2. Will the Secretary make a statement on accident and emergency units in North Wales? OAQ(5)0022(HWS)[W]

I thank the Member for the question. I am encouraged to see further improvements in performance against the four-hour target and a reduction in lengthy waits during May. Despite daily attendances rising by 8 per cent when compared with the previous month, eight out of 10 patients spent fewer than eight hours in emergency departments from arrival until admission, transfer or discharge. I have made clear, as has the NHS Wales chief executive, that further improvements are expected.

You will have received, as I have received, a letter from a former nurse who has broad clinical experience. She also was a non-executive member of the north Wales health service. In the letter she described what she saw in the Wrexham Maelor emergency department last month. She mentions in her letter a shortage of staff, a shortage of beds and the impact of that on the ability of patients to access the treatment they required in a timely manner, and to move through the system and ultimately leave hospital. In her professional opinion, she says that it’s inevitable that a continuation of that situation will lead to fatalities. That’s a very serious accusation, but would you agree that until we see more appropriate staffing levels, and until we see more beds in the system, then the likelihood of seeing an end to some of the scenes that she describes in the letter is remote?

Thank you for the question. I think it’s fair to say we need a whole-system response to the challenges that are being faced. So, it’s about: how are people conveyed to an emergency department, going back to Dawn Bowden's question earlier, to ensure people make an informed choice about what to do? It’s also about how primary care have tooled up to deal with unscheduled care, to make sure that people who can be seen and treated within their community setting and don’t need to go into an emergency department in the first place—. Then, of course, it is about what happens in the transfer between ambulances and hospitals, where people are there and need to be there. What we do need to then make sure is that flow takes place through the whole hospital system and out of the back door; that’s then the point about delayed transfers of care within the NHS and with social care too.

So, I recognise that all of those things have an impact. Staffing levels and bed numbers are only part of the challenge, and we do need to look at it in its whole sense. That’s why the unscheduled care board does look at this through that whole-systems approach. I was really pleased to attend the seasonal planning forum event last week where, actually, that whole-systems approach was in evidence, and, also, all partners were there to discuss what they needed to do to improve the whole system for the benefit of the patient and the staff working in the system.

Welsh Government targets say that 95 per cent of patients should be seen within four hours, and none should wait 12 hours or more, but in the May figures you refer to, only 82.5 per cent were seen within four hours, in A&E units in north Wales, just 79.9 per cent—the worst in Wales. Eight hundred and fifty-six people in north Wales waited more than 12 hours, the highest level in Wales, with Glan Clwyd, I think, the worst performing hospital in Wales on the 12-hour targets. You talk about changing figures, well, that was unchanged since November and worse than December 2015. How, therefore, do you respond to the repeated concern amongst staff and patients in north Wales that the removal of minor injury units and NHS community beds added to the pressure on A&E and that a twenty-first century solution must include the restoration of both those services?

I thank the Member for his question. I’ll start by making clear that, whilst there has been a welcome reduction in the number of 12-hour waits over the last month, there’s no illusion that we’re in an acceptable position. I don’t think the number of 12-hour waits is acceptable and, in my earlier answer, I made clear that that message has been given to the service and the expectation is improvement. I’m not persuaded, at this point in time, that minor injuries units are part of the solution unless there is evidence that we can staff those properly. There is the need, going through them, to actually be able to deliver a service properly. I’m interested, as I said in the first part of this question, in having a proper whole-system approach and making sure that people are sent to services that are appropriate, that they are given the care that they need and that the options they need are available. But, as the evidence is made available on what we are doing and what we can do, I’m happy to look again at the way the system is organised, so if there is a real answer to improve outcomes for patients through patient experience then we’ll do that, but, at this point in time, I don’t think there is an evidence base to reintroduce minor injuries units on the basis suggested.