Written Statement - Unscheduled Care Winter Pressures

The NHS in Wales, like health services across the UK, has been experiencing significant pressures in recent weeks.

Winter is a very busy period for our health, social care and social services – urgent and emergency care services in Wales, in particular, have experienced significant pressures over the Christmas period and into the New Year. This is not a Welsh problem – the NHS throughout the UK is under pressure as a result of increased demand from an influx of sick patients.

I would like to pay tribute to all health and social care staff across Wales who have worked tirelessly, often in difficult situations, to ensure that those people who have needed urgent and emergency care have received high-quality treatment and services and have been treated with care and compassion.  

Health boards, the Welsh Ambulance Service and local authorities worked closely together throughout 2014 to develop integrated plans for this winter, which focused on staffing cover over the Christmas and New Year period. The plans also focused on maintaining patient flow through the healthcare system, including early discharge planning, timely assessment of care and support needs, reablement and step down provision, as well as re-starting  packages of care automatically to ensure people can be discharged from hospital as soon as they are well enough.

However, despite these robust plans being in place, the pressures have been significant, including:

• GP out-of-hour services experienced their busiest festive period since they were established. In Abertawe Bro Morgannwg University Health Board area, the out-of-hours service received some 1,800 calls on a single weekend between Christmas and New Year;
• The Welsh Ambulance Service saw a significant rise in the most critically-ill patients using its services, with unprecedented levels of demand over recent weeks. Management information indicates that there were 725 category A calls on New Year’s day – an increase of around 225 incidents on what is considered a normal day and a 17.5% increase on New Year’s day in 2014; 
• Hospital emergency departments across Wales have reported an increase in admissions of patients with acute conditions, complex needs and dependency.

The NHS in Wales has seen a rise in the number of elderly patients who have complex needs and chronic conditions who need to be treated at and admitted to hospital. This is particularly challenging for Wales, which has the highest proportion of people over 85 in the UK.  

NHS Wales is treating more acutely ill patients, who have higher levels of dependency, which means they need to spend more time in hospital. This impacts on patient flow through the healthcare system, as people cannot be discharged from hospital as quickly as they would be at other times of the year and there are consequently fewer beds available for patients to be admitted to.

Health boards are ensuring all available beds are used to provide care and treatment for the most poorly patients. This has unfortunately, but inevitably, led to some delays in providing some planned operations to ensure there are beds available for those who require urgent medical attention.

Some health boards have opened extra surge capacity above that identified in their integrated winter plans in response to these pressures, however the service is also considering what further immediate action it can take.

The NHS is also dealing with an influx of people with a range of winter illnesses, including norovirus, viral illnesses, respiratory, cardiac and stroke conditions. We also know that flu is circulating in the community in Wales – there have already been a number of significant flu outbreaks reported in hospital and care home settings. One of the flu strains circulating appears to particularly affect elderly and vulnerable people.

Health boards and Public Health Wales are working together to contain these outbreaks, which includes offering antiviral drugs to people who are sick or at risk of spreading the infection. The Chief Medical Officer for Wales has also advised GPs to offer antiviral drugs to at-risk people who they suspect may have flu and, wherever possible, patients will be treated at home to help reduce pressures on hospital services.

The free flu vaccination is still available to people over 65; those under 65 years who are in an at-risk group; to pregnant women and to children aged two, three and four. Anyone who has not yet been vaccinated should contact their GP or pharmacy to have the vaccine as soon as possible as this will provide protection for the remainder of the season. Frontline healthcare workers can also receive the free flu vaccination, which will ensure they and their vulnerable patients are protected against flu and its complications while also helping to maintain essential healthcare services during this very busy period.

Emergency ambulance service clinicians continue to treat patients at the scene of their illness or injury; stabilise critically-ill patients and take people to and from hospital when appropriate. I have made it clear that health boards must work with their partners in order to reduce handover delays at A&E departments to ensure the ambulance service is able to respond quickly to other people who need emergency or life-saving treatment.

It is testament to the dedication and commitment of NHS, social care and social services staff who have worked hard to ensure our urgent and emergency care services are safely delivered so patients are able to remain at home or can return home as quickly as possible, during times of significant pressure. I would like to take this opportunity to place on record my thanks to all staff for their efforts.

The public can help the NHS by choosing well and considering whether they need to go to A&E when they are injured or unwell or whether another local health service can help or if they can look after themselves with advice from NHS Direct Wales. Our Choose Well campaign can help people decide where to go when they need help; what different NHS services do and when they should be used.

Choosing Well means people get the best treatment for their particular condition and allows busy NHS services to help people who need them most at this time.

NHS Direct Wales can be contacted on 0845 46 47.