Written question WQ83632

In April last year, the Welsh Government issued comprehensive guidance on patient discharge which was to take effect from 6th April. The ‘COVID-19 Hospital Discharge Service Requirements (Wales)’ set out procedures for managing discharge and hospital flow in a way intended to ensure that vital hospital bed capacity was not compromised by delays in discharging patients who were clinically safe to be transferred to more appropriate settings. That guidance is available here:

https://gov.wales/sites/default/files/publications/2020-04/covid-19-hospital-discharge-service-requirements.pdf

ANNEX C of the guidance (page 34) contains the Patient Information Leaflets to be shared and explained to patients on their admission and their discharge – Leaflets A and B respectively. Each patient’s discharge destination will be determined by the outcome of the required process for assessment of any ongoing care needs. The Welsh Government’s ‘Home First’ assessment and discharge policy was designed to ensure that people are returned to their own homes, with home care packages or any other necessary support measures (such as equipment or home adaptations), wherever possible. However, where the assessment concludes that their care needs are such that they can most effectively be met in a residential or nursing care home, or other specialist facility, that will be explained to them.

Prior to the production of the COVID-19 discharge guidance, previous discharge guidance had referenced the need to provide Patient Information Leaflets. Welsh Government produced a model template for that purpose, which health boards could supplement with their own additional local information.

In terms of Welsh Government’s actions to support independent living for elderly people who do not wish to enter a care home; provided the person has capacity to make their own decisions, they are not obliged to accept an assessment which concludes that it is in their best interests to move to a care setting. Patients have a legal right to ignore such a recommendation in favour of returning to their own homes. However, they will need to confirm that they are fully aware of the risks that choice would incur. In such cases, their local authority will endeavour to provide the maximum home care package that would equate to a care home placement, but that would not necessarily be sufficient to meet all of their assessed needs. As noted above, the ‘Home First’ ethos is applied wherever possible, but would not be advised where an assessment indicates that a person would be at risk of not receiving the amount of care and support required to meet all of their eligible needs.

The ‘Home First’ policy reflects our recognition that increasing numbers of people want to return to their own homes, living independently, with any necessary care and support services, for as long as possible. However, in common with much of the UK, we have experienced longstanding challenges in the recruitment and retention of home care workers. In recent months, a significant increase in demand for home care has resulted in unprecedented pressure on capacity within the care sector. The actions we are taking to address that problem include:

• Local authorities are working hard to support initiatives which will enable private providers to attract more staff into the sector;

• We have undertaken a national advertising and media campaign and are repeating this activity to ensure as many people as possible see further TV, radio and social media promotions of social care as a positive career choice;

• We are supporting the national roll out of free introductory online training for anyone who might be interested in a career in social care, with support to gain employment. This is available via the WeCare.Wales website hosted by Social Care Wales.

• We are committed to implementing the Real Living Wage for social care workers in Wales early in this Senedd term and we have asked the Social Care Fair Work Forum to work with us in meeting that commitment. We are also working collectively with unions, provider representatives and local government to ensure that we can achieve long-term sustainable change.