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Health

Concerns over standards at A&E following report highlighting ‘significant challenges’

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OVERCROWDING and patients sleeping on floor at a west Wales A&E were some of the issues raised by a report raising serious concerns, but also saying that there had been some improvements made to a hospital’s standards of care.

The health board involved, Hywel Dda, now says it has come up with a plan to address the issues raised by a report published by Healthcare Inspectorate Wales (HIW) who carried out an inspection of the emergency department at Glangwili Hospital, Carmarthen, in December.

Despite the best efforts of staff, the independent body said patients did not always receive consistently safe care.

Hywel Dda health board said it recognised “significant challenges” within the department.

Although patients and carers were said to be “generally satisfied with the service”, HIW identified several issues with the service provided at the department.

The report highlighting concerns at Glangwili came out at the same time that figures were released saying that waiting times at Welsh A&E departments had fallen slightly. Responding to those Emergency Department performance figures for February 2023 for Wales, Dr Suresh Pillai, Vice President of the Royal College of Emergency Medicine Wales, said: “We welcome the improvement in Emergency Department performance shown in February’s data. The reduction in patients facing four-, eight- and 12-hour waits is a testament to the hard and skilled work of Emergency Medicine staff who continue to tackle the crisis in Emergency Care.

“While we welcome this improvement, the situation remains serious. Exit block – where patients cannot be admitted from the Emergency Department to a bed because out of the limited bed base, many are taken up by patients who are unable to be discharged in a timely way causing a ‘traffic jam’ in the system – remains a significant issue in Emergency Departments in Wales. On the ground we continue to face severe problems around flow throughout our hospitals and delays to patient care.

“We must see faster and more tangible action around discharging patients and social care.

“We are pleased to have met with the Health Minister, Eluned Morgan MS. We recognise that there is the political will to engage with the issues facing Emergency Care. The Welsh Government is focused on delivering the six-goal programme.

“As part of this they are appointing Clinical Leads for each of the Six Goals with some overlap instead of the current model of one for all Unscheduled Care. We look forward to engaging with these Leads and would be pleased to continue engaging with the Health Minister and the Welsh Government and have further such meetings.

“There is an ongoing retention and recruitment crisis in Emergency Medicine in Wales. Our workforce census, published earlier this year, made this clear. Not only are junior doctors’ continuing to be stretched, but difficulties in recruiting persist. It is vital that both retention and recruitment in Emergency Medicine is recognised and made a priority by the Welsh government, otherwise Emergency Care will remain in crisis to the detriment of patients and existing staff.”

The report highlighted the following areas where the service is doing well or actions are already in place, including:

  • pressure damage care and prevention;
  • assessing and monitoring patients waiting in ambulances to maintain patient safety;
  • availability of food and fluids;
  • triage and supervision of areas by staff;
  • easy navigation of patient records, handwritten entries were legible and logically set out.

But the report, by Healthcare Inspectorate Wales (HIW), found that patients at an accident and emergency department in Wales were not consistently receiving safe care.

The HIW carried out three unannounced inspections at Glangwili General Hospital in Carmarthen in December 2022 and identified several areas requiring immediate action by the health board.

The report found that overcrowding, a lack of toilet and washing facilities, and patients waiting in non-designated areas of the unit were having a negative impact on patients’ privacy, dignity, and infection prevention and control procedures. Delays in children being seen were also identified in the Paediatric Care and Assessment Unit (PACU).

Although patients and carers were generally satisfied with the services they received, frustration was expressed around waiting times and the lack of updates on patients’ care and treatment.

The health board has produced a comprehensive plan to improve the emergency department.

Andrew Carruthers, of Hywel Dda health board, said: “While the report states that generally patients and carers were satisfied with the service they had received at the emergency department at Glangwili Hospital, we do, however, recognise that there are significant challenges within the department.

“We also recognise the regrettable impact these have on our patients and their experience of using our services.

“We wish to reassure people that we are focusing on our improvement plan to address the recommendations of the report, and to provide ongoing assurances for our communities of the quality of the services we have to offer and provide.”

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Health

Phone calls to reduce GP visits for 42% of patients this winter

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NEW research from the Royal Voluntary Service has shown that a simple phone call could significantly impact well-being, reducing GP visits by 42% among patients who receive regular telephone support.

The charity urges those feeling isolated this winter, particularly the elderly, to use telephone support services as a way to improve health and free up GP appointments, potentially reducing waiting times. It is estimated that if people experiencing loneliness in later life reduced their GP visits by just one appointment a year, this could free up 588,000 appointments annually.

As winter approaches, the Royal Voluntary Service reports that isolation can sharply increase, especially for adults over 75, with nearly half (47%) of people in this age group feeling lonelier in the colder months. Among those who live alone, one in six say they feel forgotten during winter, and 20% report having no one to turn to for emotional support.

In addition to loneliness, older generations face several winter worries, including increased heating costs, cited by 55% of respondents, and reduced ability to go out, which 29% said they dreaded as winter sets in.

To address these challenges, Royal Voluntary Service has launched the Stay Safe, Warm and Well campaign in partnership with Yakult. The campaign provides a guide for practical and emotional winter preparation, encouraging sign-ups for telephone support services and offering access to the Virtual Village Hall online community for events and activities. Practical advice on money-saving and energy-saving tips is also available through the guide.

