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Morgan: Ending the scandal of hospital bed blocking

Speech to the National Assembly for Wales.

"I am delighted that we have the opportunity to debate the issue of bedblocking. We welcome the amendments tabled by colleagues from other parties, and we are happy to support them.

Before I outline my concerns and the reasons why we have tabled the motion, there is a vicious rumour that the Assembly Government will support the motion, or, at best, it might not vote against it.

If that is the case, I welcome that road-to-Damascus conversion from the Assembly Government, which has been telling us for the past few months that there is no need for a debate on bedblocking; as a result, it would not concede to a debate.

So, once again, it is left to opposition parties to lead the agenda in the Chamber by bringing forward issues that people are concerned about.

I fully accept that the technical term is 'delayed transfers of care', but when people look at this subject, they see a bed which is blocked by a patient who does not need to be there, where that patient's care, wellbeing and recovery are not assisted by their being in that bed.

If that is the best contribution that we can expect from a Labour Assembly Member this afternoon, then Labour Assembly Members have lost the plot.

You are missing the point about the necessity of this debate and the damage that bedblocking is doing to our hospital system and the challenges and threats that it poses for both our hospital and social-care sectors. That is why we are having this debate this afternoon.

Bedblocking is an undisputed barrier to progress, to improvement and to efficient hospital working and patient treatment and management.

It is as simple as that. It is an issue that has a substantial impact on other areas of health and social-care delivery. At the sharp end, bedblocking will prevent an acute hospital ward from functioning correctly.

Life threatening delays to treatment are caused because acute beds simply are not available. This adds massive pressure to accident and emergency departments. At the other end, elective care is dreadfully affected, because patients cannot get into the hospitals as the beds do not become available quickly enough.

The blockage is not only one of beds, but of services throughout the system, which are deeply affected because of poor management. That is why we are having this debate today. Regardless of whether you call it delayed discharge or bedblocking, the simple fact is that there are problems in the system that need to be resolved. That is why we are calling for an inquiry today.

Looking at the broader perspective, the delay in transferring a patient from a hospital bed to an appropriate care setting can present an enormous financial burden for the health service, especially when that delay spans six months, as is the case with one patient currently at the University Hospital of Wales. I understand that this case will be highlighted later on today.

In September 2006, there were 731 blocked beds within our hospital sector. This is the highest figure since February last year. I am willing to accept that this figure is far lower than it was a couple of years ago, but a substantial cost is incurred as a result of these numbers of beds blocked.

A conservative estimate will put the cost of those beds blocked in September at somewhere in the region of £6 million. With a cumulative NHS debt of somewhere in the region of £100 million, we can ill afford to blow £70 million plus on blocked beds.

There is a substantial financial cost that is draining the NHS of resources; resources that, were they not being used by blocked beds, would be used on patient care, helping patients to recover, bringing down waiting lists, and on getting care and treatment to those people who need it urgently.

While I accept that accurately calculating the global cost of bedblocking is not that easy, and I know that the Minister has accepted this in a series of answers to written questions, there is no doubt that the figure is substantial and represents a constant shackle around the neck of the Welsh NHS.

In June 2003, in the report which has informed the direction of the Assembly Government and which has informed the way in which hospital services need to be reconfigured, Derek Wanless said:

'In the short term, immediate steps are needed to relieve pressure on the acute sector by making bed equivalents available and addressing, as a priority, delayed transfers of care.'

Which bit of 'immediate steps' and 'priority' did the Assembly Government not understand? Wanless also called for an urgent implementation plan identifying short, medium and long-term priorities to reduce bedblocking.

I accept that it is possible that hospital reconfiguration and the review of secondary care will look at this in the long term, but there are immediate short-term pressures that need to be examined. Therefore, which bit of 'urgent implementation plan' did the Assembly Government not understand when reading the Wanless review?

In short, the Welsh Conservatives do not believe that these recommendations have been taken to heart, and Wales still lacks a long-term nationally standardised policy to deal with the problem. Many of the issues surrounding whether a patient can be discharged affect south Wales as much as they affect mid and north Wales.

