With winter pressures on the horizon, the Senedd will debate ways to reduce hospital discharge delays on Wednesday 12 November.
This follows the Local Government and Housing (LGH) Committee’s inquiry into the role of local authorities in supporting hospital discharges, building on the Health and Social Care (HSC) Committee’s previous work on hospital discharge (2022).
Since April 2023, the Welsh Government has published monthly statistics on Pathway of Care Delays, when there were 1.750 people who experienced a delayed discharge. Since then the total has fluctuated, and was 1,367 in the latest available figures (September 2025), suggesting limited progress.
Persistent challenges identified across both Committees’ work include:
- A lack of social care capacity and pressure on unpaid carers;
- A shortage of appropriate intermediate (step-down) care;
- The need for stronger partnership working between health and social care, and better digital information sharing.
See our previous article for more information on the HSC Committee’s inquiry.
Social care capacity
Both inquiries highlighted the significant challenges faced by social care services, including high levels of staff vacancies, particularly in social work and domiciliary care. Capacity constraints are causing delays in care provision, which can hinder the hospital discharge process.
The Committees called for better pay, terms and conditions for the social care workforce and more parity between health and social care. The LGH Committee also heard there’s a lack of published social care data, a point which the HSC Committee has regularly raised with the Welsh Government. The LGH report called for the publication of data on waiting times for care assessments and care services, and on current staff vacancy levels. The Welsh Government said it’s working towards this, with publication expected in spring 2026.
Pressures on unpaid carers
Both Committees heard significant concerns about the pressure being placed on families and unpaid carers to support hospital discharge and fill the gaps in care provision, as well as the lack of support available for them. Local authorities have statutory duties to ensure that carers are ‘willing and able’ to provide care, and to support those with eligible needs, but stakeholders highlighted that this is not happening for many carers and there’s a significant “implementation gap” with the legislation.
In response to a recommendation by the HSC Committee, the Welsh Government commissioned the Association of Directors of Social Services (ADSS) Cymru to undertake a rapid review of unpaid carers’ rights. The review (2023) found “waiting lists for carers assessments in most areas, which prevents carers having the support they need”. It concluded that “many carers are not being offered assessments”, and “respite care is the most significant unmet need”. The Welsh Government says an action plan was developed following the review, with actions to be completed by spring 2026.
The LGH Committee stressed the need to improve respite care provision across Wales. According to the Welsh Government, this will be a strategic objective of its new National Strategy for Unpaid Carers which will be published in spring 2026.
The HSC Committee is currently undertaking an inquiry into improving support - particularly respite and breaks - for unpaid carers and will report on this in the new year.
Improving intermediate (step-down) care
People who are medically ready to leave hospital but have ongoing care needs often require a temporary (intermediate) placement for a period of recovery. Both Committees highlighted the need to increase the provision of appropriate intermediate care places across Wales.
The LGH Committee heard that the push to free up hospital beds is driving many older people into residential care prematurely, and this could be mitigated if the right type of intermediate care was available.
The inquiry found that older people requiring intermediate care are often being routinely discharged into care homes, initially as a temporary measure, but this then often becomes permanent as they lose independence. Professor John Bolton described “people being dumped out of acute hospitals into care homes, just to get them into a bed, where the bed had no facility to help the patient recover. And what happened was that the patient was then stuck and remained in the care home”.
Audit Wales reported that all regions are reliant on intermediate beds in residential care homes without therapeutic input to support discharge, due to a lack of alternative options. A local authority representative told Members that standard residential care facilities are generally used and said “people can decondition in standard residential care in the same way that they can in hospital”.
The Committee stressed the need for more recovery focused intermediate care with therapeutic and nursing input, and its recommendations included a call for a rapid review of current intermediate care practices. While the Welsh Government accepted the recommendations, its response doesn’t suggest that any new action will be undertaken as a result (including a rapid review).
Digital information sharing
Both Committees concluded that better partnership working is needed between health and social care, including digital advances to enable better information sharing.
The LGH Committee reported that the lack of digital information sharing remains a significant barrier to hospital discharge, with different and incompatible IT and communication systems being used across primary and secondary care, as well as across health boards and local authorities. Members were “extremely frustrated at the lack of progress in this area”.
Patient information is typically held on different IT systems which are not connected or viewable to all staff involved in the care and discharge planning. The Committee heard that while some areas are using real-time digital systems to track patient status and care availability, many still rely on outdated, disconnected systems. Members were “dismayed” to hear that fax machines and paper-based systems are still being used in some places, echoing the Health and Social Care Committee back in 2022.
The LGH Committee’s report is critical of the lack of progress made by Digital Health Care Wales in failing to deliver digital transformation. The Committee called for stronger leadership and more accountability to drive this forward as a matter of urgency.
Prevention and early intervention
The LGH Committee concluded that there’s currently too much focus on acute hospital care, and there needs to be a shift towards prevention and early intervention, with more focus on preventing avoidable admissions to hospital. It heard that public sector bodies focus on what they are held accountable for, and it’s difficult for the NHS to shift to more preventative, community care, when core funding and performance measures are focused on acute hospitals.
The LGH Committee report says it shares the HSC Committee’s disappointment that the Welsh Government has yet to demonstrate a significant shift in health spending allocations towards prevention, despite identifying it as a priority (a point highlighted in draft budget scrutiny).
The Cabinet Secretary for Health and Social Care acknowledged “that we have a system that mainly measures outputs from a secondary care space”, and “responds to the targets that are most publicly measured”. He noted it can be challenging to capture the result of preventative measures, but said the Welsh Government is looking at how this can be developed.
The LGH Committee recommended that the Welsh Government develop performance metrics for preventative measures in health and social care.
The Welsh Government agreed to develop further performance metrics and to identify and share best practice that will support preventative practices. “Through this we expect to develop a stronger evidence base and foundation on which to build regional and national work plans which can inform future spending allocations and planning”.
Article by Amy Clifton, Senedd Research, Welsh Parliament
