Mr. Bernard Gloster:

The Deputy asked what would I say to those families and, indeed, those patients. It would be disingenuous of me to say anything on the public record other than that I am extremely sorry that that is the case for one person, let alone for thousands of people. We cannot ever stand back from saying that. I know that might sound easy to say and some people might ask what good that is but it is an important place to start from. That is regardless of explanations about increases in attendances by those over 75 and the increase in complexity and length of stay for over-75s. Lots of really hard work has gone into reducing the overall conversion rate of admissions from emergency departments and so on. People have worked very hard on that but with that demographic, the prevalence of chronic disease and other things is very significant.

Regarding practical steps to deal with that, I would expand on what I said to Deputy Burke. One of the practical things we can do is look at the access points that are not available to those people before they present at emergency departments. Some of them do have to present because they are very unwell. It is important that we do not lose sight of that. The length of stay has gone up in some hospitals by about two days because of the level of frailty and acuity. For a lot of people, an alternative would be better. What we can mandate, regardless of contracts or job descriptions or other things, is to take the very extensive resource that has been invested in the community over the last two and a half years and ensure it is not just available to people in a health centre or people who live at home but that it is also available to the 20,000 people who are in nursing home care, many of whom present in hospital. Those referrals could be avoided or they could be discharged more quickly and supported by that. That has now been mandated. That is the first thing.

The second thing is that we can focus more on the delayed transfers of care out of our hospitals. We now have the number down to just above 500, from just below 600. I am not happy that we are anywhere near that. People are working exceptionally hard. Yesterday evening, I permitted chief officers to extend the rules and to extend the application of the definition of transition care to the widest parameter they feel is needed to facilitate people leaving hospital. If appropriate, they can also use what was transition care for people coming out of hospital as a form of respite that might support somebody to avoid them going into hospital. That is a very practical step. If we can reduce the delayed transfers of care further, we should be able to catch up to some degree with the patient experience time, as we call it. Simply put, that is the waiting time for that woman in that chair. That is a measure we can mandate.