The Waiting Game: How innovation can reduce Wales’s waiting lists
Every third Thursday of the month fills politicos and researchers like me with a certain amount of dread. Partially, it’s because of the sheer volume of NHS stats sent out at the same time, as well as the slow and clunky nature of StatsWales, which presents the data, but mainly it’s witnessing the extreme challenges the Welsh NHS continues to face more than three years after the Covid-19 pandemic.
The Health Minister’s target of no one waiting longer than two years for treatment by March 2023 is already a distant memory, with about 30,769 patient pathways (a quick word to the uninitiated: pathways aren’t the same as individual patients; they are the number of routes to medical interventions) currently languishing more than 104 weeks on the waiting list. While significant progress has been made – halving the number from over 68,000 patient pathways waiting more than 104 weeks a year ago – Wales’s high numbers in comparison with Scotland and England must surely raise some eyebrows.
England’s latest two-year waiting list comes in at just 482 in May 2023, and in Scotland, 6,985 were waiting longer than 104 weeks for inpatient or day case treatment during the quarter ending March 2023.
Now, of course, the Welsh Health Minister will say two things: first, that the figures are incomparable, and that Wales has an older, sicker population so the figures will be higher. Granted, Wales, Scotland and England have different waiting time targets – for example, England measures those waiting less than 18 weeks, compared to Wales’s 26 weeks. Scotland also doesn’t report follow-up outpatient appointments, and England’s waiting times only include “consultant-led pathways”. However, in Wales, pathways include both follow up outpatient appointments, as well as diagnostics and therapies such as physiotherapy.
However, these reasons still don’t account for the stark differences in the figures – even the Chief Statistician noted that diagnostics and therapy pathways accounted to roughly 12% of the total number waiting in November 2022. Plus, Welsh Government has made its own calculations on comparisons – one pathway for every 4.7 people in Wales compared with one pathway for every 7.6 people in England in April 2023.
With England, current understanding suggests a broadly comparable number can be produced for Wales by removing some known non-consultant led pathways which are not counted in England. On that basis, there are around 665,000 open pathways on consultant-led pathways in Wales, equivalent to 21 pathways (not patients) for every 100 people. For England, the figure in May was 13 pathways for every 100 people.
Second, the Minister will talk about the lack of capacity to carry out treatments on a large scale. True, Wales has very few private hospitals and its NHS has been known to outsource particular treatments to other countries in the UK. Again, however, this should not prevent the Welsh NHS or Health Boards from using capacity in the rest of the UK, nor should it stop innovation and the use of technology to bring waiting lists down more quickly.
One innovation which struck me in particular came out of Guy’s and St. Thomas’ NHS Foundation Trust in London. There, in 2022, Dr Imran Ahmad reduced the backlog for non-emergency surgery through focusing on one procedure at a time and using two theatres and three teams to enable surgeons to go between cases without having to wait for their patient. This enabled Dr Ahmad’s teams to carry out double the surgeries in half the time. By paying his teams overtime and rewarding them with free pizza, staff were able to work through the weekend, highlighting that small changes can reap large rewards.
Another innovation – this time using the NHS England App or NHS England website – enables patients in England to choose where they receive their NHS care. Announced last month, patients will be able to view information for a minimum of five providers for their treatment. This includes information about waiting times, the distance they may have to travel, and quality, so patients can make their own choice. According to the UK Government, this can cut up to three months off a patient’s waiting time, just by selecting a different hospital in the same region.
Wes Streeting MP, Labour’s Shadow Health Secretary, has also issued a battle cry for the NHS to use Artificial Intelligence in a range of situations, including cancer diagnosis, so plans are being drawn up by UK Labour to overhaul procurement for new technologies and join up health and social care through data systems which work together. Another key proposal from UK Labour is to reduce waiting lists in England through organising them by region and enabling patients to receive treatment more quickly if neighbouring hospitals have shorter waiting times.
In May, the Health Minister, in a moment of candour, explained that she had written to health boards to express her disappointment that they had not hit the two-year target, further stating that there was a difficulty with encouraging health boards to see people from outside their area, and that she wanted to see more innovation. However, despite providing health boards with £1 billion to clear the backlog during the Senedd term, is the Health Minister setting her sights too low?
It's not enough to mention that there have been great examples of innovation – including the Minister’s example of breast cancer surgeries being performed as day cases in Ysbyty Gwynedd – it’s how these innovations are rolled out across Wales.
Not only do Welsh health boards need to be brought together to map out any capacity and told rather than encouraged to use it, the Minister should also be ensuring that NHS Wales is speaking with its counterparts across the UK as to how they can help to bring down Wales’ waiting lists. Innovations which can be tacked onto the forthcoming Welsh NHS App should include patient choice and help use those hospitals which have capacity – and this should include ones across the border.
And this is where Wales falls short. There has been a near obsession with innovative tech which is either “Made in Wales” or stops at the border. Take the CANISC cancer database saga for example, which rumbled on for a decade, with out-of-date software leading to crashes and bugs on a system which is essential for recording diagnoses, treatments and follow-up care. Despite there being off-the-shelf databases, which are available to use and tweak, this situation was allowed to fester for many years, to the detriment of cancer patients. Recent news also highlights that its replacement doesn’t even have an option to include ethnicity data of patients(!).
There have also been delays in key tech innovations such as e-prescriptions and the Welsh NHS App – both forthcoming – which are essential in freeing up bureaucracy within the Welsh NHS. Indeed, a recent joint Senedd Committee report found that a lack of direction, slow rollout and lack of take-up from some Health Boards was limiting the ability of Digital Health and Care Wales to apply latest advances in digital tech.
That is not to say that either NHS England or NHS Scotland have been perfect in harnessing technology – one important innovation is remote monitoring, where patients are able to use “virtual wards” from their home. But, the coverage of these wards remain patchy at best, especially when funding runs out.
So, what can Wales learn from this? Innovation requires focus, long term funding and an ability to learn from and improve upon ideas which are already in use. All of this can save overstretched staff time and free up capacity. Welsh NHS lists continue to be challenging, but there are ways to bring the numbers down.
We just have to use them.
NHS England, Consultant-led Referral to Treatment Waiting Times: 2023-24 RTT waiting times data:
Public Health Scotland, NHS waiting times – stage of treatment: Inpatients, day cases and new outpatients, quarter ending 31 March 2023, 30 May 2023:
Welsh Government, Chief Statistician’s update: comparing NHS performance statistics across the UK, 21 November 2022:
Guy’s and St. Thomas’ NHS Foundation Trust, NHS staff find innovative way to tackle surgery waiting lists, 3 May 2022:
Gov.uk, More choice to help cut hospital waiting times, 25 May 2023:
Wales Online, Thousands wait years for healthcare in Wales as NHS misses its target, 18 May 2023:
Digital Health, Special Report: Remote Monitoring, 31 March 2023:
BBC News, Cancer: As a black man I wasn’t included in the cancer stats, 21 June 2023:
Health and Social Care Committee and Public accounts and Public Administration Committee, Scrutiny of Digital Health and Care Wales, July 2023:
For a bird's eye view.
Am olwg oddi uchod.
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