Action needed to tackle the planned care backlog in Wales, says Auditor General

It could take NHS Wales up to seven years or more to return waiting lists to pre-pandemic levels, according to a report by the Auditor General, the independent statutory external auditor of the devolved Welsh public sector, who says more must be done to avoid harm to patients while waiting for treatment.

The backlog for planned care is one of the biggest challenges for the NHS in Wales. Waiting times targets have not been met for many years. This backlog has been made much worse due to the pandemic.  

In February 2022, there were nearly 700,000 patients waiting for planned care, double the number in 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.

Whilst referrals for a first outpatient appointment had been rising for years, they fell dramatically at the start of the pandemic and have not completely returned to pre-pandemic numbers. We estimate that, compared to pre-pandemic numbers, there are 550,000 ‘potentially missing’ referrals that could find their way back into the system. If even half of the potentially missing referrals need treating, this will have a major effect on waiting list recovery and would increase the risk of harm from delays in patients accessing the care they need.

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.

Our modelling shows it could take up to seven years or more to return waiting lists to pre-pandemic levels.

On 26^th 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.

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.

Our report 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.

Alongside our report, we’ve also published a waiting times data tool which sets out the different waiting times by health board [opens in new window].

Auditor General, Adrian Crompton said today:

“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.”

Ends

Notes to Editors:

• This report sets out the main findings from the Auditor General’s high-level review of how NHS Wales is tackling the backlog of patients waiting for treatment and responding to the challenges facing planned care.

• Key facts can be found on page 8.

• Our recommendations are laid out in page 9.

• Our estimate of the 550,000 ‘potentially missing’ referrals is different to Welsh Government’s own estimate of around 500,000. This is in part because we have used the latest monthly information available comparing current referral patterns versus pre-pandemic levels.

• Our report is also accompanied by a data tool [opens in new window] which looks at the different waiting times for different health boards.

• The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £24 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £9 billion) and to local government (over £6 billion).

• The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government. 

• The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.

• Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself.