Patients will continue to suffer on record-breaking NHS waiting lists unless more is done to separate planned and emergency care, experts have warned. New Welsh Government data has revealed that the number of patients awaiting planned non-urgent care hit record levels for the 25th month in a row.
In May there were 722,147 so-called "patient pathways" waiting for elective hospital treatment - an alarming rise of 15,000 from the 707,098 recorded in April and way up on the 456,809 seen just before the pandemic hit in March 2020. As one patient may be on several "pathways" to treatment, the number of patients affected will be lower.
In fact, newly-collected management information presented for the first time this month suggests that in March, when the national statistics reported more than 701,000 open patient pathways, there were 543,773 individual patients on treatment waiting lists in Wales.
Read more: Welsh Ambulance Service to recruit 100 more staff to improve response times to most urgent calls
More than a quarter of a million patient pathways (260,859) currently on an NHS Wales waiting list have been on it for nine months or more, up on the 258,189 recorded the month before. In comparison there were only 28,294 waiting this long in March 2020. The longest nine-month waits are for trauma and orthopaedic treatment (98,903), general surgery (89,256), ear, nose and throat (61,209) and urology (42,868).
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 decided to cancel all non-urgent outpatients and appointments to focus on Covid cases in March 2020 these waiting lists increased substantially.
The Welsh Government has also set a target of eliminating two-year waits for planned treatments "in most specialties" by March 2023. In May, there were just over 65,000 two-year waits, an improvement on the 68,032 the previous month.
Commenting on the figures, professor Jon Barry, interim director for Wales at The Royal College of Surgeons of England, said: "The NHS in Wales is facing one of its toughest challenges yet. An unprecedented heatwave, ongoing Covid-19 pressures and escalating backlogs paint a grim picture.
"We can no longer be under any illusion that NHS pressures are confined to the winter months. We face year-round pressures so a new approach is needed. We need to support our surgeons and the NHS' hard-working staff by increasing surgical provision. Regional surgical hubs, or elective centres, must be rolled out across health board boundaries in Wales to improve the pace of recovery. We urge the Welsh Government to separate planned care from urgent and emergency care. If they fail to do so, patients will continue to suffer."
Meanwhile Welsh Ambulance Service figures for June were the second worst on record. Just half (50.8%) 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 54.5% recorded in May. The average response time to red calls was seven minutes and 55 seconds which is 33 seconds slower than the previous month.
The slowest ambulances to reach life-threatened patients were in Cwm Taf Morgannwg UHB with only 42.2% arriving within the eight-minute target, followed by Hywel Dda UHB with 44.4% and Powys with 45%.
Similarly in June the median response time for amber calls, which includes strokes, was just under one hour and 35 minutes. This was almost 17 minutes slower than in May, and 35 minutes slower than in June 2021.
Last month just over 37,000 999 calls were made to the ambulance service. This was an average of 1,249 calls per day, an increase of 42 (3.4%) calls on average per day than the previous month but 133 (9.6%) fewer calls on average per day than the same month last year. Last month was the 13th month in a row where, on average, there were more than 100 immediately life-threatening calls made each day.
On Thursday the Welsh Government announced a £3m investment in the Welsh Ambulance Service which will involve 100 extra frontline staff being recruited. The aim is to improve the NHS trust's response times to the most seriously ill or injured patients. You can read more about that here.
When it came to A&E departments it was a similarly troubling picture. In June more than a third (33.6%) of people spent four hours or more in these units before being admitted, transferred, or discharged - slightly worse than the 33.4% in May. The drop in performance comes despite the number of attendances falling from more than 91,000 in May to almost 89,000 in June.
Wrexham Maelor Hospital recorded the worst A&E figures last month with more than half (54.6%) spending more than four hours there, followed by Ysbyty Glan Clwyd (51.6%) and Princess of Wales Hospital (49.6%). Overall in Wales 10,258 patients waited more than 12 hours in A&E – up on the 10,226 recorded in May – but the target is for no-one to wait that long.
Meanwhile in June, 88,000 calls were answered by the NHS 111 service in Wales - almost 17,000 (20%) more answered calls than in May.
NHS cancer waiting times for May show that just 53% of patients started their first treatment within 62 days of being suspected of having cancer - the joint worst month (with January 2022) since the suspected cancer pathway was published in August 2019. This is also well below the performance target which aims for 75% of patients to start treatment within 62 days of first suspecting cancer. This target has never been met.
