5. Will the Cabinet Secretary provide an update on accident and emergency waiting times in South Wales West? OAQ(5)0128(HWS)

Thank you for the question. Emergency departments in South Wales West have continued to experience significant pressure and demand throughout this winter. Members will, of course, recall that this is part of the reason why Abertawe Bro Morgannwg University Local Health Board is in targeted intervention, because of the lack of sustained progress on unscheduled care. There has been some improvement compared to last winter, but there is still further progress to be made.

Thank you for that answer, and I’m glad that you acknowledge the concerns, and can confirm that intervention is actually happening now. I’ve got a slightly different question to ask you, so bear with me on this, because it’s about district nurses.

The Assembly, as you know, took evidence that the number of district nurses in Wales has dropped by 40 per cent in the last five years, with fears of further losses. And the work that district nurses do, to ensure patient recovery in their own homes, is absolutely part of keeping people out of hospital, and that’s what I’m coming to on this. Things like blocked catheters and undressed wounds shouldn’t actually, in themselves, be reasons for people to go to hospital. But if they’re not dealt with, they do become reasons to go to hospital; the consequences can be very serious, including things like sepsis.

So, can you tell us the level of emergency admissions to hospital, in Morriston, and elsewhere, as the result of conditions that have deteriorated due to insufficiently frequent attention by district nurses, and the effect of that then on A&E waiting times? Perhaps you can also tell us whether the new funding you’ve announced for nursing staff will represent replacement of those sorts of skills that district nurses have, and that we are at risk of losing. Thank you, Cabinet Secretary.

I’m not able to tell you today the sort of data that you’re asking—. I think it’s a fairly complex exercise to undertake. I’ll see if it is possible to do, but to be able to say whether it’s been a challenge to the district nursing service that’s led to an admission that’s led to a challenge in waiting times, I think is some ask, regardless of the identity of the Minister, or the civil servants available to them.

But I recognise the point that, actually, the district nursing service is an important part of the care that’s going to keep people in their own homes, and to maintain a level of independence for them. I recently had the opportunity, with my constituency Member hat on, to accompany members of the Royal College of Nursing, in my own constituency, to see some of the variety in the service that they provide—and, actually, quite complex healthcare provision, compared with what you might think takes place, including end-of-life care, recovery from significant injury, and those people who simply aren’t able to get around as they would wish to.

So, I’ve seen for myself the direct value that district nurses provide, in both recovery, rehabilitation, but also in prevention as well. And I’m happy to confirm that the £95 million investment I announced recently, in the future of healthcare training and education, does include a 13 per cent increase in nurse training. So, we recognise the value of district nurses, and we recognise the need to continue to increase, not simply to replace, but to think about how we increase nursing numbers in those areas of particular demand.

What additional support are you offering to the administration of the hospital in Morriston to improve arrangements to deal with the number of patients who attend the emergency department there?

I recently visited Moriston Hospital to have a presentation, on a range of different topics, actually, but during the visit, I took the opportunity to go into the emergency department. And it was really interesting to see, at that time, that I think they recognise that some of their own internal workings of the system has improved, but also they now think they have a better relationship both outside the front door, with the development of primary care clusters, but importantly as well within the hospital system. You’ll know from your own time within the health system, both in this place and outside it, that there is a feeling in some emergency departments that they’re not properly connected to the rest of the hospital, as if those problems at the front door remain at the front door. And, actually, there’s been a greater level of understanding that it is a whole-hospital system and they need to see that as their problem as well, and with linkage into those other specialities within the hospital to take people out of the emergency department and back into the hospital where their appropriate care and treatment will be needed.

And it’s also about the improvements in delayed transfers of care as well. In particular, in the Swansea local authority, there have been some real challenges about some of the care places that are available outside of the hospitals, but we’ve seen some improvement. So, I’m encouraged by the fact that there has been that acknowledgement of the challenge, and that it isn’t just a secondary care challenge—it is a whole-health service challenge, but also, a health and care challenge as well. And, of course, you’ll be aware that, following the £50 million investment we’ve provided, the health board’s share of that is over £9 million. So, there is real support in terms of money, as well as expertise, and some of the sharing, in fact, which is taking place between different health boards about successful systems and processes they have themselves. So, there’s a range of different actions. I expect to see that improvement, and I look forward to having a continued conversation with yourself and other Members to see where that really is going to take place.

Cabinet Secretary, ABMU has consistently high numbers of people waiting more than 12 hours in its A&E departments. In January we saw a total of 890 people waiting more than 12 hours at the two major accident and emergency departments. Wales’s biggest A&E department only saw 150 people waiting for that length of time. Cabinet Secretary, given that ABMU is trialling the 111 service to reduce inappropriate attendances at A&E, how do we explain such high numbers? Morriston Hospital has the highest number of 12-hour waits for any A&E department in Wales. Thank you.

And those are part of the challenges that I’ve put to the health board and within the service. And it is the case that people do talk to each other across the service. Emergency department consultants talk to each other, and lead nurses talk to each other about practice within their departments. So, there is a genuine attempt to share learning. But you’re right—the Heath has a significantly lower proportion and number of people who wait more than 12 hours to be seen, treated and discharged. That’s part of the challenge that I think has been recognised in my response to Dai Lloyd, actually, about recognising that it’s a whole-system problem within the whole-hospital system, as well as outside it. And if you can’t deal with some of the challenges about being able to move people, not just into an emergency department, but through that department, and either out of the hospital altogether, or into the hospital, if that’s the appropriate place for them, that’s part of the reason why some people wait too long. And I recognise there are too many people waiting too long. And I’ve never tried to soft-soap that, or cover over that.

It’s really about: will we see a determined increase in the ability to deliver within this health board, and in others, to make sure that fewer people wait 12 hours to be seen, treated and discharged, and how we build on the successful trial of 111? It’s been a really successful innovation, and, again, compared to what happened in England, where they had real challenges in 111 actually delivering a greater number of people to be referred into emergency departments, that hasn’t happened. And there’s good evidence that 111 is actually taking people away from that department by providing them with alternative pathways for care. So, there are positives within the whole system, but no lack of understanding from this Government, or the health service, that there are still continued challenges and further improvements that all of us expect to see take place.