Wales' greatest failure

The situation in the NHS is a national embarrassment

This newsletter will get a bit angry so sorry in advance.

Let me take you back to September 2012. 

There was a sense of pride in the UK after London 2012, Gangnam Style was top of the charts and Skyfall was about to be released in cinemas. 

If, during your jubilant celebrations at Mo Farah’s gold you hurt your knee, you would likely have been seen pretty quickly on the Welsh NHS.

In the entirety of Wales there were only 316 people who were waiting over one year for their first appointment in the health service. 

There were only 1,696 people waiting over a year for any appointment (and often this was because they couldn’t be operated on for medical reasons).

Interestingly, of the over three million humans inside Cymru, only one person was waiting more than two years for an appointment.  

Now fast forward a dozen years to 2024 and this is how it has changed:

• Number waiting over a year for their first appointment is now 74,000 (up from 316).

• Those waiting over a year for any appointment are now a staggering 160,000 (up from 1,696).

• Two year waits are now at over 23,000 (up from 1).

What is worse is that all of these stats are going in the wrong direction.

• People waiting over a year for their first appointment has gone up 50% in 12 months

• Those waiting over two years for an appointment has increased four months in a row after falling since the spring of 2022

• Waits of over a year for an appointment has gone from 132,000 a year ago to 160,000 now.

We have become so conditioned to the fact that we have to wait years for basic medical treatment. This isn’t normal. Two-year waits didn’t exist 12 years ago. There was just one person waiting that long. 

The human cost to this is huge. People are in pain, they can’t work, they can’t go on holiday, they can’t care for loved ones, they can’t live their lives. 

The Welsh Government has previously set the target that all two-year waits for treatment on the NHS in Wales will end by March 2023 - they are now going up month on month.

And what is Welsh Labour’s response to this? They appoint Mark Drakeford as acting health minister. A man who oversaw rising waiting lists both as First Minister and health minister. 

I am sorry but this is a f***ing emergency. Eluned Morgan has announced a “listening exercise” over the summer but the message from everyone in Wales is pretty clear - sort out these waiting lists. 

They have the ability to raise (a little) more money through raising taxes, but haven’t.

They have the ability to borrow for capital projects - they don’t.

They can demand more from their own party in Westminster - but won’t.

Barely a day went by over the last 13 years where they didn’t say that Westminster was killing the Welsh NHS through underfunding but now it is someone with a red rosette shafting Wales there isn’t a peep.

Bringing back Drakeford is the ultimate desperation. While no one can argue that the former First Minister has an incredible eye for detail and has experience in that department, the fact that he has been brought in temporarily shows that no one else was itching to take up this poisoned chalice (though the last three people in that role have become First Minister after). 

Plaid’s Mabon ap Gwynfor have argued that the appointment was “a decision that was made to appease the Labour benches following months of chaos and infighting”.

I have a lot to say on these obscenely long waiting lists so I am going to break it down…

The waits are longer than they appear

These figures are just for a single appointment (aka a “patient pathway”), not for when you are cured. Imagine if you have knee pain:

• You go to your GP who refers you to a specialist.

• You wait two years to see that specialist.

• That specialist refers you for an MRI.

• You wait for an appointment to interpret the results and it is deemed you need surgery.

• You then wait for that surgery.

Each one of these is a separate patient pathway which can take months if not years.

Two-year waits are a minimum of two years

When we talk about “two-year waits” it is important to bear in mind that these people are often not waiting just two years. An investigation I did last year found that some poor souls were waiting up to six!

No more money is coming

There is a real discontent in some areas of Welsh Labour at present because they are getting nothing from their colleagues in Westminster. The current mood music I am hearing is that they expect the UK party to do a bumper giveaway in the run up to the General Election in 2029 but are not willing to offer anything for the Senedd Election for 2026. 

The pandemic excuse is getting very thin

The first thing to say is that the pandemic clearly had a massive impact on Welsh NHS waiting lists. Cancelling the vast majority of procedures was always going to create a large backlog. 

However this ignores the fact that the lists were going up before the pandemic. Covid didn’t take a healthy NHS and make it sick. Between 2014 and 2018 the number of people waiting over a year for an appointment doubled. 

Secondly, the Welsh Government were warned about the grave and real threat from pandemics for years and did nothing of note to prepare for it. Vaughan Gething even admitted not reading a key report into pandemic readiness. 

Thirdly, there were several steps the WG could have taken during the pandemic to manage the waiting lists more effectivly. The Royal College of Surgeons were begging them to set up separate hubs, away from the A&E, where they could start to tackle the backlog but they didn’t.

Some of the falls in waiting lists are due to deaths

Since 2016 over 15,000 people have died while waiting for operations in Wales. The annual figures have more than doubled since 2016. The real figures are likely higher because some health boards didn’t return their information. 

These people died while waiting for treatment. This doesn’t necessarily mean they died of the thing they were waiting for treatment for, though it does likely mean they died in pain with a poor quality of life. 

The waits make things worse

Another issue with the long waits is it makes the problem you are trying to treat much more severe.

If you need a hip replacement and need to wait four years for it, you are likely to be in a worse condition when you eventually come to the operation. You have lived in pain for years, will have walked differently putting pressure on other parts of your body, you probably will have put on weight because you won’t have exercised. 

The Welsh and UK Government’s failings in this area are compounding the problem. 

A terrible response from the Welsh Gov

I approached the Welsh Government and asked the following questions:

• Why are these lists still going up despite it being the warmer summer months?

• When do you expect them to start going down?

• When will there be no more two-year waits?

To this a Welsh Government spokeswoman said:

"Reducing waiting times is a priority, and we have maintained an average wait of around 22 weeks for the majority of this year.

“We continue to see the longest waiting times reduce and remain focussed on eliminating waits over two years. We expect health boards to improve performance more quickly over the remainder of this year.

“The size of the waiting list has been impacted by the continuing increase in referrals into planned care pathways, and we have invested £170m per annum to further increase capacity in our planned care system to enable shorter waiting times for both outpatient appointments and treatments.

“Demand for healthcare has increased markedly and every month the NHS responds to 2m patients – a phenomenal amount for a population of just over 3m people.

“This year, in the most difficult of financial circumstances, we increased funding for frontline NHS services by more than 4% compared to less than 1% in England.”

This is, frankly, a terrible response.

For one thing, the Welsh Government has consistently argued that it is not fair to compare the Welsh NHS with England (where they have virtually eliminated two-year waits). However it seems it is ok to do it when it helps make their point. 

Secondly, “demand for healthcare has increased markedly” ignores the point that policy makers have been told that Wales has had an ageing population for decades. We knew this was coming and are woefully unprepared.

Thirdly, “we expect health boards to improve performance more quickly over the remainder of this year”. What? How? What will be different as we head into winter?

Right, I am going to leave it there because the fact the Welsh Government doesn't even seem to acknowledge the full scale of the problem really does wind me up. 

Hope you found that insightful (if depressing). 

Will