New 50-day challenge to improve hospital discharge and community care

Health boards and local authorities will work together to use a 10-point action plan to support more people who have experienced long delays in hospital, to return home. 

The challenge is designed to ensure the NHS and local councils work together to share and learn from best practice to improve our system performance and ensure we have the right support available to help people stay well or recover at home, or in the community.  

All health boards and local authorities have accepted the 50-day Integrated Care Winter Challenge set by Ministers, which will run to the end of the year.  

The challenge will also specifically target the people who have been waiting the longest to leave hospital.  

The NHS in Wales – like the NHS in other parts of the UK – is experiencing persistently high levels of pathways of care delays (delayed discharges) which negatively impact on people’s long-term health and the “flow” through the wider health and care system.

Cabinet Secretary for Health and Social Care Jeremy 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.”

Minister for Children and Social Care Dawn Bowden added: “Community-based care can improve outcomes, especially for older people and those with complex needs. We know people recover better at home than in a hospital, where unnecessary stays can affect their physical and mental wellbeing.

“There are many good examples where health and social care teams are working closely together to ensure people can be supported to stay well at home or move smoothly from hospital into the community where the right support is available to them.  

“This 50-day challenge is about promoting best practice and making sure it is available and consistently applied across Wales.” 

The 10-point action plan of best practice interventions includes steps to remove the blockages in the health and care system so people can be discharged home promptly.  

This includes improving hospital discharge procedures; planning for discharge from the point of admission; ensuring there is proportionate and effective seven-day working to enable weekend discharges; undertaking more assessments in the community and providing community rehabilitation and reablement to help people recover fully.   

Community health and social care services have a pivotal role to play in supporting people to remain well in the community. They assess what help people need, including access to rehabilitation, home adaptations or personal care in the community.  

The 50-Day challenge is a key element of the Welsh Government’s winter resilience plans. The £146m Regional Integration Fund, the £11.95m Further Faster funds, and the £5m allied health professional funding are helping to build community capacity in the system.

The Health Secretary and the Minister recently met teams at the Integrated Discharge Service in the University Hospital of Wales in Cardiff, to learn more about their approach to getting people home safely and to discuss best practice.  

Diane Walker, Head of Integrated Discharge Service at Cardiff and Vale University Health Board said: “We know it’s better for patients to leave hospital as soon as they’re ready to do so. When a patient spends longer than necessary in hospital, they are at a higher risk of losing their independence and deteriorating further.  

“Recently, an elderly frail male was admitted to hospital due to an acute illness and increased needs. Following hospital-based assessments, it was agreed that his care would need to be provided by a care home.   

"The process to find a suitable care home involved adult social care providing details about the patient to homes and waiting for a response. However, it proved difficult to find a home that could meet his needs. This resulted in his hospital discharge being delayed and an increased risk of deconditioning, catching a hospital acquired infection and risk of a fall. To prevent this, health and social care teams worked together to provide details about the patient, and a care home place was secured.  

“As a result of this successful joint approach, it was agreed that all 'pen picture' details about patients will be completed by health and social care teams in the future.”