‘Tackle exit block, improve recruitment and invest in the wider medical team’ – RCP Cymru Wales responds to Welsh Government national winter evaluation

The RCP has responded to the 2018/19 Welsh government evaluation of health and care winter resilience 2018/19.

In January 2019, as part of a UK-wide RCP poll, we asked our 1,300 members and fellows in Wales for their experiences this winter. 79% of respondents said that ‘transfer of care to social care services’ was the main pressure point[1], while a further 14% said that ‘transfer of to community or other NHS services’ caused the most problems[2]. Nobody at all told us that they ‘had no problem discharging patients’.

We have called on the Welsh government to speed up their plans to invest in social and community care services, especially those which help to keep older people out of hospital and in their own homes for longer.  When we asked our members in Wales about whether they’d noticed an improvement in the integration of NHS and social care this year, the feedback was very mixed. At least one doctor strongly disagreed with the suggestion that integrated services had performed better this year, while others said they had seen some small improvements.

There appears to be significant variation between health boards on how engaged doctors are with the winter planning process. This suggests there is still no consistency in how health boards approach winter planning – which should be clinically led and patient-centred.

We also asked our members what they felt made the most difference in their hospital this winter. Here are some of the innovative ideas they gave us:

  • Primary care MDT - virtual ward
  • Extension of the stay well at home team
  • Admission unit huddles
  • Extra funding into social services
  • Extra acute physician presence
  • Older people’s assessment service (a team of nurse practitioners, OTs etc based in ED dedicated to keeping older patients out of hospital)
  • ‘Green-to-go’ wards, staffed by specialty doctors, for patients waiting for transfer to another service, including social care. 


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