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