A Welsh Government target to eliminate two year wait lists for patients in most specialties by March 2023 has not been met, new data has shown. In March there were still 31,406 patient pathways waiting for more two years for treatment.
The number of patients on treatment waiting lists in Wales also increased last month by around 2,000 patients, meaning 576,000 individuals are waiting for treatment in Wales. Last year, the Welsh Government created a care recovery plan as part of returning services to "normal" following the coronavirus pandemic. The plan established a target to eliminate two year wait lists in most specialties by March 2023.
However, the target has not been met. The figures have been described by one health union as a "stark reminder of the NHS' failings in Wales."
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The Welsh Government said that if it excluded seven specialities from the total, dermatology, general surgery, ophthalmology, urology, gynaecology, orthopaedics and ear nose and throat services, then there were only 4,300 patient pathways in 17 specialties in Wales waiting for longer than two years as of March 2022. These are the areas where there were large numbers waiting before the Covid-19 pandemic.
Waiting times for hospital treatment have been slightly adjusted this month in order to make the data more comparable with England. Last year in England, it was announced two year waitlists were "virtually eliminated" after patients were given the option to travel to other trust areas to receive treatment. Across the border just over 10,700 patients were waiting more than the 18 months for treatment as of March 2023, around 4,000 of which were complex cases or people who had chosen to wait. It is important to note the difference between patients and pathways, as pathways represent each form of treatment a person may be waiting for, meaning one patient may have more than one pathway.
There are some examples of patients receiving treatment at a neighbouring health board in Wales, however Wales' health minister Eluned Morgan said there is a difficulty with encouraging health boards to see patients from outside their area as "none of the health boards have reached the target that we set for them. So it is understandable that they'd want to deal quite often with their own patients first."
Wales' health minister Eluned Morgan said she has written to health boards to express "disappointment that they have not hit the target for people waiting over two years for treatment." Ms Morgan added: “I want to see more innovation, like at Ysbyty Gwynedd, where more than 90% of breast cancer surgery is performed as day cases, allowing patients to be managed more efficiently and recover more comfortably and sooner at home.
“The most urgent cases must still be prioritised, but I expect health boards to work through their waiting lists more quickly. This includes by treating in-turn; increasing significantly the number of the longest waits through more day cases; provision of dedicated ring-fenced planned care beds; more efficient use of theatres; and reducing cancellations, late starts and early finishes of surgery."
When asked by WalesOnline if she believes the Welsh Government should bear some of the responsibility for failing to meet the target, Ms Morgan said: "I'm more than happy to share responsibility. But we made it very clear to health boards what they needed to do to meet these targets, for example, making sure that they treat the longest waiters first, obviously you have to accept that there will be urgent cases you need to see first."
Ms Morgan acknowledged the hard work that health boards have been doing, but added: "There are different ways of doing things and actually there are things that they can improve on, better use of theatre times, making sure that people start work on time that they finish on time. All of these things can be tightened up. Of course, we'll share our take our share of responsibility."
The health minister added that it is clear that some health boards are performing better than others, and that it is important for the public to be aware of this.
Welsh Conservative Shadow Health Minister, Russell George MS said: “In England, these waits have been virtually eliminated. In fact, there are now three times as many people waiting two years in Wales than there are people waiting 18 months in England, despite England having 18 times our population."
Number of patient pathways on waitlist rose in March for first time in five months
The number of open patient pathways increased in March from around 731,000 to 734,700. The Royal College of Surgeons of England described this upward tick as "bitterly disappointing", adding that "it shows there is still a long way to go to bring down the waiting lists in Wales."
Professor Jon Barry, Director in Wales at the Royal College of Surgeons of England, said: "The statistics illustrate the ongoing pressure across the entire health and care system." He added that failure to eliminated the two-year waits was "particularly disappointing as waiting longer for surgery can have significant negative effects on a patient's physical and mental health, as well as their quality of life."
He said: "Despite these latest figures, and they are disappointing, I have recently visited several hospitals across Wales and spoken to colleagues from all over the workforce and am encouraged by what I have heard and seen. I am in no doubt we are moving in the right direction although I understand the difficulties we face. Our workforce remains our greatest asset and despite the challenges they face, they are committed to providing the highest level of care to patients across Wales and tackling these waiting lists.”
Cancer services
In Wales, at least 75% of patients should start treatment within 62 days of first being suspected of cancer, according to the set target. For the month of March, just 55.3% of patients received treatment within 62 days of first being suspected of cancer, compared to 52.5% the previous month (which was the lowest on record). The planned care recovery plan which was published last year, established a new target of 80% to be reached by 2026. The highest proportion of pathways starting within 62 days was in Betsi Cadwaladr (63.1%) and the lowest was in Hywel Dda (44.5%).
Cancer charity Macmillan is pleased to see the improvement in treatment waiting times for a second month in a row, but says far too many people with cancer still face anxious delays. Richard Pugh, Head of Partnerships for Macmillan Cancer Support in Wales said: “While this news will provide little comfort for the significant number of people with cancer who still face anxious delays, this is a welcome improvement which was achieved during one of the busiest months on record. The trend for 2022 was that the number of people facing delays to starting treatment accelerated faster than the overall numbers of people being seen – a sure sign of a system failing to cope.
“These green shoots of recovery, with two months in a row bucking a consistently downward trend must now be built upon and we hope they signify a change in trajectory when it comes to making sure people receive cancer treatment on time. This recovery must be a recovery for all. We need to bring everyone with us and with some cancer types seeing as many as 3 in 4 people facing heart-breaking delays in their care, there could be no clearer sign of just how difficult and long a road this may prove to be."
Emergency care
In April, there were 3,799 red calls to the ambulance service which made up 11.4% of all calls. Of these calls 53% received an emergency response within eight minutes, this was 5.6% higher than in March (the second worse on record in Wales) and 1.9% high than in April 2022. This month was the best response since March 2022.
There was an average of 2,903 daily attendances to emergency departments, an increase compared to the previous month. Performance increased slightly against the four hour and twelve hour targets. The average (median) time spent in emergency departments was 3 minute shorter in April compared to the previous month at two hours and forty one minutes.
In April, 70.2% of patients in all NHS emergency departments spent less than 4 hours in the department from arrival until admission, transfer or discharge. This was only 0.7% higher than the previous month. The target is that 95% of new patients should spend less than four hours in the emergency department from arrival.
Throughout the month, 8,945 patients waited for 12 hours or more in A&E, this was 10.9% less than in March. Adjusted by population, more patients waited longer than 12 hours in Betsi Cadwaladr than in any other Local Health Board. The lowest figure was in Cardiff and Vale. The target states that no patient should be waiting more than 12 hours in emergency care.
Regarding the easing of A&E waiting times and ambulance response time, health minister Eluned Morgan said the improvements have "not been by accident" and are not a reflection of the easing of the seasonal winter pressures.
Ms Morgan added: "It is because we have got a very comprehensive six goals for urgent emergency care plan in place that is being enacted. So some of what we are seeing the results coming through in terms of those. That is not to say we will not see another difficult winter but we're doing everything we can now to prepare for what is always seasonal challenge."
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