Dai Lloyd Opens & Closes Assembly Debate on NHS Winter Preparedness

Below is a transcript of Dr Dai Lloyd AM's opening and closing remarks in the National Assembly debate on the Health & Social Care Committee's report into Winter Preparedness.

Gallwch wylio fideo o'r ddadl yn y Gymraeg isod (You can see the video of the debate in Welsh below)

Thank you, Llywydd. I’m very pleased to open this debate today on the Health, Social Care and Sport Committee’s report on winter preparedness 2016-17, which we’re in the middle of now. Of course, winter is a hugely challenging period for our health and social care services. It’s a time when the year-round pressures of an ageing population, increasing demand for services, and workforce challenges, are thrown into sharp relief. Just two weeks ago the chief executive of the Welsh NHS remarked that the NHS has already faced exceptional challenges this winter, experiencing some of the busiest days ever faced by hospital emergency units and the Welsh ambulance service.

That’s the week the Cabinet Secretary for Health, Well-being and Sport announced that certain targets for GPs are to be suspended temporarily to help free up appointments in their practices, such is the pressure on primary care over this winter. Assembly Members will almost certainly be aware also of the coverage relating to similar pressure on health and social care services elsewhere in the UK and in England in particular.

We as a committee felt it was important to examine how prepared the Welsh NHS and social care services are to deal with pressures on unscheduled care services during what is now the current winter period. As part of this work, we wanted to look at the progress that has been made in this area over the past few years, particularly since the work done by our predecessor committee in 2013-14. Our terms of reference also included a focus on patient flow, including primary care out of hours, emergency ambulance services, emergency departments, and delayed transfers of care.

We spent the 2016 summer period asking stakeholders to tell us their views on whether the Welsh NHS was equipped to deal with pressures on unscheduled care services during the coming winter. We had a really good response to this and we’re grateful to everyone who took the time to write to us and present evidence to us in our formal meetings.

That’s the evidence that’s helped us to come to some very clear conclusions and has enabled us to make what we believe are robust recommendations to the Cabinet Secretary and Minister. Although many of our recommendations are important in terms of managing additional winter pressures, they need to be considered as part of a much wider review of health and social care services in Wales. Indeed, our overriding conclusion is that a more resilient NHS and social care service would be better equipped to cope with the considerable spikes in demand over the winter period. Without that greater resilience all year round, efforts to manage winter-specific pressures will be more about trying to limit their effects than achieving the whole-system change that is so greatly needed. Regular readers of our report will know that paragraphs 71 to 75 tell us this.

I note that the Cabinet Secretary has partially accepted our first recommendation. We are all aware that statutory regional partnership boards were established under the Social Services and Well-Being (Wales) Act 2014 as a way of taking forward the agenda to deliver integrated health and social care. However, I’m glad the Cabinet Secretary recognises there is more to do and that his Government will be supporting further improvements.

Overall, we concluded there is a need for greater integration between the health and social care sectors, both in the planning and delivery of services, and there is a need to include the independent sector, both care home and domiciliary services, in this work. In light of this, I am disappointed the Cabinet Secretary has rejected our recommendation that he should commission or possibly review any available research into the effectiveness of the co-location of primary care services in A&E departments, especially as he acknowledged the evidence from across the United Kingdom outlining the effectiveness of co-location. The information he has provided relating to out-of-hours services working alongside emergency departments is welcome, despite that.

There was a difference of opinion amongst those who gave evidence to the committee about the levels of preparedness—this, in itself, is cause for some concern. There should be more confidence across the entire sector that the problem is under control and manageable. That this is not the case may be due, in part, to a need to improve communication between all the relevant parties, despite arrangements, such as integrated plans, being in place.

Linked to this, we have some concerns about the Welsh Government’s flu vaccination campaign, especially in relation to the relatively low uptake amongst NHS and social care staff. Recent figures provided by Public Health Wales show that only 48.4 per cent of NHS staff who have direct patient contact have, so far, taken part in the influenza immunisation programme. Vaccinating front-line staff is a key preventative measure, and we believe the Welsh Government and the sector should be more ambitious when setting targets in this area. We also have some concerns about the structure, visibility and targeting of the campaign this year. There is a need for clarity about the respective roles of GPs and pharmacists in the campaign and the strength and visibility of national messages to target groups. We recommended that arrangements are put in place to undertake whole-system learning based on an evaluation of the effectiveness of all Welsh Government campaigns relating to winter health. That’s recommendation 3.