Royal Voluntary Service Ambassador Elaine Paige, who has herself made support calls for the charity, described the positive impact these calls can have. “A warm, friendly phone call can transform someone’s day. Some conversations leave you smiling long after the call ends—something we could all use, especially in winter. For those facing the season alone, there are amazing people ready to remind you that you’re not alone,” she said.

The charity’s support services match volunteers with individuals across the UK for friendly chats, reducing isolation and boosting mental health. Catherine Johnstone CBE, Chief Executive of Royal Voluntary Service, said: “The feedback that conversations with volunteers are helping people to visit their GP less is testament to the value of connection.”

Yakult Marketing Manager Reshma Patel added: “Our research with Royal Voluntary Service shows that one in four adults over 75 feel they’d benefit from practical and emotional support over winter. We are committed to helping people access the Stay Safe, Warm and Well guide to support their overall well-being.”

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Health

Over 1500 patients in Wales blocked from leaving hospital

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THE First Minister Eluned Morgan has been pressured on her government’s failure to clear hospital beds in Wales, leading to delays for people seeking urgent medical care.

According to a report from BBC Wales, there are currently 1,600 patients across Wales waiting to be discharged from hospital compared to England where there are currently 12,000.

However, when comparing population sizes, it’s revealed that Wales is performing worse than its closest neighbour, with 0.05% of the population of Wales stuck in hospital beds compared to 0.02% in England.

The Welsh Labour government have been criticised for their failure to clear out backlogs in the system,

The Liberal Democrats have now called on the Welsh Government to provide urgent social care funding to local authorities to help alleviate pressures on the NHS in Wales.

Speaking in the Siambr on Tuesday, The Leader of the Welsh Liberal Democrats Jane Dodds MS described how over twenty years of Welsh Labour government in Wales had let to a “desperate situation in our NHS, with services nearing breaking point.

Welsh Labours refusal to change their approach and fix a system clogged up by mismanagement is directly responsible for the current situation faced by thousands of patients.

Delays in discharging patients from hospitals are placing huge pressures on both staff and those awaiting care, but there is a way out of this mess and the answer lies in social care.

I have been told by numerous professionals working in healthcare that the first step towards fixing our NHS is made by providing local authorities with the funding to fix social care services within their respected areas.

By dedicating adequate investment into our social care services, we can make life easier for patients discharged from hospital while also lifting the strain on health services throughout Wales.”

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Education

Concern over ‘highest-ever’ school bullying rates

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RATES of bullying in Welsh schools have reached record levels, with more than one in three children and young people reporting being bullied, the Senedd heard.

Gareth Davies raised concerns about a 6% increase in bullying between 2021 and 2023, according to a survey of more than 130,000 pupils in 200 secondary schools.

The Conservatives’ shadow mental health minister told the Senedd: “These results are higher than ever previously reported in the survey, which is deeply troubling.”

He said the latest survey showed regression on “just about every metric of pupil wellbeing”, including growing social isolation and a rise in behavioural issues.

Mr Davies, who worked in the NHS in north Wales for more than a decade, pointed to a 2021 legal duty to have regard to the mental health of children and young people.

He said: “The mental health of pupils has declined and reports of bullying in schools have only increased, so the Welsh Government have failed in that duty, unfortunately.”

Plaid Cymru’s Cefin Campbell called for an update to 2019 anti-bullying guidance for school governing bodies following a commitment from the Welsh Government eight months ago.

The shadow education secretary focused on the impact of poverty, warning the high cost of school uniforms can cause stress and lead to bullying.

Mr Campbell, a former lecturer, expressed concerns about penalties, such as detention, for pupils over non-compliance with uniform policies.

Raising a report on “horrific” experiences of racism in Welsh schools, he said one pupil was told a classmate did not want to sit next to them due to the colour of their skin.

“That’s entirely unacceptable in our schools,” said Mr Campbell.

Labour’s Carolyn Thomas warned children’s mental health is at an all-time low, pointing to smartphones and social media as major contributing factors.

She said: “They can be used to bully, manipulate and control, sending young people into an isolated world of despair, not thinking they can get out of it or go to somebody for help.”

The North Wales politician highlighted a petition calling for a ban on phones in schools.

Rhys ab Owen, an independent who represents South Wales Central, stressed that bullying can impact people for decades to come after school.

“But it’s an issue that doesn’t affect learners equally,” he said. “In Cardiff, around a third of learners come from ethnically diverse backgrounds.

“And I was staggered to read a survey from 2020, which said that 61.5% of learners had expressed stereotypes over skin colour, religion and nationality.”

In a statement on November 12 to mark anti-bullying week, Lynne Neagle accepted that bullying continues to be an issue in Welsh schools.

Pledging to prioritise the problem, Wales’ education secretary said new statutory anti-bullying guidance will be published for consultation after Christmas.

Ms Neagle pointed to concerning trends, including 42% of girls scoring high or very high in a questionnaire on psychological problems compared with 27% of boys.

She told the Senedd: “I wouldn’t want to be a teenager growing up today.”

Ms Neagle stated the Welsh Government provided more than £800,000 this year for one of the biggest surveys of children and young people in the UK.

She said: “The link between bullying and mental health is well known. At its most extreme, young people have taken their own lives as a result of being bullied. This is a tragedy for the young life lost, for their family and friends and for whole communities.”

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