Part of the debate – in the Senedd at 4:35 pm on 15 November 2016.
Thank you for the comments and questions. I think I can be upbeat and ambitious about where we could and should be and talk about a resilient service, but, as I’ve said several times in my statement, winter will be a challenge; it always is. We know that the demand profile changes in winter. We know that when we talk about the service under pressure, we're talking about our staff, and I'm very pleased that you’ve paid tribute to NHS staff. Staff in the NHS and in social care have an extremely difficult job to do, and, actually, the NHS system keeps going because of the additional efforts made by social care staff, to make sure that they can get people out of hospital acute settings and into social care settings. So, the improvements we've seen in the last few years in keeping packages of care open, for example, has been crucial to keeping flow work within the whole system. Of course, that was one of the points that you made about the investment in community services, in that every health board has a slightly varying setting, but they’ve made that investment in community services, not only thinking about—I know there's a challenge with district nurse numbers, but, actually, community-based nurse numbers have increased over the last six years, but also, the partnership with a variety of people in the third sector and in housing as well, and they've been crucial to make sure that community support mechanism actually exists to enable them to go back to their own home or to a different care setting out of an acute hospital bed.
I am, of course, looking forward to attending committee and, yes, I look forward to answering all the additional questions you don't get a chance to ask today. But, you know, there is a range of things as well I do want to point out. In terms of that thing about flow in and out of a hospital as well, about keeping people out of hospital when it's not the right place—points raised by Rhun ap Iorwerth—but, on delayed transfers of care, it's a significant achievement to have levelled off and levelled down the numbers of delayed transfers, and there's no pretending from me or anyone else that this is not going to be a pressure through the winter. We saw last winter a rise in delayed transfers of care at the toughest points in the winter, and you would expect that to be the case; it would be unrealistic to think otherwise. But, the system in Wales has seen a downward trend over a number of years compared to record rises and record levels of delayed transfers—they call them delayed discharges—in England, and also similar problems in Northern Ireland and in Scotland. So, actually, we stand out against that picture by having seen a fall-off, but our ambition is to see more, rather than just be satisfied with where we are.
And in terms of the points made about hospital flow, within the hospital system, we recognise there’s a challenge. I'm not sure how bluntly the Royal College of Emergency Medicine put it, but we know that there’s sometimes a feeling that, at the front door, where lots of pressure is concentrated, there's both a need for more decision makers, as I’ve said in my statement, as each hospital system recognises, but also to think about how the responsibility at the front door doesn't just start and end at the front door either. What that means is I want to see a push into our hospitals, but also a pull through the system as well, and that's part of the challenge in pretty much every hospital across Wales, to make sure there is that shared responsibility for different departments, and not just leaving the emergency department to fend for itself, essentially.
Now, just in terms of closing off, you asked me whether I'm utterly satisfied with the position as it is. It would be a brave, if not a foolish person in my position who said they were utterly satisfied with where we are. We recognise that we have in improving picture on planning and preparing for winter and it's important to set that out. We're in a better position now than we were last winter or the winter before. But, as I say, no-one should pretend that winter will be easy or that it will be perfect; we expect there will be challenging points in time and there will be more learning to take from this winter as well, but I expect the system to be resilient. Unlike some parts of England last winter and the winter before, I expect the doors to be kept open, unless there really is truly, extraordinary, over and above what we could reasonably expect. And that's what I'm aiming for: safe, compassionate care, and delivered with dignity for people who really need it, and then to learn again and to improve again for next winter, too.