Record-breaking NHS waiting lists and the deteriorating performance of the ambulance service and A&E departments are the consequence of a "broken" health service in Wales, experts have warned. Latest data from the Welsh Government shows the number of people on waiting lists for non-urgent hospital treatment hit record levels for the 22nd month in a row.
In February there were 691,885 patients on the waiting list – a rise from the 688,836 recorded in January and way up on the 456,809 seen just before the pandemic hit in March 2020. More than a quarter of a million people (251,647) currently on an NHS Wales waiting list have been on it for nine months or more, up on the 250,892 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 treatment (98,462), general surgery (85,263), ear, nose and throat (58,309), and urology (41,768).
Read more: Future Covid lockdowns cannot be ruled out, says Wales' top doctor
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 soared.
However more patients are concluding their treatment. The number of patient pathways closed in February was almost 70,000. This is an average of 3,492 patient pathways closed per working day, an increase of 1.7% from January 2022 and the highest since the month before the pandemic (February 2020). The Welsh Government has confirmed it will publish its plan for how to tackle the NHS waiting list backlog next week.
Meanwhile Welsh Ambulance Service figures for March 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 is down on the 55% recorded in February. The average response time to Red calls was seven minutes and 50 seconds. This is 27 seconds slower than in February, and one minute 13 seconds slower than in March 2021.
Similarly, only 17.3% of Amber call patients - which include strokes - were reached within 30 minutes, down by over five percentage points since February.
In March, almost 39,000 emergency calls were made to the ambulance service. This is an average of 1,256 calls per day, an increase of 28 (2.3%) calls on average per day than the previous month and 47 (3.9%) more calls on average per day than the same month last year.
Last month was the 10th 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 43.2% arriving within the eight-minute target.
When it came to A&E departments there was a dip in performance in the four-hour waiting times in March. Some 34.9% of people spent four hours or more in these units before being admitted, transferred, or discharged in March - up on the 33.4% in January. However A&E attendance rose dramatically, increasing from 73,520 in February to 88,599 in March.
Ysbyty Glan Clwyd recorded the worst A&E figures last month with 55.9% spending more than four hours there, followed by Wrexham Maelor with 53.8% and Prince Charles Hospital with 48.9%. Overall in Wales a record 10,886 patients waited more than 12 hours in A&E – up on the 9,150 recorded in February and 57% more than March 2021 – but the target is for no-one to wait that long. Those aged over 85 spent an average of eight hours to be seen in A&E.
Dr Suresh Pillai, vice president of the Royal College of Emergency Medicine Wales (RCEM), described the crisis in acute care as "deeply distressing for patients and staff" and added: "Long waiting times in crowded emergency departments can lead to associated harm and even death. The health system is broken; patients in the community face long waits for ambulances, patients in ambulances face long waits to be handed over to the emergency department, patients in emergency departments face long waits for a bed, and vulnerable and elderly patients medically fit to be discharged remain in hospital for longer than necessary because social care support is scarce.
"We know that in emergency medicine in Wales we have a shortage of at least 100 consultants, as well as widespread shortages of junior doctors, trainees and nurses trained in emergency medicine. Added to severe bed shortages and a crisis in social care, these are all contributing to the dire situation in urgent and emergency care. In order to tackle the crisis, we must see meaningful action to recruit more staff, open more beds, and address the issues in social care.
"Staff are burnt out and distressed, morale is low, and patients are becoming increasingly worried about the situation. We cannot continue in these circumstances. If another month passes with further deteriorating performance and new record lows, more and more patients will come to harm. We would welcome the opportunity to meet with Health Minister Eluned Morgan to discuss the deteriorating crisis in urgent and emergency care and measures that we can take to tackle it."
The Royal College of Surgeons of England claims a "perfect storm" of staff absences and high Covid-19 rates are hitting the recovery of elective services in Wales. Professor Jon Barry, its director for Wales, said: "Waiting times figures in Wales are still mounting month on month. These are a reflection of the intense and sustained pressure the health service is facing.
