Written Statement - Welsh Government investment to support delivery of health and care services over winter 2017/18

I am making this statement to provide an update on the current position and action we have been taking to support front line staff in the face of winter pressures across our health and care system.

Members will be aware that planning for winter is a significant priority for our health and care system and national agencies. Integrated winter resilience plans have been developed by all local health and care communities in Wales supported by a number of innovative national initiatives.

We have also invested heavily to drive integration between health and social care services through the Integrated Care Fund. We have invested £60 million for health boards and local authorities to work together to enable people to maintain their independence in their local communities this winter. Reports from local communities in Gwent, Rhondda Cynon Taf and Merthyr Tydfil in particular suggest this has made a real difference over the winter period to date.

In addition to our £42.6 million to support primary and community care services through the Primary Care Fund, we have provided £50 million to help health boards balance emergency and planned care activity over the winter period.

Despite rigorous preparation, the health and care system in Wales has contended with significant pressure, similarly to all parts of the UK. This has been a particularly challenging period over recent days. Activity levels in parts of the urgent and emergency care system have been, at times, unprecedented and well above what could realistically have been predicted.

Early NHS management information shows:

•  ‘life threatening’ incidents for emergency ambulance services in December were the highest since the new clinical response model was introduced and 54% higher on New Year’s Day when compared to last year;

• GPs and primary care services across Wales have seen approximately 100,000 patients per day following the Christmas period; 

• the 111 service received twice as many calls as expected on 1 January; and

• attendances at all emergency care facilities were higher over the Christmas period than last December.

This information also shows that the NHS in Wales saw the highest number of patients admitted to hospital as an emergency during a winter period for at least four years. Crucially, in terms of understanding demand, the highest number of older patients - aged 85 and over – were admitted to hospital through A&E too.

These figures are clear indicators of a more acute demand for beds over the winter to date with many of our older population, who often have complex needs, requiring longer periods of assessment in A&E and spending more time in hospital before going home.

The often extraordinary levels of demand on staff and services have been compounded by an emerging increase in ‘flu consultations and norovirus over the past two weeks, as well as reports of a general increase in patients with respiratory illness attending GP practices and A&E. These issues have almost certainly been made worse by the cold snap that hit the UK in early December.

I would like to once again thank all health and care staff for their resilience, compassion and commitment in the face of these exceptional pressures.  

General Practitioners, paramedics, occupational therapists, nurses, doctors, consultants and other staff are demonstrating immense commitment to good quality patient care and many services in parts of Wales, such as GP out of hours services, continue to function very well. They have my gratitude and respect. I recognise that at times the demands placed on them mean that they are not always able to give the care they would like, despite their professional response. They continue to provide the best possible care to our most unwell and vulnerable citizens.

The pressures across health and social care are above those anticipated during this challenging period.  I have therefore provided NHS Wales with an extra £10 million of new investment this year to help front line staff care for patients through this winter. The money will come from the existing central Health and Social Services budget. It will help health boards, the ambulance service and social care services across Wales to treat and care for the increased demand and need across our system and not just the hospital environment.  

The funding will support delivery across the whole unscheduled health and care pathway including, for example, to enable older people to leave hospital more quickly through support packages when appropriate. Health boards will be expected to work with their partners to determine the best use of the investment over these forthcoming weeks in line with local pressures, priorities and capacity.

Further, in recognition of the pressure faced by general practice I have taken the decision to relax the Quality and Outcomes Framework (QOF) element of the GP contract until 31 March 2018. In practice, this will enable GPs and practice nurses to prioritise patients with an urgent need for an appointment by avoiding the necessity to automatically call in patients for routine appointments at the busiest time of the year.

I will continue to keep Members updated on the position over the coming weeks.