More than 700,000 people are now on a waiting list for non-urgent treatment on the Welsh NHS, it has been revealed. Latest data from the Welsh Government shows the number of patients awaiting elective care hit record levels for the 23rd month in a row.
In March there were 701,418 patients on the waiting list – a rise from the 691,885 recorded in February and way up on the 456,809 seen just before the pandemic hit in March 2020. More than a quarter of a million people (253,177) currently on an NHS Wales waiting list have been on it for nine months or more, up on the 251,647 recorded the month before. In comparison there were only 28,294 waiting this long in March 2020.
The Welsh Government wants 95% of patients to wait less than six months (26 weeks) and no-one to wait nine months (36 weeks) from referral to treatment. But when ministers made the decision to cancel all non-urgent outpatients and appointments to focus on Covid cases in March 2020 these waiting lists rocketed.
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Meanwhile Welsh Ambulance Service figures for April showed that barely half (51.2%) of immediately life-threatening "red" calls were reached within the target time of eight minutes. This is well below the 65% target but slightly up on the 51.1% recorded in March. The average response time to red calls was seven minutes and 49 seconds. This is one second faster than the previous month but one minute six seconds slower than in April 2021.
Similarly in April the median response time for amber calls, which includes strokes, was just over one hour and 47 minutes. This is almost four minutes slower than in March and one hour and six minutes slower than in April 2021.
Last month almost 38,000 emergency calls were made to the ambulance service. This is an average of 1,262 calls per day, a fall of six (0.5%) calls on average per day than the previous month and 21 (1.7%) fewer calls on average per day than the same month last year.
Last month was the 11th month in a row where, on average, there were more than 100 immediately life-threatening calls made each day. The slowest ambulances to reach life-threatened patients were in the Hywel Dda UHB area with only 39% arriving within the eight-minute target.
When it came to A&E departments there was a slight improvement in the four-hour waiting times in April although it was still the third-worst performance on record. More than a third (34.1%) of people spent four hours or more in these units before being admitted, transferred, or discharged in April – down on the 34.9% in March. In April there were more than 83,000 attendances to all NHS Wales emergency departments – an average of 2,770 per day which is 94 fewer than in the previous month.
Ysbyty Glan Clwyd recorded the worst A&E figures last month with 65.3% spending more than four hours there followed by Wrexham Maelor with 60.3% and The Grange University Hospital with 42.1%. Overall in Wales 10,391 patients waited more than 12 hours in A&E – down on the record 10,886 recorded in March – but the target is for no-one to wait that long. Adults aged 85 and over spent an average of eight hours and 10 minutes in emergency departments, the second-longest on record.
Welsh Government figures for February also revealed that only 58.7% (1,009 out of 1,720) of cancer patients started their treatment within 62 days – well below the national target that 75% should start their treatment on time. This was also a reduction on the 59.5%% recorded the previous month. It means that during March alone at least 711 people faced delays in receiving vital cancer treatments.
In March more than 15,300 referrals were made for suspected cancer in Wales – the highest number since the new way of measuring cancer waiting times in Wales started. Richard Pugh, head of partnerships for Macmillan Cancer Support in Wales, said: "These worsening cancer waiting times show that more than four in 10 people with cancer in Wales did not start their treatment on time in March meaning they and their loved ones faced distressing and worrying delays.
"We are particularly concerned at the variation in waiting times between cancer types – for example just one in four with gynaecological cancers started their treatment on time. Two years on from the first coronavirus lockdown it shows how our cancer care system is struggling to cope with demand despite the valiant efforts of NHS staff.
"Just yesterday the Welsh Government announced a new NHS executive to drive improvements as well as recently announcing a commitment to publishing a Wales Cancer Services Action Plan later this year, which are welcome developments. However we need urgent focus to improve cancer care in Wales now and in the future including a dedicated cancer workforce plan with the right funding as Macmillan’s own research shows we need 80% more cancer nurses in Wales by the end of the decade."
