December 2021: Actions taken to mitigate pressures in the health and social care system
The health and social care sector is facing a tremendous amount of pressure, which is
subsequently impacting the ability of both the NHS in Wales and social care providers to
continue delivering services.
Many staff working in healthcare are exhausted, with wider workforce challenges
compounding the situation. High absence rates, due to stress, psychological issues, needing
to self-isolate or long COVID, are exacerbating staffing issues that existed before the
The challenges facing social care services include vulnerabilities in funding and market
stability, increased demand, growing unmet need and high levels of staff vacancies. Their
impact on capacity means people are missing out on vital care and support.
The NHS is reliant on a sustainable social care system, and issues of capacity and
workforce in social care are having serious implications on the NHS’ ability to discharge
large numbers of medically fit patients from hospital into care packages. At the time of
writing, there are over 1,000 patients in Wales who are medically fit and ready for discharge
from hospital. Apart from the negative impact on the patients themselves and their
outcomes, this also slows down the flow of patients through hospitals, affecting care
available for others. It also has a knock-on effect on other services, including the Welsh
Ambulance Services NHS Trust’s (WAST) ability to provide effective and rapid responses
and interventions and on elective capacity and services.
This system-wide challenge to provide care is starting to impact on the health of our
communities more generally, with higher numbers of very sick people presenting in
emergency departments (EDs). All these effects, felt by patients and across the system,
make it harder to tackle the backlog of healthcare due to the ongoing impact of the
This briefing seeks to outline some of the recent developments being taken by the NHS and
Local Authorities at a local level to assist in reducing the current extreme pressures on
health and care in Wales.
This briefing outlines the key developments under four key themes:
1. Preventing hospital admissions
Given the significant challenges to patient flow and the potential and actual harm that results from a prolonged hospital stay, it is essential that as many people as possible are supported in their own community, rather than in a hospital. Efforts are therefore focused on reducing avoidable hospital admissions.
2. Discharge to Recover and Assess
One of the main sources of system bottleneck is transfer out of Discharge to Recovery and Assess pathways to onward packages of domiciliary care. It is clear that assessing patients in hospital for ongoing and often long-term care can underestimate the ability of individuals to recover and improve. This can result in an over-provision of care and in some cases set a pattern of long-term care that becomes irreversible. A systematic approach to discharging patients from hospital to assess their strengths and identify care and support requirements is a major element of development across Wales.
It is important to recognise that workforce supply is critical. Whilst recruitment efforts are important, engaging, developing and supporting current staff to aid retention is fundamental. Some of the developments are therefore focused on supporting staff.
4. Broadening care and support approaches
This focuses on widening the approaches to the provision of care and support, including working with the voluntary sector and families themselves. It also looks to flex the role of some elements of the care system to meet local pressures.