Be careful. Thank you. Sorry, Mike, just to draw on Nicky's comment about integrated teams; it's so important, Gareth. Social care and the distance that sometimes, as a hospital clinician, you find yourself from that private provider means that there is often uncertainty from the ward staff as to what's going on on the funding stream, on where you are in maybe the allocating and identifying of a care home or the care process.
Historically, I used to speak to care home providers; we used to talk about falls and fall prevention strategies, trying to align the local policies with the care home policies and, of course, they've got their own business models and their own drives, so there is that tension. But we, as health and social care providers, do need to be making sure that the provision that we have is supported positively. And absolutely, as Nicky started saying, at the outset of what happened at the front stage of COVID where we could not test, we did not know what the future would hold. It's hard to go back and remember those times now, but it was a wave of, 'We don't know what's going to come across, and we can't really test for it.' You all might remember how hard it was.
We've got to differentiate between emergency surgery, which is the usual scenario where people end up in so much more frailty. So, often that's a hip replacement as a consequence of a fractured neck of femur, and people who suffer a fractured neck of femur are generally quite frail and we've put into our submissions some of the real issues, but usually when somebody has a minor fall causing a major hip fracture, it's often part of a functional deterioration; it's somebody closer in terms of higher levels of frailty. And so that person is very vulnerable, and post operatively, if they have confusion that's acute or dementia and chronic illnesses, that might make it hard for them to engage with rehabilitation—not because they don't want to, but because they don't quite understand what's going on—or if they have an intercurrent illness.
And one of the things about COVID, as Nicky in the nursing submission drew on very importantly, was around this PJ paralysis or deconditioning, where patients get into a hospital and, as I think you were alluding to, they sit and they don't wash themselves. They let people wash them, maybe because they're feeling ill; they sit in that chair for so many hours of the day, they're not dressed, they're not active and before the—. We, across Wales, had large engagements with the PJ paralysis about making sure our older people were getting out of bed and getting dressed, and of course, that finished—not 'of course'—that just finished as COVID came in, so that learning that we had developed, the importance of that was compromised, because we weren't able to go into the bays of the COVID patients in the same way, the family weren't able to bring in their clothes and, of course, for a short period of time, the nature of the patients in the hospital changed massively. So, if we want to try and prevent deconditioning and functional deterioration, we need to get back to that, and that requires nursing, therapy, integrated staff and indeed, I'd say, medical lead to be encouraging people from the outset to get back, to get better, to do all that they can.
It is worrying, of course—sorry, I will go—where elective patients, who absolutely should go out far better, deteriorate, and that might be in some cases because of complications, some of which can be avoided, some of which can't, prehabilitation, optimising function before surgery, making sure we choose the right people. Because there are some people whose background frailty has got to a point that, whilst it might seem it's the knee or the hip that's the problem, there's much more morbidity in the background. Mike, is that—?