Unscheduled Care system in Wales under huge pressure

Unscheduled Care system in Wales under huge pressure
A&E sign outside a hospital.

Many patients have an experience that falls below the level of quality they could reasonably expect

Our blog outlines the challenges currently facing Unscheduled Care services, the impact this has on patients and staff, and actions being put in place to tackle the problems

Unscheduled care is a term used to describe any unplanned, urgent, or emergency healthcare intervention, and refers to care which needs to be provided quickly or in some cases immediately.

The unscheduled care system in Wales is currently experiencing unprecedented pressures. A&E departments are struggling to cope, with patients facing long and often uncomfortable waits before they can be treated or admitted to a ward. 

Many patients needing an emergency ambulance can face extremely long waits. Across Wales as a whole, the target for responding to the most serious life threatening 999 calls has not been met since July 2020. The ability of the ambulance service to respond to an emergency call is seriously hampered by many of its vehicles having lengthy waits outside A&E departments before they can handover their patients. In February 2022 the equivalent of 827 hours a day of ambulance time was lost to ‘handover delays’.

These pressures are putting huge stress on staff working in unscheduled care services and are creating significant risks for patients.

Many factors are combining to create these pressures, including:

  • Increasing demand for emergency care services, driven in part by COVID related illness,
  • Workforce challenges, compounded by higher-than-normal levels of sickness absence,
  • Delays in discharging medically fit patients from hospital with knock-on effects on the flow of emergency patients from A&E to a ward, 
  • Patients not always accessing the most appropriate care for their needs.

Whilst the pandemic has undoubtedly created a new set of pressures on services, managing demand for unscheduled care has been a challenge for many years. The target of admitting or discharging 95% of A&E patients within four hours has not been met for the four years leading up to the pandemic and performance had been on a steady decline. Similarly, the ambulance response time for serious but not life threatening 999 calls has been lengthening since 2017.

Numerous reviews and policy initiatives have been launched over the years to try and tackle the problems within the unscheduled care system. The latest of these were set out in a recent Welsh Government Ministerial Statement: Six goals for urgent and emergency care [opens in new window].

During 2022, Audit Wales will be undertaking work to assess how the system is responding to these pressures in the context of the new Welsh Government policy. Our work will specifically examine the actions being taken to secure timely and safe discharge of patients from hospital. We also plan to review progress being made in managing unscheduled care demand by directing patients to services which are most appropriate for their needs.

Providing timely and responsive urgent and emergency care has presented a significant challenge to the NHS and its partners for many years. This challenge has been brought into even sharper focus by the pressures caused by the pandemic, meaning there are now real risks that patients will come to harm as a result of the unscheduled care system not being able to respond to their needs.

It is crucial that the new policy launched by Welsh Government starts to drive immediate improvements. The work that Audit Wales will carry out during 2022 will examine this more closely by looking at key aspects of the unscheduled care system which are central to achieving the new policy goals.

Adrian Crompton, Auditor General
Unscheduled Care in Wales – a system under real pressure
Unscheduled Care in Wales