A plan to reduce the record-breaking backlog of planned NHS care has been published by the Welsh Government. As part of the strategy, a series of targets have been set out for health boards to achieve, including a pledge to eliminate one-year waits for treatment in most specialties by spring 2025.
It also focuses heavily on providing care closer to people's homes and offering more consultations virtually wherever possible. During the Welsh Government press conference on Tuesday lunchtime, Health Minister Eluned Morgan said 'Super Saturdays' would be introduced to boost productivity over weekends, adding that incentives would be offered to NHS staff to encourage them to work longer hours.
However, opposition parties have described the plan as "unambitious" and criticised the lack of detail on boosting workforce numbers. The health minister also admitted that some patients could still be waiting longer than a year for orthopaedic treatment by spring 2025 because they are more easily postponed by urgent cases in A&E.
"We're looking to develop high-volume places - called 'green lanes' - where [planned procedures are] kept apart from urgent cases in the likes of A&E so we can get our consultants carrying out the operations they're very keen to do. We're looking to do more 'Super Saturdays', for example, and we will be encouraging and incentivising people to work longer hours," said Ms Morgan. "We have made a commitment to employ more than 12,000 new people into the NHS over the course of this Senedd."
At the start of the pandemic the Welsh Government made the decision to postpone non-urgent care so staff and resources could be used to tackle the Covid crisis. It meant the NHS waiting list ballooned, with more than one in five patients now awaiting some form of treatment two years on. You can read the latest update on NHS performance here.
Read more: Welsh NHS described as 'broken' as waiting times crisis deepens
Despite nearly all legal Covid measures now being lifted, hospitals are still trying to contain outbreaks of the virus and have infection prevention and control requirements in place which greatly reduces bed capacity and the ability to tackle the growing backlog of elective care. There are currently around 1,360 Covid-19-related patients in hospital beds and more than 6.6% (1,800) NHS staff absences.
"We need a determined effort to ensure people waiting for appointments and treatment are seen as quickly as possible and in order of clinical priority," the plan states. "We have been clear that it will take at least the course of this parliamentary term to reach the levels at which we were pre-pandemic, when waiting times were falling.
"Reducing waiting times will require new solutions and a range of actions. We will need to redesign and establish new expectations about what the NHS will do in the short and medium term, while ensuring there is wellbeing support for those who are waiting."
The Welsh Government said the plan will be supported by an extra £60m - £15m a year over the next four years - for health boards, bringing the Covid recovery NHS budget to around £1bn.
What are the targets?
The plan sets out a series of targets for health boards, including:
- No-one waiting longer than a year for their first outpatient appointment by the end of 2022;
- Eliminating two-year waiting times in most specialities by March 2023;
- No-one waiting more than a year in most specialties by spring 2025;
- 80% of people receiving their cancer diagnosis and start treatment within 62 days by 2026;
Increasing the speed of diagnostic tests and reporting to eight weeks, and to 14 weeks for therapy interventions by spring 2024.
Currently there are 164,000 patients who have been on an NHS waiting lists for more than a year, compared to less than 7,000 two years ago.
What does the plan prioritise?
The plan lays out a number of key objectives to reducing the backlog:
1. Fewer in person outpatient appointments
Each year there are around three million outpatient appointments in NHS Wales. Traditionally they are characterised by a visit to a hospital to see a clinical team in a pre-arranged location and time for a clinical review.
But the Welsh Government stresses this traditional model of outpatient services has to change to ease the pressures on hospital settings. It said it wants to further develop digital technology to reduce the need for face-to-face contact, delivering care through virtual appointments where clinically appropriate to do so.
"We will work towards accelerating the embedding of virtual approaches and offer telephone and video appointments so that 35% of new appointments and 50% of follow up appointments are delivered virtually," the report states. "We will make provision for the digitally excluded to avoid exacerbating inequalities, by setting up virtual centres in rural communities to prevent people having to travel to hospitals."
The Welsh Government said it also wants further develop a system to provide efficient, integrated e-referral and e-advice to manage care.
