ALTHOUGH the latest batch of NHS performance data contained some good news for the Welsh government, chronic problems with meeting targets remain the headline.

The Welsh Government announced further funding to reduce waiting lists earlier this week. Following that announcement, the Health Minister, Jeremy Miles, led a Welsh Parliament debate on waiting times on Tuesday, November 19.

HARD FIGURES

The number of patient pathways increased from 800,163 in August to 801,307 in September, the highest figure on record, equivalent to one-quarter of the Welsh population.

There were still around 618,200 individual patients waiting for treatment in September.

Two-year waits remain at 23,701 in Wales. Eluned Morgan promised to eliminate these waits by March 2023 and again by March this year. The dial is moving slowly in the right direction, but progress is painfully small.

At the end of September, the average (median) time patient pathways had been waiting for treatment was 22.7 weeks.

In October, only 50.4% of red calls (the most serious) received an emergency/ambulance response within eight minutes. This is a tiny improvement but a long way short of the Welsh Government’s performance target for the Welsh Ambulance Service. The Ambulance Service has never hit any of its performance targets since the Welsh Government first set them.

Performance worsened against the 62-day target for patients starting cancer treatment; it is now 55% as of September.

MINISTER FINDS THE POSITIVES

Wales’s Health Minister, Jeremy Miles, responded to the data: “I’m pleased to see the number of patient pathways waiting more than a year and two years for treatment have fallen in the last month.

“This shows positive progress is being made across Wales to reduce the longest waiting times. I hope to see this continue.

“While there has been a small rise in the overall number of patient pathways waiting to start treatment, more than half are waiting less than 26 weeks, and there was a fall in the number waiting more than 36 weeks in September.

“We recognise the impact long waits for treatment can have on someone’s life, both mentally and physically, so we have a laser-like focus on reducing the longest waits and improving access to patient care.

“More than 1,800 people started cancer treatment in September, and nearly 14,000 people received the good news they didn’t have cancer.

“There were also reductions in the long waits for both diagnostics and therapies services and some reductions in the numbers of pathway of care delays.

“Urgent and emergency care services continue to be under great pressure – in October, the Welsh Ambulance Service received the second highest number and proportion of immediately life-threatening calls per day on record, but more than half of these calls received a response within eight minutes.”

NHS “AT CRISIS POINT”

Sam Rowlands MS, Welsh Conservative Shadow Health Minister, said: “I fear that we are at a crisis point as waiting list figures continue to head in the wrong direction in Labour-run Wales.

“The Labour Health Minister’s latest initiatives, even if his expectations are met, will barely scratch the surface in terms of tackling these excessive, record-breaking waits for treatment. Something needs to change fast.

“The Welsh Conservatives will stand up for the Welsh people’s priorities by eliminating restrictive guidance blocking cross-border and cross-sector working and by enacting a substantial workforce plan to boost staffing numbers, with a tuition fee refund for healthcare workers at its heart.”

LOCAL TRENDS

The month-to-month performance data provide a limited snapshot of the details. Their nature encourages politicians to exchange barbs and engage in self-praise. Specious comparisons between Welsh NHS performance and English NHS performance crumble under the gentlest scrutiny, not least as the English NHS counts waiting times and collates patient data differently from the Welsh.

Long-term trends are more revealing.

Immediately before the Covid pandemic (data released in March 2020), 1.6% of patients in the Hywel Dda UHB area waited over 36 weeks from referral to treatment. 85.7% of patients went from referral to treatment within 26 weeks.

By March 2022, 35.2% of patients in the local health board area were waiting for more than 36 weeks, and the percentage seen within 26 weeks had fallen to 56.7%. By the following March, just over 60% were seen within 26 weeks, and the proportion of patients waiting more than 36 weeks had fallen to 28.2%.

If you move forward to September 2024, Hywel Dda UHB’s performance figures have marginally slipped. There are no peaks and troughs in the performance data; they remain steadily bumping along at the same level and are far worse than they were in March 2020.

