Winter time always brings a rise in demand for healthcare at a time of reduced capacity due to the festive holidays. Our associate, Phil Tyrrell, explains what his work on unscheduled pressures entail and how it can help NHS and local authorities to better plan for the delivery of unscheduled care, a problem that is very much relevant all year around.
What are unscheduled pressures?
They used to be called winter pressures because every year at winter time, pressures on hospital beds increase because of flu, cold weather, falls, etc. and there is an acute need to quickly discharge people to take on new individuals. The main time is obviously Christmas as staff want to take some leave and people want to leave the hospital to join their relatives. This means less capacity. Christmas holidays last a whole week, not just one day, and during holiday periods local authorities used to shut for a week. All that has an impact on the hospitals.
However, over the years, we have come to realise it happens all year around, not just in the winter. Pressure becomes more acute not only at Christmas but also during August, because it is summer holidays and again staff take leave. Easter is becoming another flashpoint. That’s why it is not useful to just focus on winter. We should be trying to look at it all year round and recognise what's happening.
Tell us about the project and your role…
The whole idea of the exercise is to collect from local authorities their perceptions of what pressures residential and domiciliary care have to face each week. I send out a template to heads of service in local authorities to fill in and check what’s happening in their area and what plans they have in place to overcome these pressures.
This market intelligence is collated together week by week and sent to the ADSS Cymru President, Sue Evans, and the ADSS Cymru Business Unit Manager, Gabe Conlon. They share it with Welsh Government every Monday during a briefing meeting via teleconference. The information provided enables Welsh Government to prepare for another briefing meeting later on that day between Welsh Government, social services and NHS.
The information provided is really helpful in order to put in place preventative services where needed. From an NHS perspective, they receive up-to-date information weekly with regard to the number of beds that are blocked or free. And from a social services perspective, they can go out in the community to help those who have been identified at risk.
The goal is that instead of 22 local authorities looking at 22 ways to approach the same problem, they can work together in developing collective approaches as they realise there is a commonality in the types of problems they all have to deal with.
What sort of pressures Wales is currently facing?
Pressures on reablement services are an ongoing issue. Likewise, there are continuing concerns about capacity in the independent sector to respond to demand for domiciliary care. As for residential care capacity, while non-specialised residential care is generally available, there are continuing shortages in specialist accommodation. Hospitals are not a good environment for people with dementia. Unfortunately, there is a great lack of dementia facilities across Wales and very few places are available.
Another pressure is when a care home is failing quality standards. It cannot take on more people until the quality improves and this embargoed care, along with other services closing, impacts on local authorities’ capacity to respond to demand for EMI (elderly mentally infirm) and nursing care.
Recruitment remains another big challenge for all sectors, especially in rural areas. Once people are discharged from the hospital, they sometimes need two people to come and visit them. Coordinating people’s care plan to free up two carers at the same time can be challenging, not to mention the difficulty for carers to travel. Travel time isn’t paid so as they are paid minimum wage, some argue that once the travelling costs are taken into account, they are paid below the minimum wage, which is considered illegal.
As a result, we see staff in the care sector moving to jobs with better wages and more sociable hours. For example, in Flintshire, a new Aldi store was recently opened offering living wage attracting a lot of local carers. The government is looking to increase minimum wage up to living wage over the next five years but residential homes will struggle to afford the new living wage as they are trying to remain price competitive with local authorities cutting down on commissioning.
What measures are being put in place to overcome these pressures?
Work is being done to identify people whose discharge can be expedited quickly and more efficiently. Local authorities are expanding the role of their community resource services and exploring joint opportunities locally and regionally for staff recruitment.
Meetings with providers from the independent and third sector have been organised to look at ways of encouraging individuals to see domiciliary care as a positive career choice. In addition, flu campaign for frontline staff continues to be promoted with circulation of vaccination clinics available.Back to blogs