2. More testing away from hospitals
According to latest figures, the number of people waiting for a diagnostic test stood at 106,723 in February 2022. The Welsh Government said more equipment, new facilities and expansion of the diagnostic workforce will be "critical" to providing an effective and efficient planned care service.
The plan is to create community diagnostic hubs established away from acute hospital sites. The Welsh Government said plans for two community diagnostic centres will be developed this year, with more to follow by the end of this Senedd term.
3. Focus on early diagnosis and treatment of suspected cancer patients
Each year around 165,000 people in Wales are referred with a suspected cancer. More than 90% will not have cancer, but the impact of waiting for a diagnosis to be ruled out or confirmed causes anxiety and stress to the patients and their families.
Some cancer services, including cancer screening, were paused for a short time at the very start of the pandemic. It meant Wales saw a significant reduction in the number of suspected cancer referrals during this time as patients decided not to come forward to "protect the NHS", but also due to fear of becoming exposed to Covid themselves.
It is estimated that about 4,500 fewer people were diagnosed and treated for cancer than we might have experienced based on previous years. However, people are now presenting with suspected cancer at a higher rate than the NHS has ever experienced.
Welsh Government figures for February showed that only 59.5% of cancer patients started their treatment within the 62-day target – well below the national target that 75% should start their treatment on time. The aim is for 80% of people receiving their cancer diagnosis and start treatment within 62 days by 2026. In addition to the diagnostic hubs already mentioned, the government said it aims to achieve this by streamlining pathways to care, minimising the number of visits someone must make and coordinating tests into bundles that can happen together.
4. Minimising health inequalities
The Welsh Government said children's services need to be prioritised due to the long-term impact their illness or injury could have on their growth and development. In addition, a clinical validation scheme will be strengthened to ensure those at higher risk of harm are seen first.
The referral to treatment times (RTT) will also be reviewed to ensure that they support "effective clinical decision making across the whole system", including advice and guidance to primary care. "As our system is reset, it is important that no-one is left behind and that everyone is able to access health services regardless of their characteristics in line with clinical need," the report states. "Working nationally and locally, further analysis of the waiting list needs to be undertaken to ensure that we really understand variations in access not only from where a person lives but also by their relevant characteristics such as their age, ethnicity, sexuality and condition."
5. Eliminating long waits
The plan states that there are a number of ways the Welsh NHS can reduce those waiting the longest for treatment. These include:
- Additional sessional work at weekends and evenings;
- Partnering with the private (independent) sectors to develop new approaches and models of care;
- Regional options which allow protected planned care capacity at a higher volume than traditional hospital-based theatres;
- Consolidating urgent and emergency services to free capacity for planned care;
- Transformation and introduction of new models of care at practice, cluster, hospital and health board level.
6. Appropriate information and support to people
The Welsh Government said it wants people will have "clear and simple" information about how long they will be expected to wait, information about how they can access support and who to contact should they have any concerns.
An online website will be created where patients can get the information and support to manage their own conditions, helping people to manage their own health and reducing the number who need to be readmitted to hospital for treatment.
"We are considering how best this is done as well as understanding the type of information that will be useful and meaningful to those waiting for outpatient appointments and planned care surgeries," the report states. It also wants to fundamentally transform the waiting list into a preparation list. "This will allow people to be fully supported by the right health professional in using the waiting period proactively to improve their health, make informed decisions, and prepare physically and mentally for their operation or other treatment and recovery."
Examples of how this funding has been used already to reduce waiting times includes:
- £19,937m for two new operating theatres at Prince Phillip Hospital, in Llanelli, which will treat an additional 4,600 people a year;
- £2.2m for Swansea Bay University Health Board for the Singleton Day Surgery Unit, which will treat an additional 3,000 cataract patients a year;
- £1.034m for trauma and orthopaedics at Aneurin Bevan University Health Board, to treat an extra 3,650 people;
- £827,000 for Cardiff and Vale University Health Board’s mobile endoscopy units to treat an additional 600 people;
- £1.389m for two vanguard theatres at Cardiff and Vale University Health Board which will see between 3,900 and 4,500 people a year.
