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Reflections from our ‘Regulation and the Welsh context seminar 2022: Systems under pressure: protecting patients through challenging times’

At our seminar last month, hosted jointly with the Welsh Government, we looked at the pressures facing professionals and the system in keeping patients safe throughout the pandemic and beyond. We heard from speakers at the Royal College of Nursing, the Health and Care Professions Council, the Board of Community Health Councils and Healthcare Inspectorate Wales as well as the Chief Medical Officer for Wales.      

Attendees considered how best to support professionals in Wales to better protect patients, clients and the public. Amongst the overarching themes of the day was the need for a consistent, flexible and agile approach to regulation alongside the need for a Welsh ‘voice’ in regulation and how to get the balance between these.

Speakers and attendees reflected on how system pressures have affected professionals, and the implications that this has on practice. Currently there is a 1,709 shortage of nurses in Wales. The astonishing response by nurses and other professionals throughout the pandemic was recognised, yet 70% of nurses who responded to the RCN survey said they feel undervalued, both by the rate of pay, and the pressure on the profession.

There was discussion on some of the actions taken by regulators to support registrants and the health system during the pandemic, including establishing temporary registers of students and returners to boost the workforce and supporting people to return to work safely. This included empowering registrants to expand their scope of practise and to deliver roles remotely.

The pandemic also brought about an increased focus by regulators on registrant wellbeing and reducing the regulatory burden, in some cases suspending revalidation and Continuing Professional Development requirements. There was also reassurance provided to registrants that context would be considered in any fitness to practise proceedings. We reported on a number of the these actions taken by the regulators during the first wave of the pandemic in our Learning from Covid-19 review published last year.

However, regulators highlighted that there was a challenge now in how to return to business as usual. Registrants are tired and there has been a huge impact on mental and physical health. A key aim is to reduce the risk of harm occurring, and a key factor in this is the working environment, regulators are seeking to work with stakeholders to improve the working environment for registrants and provide more support including working with employers to improve workplace culture and developing new resources around reflective practise. These ‘upstream’ actions, colleagues discussed, should help to prevent problems occurring and avoid an increase in fitness to practise cases relating to health and conduct.

The seminar moved on to look at the effects of system pressures on the patient experience, with a video portraying the different patient experiences of the healthcare system during the pandemic first-hand – from a father of a young boy who had broken his arm, to a woman’s experience of pre/post-natal care. These personal accounts were largely positive, and at times, emotional broadly showing how thankful service users have been for the care they have received during the pandemic.

The theme of patient and public experience and views about the care they receive was discussed. It was also noted that the public are very aware of the pressures on professionals during the pandemic and there may be a culture appearing where some patients feel they should not be complaining about the NHS.

The view was expressed that the special tolerance by the public during the Covid-19 pandemic may eventually fall away. The British Social Attitudes survey results, published by the Kings Fund and the Nuffield Trust at the end of March, appear to support this view with public satisfaction with the NHS at its lowest level in 25 years, despite strong support for NHS principles.

Research carried out by the Patients Association also demonstrates that patient access to care, experience and confidence in services has been impacted badly by the pandemic. The need to encourage people to come forward in the wake of the pandemic and learn from their experience was discussed by those present at the seminar.

The risks in care environments were another key area of discussion at the seminar and how these affect both patients and professionals. It was emphasised that safety in health and care settings is paramount – you can’t expect to keep patients safe if you can’t keep staff safe. Pressures on professionals which might make it more difficult for them to provide safe care included understaffing and perceptions of that regulation is punitive.   

Key suggestions from speakers for opportunities we should not miss to improve patient safety included:

  • supporting providers to manage concerns locally
  • collaborating over data on concerns with other bodies and the NHS
  • learning from complaints and clearly communicating with patients and the public about what has changed as a result
  • a great role for professional bodies in standard setting
  • more support for professionals through the curriculum
  • clarity on the role of nursing supervision
  • the extension of safe staffing duties in Wales.


The session highlighted the scope for system and professional regulators and other stakeholders to work together to address these issues to make both staff and patients safer and solidified the mutual interest that we all have in ensuring patient safety during such challenging times. We look forward to continuing to engage with stakeholders in Wales and elsewhere on these issues over the next year and at next year’s seminar. 

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Please note the views expressed in these blogs are those of the individual bloggers and do not necessarily reflect those of the Professional Standards Authority.