‘NHS needs to brace it­self for worst win­ter it’s ever seen’

Western Mail - - FRONT PAGE - MARK SMITH Health cor­re­spon­dent [email protected]­line.co.uk

PA­TIENTS and staff need to pre­pare them­selves for the worst win­ter the Welsh NHS has ever ex­pe­ri­enced, a lead­ing doc­tor warned yes­ter­day.

Dr Phil Ban­field, chair­man of the Bri­tish Med­i­cal As­so­ci­a­tion’s (BMA) Welsh con­sul­tants com­mit­tee, claimed lives could be “need­lessly lost” un­less the Welsh Govern­ment and health boards ad­dress some cru­cial sys­temic is­sues.

He warned he is in­creas­ingly hear­ing of pa­tients wait­ing on trol­leys “for hours on end” to be seen by clin­i­cians at Welsh A&E de­part­ments. And he added that a par­tic­u­larly cold win­ter, cou­pled with a bad flu sea­son, could spell dis­as­ter for both pri­mary and sec­ondary care.

“Hos­pi­tals and GP surg­eries could feel the po­ten­tially dev­as­tat­ing im­pact of a cold win­ter, bad flu sea­son, and the im­pact of Brexit over the com­ing months, with the health ser­vice in Wales fac­ing its worst-ever win­ter,” he said.

“The pro­por­tion of pa­tients wait­ing in A&E for longer than four hours is in­creas­ing and our mem­bers reg­u­larly re­port hav­ing pa­tients wait­ing on trol­leys to be seen for hours on end.

“This, along with doc­tors fac­ing puni­tive pen­sion taxes, mean­ing se­nior clin­i­cians are un­able to take on more shifts, paints a sad and bleak pic­ture.

“Pa­tient care will suf­fer if some­thing isn’t done about this now. It’s dis­tress­ing for pa­tients and for the staff car­ing for them, who of­ten take the brunt for chronic un­der­fund­ing.”

He said the only way to “avoid dis­as­ter” this win­ter is by in­creas­ing the num­ber of avail­able beds and boost­ing staffing lev­els, both in health­care set­tings and com­mu­ni­ties.

“So­cial care and com­mu­nity ser­vices must be able to take pa­tients, to free up beds in our hos­pi­tals, seven days a week. The only way for this to hap­pen is for ad­di­tional funds to be made avail­able be­fore it’s too late,” he added.

“Welsh Govern­ment needs to take this more se­ri­ously, as there is a very real chance of lives be­ing need­lessly lost.”

Ac­cord­ing to lat­est fig­ures, there were 91,869 at­ten­dances in Welsh A&E de­part­ments in Septem­ber 2019, which was sub­stan­tially more than dur­ing the height of win­ter 2018-19 (81,802 in De­cem­ber 2018 and 84,143 in Jan­uary 2019).

As a re­sult, 75% of pa­tients were ad­mit­ted, trans­ferred or dis­charged within four hours or less in Septem­ber 2019, a poorer per­for­mance than De­cem­ber 2018 (77.8%) and Jan­uary 2019 (77.2%).

The tar­get is for 95% of pa­tients to spend four hours or less in emer­gency de­part­ments, but this has never been met in Wales since the bench­mark was in­tro­duced in 2012.

Sim­i­larly, a re­cent study by the Bri­tish Med­i­cal Jour­nal (BMJ) com­pared four-hour A&E wait­ing times be­tween dif­fer­ent parts of the UK and found that Wales is lag­ging be­hind both Eng­land and Scot­land.

At the other end of the scale, in Septem­ber 2019, 5,708 (6.2%) pa­tients spent more than 12 hours in A&E, higher than the 3,896 (4.8%) pa­tients in De­cem­ber 2018 and 5,292 (6.3%) in Jan­uary 2019.

In re­sponse, the Welsh Govern­ment an­nounced in Oc­to­ber that it is in­vest­ing £30m to sup­port the de­liv­ery of front­line health and so­cial care ser­vices this win­ter.

A spokesman said: “The money will help peo­ple ac­cess care closer to home and en­able peo­ple to leave hospi­tal when they’re ready, with ap­pro­pri­ate on­go­ing care or sup­port in place.

“Of the £30m, £17m will be al­lo­cated to Re­gional Part­ner­ship Boards to pro­mote in­te­grated, re­gional plan­ning and £10m to lo­cal health boards to sup­port de­liv­ery of ur­gent and emer­gency care ser­vices in line with the pri­or­i­ties iden­ti­fied for the win­ter.

“The re­main­ing £3m will be used for na­tion­ally tar­geted ac­tions, con­sis­tent with the ap­proach taken last win­ter.”

And fol­low­ing the suc­cess of last year’s pi­lot schemes, Health Min­is­ter Vaughan Gething con­firmed that 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 over the win­ter pe­riod.

He said: “This year has been one of the busiest ever for ur­gent and emer­gency care ser­vices in Wales. Win­ter brings with it ad­di­tional pres­sures, in­clud­ing cold con­di­tions, in­creased hospi­tal ad­mis­sions for older peo­ple and more peo­ple us­ing GP and emer­gency ser­vices. These are felt by our staff, as well as pa­tients.

