Dr Hefin Gwilym discusses whether paying trusted community members to provide temporary support could free hospital beds, reduce waiting lists and strengthen local communities.
Across Wales, as elsewhere in the UK, hospitals are increasingly occupied by people who no longer require medical treatment but cannot be discharged because suitable support or accommodation is unavailable. This creates pressure across the health and care system, contributes to growing waiting lists, and places unnecessary strain on patients who often wish to return to a more normal environment.
Drawing on discussions with a Welsh local authority, a health board, and policymakers – including the Deputy Minister for Social Care – I have been developing an alternative approach that challenges the way we think about care, community, and public spending.
Every hospital bed occupied unnecessarily is a bed unavailable to someone awaiting surgery, assessment or specialist care.
The proposal is simple: rather than paying for people to remain in expensive hospital beds after acute treatment has ended, public bodies could pay family members, extended family, friends or trusted neighbours to provide temporary accommodation and support while longer-term arrangements are made.
At first glance, this may seem unconventional. Yet health and social care systems already rely heavily on unpaid care. Millions of hours of support are provided each week by relatives, friends and neighbours, often at considerable personal cost. My argument is that this contribution should be properly recognised and, where appropriate, remunerated.
The idea is rooted in a human rights perspective. Discussions about delayed discharge often focus on the rights and needs of people in hospital. Those rights are unquestionably important. However, the rights of people waiting for treatment are equally important. Every hospital bed occupied unnecessarily is a bed unavailable to someone awaiting surgery, assessment or specialist care. A rights-based approach should recognise the equal dignity and equal claims of both groups.
Paying trusted community members to provide temporary accommodation could therefore improve outcomes for several groups at once. Individuals leaving hospital would be able to recover in familiar social settings. Families and communities would gain new resources to support them. Health services would free up much-needed capacity. People on waiting lists could access treatment sooner.
Wales has sought to place dignity, participation, wellbeing and human rights at the centre of public services.
It is important to emphasise that this would be an emergency measure rather than a permanent redesign of the care system. The scheme would operate for a minimum period of six months and would be targeted specifically at people who have become chronically stuck in hospital despite being medically fit for discharge, particularly where no family member is available, willing or able to provide accommodation or support. The objective would be to address the most entrenched cases of delayed discharge that are placing considerable pressure on hospital capacity and waiting lists. Once hospital waiting lists and delayed discharge figures had reduced significantly, the scheme could be phased out, having served its purpose as a temporary intervention during a period of exceptional demand.
Syniadau uchelgeisiol, awdurdodol a mentrus.
Ymunwch â ni i gyfrannu at wneud Cymru gwell.
Importantly, this proposal has precision and flexibility built into its design. It is not intended to be a large-scale or permanent programme, but a targeted intervention aimed at a clearly defined group of people whose discharge delays are placing disproportionate pressure on the NHS. Because it can be expanded, narrowed or ended as circumstances require, it offers policymakers a practical, time-limited tool that could deliver meaningful results quickly while longer-term solutions are developed.
There is also a broader economic argument. Money currently spent on unnecessary hospital stays is largely absorbed within institutional systems. By contrast, payments directed to local families and communities would circulate within local economies. In some poorest communities, where ill-health and deprivation are heavily concentrated, this could provide an important source of income and help stimulate local economic activity. Rather than simply reducing costs, a community accommodation scheme could redirect public expenditure to strengthen local resilience and social capital.
Critics will raise legitimate concerns about safeguarding, quality assurance and regulation. These concerns must be taken seriously. Yet they are not reasons to dismiss the proposal. Instead, they invite consideration of how pilot schemes, appropriate assessments, ongoing support and regulatory oversight could be designed.
Supporting people to leave hospital and recover within trusted community settings recognises not only their right to appropriate care and support, but also the rights of others awaiting treatment who are affected by delayed discharge.
This proposal also resonates strongly with several contemporary developments in Welsh social policy. First, it reflects the growing emphasis on the foundational economy, which seeks to use public expenditure to strengthen local communities, retain wealth within local economies, and support everyday services that underpin wellbeing. Rather than directing resources exclusively towards institutional provision, a community accommodation model would invest directly in local households and neighbourhood networks, ensuring that public spending generates wider social and economic benefits.
Second, the proposal aligns with the rights-based approach that has become increasingly embedded within Welsh policymaking. Wales has sought to place dignity, participation, wellbeing and human rights at the centre of public services. Supporting people to leave hospital and recover within trusted community settings recognises not only their right to appropriate care and support, but also the rights of others awaiting treatment who are affected by delayed discharge.
Finally, the idea complements the growing prominence of social prescribing and community-based care. Increasingly, health and wellbeing are understood as being shaped by relationships, social connections and community participation rather than solely by formal medical interventions. Recovery is often most effective when people remain connected to familiar networks of care and support. A community accommodation scheme would therefore build upon a wider policy shift that sees communities not as passive recipients of services, but as active partners in promoting health, wellbeing and social resilience.
I am also aware of an innovative scheme by Carmarthenshire and the Hywel Dda University Health Board to develop the region’s first integrated intermediate care service, which has sought to address some of the challenges associated with hospital discharge and delayed transfers of care. My understanding is that one of the key lessons from that pilot is that community support is often mobilised most effectively after an individual has returned home. Once people are discharged, friends, neighbours and local networks are frequently willing to rally around and provide practical assistance. By contrast, attempting to organise these informal support arrangements before discharge can be time-consuming and may not always prove effective.
At a time when health and social care systems face unprecedented pressures, we have an opportunity to explore whether communities can be part of the solution. The question is not whether family, friends and neighbours already provide care. They do. The question is whether we are prepared to recognise and support that contribution in a way that benefits patients, communities and the wider health system.
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