Planned care backlog in Wales could take up to seven years to clear

The planned care backlog in NHS Wales could take seven years to clear and more must be done to avoid harm to patients waiting for treatment, according to a report from the Auditor General for Wales.

The report found that waiting times targets have not been met for many years, and in February 2022, there were nearly 700,000 patients waiting for planned care, a 50% increase since February 2020.

Over half of the people currently waiting have yet to receive their first outpatient appointment, which means that they may not know what they’re suffering from and their care cannot be effectively prioritised.

Adrian Crompton, Auditor General, said: “The Covid-19 pandemic will leave the NHS with many enduring legacies not least the significant impact it has had on waiting times for planned care. Just as the NHS rose to the challenge of the pandemic, it will need to rise to the challenge of tackling a waiting list which has grown to huge proportions.

“Concerted action is going to be needed on many different fronts, and some long-standing challenges will need to be overcome. Additional money has been made available and it is imperative that it is used to best effect to ensure there are equitable and targeted approaches that meet the planned care needs of the people of Wales.”

Welsh Government’s plan to tackle the backlog

The Welsh Government made an extra £200 million available during 2021-22 to help tackle the waiting times backlog, however, NHS bodies could not use it all. They bid for and were allocated £146 million, but £12.77 million was returned to the Welsh Government at the end of March 2022. NHS bodies cited staff capacity, lack of physical space and limited private capacity to carry out planned care as barriers to spending the additional funding.

On 26th April, Welsh Government published its plan for transforming and modernising planned care and reducing waits in Wales. This plan sets out waiting list recovery targets between 2022 and 2026. The Welsh Government has also guaranteed an additional £185 million annual funding for four years up to the end of 2025-26 to support the delivery of its national plan aimed at transforming and modernising planned care.

The report said that additional Welsh Government funding is going to be essential to tackle the backlog, but this, on its own, will not solve the problem. The NHS also needs to overcome some serious barriers, including the on-going impact of Covid on services, reducing the impact of emergency care on planned care service delivery and long-standing staff shortages and recruitment issues.

It makes five recommendations based on what the Welsh Government needs to do as it implements its national plan these include:

• Working with health bodies to set appropriately ambitious delivery targets;
• Producing a clear funding strategy including long term capital investment;
• Developing a workforce plan to build and maintain planned care capacity;
• Implementing system leadership arrangements to drive through the plan;
• Ensuring its arrangements focus on managing clinical risks associated with long waits, supporting patients while they wait, and delivering care efficiently and effectively.

“Workforce is the number one limiting factor for NHS capacity”

Darren Hughes, director of the Welsh NHS Confederation, added: “This report makes clear the enormous scale of the challenge ahead and we welcome the Auditor General’s recommendations. NHS leaders are all too aware that these are not just statistics, but individual people’s lives and experiences.

“The NHS has been through and continues to go through the most challenging period in its history. The effects of the pandemic won’t go away overnight and, despite leaders and staff doing all they can to deliver services for the people of Wales, it will take many years to reach a healthier position.

“The Welsh NHS Confederation has long called for a clear and sustainable long term funding strategy for health and social care. One-off, ring-fenced injections of cash that are time-limited do not allow the NHS to make the necessary long-term investments in staff and capital required to meet the needs of the people of Wales. So many NHS estates are not fit for purpose, requiring redesign and new equipment, which has major implications on the physical capacity of the NHS and its ability to make inroads in planned care backlogs.

“However, workforce is the number one limiting factor for NHS capacity. Without enough staff, the NHS is left with no option other than to think more creatively about how they deliver services. As the report points out, there is very limited private capacity to assist with tackling the planned care backlog.”