Written Statement: Update on unscheduled care pressures over winter 2018/19

I am making this statement to provide Members with an update on the current position in relation to winter pressures across our health and care system.

Members will be aware that extensive preparation has gone into planning for winter throughout Wales and across organisational boundaries, and that planning for this winter began immediately after the end of the 2017/18 winter period.

In collaboration with NHS Wales, local authorities and partners, we have learned lessons from previous winters to improve planning processes, and following the evaluation of winter 2017/18, there is increased recognition of the need for national leadership and support.  It was in this context that I made the decision to provide additional funding of £35m to support the NHS and social care partners in Wales earlier this financial year to ensure local health and care teams are as prepared as they can be for the winter period.

We have been open that last winter was exceptionally difficult and we saw spikes in demand which, at times, were unprecedented, which impacted on the ability of services to manage and cope with demand and saw performance against key indicators deteriorate.

I have been encouraged to observe that escalation levels at hospital sites across Wales have generally been lower over this past festive period when compared to the previous year.  We have seen fewer sites at the highest level of escalation and those which have seen increased pressures have been able to de-escalate more quickly, which is a real indication of improved resilience of front line services.

Pressures are visible all year round and the challenges faced by front line staff over winter should be viewed in the context of sustained and relentless pressure over recent months.  We also know there are local pinch points and that pressures will continue as temperatures drop and the ‘flu season progresses.

Public Health Wales has confirmed that the ‘flu season has started. Current levels of activity are low but are increasing and clinical evidence suggests that we can expect to see a further increase in attendances at GP surgeries and Emergency Departments for respiratory conditions within the next week or so following the recent cold snap.

Since March 2018, substantial focus has been put on forecasting the volumes of people likely to access Emergency Department services this winter, as well as the numbers of patients who will need to be admitted to a hospital bed as an emergency. 

NHS management information suggests the majority of people have been assessed, treated and admitted or discharged within four hours to date over winter.  However, NHS management information also points to a difficult festive period for ED staff when compared to five years ago:

• There was a 14% increase in attendances at EDs over the festive period (22 – 29 December 2018) when compared to the same period five years ago;
• Emergency admissions of patients to hospital beds from ED were 9% higher over the festive period when compared to the same period five years ago; and
• A 13% increase in emergency admissions of people over the age of 85 when compared to the same period five years ago when compared to the same period five years ago.

This level of activity has come at a time when primary care services have reported pressure, with GPs and primary care services across Wales reporting increased demand for appointments over the festive period when compared to the same period last year. 

The ambulance service has also received additional call volumes for the amber category in particular.  NHS management information suggests call volumes for ambulance services in December 2018 were the highest since the new clinical response model was introduced over three years ago.

Despite these pressures, Welsh Ambulance Services management information suggests performance has been sustained above the national target for immediately life-threatening incidents. Encouragingly, a significant reduction in ambulance patient handover delays has also been reported over recent week when compared to the previous year.

It has been, and continues to be, a difficult period for front line staff and it is testament to their commitment that the vast majority of people are receiving a professional response and timely care in line with public expectation.

I am also pleased to provide an update on one of the additional initiatives planned to support people and staff this winter. Members will know that the British Red Cross has been commissioned to provide winter schemes at eight hospital sites across Wales which are intended to support patients and staff in Emergency Departments. The scheme is also intended to transport relevant patients home, helping them to resettle by buying food, following up with a welfare call and connecting to community services.

I am pleased to report that Red Cross teams have supported over 2500 people already since the schemes were introduced in mid December, with patients and carers helped in Emergency Departments and dozens of vulnerable, older people resettled at home, thus avoiding unnecessary admission.

While early indications are that rigorous planning has contributed to greater resilience to date over the winter period, despite increases in ambulance activity, attendances at Emergency Departments and emergency admissions of older patients when compared with previous years, we know that pressure is beginning to increase on services across the system.

There are further opportunities to strengthen local responsiveness and delivery by allocating additional funding at this early stage of the winter period.  I have, therefore, agreed to provide additional funding of up to £4m of new investment to NHS Wales to support initiatives which will add value, improve patient experience, clinical outcomes and staff well-being through this winter.  The money will come from the existing central Health and Social Services budget and will see health boards working with the Welsh Ambulance Service, and Local Authority and third sector partners to treat and care for the increased demand and need across our system. 

Officials will continue to monitor delivery of services closely and work alongside NHS Wales and partner organisations to seek assurance on timeliness and quality of care over the winter period.