The bottom line is that the human story is just as substantial as the financial story. Many people who are stuck in acute beds do not want to be there.

They want to leave, but they are unable to for whatever reason, whether it is a lack of assessment, domiciliary care—which is the usual reason—capacity, or financial support from local authorities. It does not help their recovery.

The Royal College of Nursing has outlined its concerns and has stated clearly that patients who are victims of delayed transfers of care—and that is how it sees them—get depressed, become dependent on hospital staff, and can get ill again because they are not moved on after receiving proper treatment and healing in the first instance.

Therefore, it is bad financially and it is bad for patients who have been treated once and who want to have further treatment elsewhere to aid their recovery, but cannot do that, and so they end up staying in the acute sector where their situation can actually get worse.

Therefore, there is a double-whammy effect. It is not just financial; it also has a negative health impact following the positive impact that the acute sector supposedly had after treating them and, hopefully, supporting their illness when they were admitted to the acute sector. Therefore, there is a financial and human double whammy that we need to get to grips with. The Royal College of Nursing is right in outlining those concerns.

We would like to see a strategic, long-term, all-Wales approach taken to reducing the financial and operational burden of bedblocking in Wales, with the challenges and threats posed to the health service and social care sector in Wales. We need to get to grips with the fact that patients who are discharged into the community are often in a vulnerable position.

When they are discharged, it is often the case that the support services are not there. Often, the domiciliary care packages are not sufficient, and we often do not see the numbers of care and allied health professionals in the appropriate places in Wales to look after those people.

There is a lack of infrastructure in the community when we do manage to get those people moved out of the acute sector. It is difficult for the national health service and the social care sector to deal with chronic disease management, and to deliver care packages when we have a lack of trained therapists.

If we ignore this problem, we run this particular risk: the breakdown in relationships between the health and social care sectors will continue.

We have seen it in Cardiff with the local hospital in the Heath having a dig at the local authority for failing to live up to its promises on delivering appropriate funds for social services.

If we do not get to grips with this, it will start to happen elsewhere, and there will be a further breakdown of those relationships that we rely on to solve these problems.

We must do all that we can to ensure that the wellbeing of patients is ensured and that their experience throughout their hospital stay and beyond is improved.

If the patient is placed in an appropriate care setting that matches his or her need, that experience will improve. These key strands must form the basis of a review that is independent of politics and the Assembly Government, and which will bring forward recommendations to inform how we need to proceed from where we are now.

It is high time that we had a review of bedblocking. It needs to build on best practice, recommend what should be tackled, and examine the experience that we have in terms of personnel in the social care sector and the health sector, who can give the advice and expertise that they are so willing to provide.

Our goal in tabling this motion is simply that. It is a goal of forcing progress on an issue that we feel has been neglected for too long and one which, if not tackled soon, will add to the spiralling financial concerns of the national health service and will be to the detriment of patients. That is why we have got to get this right."

"Yr wyf yn falch bod gennym gyfle i drafod blocio gwelyau. Yr ydym yn croesawu'r gwelliannau a gyflwynwyd gan Gyd-Aelodau o bleidiau eraill, ac yr ydym yn hapus i'w cefnogi.

Cyn imi amlinellu fy mhryderon a'r rhesymau pam ein bod wedi cyflwyno'r gwelliant, mae sibrydion cas ar led y bydd Llywodraeth y Cynulliad yn cefnogi'r cynnig, neu, o leiaf, ni fydd yn pleidleisio yn ei erbyn.

Os yw hyn yn wir, croesawaf y dröedigaeth ar y ffordd i Ddamascus honno o du Llywodraeth y Cynulliad, sydd wedi bod yn dweud wrthym yn ystod y misoedd diwethaf nad oes angen dadl ar flocio gwelyau; o ganlyniad i hynny, nid oedd yn fodlon cael dadl ar y mater.

Felly, unwaith eto, y gwrthbleidiau sy'n gorfod arwain yr agenda yn y Siambr trwy ddwyn materion gerbron sy'n achos pryder i bobl.