The Health Minister’s honest acknowledgement that the £50m funding injection to address waiting times is a short-term measure to boost performance and not a long-term solution highlights the scale of the problem. The question of waiting lists is not how much money it will take to tackle them but how much money will be spent before radical reform tackles systemic problems with healthcare delivery.

Placing Hywel Dda’s difficulties in a national perspective, the Welsh Government’s planned care recovery plan established a target to eliminate two-year waits in most specialities by March 2023. ‘Most’ refers to all specialities, excluding seven recognised as exceptionally challenging even prior to the pandemic.

Those specialisms, which include Orthopaedics, ENT, and Gynaecology, are large areas of surgical practice. They are excluded from targeted improvements because tackling them is too difficult. Proposals to establish surgical hubs made by the Welsh Conservatives have not attracted Welsh Government support as resources and staffing remain highly problematic. However, a quick win for the Welsh Government on the longest waiting times is potentially available.

SENEDD Members expressed grave concerns about the impact of the UK Government’s national insurance tax hike on GPs, universities and charities in Wales.

Plaid Cymru leader Rhun ap Iorwerth warned the rise in employer national insurance contributions from 13.8% to 15% in April will have a disproportionate impact in Wales.

He told the Senedd: “Labour are quick to accuse others of fantasy economics whilst their own plans represent nightmare economics for thousands of employers and employees.”

Raising concerns about the impact on job creation and wages, he said employment levels are at their lowest for almost a decade – lower than anywhere else in the UK.

He accused Labour of breaking a manifesto pledge as he pointed to an Office for Budgetary Responsibility (OBR) assessment that three quarters of the cost will be passed to workers.

Leading a debate on November 20, Mr ap Iorwerth called on the UK Treasury to fully cover the added cost to public sector employers in Wales.

He said: “It’s not the private sector only … bearing the brunt. Charities, GPs, universities – sectors already feeling the squeeze, to say the very least – have been taken to the brink.”

He pointed to “eye-watering” bills of £90,000 for some GPs, with the British Medical Association warning some surgeries could close as a consequence.

Mr ap Iorwerth said mental health charity Plattform faces a £250,000 annual bill and Welsh universities, “already crippled by financial challenges”, will face significant further pressures.

Plaid Cymru’s motion urged Welsh ministers to press the UK Government to apply a wider definition of the public sector workforce to include universities, GPs and charities.

Peter Fox, the Conservatives’ shadow finance secretary, similarly accused Labour of breaking a manifesto commitment not to raise tax on working people.

The former council leader said: “Time and time again – the chancellor went on TV and made the claim, only to u-turn after they got into power.”

Mr Fox, who represents Monmouth, said even a 1% rise in employer national insurance contributions for the public sector would cost Welsh taxpayers an extra £100m.

He told the Senedd: “The UK Government has said that it will provide funding to cover the cost of national insurance contributions for those workers.

“However, this will still come out of the taxpayer’s pocket … ultimately it is the taxpayers who are going to pay for the Chancellor’s tax increase.”

Luke Fletcher, Plaid Cymru’s shadow economy secretary, warned the national insurance rise will be a drag on an “already anaemic” Welsh jobs market.

His colleague Sioned Williams, who also represents South Wales West, described the chancellor’s “back-of-a-fag-packet” plans as senseless.

She raised concerns about six-figure increases in tax bills for charities including Tenovus, Marie Curie, Citizens Advice Cymru and the Wastesavers Charitable Trust.

Cefin Campbell, Plaid’ Cymru’s shadow education secretary, said the national insurance increase will cost Welsh universities an estimated extra £20m a year.

The Mid and West Wales MS warned: “Without a shadow of a doubt, these additional costs could push our higher education institutions over the precipice.”

Labour’s Hefin David said difficult decisions had to be made to fill a £22bn “black hole” left by the Tories but he rejected Plaid Cymru claims of a return to austerity.

