Winter pressures: how do we break down barriers between care systems?

Winter pressures are here again, and it’s hard not to have a sense of despair and déjà vu. But one of the aims of our 2024 Update in medicine in Cardiff was to explore how we could improve things for patients in Wales. Now we need to deliver some of the bold and brilliant ideas we heard about from speakers up on that stage!  

Dr Rowena Christmas is chair of the Royal College of General Practitioners (RCGP) in Wales. She and I have committed our colleges to work together to advocate for new models of care across Wales. She told me: 

‘The greater the communication between primary and secondary care, the easier it is to manage patients well and to practise prudent healthcare. (….) We’re all on the same side, and together we can often practise more effective medicine, focusing on the outcomes that are most important to the patient.’

We all know that we need to break down the barriers between primary and secondary care. There are good examples of brilliant integrated care models in Wales in both acute and chronic disease, but it’s hard to think of any new models that have been rolled out beyond the local health board or site where they happen. At our Update in medicine – Cardiff, we heard from Dr Andrew Yeoman about work to develop specialist hepatology services in the community. His team are reaching into the community with blood-borne virus screening and home hepatology visits by clinical nurse specialists. They want to identify liver disease earlier and reduce hospital admissions, particularly towards the end of people’s lives. 

Are we training the next generation of physicians to deliver care beyond the hospital walls? As I travel around Wales, I’m finding that we need to support and develop the staff who have committed to train, work and stay in our smaller hospitals. National training standards are vital, but they can feel rigid – one size does not fit all. I am sure that our RCP Resident Doctor Committee (RDC) representatives, Dr Alexandra Burgess and Dr Sacha Moore, are flying the flag for the needs of Welsh physicians as the RDC advocates for a four-nation review of postgraduate medical training. We keep in regular touch with Health Education and Improvement Wales and there’ll be more news on joint events for resident doctors in 2025.   

Corridor care
This month, we asked governments across the UK to record and publish data on the number of patients receiving care within temporary care environments – sometimes known as ‘corridor care’ – at the moment patients are ‘hidden and uncounted’. NHS England has committed to record and publish corridor care data. Wales must do the same.  

We have just published guidance for physicians on how to support patients in temporary environments but, of course, corridor care should be a ‘never event’ – it’s undignified for our patients and soul-destroying for our staff. We can’t accept this as routine for our patients. It’s been an exceptionally difficult winter so far and the RCP voice will continue to speak out in the media on this, including in Wales. 

Winter pressures
A surge in flu and other respiratory infections this winter has had a huge impact on our hospitals over the last few weeks. According to Public Health Wales, when we look at flu, COVID and RSV – the main acute respiratory infections – there are more than 900 patients with one of these viruses in hospital beds, 50% more than this time last year. The Welsh government provides modelling and preparation for winter pressures, but does this reach local health boards – and are they using it effectively to improve the way they work? 

Delayed transfers of care 
And what about social care? The greater the number of patients unable to leave hospital, despite being medically well enough to do so, the fewer beds there are for new hospital admissions for patients coming in who are acutely ill. Social care needs to be recognised as an equal partner to the NHS in delivering patient-centred services – this means parity in status, staffing levels, governance and funding, so that we can build capacity in community care outside hospitals. And speaking of social care, the Senedd Local Government and Housing Committee is holding an inquiry into the role of local authorities in supporting hospital discharges. We want to hear your views and your experiences – please contact emily.wooster@rcp.ac.uk. 

Audit Wales recently published a damning report on cancer services in Wales. They found that health boards are failing to meet the national performance targets for cancer and described a lack of focused leadership. Dr Sian Eccles and the team in Cwm Taf Morgannwg University Health Board have proved the value of lung health checks in diagnosing cancer at an earlier and treatable stage, but we are still waiting for a commitment to roll this out across Wales. ITV Wales came to film our colorectal multidisciplinary team meeting in Aneurin Bevan University Health Board – our clear message was that we need strong leadership and a bigger focus on the delivery of cancer care.

In October 2024, Wales saw record waiting times published, with the list exceeding 800,000 people for the first time, according to Digital Health and Care Wales. We were pleased to attend Plaid Cymru’s launch of their plan for waiting times and we have contributed a briefing to a Senedd debate this month – this affects us all and we can’t continue to let these lists grow. 

To finish on some good news, Public Health Wales has provided a compelling case for investing in prevention. Using examples from across Wales, they have shown that public health interventions offer a return of £14 for every £1 invested. This winter has been bleak for us as physicians – we are seeing the result of stark health inequalities at the front door of our hospitals – and never has it been so important to invest in community and social care. As this report shows, it works. 

Finally, I was delighted to see Welsh physicians recognised in the new year’s honours for their leadership in research and patient care. We clearly have an eye for brilliance, as many of them have presented in our annual Cardiff Updates in medicine over the years! Congratulations to Dr Zaheer Yousef, Prof Susan Wong and a further distinction for Sir Leszek Borysiewicz, who has been so pivotal to our understanding of cancer immunology. And, of course, congratulations to our RCGP friend, Rowena, who was awarded an MBE. All very well deserved!