Health
Striking drop in home care hours in Carmarthenshire despite rising demand
Richard Youle – Local Democracy Reporter
THE NUMBER of hours of home care commissioned by Carmarthenshire Council has halved over the last decade, despite rising demand from an ageing population.
Jake Morgan, director of social services, said in a report that this “striking” trend was the result of measures such as helping people who might need support at an earlier stage, more help for people who have left hospital but who need care before they can go home, and more instances of one home carer – where appropriate – visiting a client when previously two had.
At the end of April this year, the council commissioned 8,601 hours of home care for people who need help with things like washing and dressing. A decade ago it was around double that.
Mr Morgan’s annual report said the council was managing home care demand, although there are more than 100 people waiting for the service. It added: “However, had we not made these radical reforms over the last 10 years then we would have a waiting list of 500 people and spend of an additional £20 million annually.”
His report, covering key trends in adult services and children’s services, was discussed by the council’s health and social services committee on October 4.
Speaking at the meeting, Mr Morgan said Carmarthenshire was the only area in Wales where home carer pay was on a par with NHS peers, and that this had helped with recruitment and retention. “But it has not solved fundamental shortages in the workforce,” he said.
In Carmarthenshire, as across Wales and the UK, many elderly people in hospital are medically fit for discharge but remain in a ward due a lack of onward support. Mr Morgan said a fortnightly meeting took place reviewing all long hospital waits, and that this had had a positive impact.
He said: “Seventy five per cent of our beds in hospital, sometimes upward of 80%, have frail and elderly people within those beds – hospitals that are designed for mending broken legs and dealing with cancer and all those kinds of functions are now largely overwhelmed by people who have multiple chronic complex illnesses.”
He said the average length of stay in Glangwili and Prince Philip hospitals, in Carmarthen and Llanelli, was more than double the equivalent of comparable hospitals. The more time frail and elderly people remained in a hospital bed with minimal movement, he said, the more they deteriorated and the harder it became to discharge them.
Mr Morgan said the health board had a very good relationship with Hywel Dda University Health Board, but he was concerned that significant health board budget deficits in Wales could mean funding being cut for initiatives to reduce hospital stays.
Moving on to social workers, Mr Morgan said the council was focusing on sponsoring and training its own, while still recruiting externally where possible.
“I think we had 22 (social workers) join last year who we had some role in sponsoring or supporting in doing their professional qualification,” he said.
His report, though, pointed out that the council had been unable to fill social worker posts that were created via a “significant” investment” in mental health services by the authority last year.
Meanwhile, referrals to the child and family services department have increased by around 70% from a decade ago. Mr Morgan said outcomes for children helped by the council were the best in Wales compared to other authorities. “We still have low numbers of looked-after children, and we are good at keeping families together,” he said.
Caerphilly Council, he said, spent £20-25 million more per year on children’s services than Carmarthenshire did. However, Mr Morgan said numbers of young people on the child protection register had risen in Carmarthenshire.
He added that the authority had plans to ramp up its provision of residential care for looked-after children to avoid them having to go outside of the county. “The looked-after children market, particularly in terms of residential care, is not serving children well,” he said.
Councillors asked questions about the fortnightly hospital stay meetings, a rise in suicide in the region, and home care agency funding, among other things, and accepted the report.
Health
GP patient lists ‘generally sound’, audit finds
Controls against list inflation appear effective, but some duplicates and deceased records remained
GP practice patient lists in Wales are in “good health overall”, with no immediate evidence of fraud found in a new data-matching exercise carried out with NHS Wales Shared Services Partnership (NWSSP), according to Audit Wales.
The pilot focused on two areas that can affect the accuracy of practice lists and, by extension, the way practices are funded: duplicate patient registrations and deceased individuals not being removed in a timely manner.
Audit Wales said the payment system for GP practices is complex, but patient numbers sit at the heart of it — creating an inherent risk that inflated lists could lead to incorrect payments. Accurate lists also support wider primary care management, including ensuring patients receive timely invitations for services such as screening and preventing people who should not be registered from blocking appointment invitations.
While auditors found no immediate evidence of fraud in the areas examined, a small number of errors were identified.
The exercise found 140 duplicate registrations to date, with a further 395 potential matches still under investigation. It also identified 15 cases where deceased individuals remained on GP patient lists, with some left on the lists for a significant period.
Audit Wales said these issues meant some GP funding had been allocated inaccurately, but the amount involved was low.
The findings suggest patient list inflation controls are generally sound in the areas covered by the pilot, though NWSSP is working to strengthen its central controls. Audit Wales also noted recent wider IT system changes affecting England, Wales and the Isle of Man.
Auditor General for Wales Adrian Crompton said data matching and other analytic techniques are becoming increasingly important as public bodies tackle risks around fraud and error.
He said: “The results from this exercise have not identified significant concerns about the accuracy of GP patient lists and that is a good thing. But there is no room for complacency. I therefore welcome the way in which NWSSP has taken forward learning from this exercise as part of wider improvements it has already made.”