Yr wyf yn derbyn yn llwyr mai 'oedi wrth drosglwyddo gofal' yw'r term technegol, ond pan fydd pobl yn edrych ar y pwnc, maent yn gweld gwely sy'n cael ei flocio gan glaf nad oes angen iddo fod yno, lle nad yw gofal, lles ac adferiad y claf yn cael eu cynorthwyo trwy fod yn y gwely hwnnw, Os mai dyna'r cyfraniad gorau y gallwn ei ddisgwyl gan Aelod Llafur o'r Cynulliad y prynhawn yma, yna mae Aelodau Llafur y Cynulliad wedi ei cholli hi.

Yr ydych yn methu â deall holl bwrpas y ddadl hon a'r difrod mae blocio gwelyau yn ei achosi i'n system ysbytai a'r problemau a'r bygythiadau mae'n ei achosi i'n sectorau ysbyty a gofal cymdeithasol. Dyna pam ein bod yn cael y ddadl hon y prynhawn yma.

Yn ddi-os, mae blocio gwelyau yn rhwystr i gynnydd, i wella ac i weithio mewn ffordd effeithlon mewn ysbytai a thrin a rheoli cleifion.

Mae mor syml â hynny. Mae'n fater sy'n cael effaith sylweddol ar agweddau eraill ar y ddarpariaeth iechyd a gofal cymdeithasol. Yn y pen draw, bydd blocio gwelyau yn atal ward acíwt mewn ysbyty rhag gweithredu fel y dylai. Mae oedi rhag trin cleifion yn peryglu bywydau oherwydd nad oes gwelyau acíwt ar gael.

Mae hyn yn rhoi pwysau enfawr ar adrannau damweiniau ac achosion brys. Yn y pegwn arall, mae'n cael effaith ofnadwy ar ofal dewisol, oherwydd nid yw ysbytai'n gallu derbyn cleifion gan nad oes gwelyau ar gael yn ddigon cyflym ar eu cyfer.

Nid gwelyau yn unig sy'n cael eu blocio, ond hefyd wasanaethau ym mhob rhan o'r system, yr effeithir yn ddifrifol arnynt gan reoli gwael. Dyna pam ein bod yn cael y ddadl hon heddiw. Pa un a ydych yn ei alw'n oedi wrth ryddhau neu flocio gwelyau, y gwir syml yw bod problemau yn y system sy'n rhaid eu datrys. Dyna pam ein bod yn galw am ymchwiliad heddiw.

Gan edrych ar y sefyllfa ehangach, mae'r oedi wrth drosglwyddo cleifion o wely ysbyty i leoliad gofal priodol yn rhoi baich ariannol enfawr ar y gwasanaeth iechyd, yn enwedig os yw'r oedi hwnnw'n para am chwe mis, fel yn achos un claf sydd yn Ysbyty Athrofaol Cymru ar hyn o bryd. Deallaf y rhoddir sylw i'r achos hwn yn ddiweddarach heddiw.

Ym mis Medi 2006, yr oedd 731 o welyau'n cael eu blocio yn ein sector ysbytai. Dyna'r nifer uchaf ers Chwefror y llynedd. Yr wyf yn barod i dderbyn bod y ffigur hwn yn llawer is nag oedd ddwy flynedd yn ôl, ond mae'r gwelyau hyn sy'n cael eu blocio'n arwain at gostau sylweddol. Bydd amcangyfrif ceidwadol yn rhoi cost y gwelyau hynny sy'n cael eu blocio ym mis Medi oddeutu £6 miliwn.

Gyda dyled gronnol y GIG oddeutu £100 miliwn, ni allwn fforddio taflu £70 miliwn a mwy i ffwrdd ar welyau sy'n cael eu blocio. Mae hon yn gost sylweddol sy'n faich ar adnoddau'r GIG; adnoddau a fyddai, pe na baent yn cael eu gwario ar welyau sy'n cael eu blocio, yn cael eu defnyddio ar ofal cleifion, yn helpu cleifion i wella, i leihau rhestrau aros, ac ar gyfer gofal a thriniaethau i bobl sydd eu hangen ar frys.

