Hospitals across Wales reported considerably less time spent at the highest levels of escalation in December 2018 and January 2019 when compared to December 2017 and January 2018 respectively. When hospitals did experience those increased pressures, this winter they recovered and de-escalated quicker, and that is a real indication of improved resilience of front-line services.

Hospitals have admitted fewer people over the age of 85 as emergencies this winter, compared with the previous two winters. The average length of stay for patients admitted as emergencies in December 2018 was at its lowest for over six years. There has been a continued reduction in the number of delayed transfers of care, and improvements have been made in waiting times; the number of people waiting over 36 weeks for elective care at the end of November 2018 was 41 per cent lower than November 2017, and now all health boards are in a better position than they were last year. 

I'm also pleased to update Members on a number of collaboratively delivered initiatives between the Welsh Government, local health boards, the Welsh ambulance service and third sector organisations that are already making a positive impact for people this winter. The Welsh ambulance service has collaborated with St John's on a falls assistance initiative, responding to 773 people who have fallen this winter. Over 85 per cent of those calls included patients over the age of 65. Patient feedback indicates 94 of people were satisfied with the response provided.

Since mid December, local health boards have been working with the British Red Cross to support over 14,000 patients in eight emergency departments across the country. The pilot aims to improve staff well-being and patient experience. It supports patients and their families in emergency departments and transports patients home. The home transport includes helping to resettle patients by connecting them again to community services. That has been especially helpful for lonely people. 

The Hospital to Home pilot, delivered in collaboration with Care and Repair Cymru, is focusing on improving housing quality to support reductions in delayed transfers of care, prevent admissions and reduce readmission rates. Collaboration and integration with the third sector is a key facet of 'A Healthier Wales', and I'm encouraged to see further progress being made here.

We're also trialling new integrated models of care this winter by deploying pharmacists into emergency departments. Again, early indications are positive. Dedicated pharmacists are now working as part of a multidisciplinary team, with some hospitals already reporting seeing up to 100 patients a week, to help support the safe and efficient delivery of care to patients in the emergency department.

However, this winter has also been difficult for services and staff across health and social care. There have been occasions where patients have waited longer for advice, care or treatment than we or health and social care staff would like. Winter stomach bugs such as norovirus place additional strain on our NHS, and since October 2018 there have been 103 gastrointestinal outbreaks in hospitals and care homes across Wales.

Members will be aware that the last flu season saw the highest number of GP consultations and flu cases in hospitals since the 2009 pandemic. We've increased testing following the roll-out of Welsh Government-funded rapid flu tests for patients in emergency departments across Wales. This winter we have seen a higher number of flu cases confirmed in hospitals compared to the same time last year.

Despite a record number of attendances at major emergency departments, performance against the four-hour access target improved at seven out of 13 hospitals. However, it is clear that performance in particular at three sites is simply not good enough, and that has affected the national overall performance picture.

Looking forward to the medium term, we're overseeing a number of programmes to support the sustainable delivery of unscheduled care services. The new primary care model will provide a 24/7 response, with the 111 service being a key component. As the 111 service rolls out over the next two to three years it will improve access through better signposting, clinical advice and treatment using a free-to-call number and other digital opportunities. There'll be greater regional and national working to meet the demand for critical advice and treatment at peak times, and 111 will be available nationally by 2022.

The amber review implementation programme, which I've highlighted to Members in a previous statement, is well under way and expected to run until November 2019. I will update Members on progress on that programme over the summer. A quality and delivery framework for emergency departments is under development and includes the piloting of new measures developed alongside clinicians over the past year. This'll be the first phase of wider work to develop clinical outcome and experience measures across the unscheduled care system.

Building on an in-depth review into how we discharge people with complex needs from hospitals, we will substantially increase focus on preventing unnecessary admission and reducing delays in hospital transfers of care for older people in 2019-20. I will also provide an update on this ‘home first’ approach in the summer. This reinforces our need to work across our whole health and social care system.

And finally, we will launch a policy framework for unscheduled care to describe our policy expectations for local health boards and NHS trusts in the summer 2019. I will, of course, provide further detail upon its release.