NHS Wales: Patients Can Be Sent Home Without Sufficient Care Packages Due To Overcrowding Crisis.

Senior NHS staff have recently been advised by the Welsh government to discharge patients who require care packages from their hospitals as long as they are well enough.  

Care Packages provided by the NHS (also known as NHS continuing healthcare), are entitled to those suffering from serious disability or illness and require further assistance following discharge from hospital. These can be put in place when the person is in a care home or at home in order for their condition to improve. 

It covers the full cost of a person’s care (in their own home or a care home), including:

  •  Healthcare
  •  Personal care, such as help getting washed and dressed
  • Care home fees, including accommodation costs

The application of the NHS care package to an individual is decided following an initial screening and then, if considered eligible, a full assessment process which determines the required assistance a person will need due to their current condition. 

A GP has called the announcement by the Welsh Government "terrifying" as the decision could cause discharged patients to deteriorate and end up back in hospital. 

When questioned, the Welsh Government stated that the current NHS situation is “unprecedented”. This message came after Director of the Welsh NHS Confederation said that NHS was on a “knife edge” in regards to its ability to cope with the current capacity of patients and that tough choices would need to be made in order to protect the NHS.  

Wales' largest health board, Betsi Cadwaladr University Health Board, declared a critical incident on Tuesday 3 January 2023 and said staff were forced to deal with overcrowding in the department. 

Across the seven health boards in Wales, nearly 1,800 patients are medically well enough to be discharged from hospital but cannot as their care packages are not in place. It has been said the NHS is facing exceptional pressure and there were more than 500 confirmed COVID-19 cases in Welsh hospitals, with rapid increases in other respiratory viruses. 

The Welsh Government acknowledged that day-to-day clinical decision-making must adapt to these exceptional pressures to ensure the NHS resource is being used for the greatest benefit. One of the ways suggested to combat the pressures of the NHS is to make sure hospital capacities are preserved for those at greatest risk with the greatest chance of benefit. This would involve staff making every effort to keep people at home; not to admit people to hospital unless absolutely necessary; and to return those in hospital to their homes or an alternative place of safety as quickly as possible.

The letter sent to senior members of NHS Wales recognised that the change to the clinical risk threshold for hospital care would be concerning for some professionals. However, the letter continued, "…there will be a need for everyone to consider discharge arrangements that may not be perfect, a care package may not yet be in place, and social assessments may need to happen at home rather than in hospital". 

The Welsh government have sought assistance from the public to help where possible in order to improve the current conditions of NHS Wales, and that the efforts made so far have allowed 500 extra community beds to become available.  

An issue which is contributing to patients being discharged without the necessary care package is the delay in getting the staff and resources to support patients. This was commented on by the chief executive of Care Forum Wales, Mary Wimbury. She believed there needed to be greater co-operation between the NHS and social care sectors, both in relation to paying appropriate rates so that social care providers can actually pay their staff to sufficiently retain and recruit them and provide the support that people need.  She added, "It is a lot cheaper for people to be cared for in their own homes than in hospitals, and this can free up money to invest properly in social care, which will keep people out of hospital in the first place, and get them out more quickly when they are there."

It is clear that the NHS is currently in crisis and that conditions have recently been exacerbated due to rising cases in flu, cold and COVID-19. The first week of the New Year is often one of the most difficult for the health service as during Christmas and other bank holidays they do not run at full staffing capacity.

Many people delay getting their illnesses checked out during the winter period to avoid the risk of not being able to spend the festive period at home or with their loved ones. For the first time since the start of the pandemic, winter flu has taken a huge toll on the NHS. However, the recent rising cases in flu is not the only reason for the current crisis of the NHS’s inability to cope with incoming demands. 

Although the pandemic and its after effects have worsened the situation, there are questions surrounding funding, staff levels and whether the social care system is fit for purpose in dealing with the demands of an aging population: a population whose needs are so much different now to when the NHS was established 75 years ago.

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