NHS Wales Publishes Key Learning from Healthcare-Acquired COVID-19 Patient Safety Reviews
NHS Wales has published the findings of its national reviews into healthcare-acquired (nosocomial) COVID-19, marking a significant milestone in patient safety, infection prevention and control, and the future resilience of Welsh healthcare services.
The reviews were launched to investigate suspected patient safety incidents from the onset of the pandemic, when the number of healthcare-acquired COVID-19 cases in hospitals and inpatient settings reached unprecedented levels. Between March 2020 and April 2022, NHS Wales identified 18,360 suspected cases of nosocomial COVID-19, underscoring the extraordinary challenges posed by the global crisis.
The National Nosocomial COVID-19 Programme, established in April 2022, brought together health boards, NHS trusts, and the NHS Wales Executive to ensure a consistent and high-quality approach to investigations. Its mission: to provide answers to patients, families, and carers, while embedding lessons that will shape safer, more resilient healthcare across Wales.
A Lasting Commitment to Patients and Families
Jennifer Winslade, Executive Director of Nursing at Aneurin Bevan University Health Board, expressed her condolences and gratitude:
“On behalf of NHS Wales, I want to extend my deepest sympathy to all those who lost loved ones after acquiring COVID-19 in healthcare settings. The impact is profound and cannot be underestimated. I also want to thank the families and carers who engaged with this difficult review process. Their voices will have a lasting impact on how we shape safe and compassionate healthcare in Wales.”
Learning That Drives Change
The reviews identified national learning themes that will directly influence patient care, infection prevention, and service delivery. Key areas include:
- The value of bereavement support services and compassionate care after death.
- Stronger communication with families and carers, especially during periods of restricted visiting.
- Addressing inequities in how patients experience the concerns process across independent and NHS providers.
- Improved approaches to infection prevention and control (IP&C) guidance and outbreak management.
- Investment in staffing, resources, and resilient healthcare infrastructure to strengthen future patient safety.
- Enhanced standards for clinical record keeping, with greater use of digital solutions.
- Better communication and practice around Do Not Attempt CPR (DNACPR) decisions.
These insights have been summarised in the National Nosocomial COVID-19 Programme End of Programme Learning Report, now available for healthcare professionals and the public.
Building a Safer, Resilient NHS Wales
A spokesperson for the NHS Wales Executive emphasised ongoing commitments:
“The National Nosocomial COVID-19 Programme has been pivotal in identifying lessons and embedding improvements across health boards and trusts. While the programme has concluded in its current form, NHS Wales remains firmly committed to strengthening patient safety, improving infection prevention and control, and ensuring every learning opportunity shapes a safer, more resilient health service.”
Moving forward, NHS Wales organisations will continue to investigate suspected healthcare-acquired COVID-19 cases beyond April 2022 as part of their statutory duties, ensuring transparency, accountability, and continuous improvement.
Towards a Stronger Future for Welsh Healthcare
As Wales continues its recovery from the pandemic, NHS Wales has reaffirmed its vision to deliver safe, effective, and modern healthcare services, underpinned by robust infection control, better communication, and greater resilience.
This national programme highlights not only the challenges faced during COVID-19 but also the opportunities to transform services—ensuring that the experiences of patients and families lead to meaningful change for future generations.
