Dear Sir or Madam,

Re: Consultation on the Social Services and Well-being (Wales) Bill

I am responding to the above as an individual consultant physician working in Wales, with 35 years' experience of practicing general internal medicine in hospital settings. My opinions on the particular issue referred to below is shared by many medical and nursing colleagues with whom I have discussed these matters.

Reducing bed blocking

The separate funding streams for health services and social care has resulted in the development of complicated and expensive burocratic processes to determine the funding channels for many hospital inpatients with social care needs who are medically fit for discharge. The resulting delayed transfer of care has several adverse consequences. Hospitals are a potentially hazardous environment for this vulnerable group who may succumb to hospital acquired infections during the extra time spent in hospital. This extra time also represents a substantial economic cost, as hospital care is more costly than care home or community care. It has been previously shown that hospital wards run most efficiently when the bed occupancy in around 85%.  Delayed transfer of care makes a major contribution to the near 100% bed occupancy currently seen on many wards, with consequent disruption of activity, as illustrated by the following examples:  1) patients requiring specialist care on a stroke or cardiac ward often end up being housed wherever a bed can be found on another ward and may subsequently be moved more than once during their hospital stay; 2) patients inappropriately housed on a surgical ward often results in cancelled operations; 3) when there are no beds available to transfer acute admissions from A&E departments, the latter may become overwhelmed resulting in a build up of ambulances waiting to transfer ill patients.  I would therefore urge that pooled budgets should be made a requirement in new arrangements for cooperation between local authorities and health boards, so as to improve the efficiency of the discharge process.

Yours faithfully

Meurig Williams

Dr Meurig Williams

Consultant Physician

Hywel Dda Health Board