The chief executive of NHS Wales has said Welsh Government guidance for hospitals to discharge patients without care packages in place "is about a balance of risk." Speaking to WalesOnline, Judith Paget addressed the advice given to senior NHS staff in a letter urging them to "return those in hospital to their homes or alternative place of safety as quickly as is possible".
The letter, which was from the chief nursing officer and the deputy chief medical officer to the health boards, offered "advice to support decisions to discharge". It said that the NHS was facing "exceptional pressure", resulting in "long delays in the provision of care, with their attendant risks".
It went on to say that day to day clinical decision making "must adapt" to the pressure, and that hospital capacity must be preserved for those at greatest risk. It continued: "There will be a need for everyone to consider discharge arrangements that may not be perfect, a care package may not yet be in place, and social care assessments may need to happen at home rather than in hospital".
On Tuesday, Swansea Bay University Health Board urged families to "do all they can" to support relatives waiting to be discharged in order to help them go home "as quickly as possible". The health board said that nearly 280 patients in the health board's hospitals were medically well enough to leave, but could not go home "for a number of reasons".
The number is the equivalent of 10 wards - or the size of Singleton Hospital. On Monday, Betsi Cadwaladr University Health Board declared a critical incident, with a lack of available hospital beds and staff shortages leading to long waiting times for patients.
A Cardiff GP has called the guidance "terrifying" and said that if patients are well enough to be discharged but are unable to look after their basic needs, "they are going to deteriorate and end up back in hospital". Dr Sayma Ahmed, of Cloughmore Surgery in the Splott area of Cardiff, responded to the plans on BBC Radio Wales on Wednesday.
"In primary care, we're directly seeing these patients in their homes, we're dealing with them day to day. There are lots of patients unfortunately we do have to send in because they haven't been able to care for themselves and essentially they become unsafe or they are already unsafe...I can understand [the thinking] that what else are we going to do? This isn't going to fix it though," she said.
WalesOnline asked Judith Paget about the risks of sending patients home without a care package on Thursday. She said the decision was "about a balance of risk" and that patients who were among the "lowest risk" needed to be discharged to make way for patients who were of the highest risk. You can read the full interview here.
Addressing the letter, Ms Paget said that it was "incredibly balanced" in its guidance and that advice was "very clear" that patients were only to be discharged when safe to do so. She went on to praise the response of families who are supporting relatives who have been discharged without a care package in place until one can be arranged.
She said: "I think this is about balance of risk. This is about us using our hospital beds for the patients who are at greatest risk. So, that will be the elderly person who's had a fall at home and is on the floor waiting for an ambulance to arrive, or the elderly person who has had a stroke and is in an ambulance outside our A&E departments.
"The balance of risk in the system, as suggested by our professional colleagues or senior nurse and senior medical staff, is that the balance of risk is out of kilter at the moment. We really need to discharge some of our lowest risk patients in order to make way for the highest risk patients that we're not getting. So, is there a risk?
"The letter that has gone out from the chief nursing officer and the deputy chief medical officer is incredibly balanced in its approach. It doesn't say, ‘We'll just discharge people and don't worry about it.’ It gives a whole host of mitigations about how we can make sure that discharges are safe. It's very clear that this to be done when it's safe to do so.
"What we're seeing over the last couple of days is a really fantastic response from families when our nursing staff are ringing them to say, ‘Mum can come home, we've got a package of care, but it's not going to start for another 48 hours. Could you help by supporting them until the package of care starts?’ The response from families has been very positive. Is there always a risk? There's always a risk, in everything. This is about balance of risk and trying to minimise the risk to the most concerning patients."
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