24 January 2019
Two world-leading medical organisations have today called on the Welsh Government to speed up their plans to invest in social and community care services, especially those which help to keep older people out of hospital and in their own homes for longer.
Following the publication of the latest accident and emergency waiting time statistics, the Royal College of Physicians and the Royal College of Emergency Medicine are calling on the Welsh Government to deliver a long-term investment in social care and the health and care workforce, or risk the health service failing to meet demand over the rest of the winter and beyond.
As more hospitals find themselves under ‘extreme pressure’, patients are facing longer waits for emergency treatment at the front door of the hospital. Many of those who are well enough to leave hospital remain trapped in the system, unable to go home or move into community care because of a lack of social care capacity and staff.
The longer a person stays in a hospital bed when they should be cared for in the community, the greater the impact on their wellbeing and the more likely they are to lose muscle strength, develop bed sores or even acquire a life-threatening hospital infection.[i]
Almost half of adults in Wales have a long-term illness, and a third of adults say they are limited by illness.[ii] These numbers increase with age, and with the proportion of people over the age of 75 in Wales projected to grow by more than 70% by 2040, and the number of people over 85 anticipated to more than double by 2040,[iii] the time for action is now.
The number of people over 65 who will require social or community care in Wales is predicted to rise by more than 50% by 2030.[iv] Yet if services caring for older and disabled people are not properly funded, all patients across primary and secondary care suffer. People who could and should be supported in the community will remain stranded in GP waiting rooms, in crowded emergency departments or in hospital beds. This not only leads to poorer outcomes for the patient, it significantly reduces the resources available to treat other people.
Dr Jo Mower, vice president of RCEM Wales, said: “Despite the mild winter so far, 3,900 patients spent 12 hours or more in an Emergency Department, from arrival until admission, transfer or discharge – an increase of 4.6% compared to December 2017. Furthermore, four-hour performance in Major Departments has fallen from 74.4% in December 2017 to 73.0%.
“Insufficient social care resources impact on the entire hospital system and contribute to emergency department crowding, ‘exit block’ and delayed transfers of care – all of which are associated with poorer patient outcomes.
“A seamless journey through the system is vital for the wellbeing of patients. We cannot allow vulnerable patients to be subjected to excessively long waits in crowded emergency departments and then struggle to be discharged from hospital into community care because there is too little available capacity.
“Social care is an invaluable resource that should not be underestimated. It means patients can stay closer to home and their families – this is particularly important for Wales given its large rural areas. It means that some patients can keep a level of their former independence. And it often means that patients receive more personal care than hospital staff are able to provide.”
Dr Gareth Llewelyn, the RCP’s vice president for Wales, said: “We’ve been lucky so far this winter. The weather has been relatively mild, and we’ve had no serious flu outbreak. But that doesn’t mean that we’re out of the woods.
“While I welcome the health minister’s plans to explore a social care levy, as well as his promise to invest £180m in integrated health and social care services in Wales, I’m concerned that we’re not moving quickly enough. Many of my colleagues feel that we’re already stretched too thinly. Workforce rota gaps, a lack of bed space and the growing social care crisis are all contributing to a frustrating situation where many people are stuck in limbo because of blockages in the system.
“Of course there are pockets of really good practice, and in my experience, social care teams are working harder than ever – but last month, the number of people waiting to leave hospital in Wales was at its highest for two years.[v] This is increasingly unmanageable.
“Every part of the system is linked, and we can no longer afford to plan and fund health and care services in isolation. To treat people more quickly at the front door of the hospital, we need to help people get home as soon as they are well enough. Everyone is agreed that health and social care should be working together – but things are moving too slowly. We need health boards, local authorities and the Welsh government to speed up the pace of change, with renewed investment in more staff and social care funding.”
[i] Forbes, 4 Ways Hospitals Can Harm You (2014)
[ii] Welsh Government, National Survey for Wales 2016-17: Illnesses (2017)
[iii] Welsh Government, Future funding of social care (2019)
[iv] LE Wales, Future of Paying for Social Care in Wales (2014)
[v] Welsh Government, Delayed transfers of care – Delay length by LHB Provider and delay band (Nov 2018). The November 2018 figure across all health boards/Velindre was 480. The highest figure before that was recorded in November 2016 (485). The December 2018 figure (published today) is 450.