6. Debate on the Health and Social Care Committee Report: Hospital discharge and its impact on patient flow through hospitals

Part of the debate – in the Senedd at 4:05 pm on 12 October 2022.

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Photo of Russell George Russell George Conservative 4:05, 12 October 2022

And let's just remember as well that delayed transfers of care are not just statistics. Behind every delayed transfer, there is a person who has not received the care and support they need to be able to return home or to move into appropriate accommodation. It also affects family members and unpaid carers, who find themselves in the impossible position of leaving their loved ones in hospital longer than is necessary or taking on further caring responsibilities that they may not be able to cope with, often at a cost to their own health or well-being. And the financial implications, of course, with that as well also can be significant, especially in the context of rising costs of living.

We’ve all seen pictures of ambulances queuing outside A&E departments unable to hand over patients. This inevitably affects the number of ambulances available to respond to emergency calls, leading to the unacceptable long waits for people who are ill or injured and in pain, and in some cases, sadly, with life-threatening consequences. But at the heart of this issue is the severe lack of capacity in our social care system. Patients who may be ready to leave hospital are unable to do so because there isn’t enough capacity in the care services to put in place homecare packages that would enable safe discharge. This lack of capacity, coupled with the social care workforce crisis that we have, continues to be one of the main causes of delayed hospital discharge and restricted patient flow through hospitals.

Now, unlike the NHS, which I'm sure everyone will have accessed at some point in their lives, the social care sector is largely invisible except to those who need its support; to them it's invaluable. Unless radical steps are taken to reform the way in which social care is provided, rewarded and paid for, we are unlikely to see any real change. Social care providers told us that these are unprecedented times in terms of staffing shortages. People are leaving the sector because they can earn similar amounts elsewhere for doing less pressured jobs. Until there is true parity in pay and terms and conditions for social care staff with their NHS counterparts, I think the sector will continue to struggle to recruit and retain staff.

So, it was disappointing that the Welsh Government’s response to our request for information on how it will increase recruitment to the social care sector was less than robust. While it repeated what has been done to date, it provided no real clarity or assurance on plans for the future, so I do hope perhaps the Minister could provide that detail this afternoon. It would also be helpful if the Minister could provide an update on the work of the social care fair work forum in developing a pay and progression framework for social care workers, and assurances that this work is being taken forward with the urgency it needs.

A very strong theme that we received was concern about the pressure being placed on family and unpaid carers to fill the gaps in care provision. I was pleased that the Welsh Government accepted our recommendation to undertake a rapid review of whether carers’ rights under the Social Services and Well-being (Wales) Act 2014 are being breached as a result of having to take on more caring responsibilities than they may be willing or able to, due to the lack of available services. And I welcome also the priority being given to unpaid carers by the chief social care officer for Wales in his forward work plan.

The involvement of patients and carers is central to the discharge process, and we heard from families and unpaid carers that, in many cases, this is sadly lacking. I'd like to point out or mention Angela Davies, an unpaid carer whose father had dementia, who told us about the difficulties she experienced. We also heard from other stakeholders, like Care Inspectorate Wales, about the quality of patients' needs assessments in hospitals. We heard about assessments being filled out by ward staff or social care staff with no involvement of the patient or people who know them best.

The Minister herself told us that there was room for improvement in communication with carers and families in hospital, so I welcome the acceptance of recommendation 24 and the commitment to commission a review of the quality and effectiveness of carers’ needs assessments in this financial year. I do wonder: is the Minister able to confirm whether the quality and effectiveness of patients' needs assessments in hospitals will also be reviewed?

Finally, I do want to move on to talk about the lack of consistent communication and joined-up working between health, social care and third sector bodies, which is all the more concerning because it’s an issue that has been consistently raised by other Senedd committees. Indeed, our recent report on the impact of the waiting times backlog on people in Wales found that progress needs to be made on digital records and information sharing, so that patients can receive seamless services from all parts of the health and social care system, and on the compatibility between ICT systems used in different parts of the health and social care services. Witnesses told us that clear and consistent communication between hospital-based medical professionals and primary care is invaluable, and unhelpful distinctions between clinical and non-clinical staff need to be removed if patients are to benefit from an integrated health and social care workforce.

The general data protection regulation is often cited as an obstacle to data sharing, however we were told that it is possible to have memorandums of understanding amongst statutory organisations and information governance protocols that would allow a truly shared electronic record.

I do look forward to Members' contributions this afternoon. Finally, I would have to say, Minister, that we were astonished to hear that, in 2022, not only are fax machines still being used by the NHS, new ones are actually being bought. I look forward to contributions this afternoon.