‘Many ill patients are not the care they desperately Getting need’
TOP doctors in Wales are seriously concerned about the huge delays to routine surgeries and cancer treatments.
In March the Welsh Government was applauded for suspending all nonessential procedures to help the NHS cope with the first wave of coronavirus.
But roll forward six months and the Welsh NHS is in dire straits.
Though it was quick to turn off the tap, getting it running again is proving to be a real challenge.
Not only have many elective surgeries barely even got going in Wales, the Welsh Government has not published the waiting times since March so we do not know how big the problem is.
Though these procedures are known as “elective” and are therefore classed as “non-urgent” – that doesn’t mean they are not vital. They include many cancer treatments and hip replacements and often would alleviate severe pain and suffering.
To try to get to grips with the problem that Wales is facing, the Glamorgan Gazette spoke to Dr Phil Banfield, chairman of the British Medical Association’s Welsh Consultants Committee, and Richard Johnson, director in Wales at the Royal College of Surgeons in England, who is a consultant breast surgeon based at the Princess of Wales Hospital in Bridgend.
How large is the backlog?
The short answer is, it’s significant, but it’s impossible to give a definitive answer on how long the backlog really is.
A BBC FoI request suggested that the list of people waiting for routine surgery in Wales is nearly six times longer than a year ago, with 57,445 awaiting an operation in August compared with 9,859 during the same period in 2019.
“We’ve been asking for the waiting time figures from Welsh Government because they haven’t been published since March,” said consultant surgeon Mr Johnson. “There is a backlog and we need to be making plans to treat that backlog but we don’t know the extent of the problem to be able to make definite plans going forward. We are calling on the Welsh Government to publish the figures again.”
What is the current situation?
It is very mixed across Wales.
Dr Banfield said: “Whilst some surgery has resumed, non-Covid patients have suffered. Many ill patients are not getting the care they desperately need, and they risk their conditions deteriorating. Some may have sadly died.
“It doesn’t appear that Covid-19 is going anywhere anytime soon, so it’s vital that patients continue to get the care and treatment they need.
“The doctors of Wales are ready to play their part but need to be better engaged in planning and delivery of services. The cost of investing in safe service expansion is great, but the cost of not doing this will be greater.”
Cancer screening and treatment have recommenced, but capacity is wildly reduced – and takes time and additional resources to catch up to shorten waiting times again. The NHS has adapted to make patients as safe as possible when they access services.
According to the BMA “there is virtually no medical speciality that is untouched”.
How bad the situation is depends on where you live.
“It is very patchy across health lth boards and hoshos pitals,” ls,” said Mr Johnson. “There ere is no consistency so there re is a bit of a postcode lottery ery going on depending on where you are living and how well your health board rd is getting their plans going ng again.”
In n a statement the BMA added: ed: “Mental health services vices have struggled because ause of increased demand nd and deployment of staff during the first wave ve of Covid. Suicide rates s have increased. The service vice is woefully underfunded ded and under-staffed; access ess to interventions that t demonstrably improve prove mental illhealth, such as cognitive behaviour therapy, is said to be non-existent in some areas.”
Why is it taking so long to work through the backlog?
Part of the problem with operations is how long it takes to do a single procedure compared to before the crisis.
“Staff have been redeployed to other areas to support the pandemic and it’s taking time to get those staff back to the normal place of work to allow it to get elective procedures going,” said Mr Johnson. “The turnaround time is also a lot slower for operations because of all the increased infection control measures we have to follow. We are losing 30% to 60% of our normal capacity ity”
Orthopaedics has been particularly badly affected, because so much depends on hospital bed capacity and theatre access.
Many theatres were converted to generate additional rooms to ventilate critically ill patients, as part of expanding intensive care capacity in hospitals in Wales. It has been frustratingly slow to get theatre capacity and operating back – BMA feedback from consultants estimates that about 20% of the previous work done is being undertaken currently – so the waiting-lists and times are set to keep growing.
What do surgeons want the Welsh Government to do to deal with the problem?
According to Mr Johnson, there are a few steps they want the Welsh Government to take.
The first is to publish the waiting lists.
Secondly, they want the Welsh Government to continue to use the private sector to get through the backlog. Thirdly, the Royal College of Surgeons wants the Welsh Government to set up Covidlight hospitals. These are facilities which aim to have zero Covid-19 inside them.
