Written Statement: Preparations for winter and new emergency care measures

I would like to take this opportunity to update Members on how NHS Wales, local authorities and other partners are planning to deliver resilient services for the forthcoming winter period, and on new emergency care measures which will trialed over the winter.

Consistent with significant pressures experienced across the UK, it has been, and continues to be, a very difficult period for front line staff working in the Welsh NHS. I would like to offer my sincere thanks to staff across health and social care services for their dedication and commitment during the difficult winter period, and throughout the year.

Last winter was milder and less severe than the previous winter, though activity levels for key services remained high at key points of the season. We saw more people attending emergency departments, including a greater number of older frail people self-presenting with acute needs at Emergency Departments (ED), and an increase in both acute respiratory illness (ARI) and gastrointestinal illness outbreaks in hospitals.

Despite these pressures, we observed that rigorous national and local planning was able to strengthen resilience to maintain safe and timely services. Hospitals across Wales reported considerably less time spent at the highest level of escalation, when compared to the previous year, and when sites did experience increased pressures, they were generally able to recover and de-escalate more quickly.

I was encouraged to note that the vast majority of people who needed an immediate ambulance response or assessment and treatment in an ED were supported in a timely manner, and primary care services generally reported pressures were better managed.

As I have previously stated, system-wide pressures on health and social care services are a year-round experience, and recent months have seen our services responding to pressures at similar - and in some cases higher - levels than we would usually expect to see over the winter. These pressures have impacted on key performance indicators for urgent and emergency care services, such as ambulance patient handover, time spent in emergency departments and delayed transfers of care. These challenges are often exacerbated by capacity issues in other parts of the system and demonstrate a pattern of increasing level of demand on our services.

Winter presents a very particular set of challenges, and it is important that we learn lessons from previous winters - not only to plan for the winter ahead, but to take a longer-term view to planning for these types of year-round pressures. In line with ‘A Healthier Wales’, this must be done by exploring new models of care and embedding successful initiatives into core services.

Timely access to urgent and emergency care is a whole-system issue that is significantly affected by community, social care, primary care, domiciliary and residential home care and preventative care services, and vice versa. I have been clear with NHS Wales and local authorities, therefore, that planning for winter must draw in partners from across the health and social care system to ensure seamless care for all patients and service users.

Preparations for winter are well underway and we have shared learning from last winter with system leaders to inform this planning. In June, we held a multi-stakeholder winter delivery workshop, which brought together clinical and operational leads from across health and social care to collaboratively review winter delivery and develop priorities for winter 2019/20.

To support local planning, the Welsh Government has undertaken a review of delivery of urgent and emergency care services over winter 2018/19, drawing on input from a range of sources including patients, local health boards, NHS Trusts, local authorities, third sector organisations and professional bodies.

A copy of the report can be found at the link below:

https://gov.wales/national-review-delivery-urgent-and-emergency-care-over-winter-2018-2019

Taking learning from this review of winter 2018/19, and feedback received from the winter delivery workshop, a small number of themes have been developed with clinical and operational leads from across the health and social care system for local organisations to deliver over the remainder of 2019/20, with a particular focus on winter. These are:

• Optimising cross organisational and sector working
• Urgent primary care out of hours resilience
• Preventing unnecessary conveyance and admission to hospital
• Discharge to assess/ recover (D2AR)
• Community step down capacity
• An enhanced focus on the respiratory pathway
• An enhanced focus on frailty pathway

These themes are focused on enabling at-risk and vulnerable populations to remain at home or in their community through integrated action, and promoting flow through the system to enable people to leave hospital when they are ready to do so, with any ongoing care or support they require in place. Delivery of these actions should strengthen resilience for the winter period.

The Deputy Chief Executive of NHS Wales has held winter delivery meetings with health and social care communities to track development of their integrated winter delivery plans. This will be followed by a second round of meetings in October-November, which will concentrate on organisations requiring additional support.

Winter delivery guidance, co-produced with Directors of Primary, Community and Mental Health, national clinical leaders and through the national programme for unscheduled care has also been provided, and advice and national support on developing local plans has been made available.

Final winter plans are due to be submitted to Welsh Government for review by 23 October, with feedback to be provided as soon as possible following their receipt to support refinement of local plans.

In recognition of the ongoing challenges across the health and social care system, I have agreed a package of £30 million to support delivery of health and social care services over the remainder of 2019/20, with a particular focus on winter. This funding is being made available earlier than ever before and reflects the unrelenting pressure being experienced by services across the whole system.

I view Regional Partnership Boards (RPBs) as key vehicles to support integrated planning and delivery, and as such £17 million of this funding has been allocated to RPBs to administer. This will be the first time RPBs have been directly involved in the winter planning process in this way. We have made clear our expectation that this process should promote integrated, regional planning across health and social care services to support delivery of the Quadruple Aim, through joint decision making and formal agreement via RPBs.

An allocation of £10 million has been made directly to local health boards to support immediate action and support delivery of integrated winter delivery plans, alongside the ambulance service, local authority and third sector partners.

We have been clear that this funding must be used to target action against the key themes identified for winter, or related action to support improved flow through the health and social care system that will optimise patient experience and outcomes.

In line with the commitment made in 'A Healthier Wales', that we will provide stronger direction to decision making at a national level, £3 million will be retained centrally to target funding for nationally agreed priorities. This is consistent with the approach that enabled tangible impact for winter 2018/19.

I am pleased to confirm that, as part of this national approach, the Emergency Department Wellbeing and Home Safe service, delivered by the British Red Cross, and the Hospital to A Healthier Home service delivered by Care and Repair Cymru will continue to support staff, patients and their families over what we know will be another challenging winter.

I mentioned in my oral statement in February that a quality and delivery framework for Emergency Departments has been under development and I am pleased to inform Assembly Members that this winter will see the piloting of new emergency care measures, which have been developed alongside clinicians. This will be the first phase of wider work to develop a broader range of meaningful clinical outcome and experience measures across the unscheduled care system to provide more context about delivery of care in Emergency Departments.

There will also be improved measurement of patient experience via newly installed terminals in all emergency departments from November 2019. This will enable patient experience information to be gathered consistently across Wales and inform service improvement based on results.

We will also test new emergency ambulance service ‘call to door’ measures for timeliness of response, time spent at scene and time to receiving unit for stroke and STEMI (a type of heart attack).

We know challenges previously confined to winter are now a very real year-round experience, with pressures right across the system, and there is no reason to think that this winter will be any less challenging than previous years. However, the combination of local and national actions should provide increased resilience against the inevitable pressures that will come over the coming months. As ever, it is our collective aim to make sure that patient outcome and experience our optimised, and that staff are fully supported to deliver their essential work this winter.