Hospital stays and appointments 'for essential care only'

Patients should only go to hospital when it is "essential" and more care should be provided in communities or at home, the Welsh Government has said.

It is part of a new strategy to reduce pressure on the NHS, backed by a £100m fund to support the best ideas.

It comes after warnings that future health and care needs would not be met without urgent transformation.

Ministers expect progress within three years but opponents claimed it lacked concrete proposals or tangible targets.

Some of this is already happening in certain places but it does not happen everywhere and it is nowhere near the scale that is needed.

Marilyn Benjamin, 74, fell and broke her ankle in her garden in Ynysybwl, Rhondda Cynon Taf, but after a plate was fitted she was allowed home from hospital because a proper care package was in place.

"A broken ankle is serious with old people but you're wasting your time in hospital in bed," she said. "You're taking a bed for more serious cases which I believe they need more than me - but you've got to have help, you can't do it on your own."

Health Secretary Vaughan Gething said it would be a "revolution from within the health service".

He added: "We have to move on from the idea that the hospital is the first or best place for you to be when you are unwell.

"That isn't always the case, especially when there are a range of local services that will allow you to remain safely at home."

A new National Transformation Programme will also be created to "kick start" the changes across Wales.

Regional panel boards made up of councils, health boards and voluntary representatives - set-up four years ago - will drive this work to bring health and social care work more "seamlessly" together.

They will be asked to find the best and most innovative new ways of working in local areas - and scale them up quickly to work across all of Wales.

At the same time, a centralised NHS executive, sitting above health boards, will be created to speed up decision-making about national issues - including the future shape of hospital and specialist services.

The public will also be part of a "continuous" dialogue about the future of services, not just invited to have their say from time-to-time.

The clock is ticking loudly. A lot has been said about a growing and ageing population - and the numbers over 80 in particular are set to steadily rise. This strategy follows a major review led by independent experts which called for a "revolution" in how things are done but also builds on an earlier leading international report which called for far better sharing of expertise across the health system. There have been warnings that without urgent change, health services could further decline in the next five years.

The system is still too geared up to looking after people inside hospital buildings. So we see elderly people being taken to A&E or stuck in hospital when in an ideal world they would be getting the same care at home - more convenient to them and far cheaper. It is going to take a massive cultural shift - and the right mix of service and workforce being in place.

This is an interesting bit. To deliver the vision, the health secretary admits the way the NHS and social care is funded may also need to change. That may include a "national conversation" to explore how the Welsh Government's new tax-varying may be used to raise funds. Half of the Welsh budget is already spent on health and care - so if ministers spend more without a cash injection from Westminster, then health could start squeezing other public services. That is also why the current debate about NHS funding in Westminster also matters here in Wales.

Gething 'open to the idea' of social care tax

Launching the strategy, Mr Gething said none of the changes would come easily but he called on people to "rediscover the confidence and bold ambition" which set up the NHS 70 years ago.

NHS Wales chief executive Andrew Goodhall said: "The need for change is with us now, not just at some distant date.

"Our focus has to be on transformation, innovation and delivery knowing we have foundations to build on in our current system.

"Without response and change we will fall short of meeting the needs of the Welsh population."

Conservative health spokeswoman Angela Burns welcomed the change in emphasis towards the community but said: "We need clear plans for delivery and this document contains very few tangible targets or commitments for the Welsh Government, health boards, regional partnership boards and local authorities to work towards."

Plaid Cymru health spokesman Rhun ap Iorwerth criticised a lack of firm proposals in the plan.

"Treating more people closer to home and outside of hospitals has been the stated aim of Labour policy for well over a decade yet they have failed to translate this aspiration into anything concrete," he said.

"In fact, the only changes we've seen have involved the opposite which has included services moving away from local communities due to staff shortages."

The chair of the BMA's Welsh council Dr David Bailey called for health boards to work with clinicians and frontline staff to understand how best to use the £100m transformation fund.

"This plan shows that the Welsh Government is moving in the right direction and taking steps to ensure that health and social services in Wales are sustainable in the future," he said.

The Welsh Government said this was the first UK joint health and social care strategy.

It wants to see progress on the ground within three years, with the best ideas working and being shared across the country.

Within 10 years, ministers want to be celebrating the NHS's 80th anniversary with things looking very different.