Er fy mod yn derbyn nad yw'n hawdd cyfrifo'n fanwl faint yn union yw cost blocio gwelyau, a gwn fod y Gweinidog wedi derbyn hyn mewn cyfres o atebion i gwestiynau ysgrifenedig, nid oes amheuaeth nad yw'r ffigur yn un sylweddol a'i fod yn faen tramgwydd parhaus i'r GIG yng Nghymru.

Ym Mehefin 2003, yn yr adroddiad sydd wedi bod yn sail i gyfeiriad Llywodraeth y Cynulliad ac sydd wedi bod yn sail i'r ffordd y mae angen ail-gyflunio gwasanaethau ysbytai, dywedodd Derek Wanless:

'Yn y tymor byr mae angen gweithredu'n syth i leihau'r pwysau ar y sector acíwt trwy sicrhau bod darpariaeth sy'n cyfateb i welyau ar gael, a rhoi sylw, fel blaenoriaeth, i oedi wrth drosglwyddo gofal.'

Pa ran o 'gweithredu'n syth' a 'blaenoriaeth' nad yw Llywodraeth y Cynulliad yn eu deall? Galwodd Wanless hefyd am gynllun gweithredu brys i bennu'r blaenoriaethau tymhorau byr, canolig a hir i leihau blocio gwelyau.

Yr wyf yn derbyn ei bod yn bosibl y bydd ail-gyflunio ysbytai a'r adolygiad o ofal eilaidd yn edrych ar hyn yn yr hirdymor, ond mae pwysau tymor byr sy'n cael effaith ar y gwasanaeth yn awr ac sy'n rhaid edrych arnynt. Felly, pa ran o'r 'cynllun gweithredu brys' nad oedd Llywodraeth y Cynulliad yn ei deall wrth ddarllen adolygiad Wanless?

Yn fras, nid yw Ceidwadwyr Cymru yn credu bod yr argymhellion hyn wedi cael eu cymryd o ddifrif, ac mae Cymru yn dal heb bolisi safonedig cenedlaethol hirdymor i ddelio â'r broblem. Mae llawer o'r ystyriaethau ynghylch a ellir rhyddhau claf yn effeithio ar y De cymaint ag yr effeithiant ar y Canolbarth a'r Gogledd.

Diwedd y gân yw bod y stori ddynol yr un mor sylweddol â'r stori ariannol. Nid yw llawer o'r bobl sy'n gaeth i welyau acíwt eisiau bod ynddynt.

Maent eisiau gadael, ond ni allant wneud hynny am ba bynnag reswm, boed hynny oherwydd diffyg asesiad, gofal cartref—sef y rheswm arferol—lle, neu gefnogaeth ariannol gan awdurdodau lleol. Nid yw'n gymorth iddynt wella.

Mae Coleg Brenhinol y Nyrsys wedi amlinellu ei bryderon ac wedi dweud yn bendant bod cleifion sy'n dioddef oedi wrth drosglwyddo gofal—a dyna sut mae'n eu hystyried—yn mynd yn isel, yn mynd yn ddibynnol ar staff ysbytai, ac yn mynd yn wael drachefn oherwydd na chant eu symud ymlaen ar ôl cael triniaeth ac iachâd priodol yn y lle cyntaf.

O'r herwydd, mae'n beth drwg yn ariannol ac yn beth drwg i gleifion sydd wedi cael eu trin unwaith ac sydd eisiau triniaeth bellach mewn man arall i'w helpu i wella, ond na allant wneud hynny, ac o'r herwydd, maent, yn y pen draw, yn gorfod aros yn y sector acíwt lle gall eu sefyllfa mewn gwirionedd waethygu. O'r herwydd, ceir ergyd dwbl.

