TENS OF thousands of people at the greatest risk of irreversible sight loss are languishing on waiting lists for too long, with services woefully under-resourced, a committee heard.

The Senedd’s health committee took evidence from clinicians, charities and patients as part of a short inquiry into ophthalmology in Wales on March 20.

More than 80,000 patient “pathways” – which include those waiting for multiple treatments – were waiting too long for sight-saving treatment in January, according to the latest data.

Russell George, who chairs the health committee, asked about prevention given half of all sight loss is avoidable with early detection and timely treatment.

Ansley Workman, director of the Royal National Institute of Blind People (RNIB) Cymru, welcomed a new national clinical strategy but warned of a lack of commitment.

“There’s no investment, there’s no timeline,” she said: “And that timeline needs to be at pace and the reason for that is people are going blind in Wales now, so it is a matter of urgency.”

In its written evidence, RNIB Cymru voiced concerns about the lack of a significant investment and direction from ministers in Cardiff Bay.

The charity warned: “Without this, Wales’ eye care waiting lists will continue to rise as will the number of patients … needlessly losing their sight while waiting for NHS treatment.”

Ms Workman raised underreporting of the scale of harm befalling patients in Wales, with “shockingly low” reports despite 80,000 patient pathways being over their clinical target.

Senedd Members heard powerful stories from patients who shared their frightening experiences of living in constant fear of losing their sight.

Rhianon Reynolds, clinical lead for ophthalmology within the NHS Wales Executive, pointed to the development of the national strategy but warned of a lack of support to drive change.

The consultant ophthalmologist said: “We can put the blueprint in place but without investment … it’s going to be difficult to show significant change.”

Ms Reynolds, who is president of the Royal College of Ophthalmologists in Wales, told Senedd Members that ophthalmology is the biggest outpatient speciality in the NHS.

But she said: “We are often perceived as a small speciality because we don’t have inpatients, so … we’re often not overly prioritised in terms of how we are funded.”

Ms Reynolds warned: “In terms of consultant ophthalmologists we are woefully under-resourced in Wales right across the board. Some areas are like a desert.”

She added: “Even if we had more secondary care clinicians, we don’t have the space.”

Ms Reynolds, who works at Aneurin Bevan health board, raised “fundamental problems” with the estate, citing examples of ceilings falling in and plants growing through the walls.

On the £8.5m roll-out of the OpenEyes patient record system, which began in 2021, she explained that Digital Health and Care Wales (DHCW) is responsible for the project.

She told the committee: “We don’t have it across all the health boards, it’s available in Cardiff, it’s potentially being rolled out to other health boards.”

Last week, health secretary Jeremy Miles escalated intervention arrangements at DHCW due to serious concerns about its ability to deliver major programmes.

Asked if roll-out of OpenEyes is being prioritised, Ms Reynolds said: “No, I don’t think it is.”

She told the committee a digital transformation is required, saying: “It’s a huge area of frustration for us,” with services still receiving letters rather than digital referrals.

Ms Reynolds said Wales is well below the Royal College’s recommendation of 3.2 ophthalmologists per 100,000 people, with around 1.9.

“In terms of the consultant workforce, we’re extremely under-resourced,” she warned, adding that there is not a much-needed workforce plan in place.

Wales has the lowest numbers of consultant ophthalmologists of any part of the UK and, across Europe, only North Macedonia has fewer, according to the RNIB’s evidence.

Owain Mealing, chair of Optometry Wales, warned of “clunky” integration between primary optometry and hospital services, with fax machines and paper records still in use.

Andrew Pyott, a consultant ophthalmologist at NHS Highland, undertook a 2021 review on eye care services in Wales which described the situation as serious and fragile.

He said: “The biggest driver is for cataracts services, that’s what patients often see as a priority for them – many who are languishing on long waiting lists, with an impact on their daily lives because they can no longer drive or, in some cases, keep down employment.”

Asked about agreements for patients to be treated in England, he told the committee that Welsh taxpayers are effectively subsidising Bristol’s training programme.

Prof Pyott said: “It would be much better for the Welsh taxpayer to be preparing the next generation of vitreoretinal surgeons for your country.”

WALES’ health secretary set out plans for the biggest changes to NHS dentistry services in almost two decades despite still being at loggerheads with the profession.

Jeremy Miles said the Welsh Government will launch a consultation on dentistry reforms, which will mark a significant change to the old 2006 contract, by the end of the month.

In a statement on March 18, Mr Miles told the Senedd the new general dental services contract will be implemented rom April 2026.

