Extreme levels of demand on the Welsh NHS and the impact of Covid-19 are hindering the quality of care given to those most in need, it is claimed.
Latest monthly Welsh Government data shows that the performance of A&E departments and the Welsh Ambulance Service have deteriorated, and the number of people on an NHS Wales waiting list has increased to record levels once again.
In November 2021 there were 682,279 people waiting for non-urgent NHS care – a rise from the 679,626 recorded in October and way up on the 456,809 seen just before the pandemic hit.
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Nearly a third (241,667) of people currently on an NHS Wales waiting list have been on it for nine months or more but this was actually down on the 242,101 recorded the month before. In comparison there were only 28,294 waiting this long in March 2020.
The largest number of patients currently waiting are for trauma and orthopaedic surgery (97,422), general surgery (84,447), ear, nose and throat (57,224), and urology (40,809). However November 2021 saw more than 78,000 patient pathways closed – the highest number in nearly two years.
Median waiting times for November in Wales are nearly double that of England - 22.3 weeks compared to 11.5 - while a quarter of Welsh patients are waiting over a year for treatment compared to only one in 19 across the border.
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 it made the decision to cancel all non-urgent outpatients and appointments to focus on Covid cases in March 2020 these waiting lists skyrocketed.
Meanwhile Welsh Ambulance Service figures for December 2021 showed that barely half (51.1%) of immediately life-threatening "Red" calls were reached within the target time of eight minutes. This is well below the 65% target and down on the 53% recorded in October.
The slowest ambulances to reach life-threatened patients were in the Hywel Dda University Health Board area with only 42.2% arriving within the eight-minute target. Only Cardiff and Vale UHB (65.3%) and Aneurin Bevan UHB (57.6%) posted figures above 50%.
When it came to A&E departments 66.5% of people spent four hours or less in these units before being admitted, transferred, or discharged in December. This was down on the 67.6% in November despite the average daily attendances decreasing from 2,684 in November to 2,381 in December.
Wrexham Maelor Hospital recorded the worst four-hour A&E figures last month with 43.4% followed by Ysbyty Glan Clwyd with 49.9%. Overall in Wales 8,554 patients waited more than 12 hours in A&E – around one in 11 patients – but the target is for no-one to wait that long.
Commenting on the latest NHS performance figures Darren Hughes, director of the Welsh NHS Confederation, said: "The statistics show the extreme levels of demand on the NHS and the impact Covid is having on our ability to treat those in need.
"December saw the seventh consecutive month where over 100 immediately life-threatening calls were made to the ambulance service each day.
"Although these figures paint a very serious picture, including the considerable number of patients waiting to start scheduled care, there are small positives to be seen. For example the number of patients completing their treatment was the highest since the start of the pandemic.
"However it's important to remember this data reflects the situation before the Omicron variant took hold and staff sickness absences rocketed across the NHS and social care. We must therefore be realistic about what subsequent reports will show and how quickly services will be able to bounce back now Covid-related admissions are showing tentative signs of declining.
"While NHS leaders are doing everything they can the elective care waiting list continues to grow and we need to be honest with the public that this can't be cleared overnight.
"We also need to be mindful of what these figures don't show. Primary, community, and social care services play a vital role in keeping people well and out of hospital and they are feeling the pressure caused by Omicron. They too are experiencing high levels of staff absences and more patients needing care as well as helping drive the booster programme.
"Behind these statistics are both patients and staff. More is being done to care for those on waiting lists and exhausted staff are doing everything they can to treat as many people as quickly and safely as possible. We can't thank them enough."
The Royal College of Surgeons of England has called on the Welsh Government to introduce Covid-light surgical hubs in Wales to tackle the "colossal" backlog of elective surgery.
Susan Hill, a consultant vascular surgeon in Cardiff and acting director for Wales at the Royal College of Surgeons of England, said: "Throughout the pandemic patients in Wales have shown formidable patience and understanding as their planned operations have been either cancelled or postponed.
"The figures published today show the colossal scale of the backlog in Wales. It is important to remember that these huge numbers represent individual people waiting in pain and distress.
"We need to start planning for the recovery of surgical services in Wales to reassure patients they will receive their treatment. The Welsh Government must develop, as a matter of urgency, a clear, strategic plan outlining how it will introduce the roll out of Covid-light surgical hubs across Wales."
Welsh Government figures also revealed that almost 57.9% of cancer patients started their first definitive treatment within 62 days of it first being suspected – a fall on the 60% recorded the previous month and below the target of 75%. This was the second lowest on record since comparable data was first collected in June 2019.
Welsh Liberal Democrats leader Jane Dodds MS said ambulance waiting times in Wales have become "unacceptable and dangerous".
"These figures are a tragedy. Targets aren't even close to being met and ambulance response times have deteriorated further. We all understand the severe pressure the pandemic has placed on NHS but these problems are not new," she said.
"If we are to reduce pressures on our ambulance services and A&Es we must invest more in community healthcare and GPs. If people could get a GP appointment in reasonable time there would be far less pressure on emergency services.
"We also need action on social care both to prevent high numbers entering emergency departments and to ensure people have safe environments to be discharged to following any emergency treatment.
"What really stands out is the huge variance in performance across Wales. People in rural areas pay their taxes the same as those in cities – it shouldn’t just be expected that services will be worse.
"This situation cannot continue. The Labour and Plaid Cymru administration must do more to tackle this issue."
The Welsh Government said that although the number of people waiting to start NHS treatment had risen the 0.4% increase in November was the smallest increase in the total numbers waiting since the start of the pandemic.
A spokesman said: "Our NHS is currently dealing with a hugely difficult winter whilst facing the gruelling challenges of the Omicron variant, severe winter pressures, and staff absences caused by the pandemic.
"The data shows how progress was beginning to be made in planned care in November before the impacts of the Omicron wave were truly felt and exerted considerable winter pressures on the health service. We anticipate next month's data, which will include December, will reflect this.
"Healthcare workers should be commended for their determination to maintain high-quality care to hundreds of thousands of patients each month as well as supporting record-breaking levels of boosters during the latest phase of our Covid-19 programme over the last two months.
"We are doing all we can to support our urgent and emergency care services and we would urge everyone to help us help you this winter by considering how and when they access care."
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