“With this ex­tra fund­ing and care­ful plan­ning with lo­cal health boards, Re­gional Part­ner­ship Board and part­ners, we are do­ing ev­ery­thing we can to en­sure ser­vices con­tinue to run ef­fec­tively.

“To­gether with the hard work and com­mit­ment of our ded­i­cated health and so­cial care work­ers this will help im­prove re­silience across the ser­vice this win­ter.”

Mean­while, the Royal Col­lege of Nurs­ing (RCN) Wales added that ur­gent ac­tion is needed to tackle a sig­nif­i­cant short­age of nurses work­ing in care homes across Wales.

The union claimed the lack of nurs­ing staff has be­come so acute that some care homes are strug­gling to pro­vide care.

It has re­cently pub­lished a new re­port, called Nurs­ing in Care Homes: A View from the Front­line, which as­sessed the sit­u­a­tion in Wales with help from a cross-party group of AMs.

It con­cluded that the low staffing lev­els are “deeply con­cern­ing” and ca­pac­ity is not suit­able to meet cur­rent


The re­port added that nurses must feel more val­ued in their roles in a bid to im­prove the re­cruit­ment and re­ten­tion of such work­ers.

It makes rec­om­men­da­tions to ex­tend the scope of the Nurse Staffing Lev­els (Wales) Act 2016 to in­clude care homes.

He­len Why­ley, di­rec­tor of RCN Wales said: “This re­port clearly demon­strates that there is sig­nif­i­cant cause for con­cern around nurse staffing lev­els in the care home sec­tor.

“Health Ed­u­ca­tion and Im­prove­ment Wales should ad­dress this in their forth­com­ing work­force strat­egy, and the Welsh Govern­ment Train Work Live cam­paign should be ur­gently rolled out to in­clude so­cial care.

“Ac­cess to nurs­ing ca­reers in this area needs to be widened and more stu­dent nurse ed­u­ca­tion place­ments made avail­able in care homes.”

Ac­cord­ing to So­cial Care Wales, in 2017 there were 1,600 reg­is­tered nurses in the care home work­force in Wales – a fig­ure de­scribed as “crit­i­cally low”.

The RCN Wales re­port also claimed that the over-re­liance on agency and locum staff has led to the “ero­sion of con­ti­nu­ity of care” be­tween nurs­ing staff and res­i­dent.

It went on to state: “Feel­ing val­ued as part of the work­force builds and main­tains morale.

“It is ex­tremely im­por­tant that reg­is­tered nurses (RNs) and care work­ers in the care home sec­tor have an equiv­a­lence of pay, terms and con­di­tions, en­sur­ing that there is par­ity of es­teem with col­leagues in the NHS.

“How­ever, this is just one el­e­ment of im­prov­ing re­cruit­ment and re­ten­tion in the sec­tor.

“Other el­e­ments in­clude en­sur­ing that there is suf­fi­cient op­por­tu­nity to un­der­take con­tin­ued pro­fes­sional de­vel­op­ment and a suit­able ca­reer path­way for both RNs and for care work­ers.”

The re­port also looked how Brexit could af­fect the care home nurs­ing work­force in Wales.

It found that reg­is­tered nurses are the staff group within so­cial care with the high­est pro­por­tion of non-UK EU work­ers (ap­prox­i­mately 17.7%) which means Brexit could hit this sec­tor hard.

Carol Cleary, deputy home man­ager of the Royal Ma­sonic Benev­o­lent Home, Porth­cawl, was part of the cross-party group.

She said she un­der­stood the im­por­tance of re­cruit­ment and added: “It’s a chal­leng­ing sec­tor to work in but one where we can make a real dif­fer­ence to our res­i­dents’ health and well­be­ing.

“We are ac­tively work­ing with the Uni­ver­sity of South Wales to es­tab­lish stu­dent nurse place­ments at our home by early 2020.”

Carol has called for more part­ner­ships like this be­tween uni­ver­si­ties and care homes in or­der to share the ex­pe­ri­ences of so­cial care nurses with nurs­ing stu­dents, in the hope of in­creas­ing staffing lev­els in the fu­ture.

In re­sponse to the RCN re­port, a Welsh Govern­ment spokesman said: “We have in­tro­duced a pack­age of mea­sures to help care homes re­cruit and re­tain nurses.

“The num­ber of reg­is­tered nurses in Wales con­tin­ues to in­crease and train­ing places have risen by 68% over the last five years.

“We have also re­tained the NHS bur­sary for stu­dent nurses and are re­cruit­ing ad­di­tional nurses, sup­ported by our Train Work Live cam­paign.

“Staffing lev­els at reg­is­tered care homes are cov­ered by the Reg­u­la­tion and In­spec­tion of So­cial Care (Wales) Act 2016.”

Rob Browne

> The NHS in Wales is brac­ing it­self for its worst-ever win­ter

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