The Royal College of Surgeons of England has called on the Welsh Government to roll out regional surgical hubs, or elective centres, as waiting lists in Wales soar to a record high. Some 9,238 patients in Cardiff and Vale UHB, 6,921 in Aneurin Bevan UHB, 18,189 in Betsi Cadwaladr UHB, 13,457 in Swansea Bay UHB, 8,727 in Hywel Dda UHB, and 13,885 in Cwm Taf Morgwnnwg UHB were waiting over two years for planned treatment.
Professor Jon Barry, the Royal College of Surgeons of England's director for Wales, said: "Today's figures are a brutal reminder of the challenges facing the health service in Wales. Every month we are witnessing an increase in the number of patients waiting in pain to begin their treatment, which is very distressing.
"We are still concerned about the number of patients waiting a very long time across health boards in Wales. As waiting lists hit a record high there is a risk that in some cases patients will have to wait years for treatment, which is unacceptable. To resolve this the Welsh Government needs to deliver on the commitments set out in its planned care recovery plan. This includes creating regional surgical hubs, or elective centres, to make access to planned surgery fairer."
In response to the overall NHS performance figures a spokesman for the Welsh Government said: "As the health service continues to recover from the pandemic, and more people are coming forward with health concerns, we have seen the highest number of referrals for a first outpatient appointment since January 2020 with just over 115,000 referrals made in March. This increase in referrals helps to explain why the total waiting lists size increased by 1.4% on the previous month. It should be noted that activity levels for treatment and outpatients are at their highest level since the start of the pandemic.
"The number of outpatients appointments in March was the highest since January 2020 (255,384). On top of this the numbers of inpatient and day case treatments were the highest since the start of the pandemic. The number of patient pathways closed in March – that is people who have started or no longer require treatment – was the highest since the start of the pandemic, 1.7% more per day on average than in February."
The Welsh Government also noted that the numbers waiting over the eight-week target for a diagnostic test decreased for the second month in a row to their lowest level since April 2021 and by 4.9% compared to February 2022.
The spokesman added: "The planned care recovery plan published last month set out a series of ambitions. The first ambition was to reduce the number of open pathways waiting over 52 weeks for a first outpatient appointment to zero by the end of 2022. In March 2022 the number of pathways waiting over 52 weeks for the first outpatient appointment decreased by 1% compared to February. In March 2022 the number of pathways waiting over 52 weeks decreased by 4.8% compared to March 2021. 999 emergency ambulance and emergency department staff and services remain under considerable pressure and performance is not where we want it to be."
The Welsh Government said the NHS is making changes and improvements to the way it provides services – including increasing staffing in crucial areas – as part of its Six Goals for Urgent and Emergency Care programme backed by £25m. In 2022-23 this includes around £20m for health boards and partners to increase capacity in urgent primary care and same-day emergency care services and a new £4m innovation and delivery fund to support nationally coordinated projects to support the delivery of the six goals.
The six goals for urgent and emergency care are:
- Coordination, planning, and support for people at greater risk of needing urgent or emergency care;
- Signposting to the right place first time;
- Access to clinically-safe alternatives to hospital admission;
- Rapid response in a physical or mental health crisis;
- Optimal hospital care following admission;
- Home-first approach and reduce risk of readmission.
Each health board will be asked to submit plans showing they are meeting the programme's priorities, which includes setting up urgent primary care centres and same-day emergency care services, recruiting new Six Goals programme improvement teams consisting of clinical, operational, and analytical expertise, and working on additional projects that align to delivery of one or more of the six goals.
Health minister Eluned Morgan said: "The NHS is under a lot of pressure at the moment but every day it provides life-saving and life-changing care for tens of thousands of people across Wales.
"The Six Goals programme is designed to help improve access to urgent and emergency care for all those people who need this care and ensure there are alternative services available for those people who need a different type of response – we want everyone to get the best possible care as quickly as possible and as close to home as possible. But it’s also important they get it from the right service the first time."
