4. What assessment has the Cabinet Secretary made on the progress to reduce accident and emergency admissions? OAQ(5)0102(HWS)

Thank you for the question. We are committed to reducing accident and emergency admissions through a number of initiatives, including Choose Well, NHS 111 and a range of falls response services. Health boards and the Welsh Ambulance Services NHS Trust are supporting these and similar initiatives in order to ensure that the service operates at maximum efficiency.

Thank you, Cabinet Secretary. Several of my constituents have contacted me recently to praise the falls prevention service currently being piloted in Aneurin Bevan health board. Launched in October, this service has helped 183 out of 229 emergency calls to get back to their feet without having to be taken to an accident and emergency department. Not only does this prevent hospital admissions, but the team also conducts a home assessment to prevent further falls in future. Can the Cabinet Secretary keep a keen eye on the evidence and the results of the pilot in Gwent? What more can be done to prevent people being admitted to hospital following a fall when other action is more appropriate?

I thank you for the question and, in particular, for highlighting one of those pilots that we are actively looking at. I was also pleased to see that it was highlighted in an ITV Wales report previously as well—that work with the Welsh Ambulance Services NHS Trust, and how their staff are used in a way that avoids emergency hospital admissions and avoids emergency ambulances being sent out as well. It’s about the smarter use of all of our resources, and that’s something that we really do have to do more of now and in future—it’s people in their individual homes, but also people in residential care.

We also have a range of pilots—for example, some involving the fire and rescue service in Wales as well. So, there’s a programme of different pilots in different parts of the country. We want to assess and understand what those are, and that will be undertaken through the emergency ambulance services committee. We then expect to learn from those and understand how much more, progressively, they can be rolled out across the country—what evidence works and what’s appropriate in each part of Wales, and then go out and do that successfully. Even while these are reducing the number of admissions that would otherwise come into an A&E department, we do know that we’re still seeing a rising tide of numbers coming into our departments. So, more work on this front is required, not less.

Welsh Government targets say that no patient should wait longer than 12 hours for treatment in an accident and emergency department in our hospitals. However, figures show that the number of patients waiting longer than 12 hours for treatment was 31 per cent higher in December 2016 compared to the same month a year earlier. This is in spite of a 5.5 per cent drop in admissions in our hospitals. What reason can the Cabinet Secretary give for this increase in waiting times when admissions really have fallen in our hospitals?

I thank the Member for the question. Actually, we’ve seen an increase in the number of people going into hospitals and in admission rates. The challenge for us is, though, not just accepting that far too many people do wait too long, but what we’re able to do about them. That goes back, again, to previous questions about what we do to keep people out of hospital successfully and what we do to actually recognise the fact that we do have an older and broadly sicker and poorer population than England itself. That means we’re more likely to see people who do come in in the winter time in particular who will need to be admitted. How do we make sure that those people actually have a good patient experience when going through and receiving care in our hospitals? There’s no point pretending that this is an easy challenge to resolve, but it is why we do need a whole-system response—not just the front door of a hospital, but through the whole hospital system, people taking responsibility, and at the front end and at the back end with social care and primary care as well. So, I’m certainly not complacent about the challenges that we face, and I expect Members will continue to ask me a question until we see a fall in the number of 12-hour waiters that continues and is a sustained drop. Because I recognise there is unlikely to be a great patient experience for somebody who waits that long before they’re seen through to their discharge.

Cabinet Secretary, one of the ways to actually reduce the pressure on A&E units is to look at how the minor injuries units can be used effectively. Now, in Neath Port Talbot and in Singleton at the moment, there is consultation going on about reducing the hours, but part of the problem is the staffing and resourcing of those units. What action is the Welsh Government taking to actually improve the training of advanced nurse practitioners so that we can deliver MIU units that will work effectively, take pressure off A&E, allow patients to go through A&E and major units faster, and therefore also allow patients to be seen within hours rather than perhaps longer hours? And, from personal experience, I know that feeling.

Thank you for the question. You’re right to point out that our minor injuries units around the country have a very good record of seeing people quickly, seeing, treating, discharging, or arranging for them to be admitted if that’s required. They are led, in most instances, by advanced nurse practitioners, providing high quality care and able to make decisions that people might think you would need a doctor for. Now, part of the challenge is how we understand what’s sustainable in that way, because you’re right in that some of those units have very small numbers of people attending at various hours in the day, and so health boards will need to understand properly how to make the best use of their staff to meet the demand that exists.

There is something to do also about minor injuries streams within major units as well, and, if we get that right, we’re more likely to see a quicker turnaround, not only for people in that particular unit within a hospital, but how we understand how we direct through to the right part of the service. So, again, it goes back to having that whole-system approach and understanding what we need in our minor injuries units, where those should be, what the evidence is for them being at the right time and the right place, but also there is still improvement we do need to see within the major units for that minor injuries stream.