Describing the reforms as the biggest in nearly 20 years, the health secretary said the central aim will be to make it easier to access NHS dentistry.

But, in an open letter last month, the British Dental Association (BDA) accused the Welsh Government of “spin, half-truths or doublespeak” on the future of dental services.

Mr Miles warned of issues with the current model, which is based on the “treadmill” of units of dental activity, saying substantive contract reform is required.

He said instead of recalling everyone every six months for a routine check-up, the new contract will be based on prevention and needs-based provision of treatment.

Negotiations between ministers, the NHS and the BDA over more than a year to design and develop the new contract ended without full agreement.

Mr Miles told Senedd members: “As is the case in all negotiations, there are aspects that all parties can readily agree on; there are some points that may be more contentious. Not everyone gets everything that they want but it is an improvement for everyone.”

He said key aspects of the reforms include:

• creating a single route of entry for people to access NHS services;
• implementing a ‘fairer, more transparent’ remuneration system;
• disincentivising unnecessary routine examinations;
• adjusting patient charges; and
• making changes to terms and conditions, such as around parental leave.

Urging people to have their say as part of the consultation, which he suggested will open next week, Mr Miles said: “It’s one of the biggest changes, probably the biggest change in dentistry within the NHS in coming up to close to a quarter of a century.”

James Evans, the Conservatives’ shadow health secretary, told the Senedd that 189 NHS dentists, or about 13% of the workforce, have left the service in Wales since 2022.

He said the BDA has warned 2025 could see the largest number of contracts handed back in history, with more dentists reducing NHS commitments due to financial pressures.

Mr Evans compared a 6% contract uplift, which the BDA has described as a real-terms cut following the “flawed” negotiations, with an 11% increase for GPs.

“NHS dentistry is in crisis,” he said. “Patients are paying more while receiving less. Dentists are leaving in record numbers and practices are struggling to stay afloat.”

Mr Miles claimed the reforms have been broadly backed by the profession, with eight in 10 practices taking up the offer of a contract variation since 2022.

He said he was not prepared to wait any longer after talks broke down, taking a unilateral decision earlier this year to implement the 6% increase to contract payments.

Mabon ap Gwynfor raised the BDA’s warning of a dental desert spreading across the country, with a rise in so-called DIY dentistry and an increasingly disaffected workforce.

The Plaid Cymru politician accused the Welsh Government of ploughing ahead on a road to ruin and turning a blind eye to a rapidly unfolding crisis in the sector.

Warning dentists have been kept in the dark since September, Mr ap Gwynfor said: “On the one hand, this government says that it is unlocking hundreds of thousands of extra appointments but the BDA accuses them of cooking the books.”

NHS leaders in Wales are urging the next Welsh Government to take a long-term approach to ensure the sustainability of health and social care services.

The Welsh NHS Confederation (WNHSC) has outlined key priorities it wants to see included in political party manifestos ahead of the 2026 Senedd election. These include prevention, workforce planning, performance and financial frameworks, social care reform, and investment in infrastructure.

The WNHSC, which represents all NHS organisations in Wales, conducted a survey of 95 NHS leaders to identify the most pressing issues facing the sector. The five key priorities are:

• Delivering a cross-government national strategy to improve health and wellbeing and reduce inequalities.
• Investing in a long-term workforce plan for the NHS and social care, including education and training.
• Publishing a joint health and social care performance and financial framework for seamless care.
• Establishing an independent rapid review to develop a long-term plan for social care sustainability.
• Launching a long-term capital and infrastructure strategy.

NHS leaders warn that health and social care services are under extreme pressure, with high demand and limited resources. The growing elderly population is adding further strain, with the number of people aged 80 and over expected to double between 2000 and 2038. Additionally, the number of people living with four or more long-term conditions is predicted to nearly double by 2035.

Darren Hughes, director of the WNHSC, said: “The needs of the population are evolving. Over the next decade, we need a fundamental shift from a reactive healthcare model—treating illness—to a proactive one that focuses on prevention and early intervention.

“There’s an alarming wave of demographic and health challenges ahead, but we have an opportunity to make significant improvements within the next five to ten years. This requires a whole-system approach, with government, public services, and society working together to drive better health outcomes.”

NHS leaders are calling on the Welsh Government to prioritise investment in community-based services and prevention across all sectors. They argue that sustainable reform will only be possible through collective action and long-term planning.

The WNHSC will be engaging with politicians in the coming months and plans to release a more detailed report outlining the steps needed to secure the future of health and social care in Wales.