Health leaders have aired concerns about the viability of a Welsh Government plan to implement “24/7” community nursing care across Wales.
Welsh minister for health and social services Eluned Morgan, and deputy minister for social services Julie Morgan, earlier this week unveiled the plan which will be accompanied by £30m to deliver more care at home.
“As we know, we can’t magic up a workforce overnight”
Nesta Lloyd-Jones
The minister for health said the investment aims to “improve people’s chances of living at home independently”, and to reduce the time people spend in hospital when they do need a bed.
To do this, the plans will see community nursing care in Wales move towards a 24/7 system, with 10 additional hours of community nursing on both Saturday and Sundays.
The money will also be used to increase the number of community palliative care nurses who are available “seven days a week”, and to put in place an individual care plan for everyone at most risk of urgent hospital admissions.
It will also provide “thousands” of additional hours of reablement services as an alternative to hospital care for people who can recover at home, among other initiatives.
Eluned Morgan said the plans were being made in part to future-proof health services.
“It’s estimated that in less than 20 years there will be nearly 150,000 more people aged 75 or older in Wales and there is a projected increase of 61.3% in the Welsh population who are 85 and over,” she said.
“This is a sign of the success of our NHS and is something we should be proud of.
“Older people contribute hugely to Welsh society and they tell us what matters to them is fairly simple – if they need care and support, they want to be cared for in familiar surroundings with familiar people and do not want to go to hospital unless this is really necessary.”
The £30m investment in community care has been welcomed by leaders, but they are also airing concerns about whether 24/7 community nursing is possible, and where the staff will come from.
Nesta Lloyd-Jones, assistant director of the Welsh NHS Confederation, questioned if the plans are too vague.
She said they lacked detail about how they could be delivered under the budgetary and personnel headwinds the health service faces.
“Proposals to deliver additional hours of reablement services, moving towards 24/7 community nursing across Wales and strengthening community specialist palliative care are encouraging,” said Ms Lloyd-Jones.
“However, there is currently little detail on how this will be achieved and where this extra resource will come from. As we know, we can’t magic up a workforce overnight.”
Ms Lloyd-Jones said that while the plans are positive, the workforce was already struggling to meet current demand.
Royal College of Nursing Wales director Helen Whyley welcomed that more money was going into community care – but shared similar worries to Ms Lloyd-Jones about how viable the plans were.
She said: “The community nursing workforce is facing extensive staffing challenges and is chronically understaffed, undervalued and overstretched.”
Ms Whyley said the money needed to support fair pay and training opportunities for community nurses.
“This investment must include commissioning more specialist practitioner qualifications for district nurses,” she said.
“It is essential that the variety of qualifications available meet the complex needs of people in the community and reflect the level of specialist care that nurses are able to provide.
“Funded career pathways for specialist palliative care nurses would also be greatly welcomed.
“We need to see a genuine investment in community nursing in priority areas and this must start with fair pay for nursing and vital professional development opportunities.”
“The community nursing workforce is facing extensive staffing challenges and is chronically understaffed, undervalued and overstretched.”
Helen Whyley
This plan, and the £30m investment to go alongside it, will be accompanied by further proposals to be announced later this year from Julie Morgan around “strengthening social care”.
She said: “I want to see consistency across Wales in the standards of care frail people can expect to get in their community, leading eventually to a community care service for Wales.
“I was impressed and encouraged by what was achieved by local authorities and health boards this winter in securing 670 extra community beds across Wales.
“But now we need to go further, faster to make sure more people can get the care and support they need at home or in their community and spend less time in hospitals.”
Social care, in Wales as it is in England, is overseen by local authorities.
Councillor Andrew Morgan, Welsh Local Government Association (WLGA) leader, welcomed the focus on community and social care, but cited the “enormous pressure” on the system currently.
“It is essential that we take this chance to consider how resources and capacity can be used as efficiently and effectively as possible, and to examine what can be done differently across the system to improve the health and wellbeing of people in communities all over Wales,” he said.