What do the experts make of the plan?
Dr Hilary Williams, the Royal College of Physicians regional adviser for south-east Wales said: "The pandemic has simply exacerbated the problem of waiting lists. The NHS was in a fragile position even before Covid-19: there are some good ideas in this new planned care recovery plan, but for the RCP, the challenge is how will the ideas in this plan be delivered?
"We know that the chronic shortage of NHS staff is a very limiting factor to reducing the backlog, and there’s simply no real detail on that. How many doctors, nurses and allied health professionals will we need in the next five years, to actually meet some of these targets on diagnosis and treatment?
"Clinicians are struggling too. It can be genuinely heartbreaking. But we’re not giving up. We’re hanging on in there. We want to see change – we want the best for our patients and we need to know that there’s light at the end of the tunnel. We need a workforce plan that gives staff time to care properly for their patients, instead of firefighting all the time. We have a first-class health and care workforce, but we need more people on the front line.
"There are some really good strategies out there. But we need to work much more closely together. We need detailed delivery plans: we need to know projected numbers of staff, how they’re going to be funded, how they’re going to be trained. If we work together, we can get there, but we need a much more collaborative approach from the Welsh Government."
Richard Pugh, head of partnerships for Macmillan Cancer Support in Wales said: "While we welcome the ambition of raising the target to 80% of cancer patients being treated on time, we have to acknowledge that this is a long term aim at a time when urgency and energy in the short term is also desperately required.
"The fact remains that Wales has had cancer treatment targets in a number of different guises over the years and not one of them has been met. Only recently Wales saw as few as 53% of cancer patients starting their treatment on time in January – leaving hundreds to face delays in life saving care.
"While we fully support the aim of raising the bar on cancer treatment waiting times performance in the future, what we desperately need to see now is the detail on how Wales will actually achieve this.
"The revised 80% target speaks volumes. To reach it Wales will need specialist facilities and a workforce that is capable of meeting demand for care. Macmillan’s own research shows Wales will also need 80% more cancer nurses by the end of the decade alone. One will not happen without the other. That is why it is so vitally important that Wales catches up with the rest of the UK by putting a detailed and fully funded cancer strategy and workforce plan in place. Any ambition for future improvement will flounder without it."
Welsh Conservative and Shadow Minister for Health, Russell George MS said: "Twenty-three years of Labour mismanagement has seen the NHS breaking all the wrong records in Wales. Only last week we saw the worst A&E waits and longest treatment list in NHS Wales history. Much more needs to be done.
“Labour’s mismanagement of our NHS predates the Covid-19 with waiting times doubling in the year before the pandemic. For years, Welsh Conservatives have been calling on the Labour Government in Cardiff Bay to tackle the crisis in our NHS. We need to be assured that this plan is more than a just sticking plaster to cover deep rooted issues.
“We must also be assured that this extra funding will go towards addressing long standing gaps in the NHS workforce as this can’t be just about equipment, it’s about the people. This is a matter of life and death for people in Wales. It’s about time Labour ministers started treating it as such."
Plaid Cymru’s spokesperson for health and care, Rhun ap Iorwerth MS said: "What the NHS in Wales needs is a plan that looks at every aspect of the patient journey through the health and care sector. This has to start with increased focus on prevention, to reduce the number of people who are seeking health care in the first place, and must include plans to quickly support those patients who need care packages after hospital treatment, to free up beds in hospitals It’s also not clear if government are taking any additional steps to address the severely depleted workforce across health and care.
“While the increased support for those on waiting lists is to be welcomed, as is the promise of a new focus on diagnostics, what the NHS in Wales desperately needs and deserves is a comprehensive plan that addresses the whole patient journey, including the workforce required to deliver the service.
“The fact that new targets are to be set is welcome, but we’ll have to assess the level of ambition and firmly hold the government to account to ensure targets are met.”