I welcome the fact that the Cabinet Secretary has accepted our recommendation on this matter. I am pleased to note—and I’m sure that other committee members will feel the same way—that learning from the evaluation will be incorporated into future all-year planning, including the campaign for next winter. There is no doubt that there have been some clear improvements within the system. The Welsh ambulance services trust is an obvious example, and they should be congratulated for this. However, a number of matters reported on by our predecessor committee in 2013 have been identified in the course of this inquiry as continuing to need attention as a matter of priority, including inappropriate A&E admissions, patient flow through hospitals and delayed transfers of care. We had a lot of evidence about beds, the need for more beds and the great pressure on social care. More from other committee members on that, evidently.

As a committee, we recognise that planning for this winter has required a great many resources. We welcome the fact that the work on planning for the winter started early. It’s important that the lessons of previous years are learnt. Now, despite this, we are concerned about the ability of the system to cope with the additional seasonal pressures, and the damage that one serious incident such as a flu outbreak or the closure of a care home could cause. We welcome the additional investment of £50 million by the Welsh Government for winter preparedness this year. The Cabinet Secretary said that he expected to see specific outcomes as a result of this additional investment: dealing with the additional demands of unscheduled care and maintaining elective surgery over the winter period. We recognise that these are ambitious targets for this level of investment. That’s recommendation 4. We look forward to hearing from the Cabinet Secretary in May regarding the progress made against those ambitious targets. Thank you very much.

Closing Remarks

Thank you, Deputy Presiding Officer. I’d like to thank the Cabinet Secretary for his contribution, and also other members of the committee, and Members who are not members of the committee as well, for their contributions this afternoon.Rhun ap Iorwerth started by referring to the importance of acknowledging that we have to do something about flu and the pressure on social care, the pressure on our beds, and the need to tackle that situation.

Angela Burns, then, also discussing in her own mature, inimitable way, and making very valuable points in terms of the fact that’s recognised by everyone: that different patients appear in the winter and that we should be able to plan for that because the same kind of thing happens winter after winter. We are expecting another winter at the end of this year as well. She also made the point about integrated care.

I’m very grateful for the contributions of Caroline Jones, Janet Finch-Saunders and Gareth Bennett to this debate, because this was a very important report on the NHS’s preparedness for winter pressure. It was a result, of course—a report had been issued previously in 2013-14, and therefore building on those recommendations was the intention, and seeing what kind of improvement there had been in terms of the work that’s being done in this area.

Of course, the overriding conclusion of the committee is that the entire system that we’ve been mentioning—not just the health service, but also the social care system—should be more resilient throughout the year, and therefore in a much better position when additional pressures are applied at those very busy times in the middle of winter, so that the system in its entirety can deal with that in terms of capacity when a great number of patients appear on certain days, as we’ve heard about recently. Of course, we know that the arrangements in place for this winter will be evaluated soon and we look forward eagerly to the findings of that evaluation.

And just to close, and just to echo the thanks of those who have contributed this afternoon in terms of recognising the heroic contribution of the staff in the health service. Naturally, I meet them very often in the workplace, and I felt the emotion and that passion in the different contributions made to the committee inquiry. There is a passionate love towards our health service—yes, from the patients’ side, but also particularly from the staff as well. You can’t put a price on that passion and that commitment to a system that is vital so that we can keep it and develop it to be even more innovative than it is at present.

We’ve been looking at new ways of working, but to do that we have to get over the difference between primary care out there, compared with hospital care. We have to bring those sectors together. We like to see that aspiration that doctors and nurses can work in those hospitals, but also in our communities—a dual approach for the way ahead. We expect to see exciting developments of that nature in the future, not just GPs working in the hospitals, but also hospital specialists increasingly working in our communities. We have to tackle ensuring that every specialist can look at the patient in more general terms—not just at one system that is struggling. We have enough specialists now that just look at the thyroid, diabetes, or the heart, but increasingly we need specialists who can look after the patient as a whole, because we have a growth in the number of older people. The way to cope with that is to have specialists who can look at the patient as a whole, as we used to have. Now, it is only GPs, basically, aside from certain specialists who look after older people, who have the necessary skills to do that. So, we need to look again at that system as well.

So, can I thank from the bottom of my heart the staff in the health service for their contributions—our doctors and nurses, physiotherapists, OTs and so forth? And also, in closing, could I thank the clerks and all the officials who support my work as Chair of the Health, Social Care and Sport Committee for all the support, and for their hard work in ensuring that this inquiry and this significant contribution that you see before you in this report could see the light of day? It means a lot of work behind the scenes to bring this to life in the first place, but I thank everyone for their contributions this afternoon and for their attention. Thank you very much.