Welsh Government launches ’50-Day Challenge’ to free up hospital beds quicker

The Welsh Government has announced a 50-day initiative to improve hospital discharge procedures and strengthen community care services, aiming to ease winter pressures on the NHS and social care systems.

Launched today, 11 November, the ‘Integrated Care Winter Challenge’ will run until the end of the year, supported by a 10-point action plan that encourages health boards and local authorities to collaborate on improving care transitions.

The initiative focuses on helping patients who have experienced long delays leave hospital safely and receive tailored care at home or in the community.

Cabinet Secretary for Health and Social Care Jeremy Miles stressed the importance of reducing hospital stays to support patient recovery and free up NHS capacity.

Mr Miles said: “It’s essential we support our health and care services over the winter so they can continue looking after the sickest and most vulnerable people.

“There is no place like home for people to recover from an illness or injury once they are ready to leave hospital. Equally there are a wide range of support services available in our communities that can help prevent people needing to go to hospital in the first place, helping them to stay well at home.

“The 50-Day Integrated Care Winter Challenge and the 10-point action plan will strengthen our health and social care system so that we can help more people to stay well at home and get more people home from hospital when they are ready to leave.

“I’m really pleased the NHS and local authorities have constructively embraced this challenge and have prepared to take immediate collective action to respond.”

The plan includes measures to address delays, such as planning for discharge from the moment of admission, enabling weekend discharges, and conducting more assessments in community settings. It also involves scaling up community rehabilitation and reablement services to aid recovery.

Focus on Best Practice

Minister for Children and Social Care Dawn Bowden highlighted the benefits of community-based care, especially for older individuals or those with complex needs.

“People recover better at home than in hospital, where unnecessary stays can negatively impact their wellbeing. This challenge promotes best practices to ensure they are applied consistently across Wales,” she said.

Diane Walker, Head of the Integrated Discharge Service at Cardiff and Vale University Health Board, provided an example of improved practices. Recently, collaborative efforts between health and social care teams helped secure a care home place for a patient, reducing the risks of prolonged hospitalisation.

“We know it’s better for patients to leave hospital as soon as they’re ready. Delays can increase risks like infections or loss of independence,” Walker explained.

Opposition Criticism

Opposition figures have raised concerns about the initiative, with Welsh Conservative Shadow Health Minister Sam Rowlands criticising it, stating:

“Labour’s initiative lacks financial backing and a clear plan to expand social care capacity. We need to integrate the NHS and social care more effectively and implement a robust workforce strategy.”

Dr Altaf Hussain, Shadow Minister for Social Care, pointed to ongoing issues with delays:

“Discharge delays are a massive factor in Wales’ record-breaking waiting lists. We must value and support care workers to expand sector capacity.”

Speaking to BBC Wales Breakfast, Dr Iona Collins, Chair of BMA Cymru Wales Council, highlighted broader challenges, noting a growing gap between healthcare demand and capacity.

She said: “The difference between demand and capacity is stark. The population of Wales has grown by about 8.2% over the last decade, and in that same period, hospital admission rates have risen by over 48%.”

“There’s a clear mismatch between the demands on hospitals and the care that we can deliver. In fact, we’re getting the opposite with GP practices closing. We’ve lost over 100 in the last 10 years. It just seems quite a paradox that, on the one hand, we’re trying to get more out of our service, and at the same time, we’re supplying less to that service.”

The Welsh Government’s 50-Day Integrated Care Winter Challenge includes the following key measures to improve hospital discharge and community care:

1. Embedding the Optimal Hospital Flow Framework
   • Proactively integrating community rehabilitation and reablement across health and social care systems.
2. Implementing 7-Day Working
   • Ensuring effective discharge processes during weekends by enabling seven-day operations across health and social care teams.
3. Community-Based Decision Support Tool (DST)/CHC Processes
   • Moving these processes out of hospitals and into community settings.
4. Establishing Integrated Navigation Hubs
   • Creating hubs to support hospital discharge processes and avoid unnecessary community admissions.
5. Weekly Reviews of Long-Stay Patients
   • Conducting regular reviews of patients with a length of stay exceeding 21-28 days, focusing on the 20 longest stays in hospitals.
6. Proactive Management of High-Risk Populations
   • Multi-professional community teams to manage the 0.5% of the population at the highest risk of hospitalisation.
7. Enhanced GP Services for Care Homes
   • Expanding proactive and urgent care services for high-risk groups in care home settings.
8. Trusted Assessor Model
   • Establishing a trusted assessor approach for all care settings to streamline the discharge process.
9. ‘Home First’ Approach
   • Adopting a policy of beginning discharge planning from the point of admission to prioritise recovery at home.
10. Community-Based Falls Response Pathways

• Developing seven-day falls response services to address community incidents effectively.

The challenge aligns with the Hospital Discharge Guidance issued by the Welsh Government in September, which provides additional support and structure for improving patient transitions from hospital to home.