"We are hearing from surgeons across Wales that Covid-19 is still impacting planned or elective surgery due to patients and staff testing positive and high levels of staff absence. In some areas, elective services are once again being brought to a standstill. These last-minute cancellations are agonising for patients who are waiting in pain and distress for their planned surgery. The Welsh Government must to get to grips with the severity of the situation and establish elective centres or surgical hubs across Wales to get elective services back up and running."
Welsh Government figures for February also revealed that only 59.5% of cancer patients started their treatment within 62 days – well below the national target that 75% should start their treatment on time. However this was an improvement on the 53% recorded the previous month. It means that during February alone, an estimated 620 people faced delays in receiving vital cancer treatments.
Richard Pugh, head of partnerships for Macmillan Cancer Support in Wales, said: "While the statistics show a slight improvement on last month's data, the figures also show a worrying variation in treatment times for different cancer types with fewer than half of people with gynaecological, urological and lower gastrointestinal cancers being treated on time.
"Today’s figures show why Wales urgently needs a detailed cancer strategy as the only UK nation without one as well as a cancer workforce plan and funding to ensure we have enough cancer professionals in place to treat and support people with cancer now and the future. Macmillan’s own research shows we need 80% more cancer nurses in Wales by the end of the decade and this can’t happen without the right funding and plan in place."
Welsh Conservative and Shadow Health Minister Russell George MS said: "Here we are on the verge of NHS waiting lists breaking its own record on a monthly basis for two years, A&E waits at their worst-ever, with ambulance responses not far behind – all the more dispiriting when things are getting better in England.
"Every one of these cases is more than a mere statistic – it is a person languishing in pain wondering how the public services they pay for have been so badly mismanaged. That person in one in every five: family, friends, colleagues – you will know one of them if you are not one of them yourself. Labour need to get a grip on the NHS and stop breaking all the wrong records."
Rhun ap Iorwerth MS, Plaid Cymru's spokesperson for health and care said the latest NHS figures were "immensely worrying". He added: "Frontline staff continue to work flat out, but leadership needs to come from the top and that's why we need to see the Welsh Government's plan to reduce waiting times in all sectors of care, treatment and diagnostics as a matter of urgency.
"Recovering from Covid and reducing these waiting lists is an enormous mountain to climb. A recovery plan must have a clear focus on prevention, not just patient through-put. Publication of the plan has been pushed back several times, but cannot be delayed further. We also need a cancer action plan to deal specifically with diagnosis and treatment. A year has passed since the quality statement but there's still no implementation plan."
In response to the overall NHS performance figures, a spokesperson for the Welsh Government said: "Covid-19 continues to impact waiting times and staffing levels. Increased infection prevention and control measures continue to affect the level of activity health boards can undertake.
"Despite this, the number of patient pathways waiting over eight weeks for diagnostic tests decreased by 10% compared to January 2022 and by 30% compared to the high point of May 2020. All health boards have shown an improvement.
"Although some people continue to wait longer for treatment than we would like, with the over 36 week position increasing again in February, this increase was the second smallest month-on-month increase since the start of the pandemic. In addition, five health boards showed a decrease in their over 36 week waits, an improvement from January, when only two health boards showed an improvement.
"February 2022 saw the number of patient pathways waiting over 52 weeks decrease by 1% compared to January 2022. The number of open pathways waiting over 26 weeks for a first outpatient appointment decreased by 583 (0.3%) in February compared to January 2022; with four out of seven health boards showing improvements in February.
"There are several factors contributing to make it difficult for urgent and emergency care services to deliver timely care consistently. These include higher sickness absence rates and difficulties in discharging people from hospital, resulting in longer delays in emergency departments for beds.
"We have also seen an increase in demand and the emergency ambulance service reported a 10% increase in the volumes of ‘red’ or life threatening calls per day in March when compared to February. There were also 46% more red calls reported in March 2022 when compared to the same month in 2021.
"There has been a sharp increase in the volumes of people attending emergency departments, with a 23% increase in daily attendances reported in March 2022 when compared with the same month in 2021. A near 10% increase in emergency admissions was also reported in March when compared with February.
"The national Six Goals for Urgent and Emergency Care Programme is intended to support health boards and partners to improve experience, outcomes and value, and we have made £25m available in support.
"Next week we will publish a detailed plan on how we will tackle the waiting times for patients whose treatment has been delayed by the pandemic."
