Of ageing population

and timely healthcare close to home.

But according to a new report published by the Older People’s Commissioner for Wales Sarah Rochira, this age group found problems with making appointments and the accessibility of the surgery itself.

It discovered that too many older people found it difficult to raise a concern or complaint about their GP service and were fearful of the perceived implications of doing so on their future access and treatment.

Some practices also failed their elderly patients when it came to providing hearing loops, appropriate seating, use of audio-visual announcements and the functioning of automatic doors.

The commissioner’s findings are based on information shared by more than 1,600 older people from across Wales.

She said these issues could prevent older people from accessing GP services or push them towards accessing other, less appropriate services like A&E departments.

But the Welsh Government says more GP practices in Wales are now open between 8am and 6.30pm on weekdays and more appointments are being made available to patients early in the morning and later in the day.

A spokesman said: “Health boards and GPs are modernising their systems so the public can access the right clinician – the public need to understand, based on good experience, how these systems help them.

“We would want to thank our GPs and their teams who are working hard to extend their opening hours in Wales. They are also working with other health professionals to ensure that people receive their care from the right person.

“This will allow GPs to focus their time and expertise on people with complex care needs such as older people. We will continue to work collaboratively with GPs and other professions to improve access and patient experience.

“We made a commitment in Taking Wales Forward to continue to improve access to GP surgeries, making it easier to get an appointment.

“We will be writing to all local health boards to encourage them to use the report’s findings and the accompanying guidance when working to improve access to primary care services for older people across Wales.

“We want to see the good practice the Older People’s Commissioner refers to adopted across Wales.” entrances.

The problems have been blamed on everything from lack of beds, to inadequate staffing levels, to delays in discharging patients.

But one of the main problems is the higher rates of elderly people coming through the doors with a range of chronic conditions.

This group of people often need more medical attention than most and need longer stays in hospital.

And once they have finished their critical treatment, there is a significant problem in Wales with delayed transfers of care, also known as “bed blocking”.

It takes place when people are ready to leave A&E and move onto another ward but face delays in their transfer.

Vice-president of the Royal College of Emergency Medicine for Wales, Dr Robin Roop, said: “In emergency departments, exit block is most usually due to a lack of inpatient beds which results in patients being ‘held’ in A&E.

“This means that departments fill up with patients who should be in a ward and new arrivals whether selfpresenting or arriving by ambulance find there is no clinical space available in which they can be seen or treated.

“The knock-on effects are longer waiting times in A&E, enormous pressure on staff and a higher risk of death for patients.”

But health boards are doing all they can to make patient flow more manageable.

A Frail Patient Assessment Team was set up at Swansea’s Morriston Hospital in 2015, a site which consistently has the lengthiest waiting times in Wales.

It features specialist doctors and therapists who assess patients as soon as they come into A&E so doctors can decide early on whether to admit them or not.

As part of the service, physicians spend their mornings assessing frail patients on the wards and in the emergency department awaiting possible admission.

Physician Dr Nicholas Coles said: “Not every elderly patient is frail. There are patients in their 90s who regularly walk their dog, for example, are generally well, and may have just have one thing wrong with them.

“These are not the patients we are focusing on.

“We assess patients who are frail – whatever their age – as soon as possible, and offer them consistent care, with a clear treatment plan and quicker access to the right services which meet their individual needs.”

When it comes to leaving hospital, the third sector is also on hand to help.

In Cardiff, the Vale of Glamorgan, Rhondda Cynon Taff, Merthyr Tydfil and Bridgend a Hospital Discharge Service is being run by Age Connects Cardiff and the Vale or Age Connects Morgannwg.

These services provide short-term, flexible support for older people on discharge from hospital.

“A spell in hospital can leave older people feeling anxious and sometimes quite vulnerable,” said a spokeswoman from the charity.

“Many older people live alone or with an elderly partner or relative and after a stay in hospital the transition from hospital ward to home environment can be traumatic.

“Additional support is available if needed during this period of readjustment to help get back on their feet.

“Not only are these services invaluable to the older people they help but they are also vital in assisting better management of recovery at home which in turn reduces readmission to hospital and supports early discharge saving valuable NHS resources.”

In Cardiff and the Vale of Glamorgan, the service is available to those aged over 60 to anyone who has had a stay in hospital and personal care is included.

Whereas the Hospital Discharge service in Rhondda Cynon Taff, Merthyr Tydfil and Bridgend is available to those aged over 50 who have been discharged from hospital within the previous 13 weeks and meet the following criteria:

Lives alone or will be alone during the day

Lives with carers who may need support themselves

Is frail, housebound, have poor mobility Is deemed ‘at risk’ Refuses other support but prepared to accept our service Has any illness or disability Is in need of emotional support Is in need of help with day-today tasks is

The Age Connects team make home visits and can provide practical support such as help with laundry, preparing a meal or doing a small shop.

They also ensure older people have enough food, take discharge letters to the nearest GP surgery and help sort out their mountain of mail.

Esyllt Williams, Business Development Manager at Age Connects, said: “The Hospital Discharge Service Coordinator will visit as soon as possible after discharge and a plan of visits will be arranged.

“A discussion with the coordinator and the service user will take place as what type of support will be required and this continues to be reviewed throughout the process.

“By partnering closely with other agencies we are able to work hard to ensure no one is left to cope alone.”

There are also teams on hand to stop elderly patients from needing to visit hospital altogether.

The Acute Clinical Team (ACT) provides rapid assessment and clinical intervention for a growing number of patients – mainly the frail older patient – living in Neath Port Talbot.

This means they can receive treatment such as intravenous antibiotics and fluids at home, reducing distress and upheaval for both the individuals and their loved ones.

ACT’s clinical lead Annette Davies says Swansea and Bridgend are now both developing similar teams.

“It is a large area and at any given time we can be looking after 30 to 35 patients which we consider as our virtual ward. Our aim is to provide comprehensive care for our patients and work with GPs and primary care teams to provide better care in the community.”

If you live in Cardiff or the Vale of Glamorgan and would like to find out more about the Age Connects Hospital Discharge Services, call 029 2068 3693. If you live in Rhondda Cynon Taff, Merthyr Tydfil or Bridgend, call 01443 490650.