Nid effaith ariannol ydyw yn unig; mae hefyd yn cael effaith negyddol ar iechyd yn dilyn yr effaith gadarnhaol y mae'r sector acíwt i fod wedi ei chael ar ôl eu trin a, gobeithio, wedi bod yn gefn iddynt yn eu salwch pan y'u derbyniwyd i'r sector acíwt. O'r herwydd, ceir effaith ariannol a dynol ddwbl y mae'n rhaid inni fynd i'r afael â hi. Mae Coleg Brenhinol y Nyrsys yn iawn i amlinellu'r pryderon hyn.

Hoffem weld dull Cymru-gyfan, hirdymor, strategol yn cael ei weithredu i ysgafnu baich ariannol a gweithrediadol blocio gwelyau yng Nghymru, gyda'r sialensiau a'r bygythiadau a berir i'r gwasanaeth iechyd a'r sector gofal cymdeithasol yng Nghymru.

Rhaid inni fynd i'r afael â'r ffaith bod cleifion a ryddheir i'r gymuned yn aml mewn sefyllfa fregus. Pan y'u rhyddheir, nid yw'r gwasanaethau cymorth yno yn aml. Yn aml, nid yw'r pecynnau gofal cartref yn ddigonol, ac yn aml nid oes digon o weithwyr proffesiynol y maes gofal a'r maes iechyd cysylltiedig yn y mannau priodol yng Nghymru i ofalu am y bobl hyn.

Ceir diffyg seilwaith yn y gymuned pan lwyddwn i sicrhau bod y bobl hyn yn symud allan o'r sector acíwt. Mae'n anodd i'r gwasanaeth iechyd gwladol a'r sector gofal cymdeithasol ddelio gyda rheoli clefydau cronig, a chyflwyno pecynnau gofal pan fydd gennym brinder therapyddion hyfforddedig.

Os anwybyddwn y broblem hon, yr ydym mewn perygl penodol o weld y berthynas rhwng y sector gofal cymdeithasol a'r sector iechyd yn parhau i chwalu.

Fe'i gwelsom yng Nghaerdydd gyda'r ysbyty lleol yn y Rhath yn edliw i'r awdurdod lleol am fethu â chadw at ei addewid i gyflwyno'r arian priodol ar gyfer y gwasanaethau cymdeithasol. Onid awn i'r afael â hyn, bydd yn dechrau digwydd mewn mannau eraill, a bydd chwalfa bellach yn y cysylltiadau hynny y dibynnwn arnynt i ddatrys y problemau hyn.

Rhaid inni wneud popeth yn ein gallu i sicrhau bod lles cleifion yn cael ei sicrhau a bod eu profiad gydol eu harhosiad yn yr ysbyty a thu hwnt yn cael ei wella.

Os lleolir y claf mewn sefydliad gofal priodol sy'n cyd-fynd â'i anghenion ef neu hi, bydd y profiad hwn yn gwella. Rhaid i'r elfennau allweddol hyn fod yn sail i adolygiad sy'n annibynnol ar wleidyddiaeth a Llywodraeth y Cynulliad, ac a fydd yn esgor ar argymhellion i ddylanwadu ar sut mae'n rhaid inni fwrw ymlaen o'r sefyllfa yr ydym ynddi yn awr.

Mae'n hen bryd inni gael adolygiad o flocio gwelyau. Rhaid iddo ychwanegu at yr arferion gorau, argymell beth mae'n rhaid mynd i'r afael ag ef, a phwyso a mesur y profiad sydd gennym o safbwynt personél yn y sector gofal cymdeithasol a'r sector iechyd, unigolion a all roi'r cyngor a'r arbenigedd y maent mor barod i'w darparu.

Dyma yn syml ein nod wrth gyflwyno'r cynnig hwn. Mae'n nod o orfodi cynnydd gyda mater sydd, yn ein barn ni, wedi cael ei esgeuluso ers rhy hir ac yn un, os na eir i'r afael ag ef yn fuan, a fydd yn ychwanegu at bryderon ariannol cynyddol y gwasanaeth iechyd gwladol ac a fydd yn andwyol i'r cleifion. Dyna pam mae'n rhaid inni gael hyn yn iawn."

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