not just a record of our work - it is a challenge to the system to do better,” Mr Jones said.

“This year, we have seen a healthcare system under immense pressure, but pressure cannot be a reason for quality and safety to be compromised or normalised.

“Our work has uncovered many positive findings, with services that are compassionate, safe, and person-centred.

“However, we also found environments that are unsafe and systems that are being stretched to their limits.

“Everyone in Wales deserves safe, dignified, and effective healthcare, and HIW will continue to challenge, support, and drive improvement wherever it is needed most.”