Unscheduled Care Services in Wales

1 April 2014

Article written by Sarah Hatherley, National Assembly for Wales Research Service

Image from Flickr by Chris Sampson.  Licensed under Creative Commons.

Image from Flickr by Chris Sampson. Licensed under the Creative Commons.

The Welsh NHS faces many pressures; nowhere more than its unscheduled care services. Last winter saw Health Boards reporting unprecedented demand on their services; warnings were issued by professional bodies that emergency departments were at the point of meltdown and concerns were raised about the safety and quality of patient care. The pressure has eased somewhat during this winter, which has been relatively mild in comparison to last season. So how well did the Welsh NHS and social services cope with winter 2013/14 and is the NHS in a better place as a result?

Performance

The Welsh Government has released updated statistics that provide a breakdown of performance delivered along several aspects of the unscheduled care pathway – from emergency ambulance response performance to the numbers of Delayed Transfers of Care.

  • Emergency departments – The latest data on time spent in NHS Wales A&E departments – released on 12 February 2014, shows that 89.4 per cent of patients spent less than 4 hours from arrival until admission, transfer or discharge in December 2013. This percentage has fallen each month since June 2013 – the target is that 95 per cent of new patients should spend less than 4 hours in all emergency care facilities from arrival until admission, transfer or discharge. The data also shows that 849 patients (1.1%) spent 12 hours or more from arrival until admission, transfer or discharge in December 2013. This is a large drop from over 2,250 in April 2013 when the target was introduced and the number has been between 770 and 905 since September 2013.
  •  Ambulance Response times – The Welsh Government publishes monthly statistics containing information on the performance of the Welsh ambulance services including, emergency responses to Category A (immediately life-threatening) calls by unitary authority, Local Health Board and ambulance region. The latest figures – published on 26 March 2014, show that 52.8 per cent of emergency responses to Category A (immediately life-threatening) calls arrived at the scene within 8 minutes – down from 57.6 per cent in January 2014 and from 60.8 per cent in February 2013 – below the target of 65 per cent.
  • Delayed Transfers for Care – The latest available data – published on 27 March 2014, reported a total of 430 patients whose transfer of care had been delayed in February 2014. This represents an increase of 47 delays or 12.3 per cent compared to the January period, but 11 down (2.5 per cent) on the figure in February 2013. The principle reasons for delays were healthcare reasons (28 per cent of all delays); community care reasons (23 per cent); waiting for availability of a care home place (16 per cent); and selection of a care home (15 per cent).

New Health Targets

On 26 March 2014, the Minister for Health and Social Services announced that there will be changes to some of the unscheduled care targets from April 2014; this includes the current ambulance response time target and waiting times at A&E departments. For a year, the new targets will run alongside the existing ones and the Minister will decide what approach to take after this.

The Welsh Government’s current national targets for its emergency care services are:

  • Emergency departments: of new patients, 95% should spend no longer than four hours in the department from arrival until admission, transfer or discharge; 99% should spend no longer than eight hours until admission, transfer or discharge;
  • Ambulance response times: a monthly all-Wales average of 65% of first response to category A (immediately life-threatening) calls arriving within eight minutes. A monthly minimum performance of 60% of first responses to category A calls arriving within eight minutes in each unitary authority area; and
  • Handover of patients from an ambulance to an emergency department: no patient should spend longer than 15 minutes being handed over from an emergency ambulance to a major emergency department.

Health and Social Care Committee

The National Assembly’s Health and Social Care Committee will be considering the progress and delivery of the Welsh Government’s programme for unscheduled care this week – on Thursday, 3 April 2014, when they meet with the Minister for Health and Social Services and Deputy Minister for Social Services. The Committee will be questioning the Ministers about the pressures facing its unscheduled care services; how well prepared the Welsh NHS and social services were for winter 2013/14; and whether the actions taken so far by Health Boards and the Welsh Ambulance Service are likely to produce sustainable improvements in performance and patient safety.