Cwestiwn ysgrifenedig WQ100806

We continue to work closely with local authorities, health boards and care providers to strengthen transitions between hospital, care home and community settings, ensuring people receive the right care, in the right place, at the right time.

We have published Hospital Discharge Guidance to support consistent and effective discharge practices. The guidance promotes early engagement between partners, including care home providers, and aligns with the Discharge to Recover then Assess (D2RA) pathways. These arrangements help identify likely support needs early, support patient flow and enable timely discharge, including through the use of step-down and transitional care services where appropriate.

The principles set out in the guidance are supported through the £30 million Pathways of Care Transformation Grant, which is helping all 22 local authorities strengthen discharge arrangements and community-based care. This includes investment in brokerage, commissioning, discharge coordination, workforce capacity, reablement services and multidisciplinary working.

These arrangements are complemented by wider regional partnership working. Regional Partnership Boards bring together local authorities, health boards and partners to plan and commission integrated care based on Population Needs Assessments, helping ensure sufficient community, housing with care and residential care capacity is available to support timely discharge and recovery closer to home.

The funding is also supporting the role of care homes within discharge pathways, including step-down, assessment and transitional placements for people who are clinically optimised for discharge but require further recovery, assessment or care planning outside hospital.

To support continuous improvement, the Welsh Government’s Pathways of Care Delays reporting framework provides partners with monthly oversight of the causes of delays. Data indicates delays relating to temporary step-down care home placements have remained relatively low throughout the year, while delays associated with care home placement arrangements have stabilised, with some reductions in delays linked to care home availability.

We have also established stakeholder network groups with care home providers to identify and address barriers to effective discharge planning and patient flow. Alongside this, we continue to support good practice through resources such as the resident well-being toolkit developed with Age Cymru to help people transition successfully into care home settings.

Together, these actions are helping to reduce avoidable discharge delays, strengthen links between hospitals, local authorities and care home providers, and improve outcomes for people who require ongoing care and support following a stay in hospital