Betsi home care service ‘chaos’ under fire

Betsi Cadwaladr health board has been accused of “organisational chaos” after revealing that it doesn’t keep checks on how long it allows enhanced care at home or how much it costs.

Home Enhanced Care Services is currently offered to people leaving hospital, usually for a fortnight. But Llyr Gruffydd, Plaid Cymru’s North Wales AM, has been told through a Freedom of Information request to the health board, that the three different areas of the health board – West, Central and East – operate three different systems and that the health board does not know how many patients overall are being treated or at what cost.

Mr Gruffydd said: “Enhanced Care at home is a good way to enable frail patients to leave hospital and be assured of getting good nursing care in their home for a transitional period. This is meant to be for a strictly limited time as it takes a great deal of time to visit individual patients in the community.

“Freeing up hospital beds is clearly a benefit but what the FOI reveals is that the enhanced care is now lasting more than 10 weeks in some cases and the three different areas within Betsi are operating three totally different systems to manage the scheme.

“In the West (Gwynedd and Môn), there seems to be a clear record of how many patients are being cared for at any one time. In the East (Flintshire and Wrexham) there is no central record of care. The Central area (Conwy and Denbighshire) typically has 30 patients receiving enhanced care at home each day.  The health board admits ‘due to the way the service is set up, we do not record how many patients are receiving enhanced care at home, the different nursing teams categorise slightly differently and our systems currently do not have the function to report on this information’.

“I have no doubt the frontline staff are providing excellent care for patients, that is not the issue here. But the organisational chaos at the top of the health board that this answer reveals is depressingly familiar. Surely the health board should have a standard system of assessing how many people are under its direct care, as is clearly the case in the West of the health board region?

“My office also asked how much the service is costing and, again, the health board was unable to say as the costs are integrated into the wider service. As this is a specialist service established back in 2013 in part to justify closing many community hospitals across the region and make financial savings, it’s inconceivable that health board bosses would not know the costs involved.”

Mr Gruffydd added that his office was aware of at least one case where enhanced care had lasted for 10 weeks, five times the norm, and the FOI response also talks of another case lasting 60 days in the West. He added: “Unfortunately, the health board admits it has no such statistics for the East area at all. How is an important service like this able to be monitored effectively if management does not know how many patients are being cared for and at what cost?

“After more than three years in special measures and under direct Welsh Government control, we still find senior managerial processes lacking in the health board. Reading this response suggests it’s already becoming, in reality, three separate area health boards and the lack of joined-up thinking at the very top is worrying.”

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