Concerns have been raised that Betsi Cadwaladr University Health Board’s winter pressure strategy has been delivered too late – and may not be deliverable in full.

The 2024/25 Winter Resilience Plan was praised as an improvement on previous years by board members when it was presented on Thursday – but Interim Chief Operating Officer Imran Devji faced challenges over its timing and the reality of delivering such a huge programme this year.

“This plan is absolutely more robust than the plan we considered last winter so thank you,” said Independent board member Clare Budden, CEO of ClwydAlyn Housing.

“Winter’s here now so it is very late. I’m pleased to hear that you expect next year we’ll be looking at the winter planning before winter rather than as it’s about to start.”

The plan details the strategy across North Wales for dealing with increased numbers of patients throught the winter months.

Among the key points within the plan are to focus on care home residents being treated where they live where possible and increasing vaccination levels to tackle flu and Covid.

There are also plans to encourage patients to present at Minor Injury Units or other community health providers rather than their local emergency department where appropriate and increase access to Community Pharmacies via the Common Ailments Service and the Pharmacist Independent Prescriber service.

The plan also outlines the need to avoid, where clinically appropriate, admitting patients assessed as needing Same Day Emergency Care and to ensure initial assessment at the emergency department is robust enough to signpost those not requiring emergency medical care to more appropriate treatment providers.

“When I triangulate this paper with the one on our progress on the annual plan, the winter plan is strong on ambition, so it should be,” said Ms Budden. “My question is about our confidence levels around our ability to deliver this plan.

“We are red in terms of our progress in a number of areas (on the annual plan) that are also actions within this winter plan. If we’ve not made progress on them as annual plan actions – and they are things that will affect our ability to respond to winter pressures – then how far will we be able to fulfil its ambitions?

“We’re at the start of a journey here to make some really big changes and we need to be realistic during this winter.”

Among the annual plan actions in red that pose a challenge to the winter plan are same day primary care, including in-hours primary care access, out-of-hours primary care, 111 and Minor Injury Units and Same Day Emergency Care. Demand and capacity modelling and management remains an area of concern as do ambulance handovers, where four hour wait times remain an issue.

“For urgent and emergency care there has been really strong support from the North Wales Regional Partnership Board,” said Mr Devji. “We don’t just want to have this as a health board plan, but a system resilience plan.

“We are at the start of that journey, working together. The idea is that next year we will not be discussing this in December, it will be a lot earlier as part of our planning process. We have learned from this time round.

“It’s really important to ensure there’s a single plan and essentially everything feeds off that so there’s less confusion in the system. We will have a monthly formal review of the winter plan with the Welsh Government around the operational and tactical elements.”