The scale of the horrific problem facing people in Wales waiting for hospital treatment has been revealed in new figures showing there are more than 60,000 cases in which people have been referred for treatment but have had to wait more than two years.
Health bosses in England recently published new figures showing that the problem of two-year-plus waits appears to have been dealt with across the border. There are now fewer than 200 open waits for treatment in England where the referral happened over two years ago. In Scotland, figures in the summer showed more than 10,000 patients had been waiting more than two years for treatment.
However the problem in Wales, which is significantly smaller than either Scotland or England, appears to be several orders of magnitude worse. According to the latest Welsh Government data (which runs to the end of July), there are 60,000 open cases in the NHS system where people have been referred for treatment and are still waiting more than two years on. These are called 'patient pathways'
At present for every 100,000 people in Wales, there are 1,949 waits of more than two years for a procedure. In England it is more like 0.35.
The Welsh NHS had 56,515 outstanding waits in January. This figure rose to a high of 70,000 in February but has remained stubbornly high at 60,557. The back log was largely caused by the mass cancellations that took place at the start of the Covid pandemic but in Wales, unlike other parts of the UK, the two year waits don't appear to be falling at a significant pace.
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The issues appear to not only be in two-year waits (which have seen a slight drop in recent months. The amount of pathways waiting longer than a year is actually going up moving from 168,000 in February to 181,000 in July 2022. Patient pathways waiting longer than a year for a first outpatient appointment have reached 101,106 - this number was zero back in 2012.
How does this compare with England?
This is a little complicated but stay with us.
In July, England had only 200 pathways waiting more than two year. England is far larger than Wales and if it had proportionately the same two year waiting times it would have over 1m people waiting more than two years. However we do need to take into account how this is counted.
Whenever challenged on the difference between England and Wales, the Welsh Government are always really keen to point out that England and Wales don't capture the data in the same way. In England they exclude non consultant-led mental health services, maternity services, public health service commissioned or provided by local authorities, direct referrals from primary care to diagnostic services in secondary care (unless they are ‘straight to test’ referrals).
In Wales they exclude mental health hospital services, palliative care and inpatient/day case dentistry. Cardiology is measured separately with different methodology.
So it is fair to say we are not comparing apples with apples here. But it is also perfectly reasonable to say that the differences in measurement don't come close to accounting for the enormous difference between the Welsh and English NHS. For example, maternity service would almost never be over two years anyway.
Plus we need to take into account how their levels have changed. England have gone down from 22,500 in January to basically zero now. Wales has gone up from around 50,000 to 60,000. over the same period. Even putting the comparison aside, the glacial speed these figures are coming down (and on some measures going up) is a massive cause for concern.
When looking at the data we also need to understand what a "pathway" is. A pathway is based on the ailment, not the person. So if a person needed both a hip replacement and a cataract you would technically be on two waiting lists and therefore on two pathways. Policy makers will sometimes try to use this so called "double counting" to try and play down their monstrously long waiting lists perhaps saying "well one person is on there three times".
But this really misses the point. If someone is on there several times this is actually worse. It means you have someone with multiple ailments, often which are life limiting, waiting years for relief. It has a horrific human costs. Plus from an England/Wales comparison perspective England also uses pathways when counting so you can still compare the data.
"Fixing this issue should be a national priority for the Welsh Government"
Opposition parties have slated the Welsh Government for failing to get on top of these lists.
Welsh Conservative shadow health minister Russell George MS said: “The gulf between two-year waits in Wales and elsewhere in the UK is enormous and only goes to show that the Labour Government is letting down patients and NHS staff across Wales. We told health ministers these two-year waits were unacceptable and proposed solutions – but they did not listen, with one saying it would be foolish to publish a recovery plan, and now we’re in a position where people elsewhere in the UK can expect far more efficient healthcare.
“The progress we have seen in tackling the longest waits in England, using approaches like surgical hubs, shows that the NHS does not have to be this way – if only Labour focussed on the day job rather than impose the dreaded tourism tax and 36 more politicians in Cardiff Bay with no mandate. Labour need to get a grip of the NHS and stop breaking all the wrong records.”
Plaid Cymru’s spokesperson for health and social care, Rhun ap Iorwerth MS, said that this can't just be put down to seasonal pressure and that he was not surprised at reports some people were going abroad for treatment. He told WalesOnline: “We’ve reached a stage – and it’s been clear to me that we’ve been here for some time – that the pressures being faced by our NHS are not just simply about seasonality. We’re at the end of the summer, waiting lists are as long as ever – with many important metrics getting worse – and this isn’t just about clearing the backlog from ‘winter pressure’. In fact, the problems being faced by our NHS pre-date the pandemic.
“Too many people are being left to wait in pain for too long - is it any wonder that they are seeking solutions elsewhere? The key principle of the NHS is that ‘good healthcare should be available to all, regardless of wealth’ and yet one consequence of ever-lengthening waiting lists is the entrenchment of a three-tier healthcare system – those that can afford private healthcare from the start, those who have the means to pay for treatment after waiting for too long, and everyone else.”
Leader of the Welsh Liberal Democrats Jane Dodds MS said that if people were able see their GP more easily it could reduce the need for long waits. She said: “We urgently need to see an action plan from Labour. It cannot be acceptable that Wales preforms so poorly compared to England and Scotland, who have both faced similar pressures resulting from Covid yet have a lower proportion of people stuck languishing on a waiting list. What is immediately clear is we need to see more resources ploughed into primary healthcare and prevention.
"If more people were able to see their GP when symptoms presented themselves less people would experience a deterioration that eventually requires either surgery or emergency treatment. Fixing this issue should be a national priority for the Welsh Government. All the figures we have seen recently suggest the NHS in Wales is close to buckling and we are not even in winter yet."
Commenting on the latest figures a Welsh Government spokeswoman said: “We are determined to tackle the backlog and are very aware of how difficult it has been for people waiting a long time for treatment. We continue to make progress to reduce the longest waits and the number of patient pathways waiting more than two years fell for the fourth consecutive month, down 2.5% in July and 14% lower than the peak in March.
“Our planned care recovery plan, backed by a £1bn investment this Senedd term, sets out how we are investing in new solutions, more equipment, new facilities and more staff to help transform planned care. More than 358,000 patient consultations were undertaken by the NHS in Wales in July across departments and just over 87,000 patient pathways closed, a significant increase from the early stages of the pandemic and 15.1% higher per working day than for the same month in 2021.
“Opportunities for patients to be seen more quickly in alternative providers, including neighbouring health boards, continue to be available and we encourage people to accept any potential offer if they are able to.”
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