They do not take emergency procedures and there is a strict testing regime, with the idea being that not as many safeguards will be needed inside so that operations can be conducted faster. This means operations can be conducted in their normal timescales.
Fourthly, they want the Welsh Government to have a regional or national strategy instead of just leaving it to health boards.
What is the Government’s plan?
The Welsh Government is currently relying on health boards to set up Covidlight corridors or “green zones” in their hospitals.
Speaking in Plenary last week, First Minister Mark Drakeford said: “Plans were published only recently. They demonstrate the actions that are being taken by health boards right across Wales to accelerate a return to the sort of activity that the health service would have been carrying out this time last year, before the coronavirus crisis hit. And that does include the creation of more green zones—it’s not always possible in Wales to create whole hospitals as green zones.
“It’s inevitable, given our geography and disposition of services that, in some places, hospitals will have to be divided into zones that deal with coronavirus patients and green zones that are Covid-free.”
Mr Drakeford painted a bleak picture, saying the deals were “inevitable and inescapable”.
He added: “While the health service is working very hard to create the conditions in which as much activity as possible can be safely carried out while the coronavirus crisis continues, there’s no escaping the fact that there will be longer waits for some procedures in Wales than we have seen for some time.”
Creating Covid-light pathways inside hospitals is being pursued by Welsh health boards but doctors fear that with a potential second spike in the winter this will become harder to do as community cases rise.
Mr Johnson said: “Major cancer surgeries require more access to intensive therapy after the surgery and therefore it is very hard to create Covid-light pathways to these units because they tend to be in the centre of hospitals.”
How long could it take the NHS to get back to where it was before the crisis?
According to the BMA, consultants in Wales are reporting that hospitals are full already, even before the expected winter crisis and at a time when the number of Covid-19 admissions is expected to continue to rise for a while yet.
Even before Covid, this was not a system that was working well. Waiting lists were already long and every winter our NHS was coming under extreme pressure.
Mr Johnson said that, going forward, there needs to be a strategy and funding to meet this increased demand and growing waiting-lists.
He said: “We are also looking for long-term plans to manage the situation.
“There is an issue about training future surgeons.
“Even if Covid went away tomorrow we would still need to know what the full extent of the problem is that we are dealing with because we need to make appropriate plans to get through that backlog. We need the Welsh Government to publish the waiting times.”
How have other countries coped with this issue?
In a statement the BMA said: “Everyone is struggling. The UK had one of the lowest numbers of doctors and hospital beds per 1,000 population in Europe. We went into the pandemic with a chronic shortage of intensive care beds – the lowest per capita in Europe.”
What effect is this having on patients?
Even those patients who do not die while waiting are facing real issues if the lists keep growing.
“There are a lot of patients waiting for hip and knee replacements in a lot of pain and their condition is deteriorating,” said Mr Johnson.
“Therefore, when they come to have surgery their surgery is potentially more complicated and there is also an increased recovery time.
“There is also an increased reliance on painkillers, they will need more
help at home to manage normal activities, they can’t go to work. It’s not just a question of waiting for an operation but also the reason they are having the operation.”
This is not a problem that will get better on its own. If Covid disappeared tomorrow there would still be serious problems for the Welsh NHS.
A new report from Public Health Wales has shown that the number of people with a longstanding illness is expected to increase in line with the rise in unemployment following coronavirus, unless reparative interventions are implemented.
Based on an estimated increase in the unemployment rate in Wales from 3.8 per cent in 2019 to around seven per cent in 2020, projections from Public Health Wales suggest that the proportion of the population suffering from longstanding illnesses could increase by around four per cent over the next three years from 46.4 per cent prior to the pandemic to 50.3 per cent in 2022/23.
There could be a greater increase in the percentage of adults living with limiting longstanding illnesses from 18.1 per cent prior to the pandemic to 24.4 per cent in 2022/23.
The forecast also shows a higher percentage of adults with chronic health conditions. For example, endocrine and metabolic disorders could increase from 7.9 per cent prior to the pandemic to 10.9 per cent in 2022/23; and mental health problems from 8.8 per cent prior to the pandemic to 11.9 per cent in 2022/23.