Select Committee on Welsh Affairs Minutes of Evidence


Memorandum submitted by the Welsh Office

EMERGENCY CARE OVER THE WINTER

BACKGROUND

  1.  In common with the rest of the UK, the NHS in Wales has experienced a steady increase in demand for emergency admissions. Since 1993-94, demand has risen by around 14 per cent, with the largest increases reported by hospitals in South Wales. Demand for emergency admissions is set alongside a wider background of increasing demand for, and supply of, in-patient hospital services, which have risen by around 13 per cent over the same period and reflects, among other things, an ageing population, a decline in the extended family, higher patient expectations, and improved opportunities for treatment made available by advances in drugs and technology.

ACTION TAKEN

  2.  As a consequence of the operational difficulties being experienced by the NHS and the apparent need for a more collaborative approach to issues which had strategic and cross-organisation implications, in early December 1995 the department instigated a joint Welsh Office/NHS review of the management of emergency admissions. The intention was to agree mechanisms to minimise the risk to patients during the winter months, while also looking forward to more effective ways to manage activity and pressures in the longer term drawing upon best available practice. This collaborative approach has continued, producing significant cumulative improvements in the organisation and management of emergency care during the winter months.

  3.  As a result of the department's action to develop a more targeted approach to emergency activity during the winter months, health authorities and NHS trusts agreed on the need for closer co-ordination of their respective activities and those between the NHS and social services departments. They also agreed to produce an action plan for the 1995-96 winter to avoid hospital closures and to develop a longer term strategy to improve the purchasing and provision of emergency care services. This undertaking anticipated that the strategy would need to address the information needs of managers, clinicians and GPs; the development of contract service specifications which set good standards of practice in admissions and discharge planning; and the development of indicators to monitor admissions, delays in discharge and lengths of stay in hospital.

  4.  The programme of action agreed for 1995-96 was intended to reflect the differing circumstances obtaining in each health authority area and included:

    -  sharing experience of bed management and admissions and discharge policy to establish best practice;

    -  collecting information on admissions, bed availability and closures and length of stay data on a daily basis;

    -  establishing and communicating social services departments' policy on provision of services over the Christmas period; and

    -  appointing health authority and trust project managers to take forward this programme of activity.

  5.  In the light of experience gained during 1995-96, a joint health authority/trust conference was held in September 1996 to review the outcome of the arrangements that had been put in place and to agree a strategy and action plan for winter 1996-97. The conference noted the progress made in collectively managing emergency admissions and concluded that additional measures were needed to firmly secure the benefits produced by the steps already taken. These new measures included the establishment of emergency admissions task forces in each health authority, with input from trusts, GPs and social services departments, to provide effective planning and managing of emergency care to meet local needs. Each task force was charged to draw up plans to meet short, medium and long term needs in their areas. Systems were set up to collect information from the task forces on a quarterly basis and to report progress to the department.

  6.  As a consequence of the cumulative effects of the measures taken in 1995-96 and the additional steps agreed in September 1996, the management of the increased levels of demand in winter 1996-97 was significantly improved. Despite a 3 per cent increase in emergency medical admissions on the previous year, hospital closures were down and fewer patients were transferred between hospitals. Health authorities anticipated the growth and contracted for an additional 14 per cent of activity compared to 1994-95; 8.6 per cent up on the 1995-96 outcome. Emergency patients were better served and, for those hospitals with severe capacity problems, health authorities invested in emergency admissions units and in the provision of extra beds to be deployed at critical times. A note from a report by health authorities and trusts on the progress made is at Annex 1.

PREPARATION FOR 1997-98

  7.  A a result of these various measures and the much improved levels of co-operation which this strategic approach has encouraged, health authorities and trusts in Wales have put in place for 1997-98 arrangements which will provide extra capacity in hospitals, particularly at times of peak pressure; built on improved arrangements with social services departments to ease the pressure of delays in hospital discharge; and improve phasing of emergency/elective work over the year to avoid cancellation of routine operations over the winter period.

  8.  In addition to stimulating the programme of co-operative and strategic action, the department has supported this approach by giving the treatment of emergency admissions top priority. This has been enshrined in planning and purchasing guidance to the NHS. As a consequence, the preparation for and the handling of emergency pressures last winter has been markedly improved and the prospects for 1997-98 are better than in previous years.

  9.  In November, an additional £9.5 million was made available to health authorities in Wales, together with a further £600,000 to improve cancer services. This was in addition to a £2.5 million package of measures announced in July to develop and improve primary care, which included £250,000 to provide for additional nursing home care over the winter. The extra money has been targeted at easing the pressures on the health and social care system during the winter period and restraining the growth in waiting lists and waiting times. It is aimed at both enabling hospitals to cope with the surge in activity in emergency admissions over the winter period and reducing the need for people to be admitted to hospitals by providing more community and home care support; ensuring hospitals can better cope with emergency pressures by improved staffing levels at times of peak pressure; and avoiding delays in discharging patients. It is also aimed at ensuring that non-emergency workloads are maintained throughout the winter keeping any increases in waiting lists and waiting times to a minimum.

  10.  The Department is also supporting a project to look at the interface between the NHS and social services departments in north Wales over the winter period. It will identify any bottlenecks and differences in approach, explore the scope for better communication between the NHS and other agencies, clarify issues around the reasons for delayed discharge and "bed blocking" and identify and disseminate good/best practice to ensure a seamless approach to emergency patient care across organisational boundaries.

GUARANTEE

  11.  Health authorities and trusts in Wales have given Ministers a guarantee about the treatment of patients over the coming winter. This is a landmark commitment. Subject to a major disaster or to the impact of natural events over which the NHS can have no control, all patients needing emergency admission will be admitted to their own appropriate local hospital or the nearest one with available beds. Health authorities have pledged to work to eliminate the unacceptable practice of patients being referred to several hospitals which are closed to admissions. This undertaking will require the co-operation of social services departments, GPs and GP fundholders, trusts and ambulance services as well as a recognition of the relationship which exists with elective activity. The department will monitor NHS progress in delivering the guarantee and in its ability to cope with emergency pressures throughout the winter months. Regular weekly reports will be sent to the department which will report issues of concern, including any hospital closures to emergency admissions, operations cancelled, bed shortages or increases in staff sickness rates.


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries

© Parliamentary copyright 1998
Prepared 8 April 1998