NHS delays in Wales caused by patient flow problems: experts

The NHS in Wales has been hit with record waiting lists for treatment times, exacerbated by two years of the coronavirus pandemic, and the Argus has published several accounts in recent months of patients in Gwent who have struggled with delays.

This includes, most recently, a 91-year-old woman who had a heart attack and then spent eight hours in an ambulance outside the Grange University Hospital, in Cwmbran, while she waited for a bed. The health board has apologised for that incident and said wider issues with “the flow of patients through our hospitals… results in longer waiting times in our emergency department”.

Meanwhile, members of the Senedd’s health committee are currently holding a series of evidence sessions to get to the bottom of the Wales-wide issue and find out how patient flow can be improved in the nation’s hospitals, thereby cutting delays at the front door.

Kate Griffiths, of the British Red Cross, told the committee the NHS in Wales could secure a series of “quick wins” around patient flow in hospitals if current guidance was updated. She said hospitals should provide outgoing patients with information leaflets and points of contact, “but from our research we've seen that doesn't always happen”.

Steps to speed up patient discharge in Wales suffer “a lack of clarity” and vary across health boards, she said, adding that hospitals would benefit from a “holistic check of a person's practical, social, psychosocial, physical and financial needs prior to discharge, so that it can all be incorporated within that pre-discharge assessment process”.

File photo of hospital staff on a ward. Picture: Peter Byrne/PA Wire

For patients who are discharged into care, Catrin Edwards, of Carers Trust Wales, told the committee carers don’t always feel “fully involved” in the process and “the cared-for person is often discharged without an appropriate care package in place to meet their needs”.

Some former patients wait three months or more for support, and in some cases – when people become carers for the first time – they are left to go it alone, under “significant pressure” to deliver “around-the-clock care in some instances”.

When patients have dementia, the situation can be even more delicate. Huw Owen, of Alzheimer’s Society Cymru, said “the big issue is getting assessments done to make sure they are discharged to suitable situations for their condition [and] ensuring people with dementia are sent to their own home [that is] adapted to be suitable for them… or to a care that has staff suitably trained to manage their care needs.”

He added: “Often assessments are so slow in actually getting to the person… that by the time a care package is put in place, the person with dementia has further deteriorated.”

Jake Smith, of Carers Wales, warned of cases where hospitals discharged patients without knowing who their unpaid carer was. He said it was “highly unlikely” that unpaid carers will be “communicated with and meaningfully consulted with” during the discharge process.

When people are discharged to care homes, there are often communication problems, Ms Edwards said, adding: “We've heard several examples where the patient has been discharged into a care home that is a long way away from the carer, or the carer isn't aware of the [financial] implications in terms of that care home.”

Each expert recommended strong, clear national guidance that would work across health boards and hospitals. By helping patients get out of the hospital more quickly, they said, the NHS could help people get into hospital more quickly.