Dr David told the Senedd: “Yes, tough decisions have to be made but I think that in the longer term, this is to everyone’s benefit.”

Andrew RT Davies, leader of the Conservative opposition, disputed the “incorrect” £22bn figure, saying the OBR found a £9bn gap.

Replying to the debate, Mark Drakeford stressed that neither he nor the Welsh Government has responsibility for national insurance contributions.

Wales’ finance secretary, who was appointed in September, criticised “fantasy economics” from opposition members on the Plaid Cymru and Conservative benches.

Deriding the “politics of the playground”, he said: “Both of them are willing to spend money on almost anything; neither of them are willing to raise the money necessary from anyone.”

Prof Drakeford said the chancellor returned national insurance broadly to where it had been as a share of gross domestic product for 13 of the 14 Conservative years.

The former First Minister pointed out that the UK Government offset national insurance rises on small employers by more than doubling the employment allowance.

He told the debating chamber or Siambr: “If you want to pay for things, you have to find the money to do so. That is what the chancellor had to do. That is how we will get the money that will come to public services here in Wales.”

Senedd Members voted 25-19 against Plaid Cymru’s motion.

NHS staff in Wales may have put their health at risk during the Covid-19 pandemic by treating patients without adequate personal protective equipment (PPE), former health minister Vaughan Gething has admitted.

Giving evidence to the Covid inquiry, Gething acknowledged significant challenges in distributing PPE despite assurances that national-level supplies were maintained. He revealed that stocks of key items ran out far quicker than anticipated, with some equipment deemed unfit for purpose and discarded.

“There were some very real challenges,” Gething said, noting that gloves, expected to last 15 weeks, were depleted within 11 days. Aprons and other essentials soon became critical concerns. He also condemned opportunistic profiteering during the crisis, calling some suppliers “shysters” who exploited global demand to sell inadequate equipment.

The Welsh Conservatives described the revelations as “completely unacceptable” for NHS staff, while Plaid Cymru accused the Labour-led Welsh Government of “significantly letting down” frontline workers.

The inquiry also heard of chaotic conditions in some hospitals. An email from a consultant at Prince Charles Hospital in March 2020 described a dire situation, with staff lacking protection, low morale, and masks unavailable.

In some instances, healthcare workers resorted to makeshift solutions, including wearing bin bags or purchasing their own safety gear. Trade unions highlighted that schools even stepped in to produce masks and hand sanitiser for local health services.

When asked whether healthcare workers treated Covid-19 patients with inadequate PPE during the first wave, Gething replied, “I’m afraid that’s possible.”

Decisions under pressure

The session also addressed difficult decisions made during the pandemic. Evidence was presented that some patients with little chance of survival were not admitted to critical care due to limited space.

“It’s very upsetting to read,” Gething said, acknowledging the heartbreaking choices faced by medical teams, though he claimed to be unaware of specific instances.

Gething, who served as health minister until May 2021, conceded that delays in tackling hospital-acquired infections could have contributed to the challenges. He admitted he might have acted earlier in forming a task group to address the issue, which worsened during the second wave.

First Minister reflects on birthing partner rules

Current First Minister Eluned Morgan also testified, reflecting on delayed decisions to allow birthing partners in hospitals during the pandemic.

Morgan, who succeeded Gething as health minister in May 2021, acknowledged that guidance was not updated until May 2022, more than a year after England implemented similar changes.

“If I had my time again, that’s one of the things I definitely would have changed,” Morgan said, calling the delay regrettable for new parents.

She also defended the decision not to launch a national investigation into hospital-acquired infections, citing extensive reviews conducted by health boards. However, Morgan acknowledged shortcomings in resuming routine surgery and criticised poor management at some facilities.

The inquiry continues to examine decisions made by Welsh ministers and NHS leaders during the pandemic, focusing on lessons learned to prevent similar issues in future crises.