'It's not just a crisis, it's a national emergency': Addressing the challenges in social care

This briefing provides an overview of the results from a survey of Welsh NHS Confederation members regarding the impact of social care on the NHS.

28 September 2022

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  • Liv Baker
    Liv Baker
    Senior Media and Communications Adviser, Welsh NHS Confederation


Key points

  • NHS leaders have said the pressures in the care sector are having a knock-on effect across the health and care system. Many of the 50+ leaders surveyed said these pressures are driving urgent care demand, with a lack of social care capacity having an impact on the ability to tackle the elective care backlog.

  • 100 per cent of NHS leaders agreed there is a crisis in the social care workforce, with a subsequent impact on patient care and safety. Many of those surveyed expect the situation to deteriorate over winter.

  • These pressures require urgent government action, with healthcare leaders standing in support of their care colleagues. There are opportunities for Wales to deliver on integrated citizen-centred care. Therefore, we are calling on government to take actions to alleviate current pressures in the system and ensure future sustainability.

“This is the single most important issue for the NHS”

 - Healthcare leader’s survey response


The health and social care sector is facing tremendous pressure, which is subsequently impacting the ability of the NHS and social care providers in Wales to continue delivering services.

Social care services play a crucial role in care pathways – keeping people well for longer outside of hospital and enabling faster, safer discharges home. Therefore, the sector plays a critical part in protecting NHS capacity and its ability to deliver high-quality, safe care.

However, social care services are facing significant challenges, including vulnerabilities in funding and market stability, growing unmet need and high levels of staff vacancies. The impact of these challenges means people are missing out on vital care and support, leaving them less independent, more vulnerable and more likely to rely on healthcare services.

To understand how these system-wide challenges are playing out on the NHS frontline, we surveyed our members, NHS leaders in Wales, between 5-18 August 2022. We asked our members to describe the impact that staff shortages and a lack of capacity in social care are having on NHS services in Wales, as well as what effective solutions may look like. We received over 50 responses from NHS chairs, vice chairs, chief executives, executive directors and assistant directors.

This briefing provides an overview of the survey results and seeks to outline some of the actions being taken by the NHS and local authorities at a local level to assist in reducing the current extreme pressures on health and care services in Wales.

We are calling on the Welsh Government to:

  1. Provide sustainable funding for social care with a fully funded pay rise to enable recruitment and retention, alongside greater overall investment and career progression opportunities.
  2. Support better integration between health and social services to achieve seamless care and support for the patient.
  3. Provide sufficient, ring-fenced funding and longer-term investment to transform out of hospital care and allow for long-term service development.
  4. Publish locality-based delayed discharge data so there is clear information and evidence of the current issues in providing packages of care to people leaving hospital.
  5. Introduce performance measures that focus on quality-based outcomes, prevention, community services and whole-system collaboration.

“People are having to stay in hospital longer, leading to impaired outcomes, ambulance delays, as flow through the hospital/healthcare system is slower and delayed" 

- Healthcare leader’s survey response

Actions taken to mitigate pressures in the health and social care system

While NHS leaders have indicated support for future solutions, they are also undertaking work to alleviate pressures in the here and now. Some examples can be found below but a wider range of actions can be seen in our more detailed briefing, which can be accessed here. This briefing provides examples under the following four headings.

  • Some examples in this category include a Betsi Cadwaladr University Health Board/Welsh Ambulance Services NHS Trust pilot to enable occupational therapists or physiotherapists to travel with paramedics as an initial response to falls. It also highlights Cwm Taf Morgannwg University Health Board’s hospital frailty assessment service to reduce admissions for vulnerable people who attend ED.

  • This section looks at initiatives such as Marleyfield House in Flintshire, which provides dedicated D2RA beds to support safe and timely hospital discharge. Cardiff and Vale University Health Board have also appointed additional discharge coordinators to reduce the amount of time qualified nurses spend organising packages of care to enable discharge.

  • The briefing takes a look at actions to better support the care workforce such as Health Education Improvement Wales’ care home education facilitator roles, Powys Teaching Health Board’s Health & Care Academy and Digital Health and Care Wales’ Welsh Nursing Care Record.

  • NHS leaders are working with local authority and voluntary sector partners to find solutions to challenges faced and minimise disruption. These examples include Aneurin Bevan University Health Board commissioning packages of care from a private domiciliary care agency and vacant care home beds as a short-term solution, and micro-enterprise home-based care in Hywel Dda University Health Board.

Further detail and more examples can be found in the briefing linked above.