HSC(6)-11-22 Papur 2 / Paper 2

Health and Social Care Committee Inquiry: hospital discharge and its impacton patient flow through hospitals

Carers Trust Wales, January2022

Carers Trust is a major charity for, with and about carers. We work to improve support, services and recognition for anyone living with the challenges of caring,unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. Our vision is that unpaid carers count and canaccess the help they need to live their lives.

In Wales, we are supported by our eight Network Partners who provide direct supportto unpaid carers across the country.

Unpaid caring in Wales

· There are more than 370,000 unpaid carers in Wales

· Of these, around 30,000are young carersor young adult carers

· An estimated 96 per cent of care in Wales is provided by families and unpaid carers

Unpaid carersand hospital discharge

Time spent in hospital can be a significant transition point in the care needs of a family member or loved one. Many people will become unpaid carers for the first time when a lovedone is discharged from hospital. Some unpaid carerswill be faced with caring for a person with increased care needs as they return home. This can mean the introduction of a new social care package at home or the person being discharged to a new setting, such as a care home, whether temporarily or permanently.

Tailored support for carers withinhospital settings

Of the eight Carers Trust Network Partner organisations working in Wales, six have dedicated in-hospital and hospitaldischarge services supporting unpaid carers.

Theseinclude:

· NEWCIS: supports carers around the discharge process from Wrexham Maelor and Ysbyty Glan Clwyd and supports the carer with their caring role once the cared for person returns home.

· Bridgend Carers Centre: the integrated hospital carers support service atPrincess of Wales Hospital supports carers of people who have been admitted to hospital, including by supporting carers to communicate their concerns with healthcare professionals, social workers and discharge staff.

· Swansea Carers Centre: Hospital outreach project providing support, advice and information in Morriston, Singleton, Gorseinon and Cefn Coed hospitals

· Carers Outreach in North West Wales: specialist officer within the dischargeteams at Ysbyty Gwynedd,Dolgellau Hospital and Ysbyty Tywyn.

The impact ofthe pandemic onhospital discharge and patientflow, from a carer-perspective

Carers have shown incredible strength and resilience during the pandemic. Howeverour Network Partners have told us the pandemic has placed significant pressures on carers in relation to hospital discharge:

There is often insufficient consultation with carers about discharge, in many cases this is because of the speed of the process. We have been told of some patients being transferred or discharged to other hospitals without their carer’s knowledge.

The discharge-to-assess policy is causing anxiety for some carers, especially in relation to new care home placements. Anxiety is often around financial concerns and eligibility for Continuing Health Care. We have heard of patients who were assessed in their care home when CHC was declined; carers were not appropriately involved in the process and therefore could not discuss or challenge decisions as they would like. Faced with this situation, many carers confront financialhardship due to high top up fees because there has been a lack of choice and controlin relation to the care home placement of their loved one.

Hospital discharge is continuing to happen rapidly. This is experienced as a positive for some unpaid carers as hospital continues to feel unsafe because of the risk of hospital-acquired infection with Covid-19. Countering this, carers continue to feel under great pressure to care for their loved ones at home and facilitate fast discharges without an assessed and agreed social care package in place. We also heard of some people being discharged rapidly without being tested for Covid-19.

Long delays in obtaining care packages mean that carers are under pressure to provide prolonged and unsustainable levels of care at home without the support they and their loved one are entitled to from statutory sources. We have heard of delays of upwards of three months and carers faced with the choice of leaving their loved one in hospital to wait for the care package, visibly deteriorating in hospital, or to shoulderthe care burden themselves at home. Withoutthe appropriate support in place at home or in the community some discharges inevitably fail very quickly, with the patient readmitted to hospital shortly afterwards.

All sources referred to in this evidence have provided their consent to Carers Trust Wales sharing their views.