The NHS diagnostic and therapy service waiting times for May show an increase in the number of people waiting more than eight weeks for one of seven key tests most commonly used to diagnose cancer, compared to pre-pandemic levels. By the end of May, around 12 times more people were waiting more than eight weeks for one of these diagnostic tests compared to before the pandemic. There is substantial variation between health boards with Cwm Taf Morgannwg UHB seeing just 45.2% of patients starting treatment within 62 days of cancer first being suspected compared with 62.3% of patients in Betsi Cadwaladr UHB. No health board has met the 75% target since July 2020.
Katie Till, Cancer Research UK’s public affairs manager in Wales said: "It is unacceptable that people in Wales are waiting too long to find out if they have cancer. Early diagnosis followed by swift access to the most effective treatment can save lives.
"Despite the best efforts of NHS staff, many of the delays are due to Wales’ chronic workforce shortages in the areas key to diagnosing and treating cancer. These shortages have hampered progress for years – well before the pandemic.
"We have been calling for a cancer strategy in Wales after being the only UK nation without one, so we are pleased the Welsh Government has announced a new Cancer Services Action Plan for later this year. But this plan needs to be ambitious and properly funded to address staff shortages and transform cancer services for the future."
Commenting on the overall performance figures, Welsh NHS Confederation assistant director Nesta Lloyd-Jones said: "Numbers of those coming forward for, and those waiting to start, treatment continues to increase - not through any reduction in NHS activity, but due to the sheer demand on the service. For example, May saw an admirable 73,000 patient pathways concluding their treatment, an increase of 8,000 compared on the previous month.
"With high volumes of red (life threatening) calls to the ambulance service and more people attending emergency departments, it's no wonder the NHS is creaking under these consistently high levels of pressure. We must remember that it's not just high demand and unrelenting pressure on a whole system, but on individual teams and members of staff who give their all to help the people of Wales, day in day out.
"Therefore, funding for more frontline ambulance staff is only addressing part of the problem. Unless we can improve patient flow and speed up hospital discharge by alleviating the pressure on and creating capacity in social care, we’ll continue to see a large number of patients waiting longer than we’d like them to for both urgent and emergency care and planned care.
"These challenges may hinder the resilience of the NHS as Covid cases and Covid-related staff absences have risen over recent weeks, and as the challenges that health and care organisations face in summer increasingly look as difficult as those experienced in winter."
Welsh Conservative and Shadow Health Minister Russell George MS said: "When Mark Drakeford and his health minister were questioned last week about NHS waiting times, they said they were making progress, but just look at these figures.
"The backlog increasing by 15,000 in one month, 65,000 people waiting over two years for treatment, over 10,000 waiting over half a day in A&E, and the second worst longest ambulance waits on record – Labour cannot call this progress.
"We have been calling for surgical hubs to deal with the backlog in Wales for two years, but Labour said it would be 'foolish' to have a Covid recovery plan while the pandemic was still ongoing – this reckless and arrogant attitude has meant patients and staff paying the price. Labour need to get a grip on the NHS and stop breaking all the wrong records."
In response, a Welsh Government spokesman said: "Progress continues to be made to reduce the longest waits with the number of pathways waiting for more than two years reduced by 4.4% – the second consecutive monthly fall after two years of consistent increases since the pandemic began.
"Despite the increase in demand, huge numbers of patients were seen in May with the highest number of inpatient and day case treatments carried out (24,167) since the start of the pandemic. This figure forms part of a total of almost 365,000 patient consultations (not including GP appointments or therapies) undertaken by the NHS in Wales, the fourth highest since the start of the pandemic back in March 2020.
"In May, 1,646 people started cancer treatment, 15% more than in April 2022. In addition 11,883 pathways were closed following the patient being informed they did not have cancer, an increase of 13% compared to April 2022. The expected increase in demand saw referrals rising by 16.7% in May 2022, compared to April, as more people seek help for their conditions following the pandemic.
"There continues to be increased demand for emergency care and pressures are being intensified due to challenges with patient flow through the hospital system, as well as staffing constraints including a rise in Covid-sickness. In June, the proportion of all calls that were immediately life-threatening was 10%, which is only the second time since a change to categorisation over three years ago.
"An additional 263 ambulance clinicians have been recruited over the last two years and today we have announced a further £3m to recruit around 100 additional frontline staff to support improved response times for the most critically injured and seriously ill for the winter period. A new ambulance improvement plan was also agreed by Health Board chief executives last week and we expect to see improvement in ambulance patient handover performance as a result."
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