The pilot compared certain personal details for permanently registered adult patients across GP lists in Wales and against UK Government death registration records. It identified just over 7,000 potential matches from around 2.7 million records processed, with most of the matches investigated by NWSSP found to be explainable false positives.
Audit Wales said the Auditor General is the independent statutory external auditor of the devolved Welsh public sector, responsible for the annual audit of the majority of public money spent in Wales.
Health
Air quality scheme in Pembroke and Haverfordwest areas could be ended
A PUBLIC consultation which could lead to the ending of an air quality management scheme in Pembroke and Haverfordwest, brought in after high levels of pollution were recorded back in 2012, has been backed.
At the Pembrokeshire County Council Cabinet meeting of January 12, members were recommended to support a six-week public consultation on the proposal to revoke the Haverfordwest and Pembroke Air Quality Management Areas (AQMAs).
A report for members ahead of the meeting, presented by Cabinet Member for Planning & Regulatory Services Cllr Jacob Williams said: “In 2012, Pembrokeshire County Council identified that concentrations of nitrogen dioxide (NO₂) were exceeding the national annual mean objective within certain areas of Pembroke (specifically along Main Street) and within sections of Haverfordwest’s main commercial streets.
“The elevated concentrations were attributed primarily to road traffic emissions, particularly in narrow streets where vehicle emissions were less effectively dispersed. Although the number of exceedances was limited, the council had a statutory duty under Part IV of the Environment Act 1995 to take action to achieve and maintain compliance with national air quality objectives.
“Consequently, as a precautionary measure, Pembrokeshire County Council formally designated these areas as Air Quality Management Areas (AQMAs).”
It added: “To support the AQMA designations, a comprehensive local monitoring network was established, comprising 48 diffusion tube monitoring stations across both Haverfordwest and Pembroke. Each diffusion tube is tested and replaced on a monthly basis, providing a continuous dataset on ambient nitrogen dioxide (NO₂) concentrations to track progress and assess the effectiveness of implemented measures.
“Over several years, measured NO₂ levels have shown a consistent downward trend, reflecting the effectiveness of local emission reduction measures and broader improvements in vehicle technology and fleet composition.”
It says monitoring over the last three years has shown levels to be below national objective and precautionary threshold levels, adding: “On the basis of this sustained compliance and the clear evidence of air quality improvement, Pembrokeshire County Council proposes to revoke both the Haverfordwest and Pembroke AQMAs.”
It stressed: “Although the statutory Air Quality Management Area (AQMA) designations for Haverfordwest and Pembroke have been proposed for revocation; Pembrokeshire County Council will continue to undertake air quality monitoring to ensure that standards are consistently maintained and that public health remains protected.”
Cllr Alistair Cameron said: “This is a good news story, it’s so important for people to breathe good quality air in Pembroke and Haverfordwest.”
He was joined by Leader Cllr Jon Harvey, who represents Pembroke St Mary North, who said: “Modern vehicles are less pollutive than previous ones, it’s a good news story.”
Health
Ward closures at Prince Philip Hospital, Llanelli as norovirus cases rise
FOUR wards at Prince Philip Hospital in Llanelli have been temporarily closed and visiting restrictions introduced after cases of norovirus were confirmed on the site and in the wider community.
Hywel Dda University Health Board said the measures came into force on Tuesday (Jan 13) and apply to the whole hospital, even though four wards are currently affected.
Visiting has been limited to essential visits only, with the health board asking members of the public not to attend the hospital “until further notice”. Essential visiting may be permitted in exceptional circumstances, and families are being advised to contact wards directly or the hospital switchboard for guidance.
Norovirus is a highly contagious virus that can cause vomiting and diarrhoea, and outbreaks often lead to ward closures to help prevent further spread.
Sharon Daniel, Hywel Dda’s Director of Nursing, Quality and Patient Experience said: “We have taken the decision to restrict all but essential visiting to Prince Philip Hospital in order to keep patients and staff safe and to halt the spread of norovirus, which is currently circulating in our local community.
“I know this will be difficult for those who have loved ones in hospital and we will re-open the wards as soon as it is safe to do so. Please keep an eye on our website or social media for further updates.”
The health board said other hospital sites across Hywel Dda are operating as normal, but urged people not to visit friends and relatives if they have symptoms of flu, sickness or diarrhoea, and to wear a face covering when attending clinical sites.
Ms Daniel added: “You should only come to our sites if you are feeling well. This helps us limit the spread of viruses and protect our most vulnerable patients. It also helps us to keep staff well, so that they can look after those in greatest need of our care.”
Hywel Dda also encouraged eligible people to take up flu vaccinations, and said information on flu jabs — including RSV and COVID-19 boosters where applicable — is available via the health board’s website or its vaccination helpline.
For further information, the public can call 0300 303 8322 (option one) or email [email protected].
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