How will the NHS in Wales clear growing ops backlog?

The number of people waiting more than 36 weeks for non-essential surgery and appointments has increased to more than 220,000 people as of the end of December

WALES now has 538,000 outstanding operations and appointments following the ongoing Covid-19 pandemic crisis.

Back in March 2020 all elective – non-essential – procedures were cancelled to free up capacity for the first wave of the virus.

But when cases came down in the summer it proved hard to turn the tap back on.

There is also pressure in terms of longer times to conduct operations because of the amount of cleaning needed between procedures.

The Welsh Government will be publishing a Covid recovery plan by the end of this month which will outline in more detail how they will work through the backlog, but Health Minister Vaughan Gething has warned it could take until the next Senedd election in five years for the Welsh NHS to fully recover from the past year.

Ahead of this, the Echo put questions to Welsh NHS chief executive Dr Andrew Goodall to find out how he plans to get on top of this enormous backlog.

Can you quantify the increase in waiting times for different elective procedures?

■

Dr Goodall said: “The need to focus on the pandemic response, to ensure people with coronavirus receive life-saving treatment, has inevitably had a significant impact on waiting times as procedures have had to be postponed.

“But, just like all other parts of society, the NHS has also had to introduce measures to protect people from the risk of contracting coronavirus and these measures have also had an impact on the amount of planned activity the NHS can provide – for example, a reduced number of outpatient appointments are being provided because of the need to clean

between appointments.

“During the second wave, health boards have tried to balance restoring waiting times – elective – activity where local circumstances allow while also responding to winter and pandemic pressures.

“However, it is not possible to see and treat the same numbers of patients as before due to the physical changes and safety arrangements in place to ensure patients and staff are protected and these protective measures will need to continue for some time.

“The overall waiting list has grown by 18% from 456,000 to 538,000.

“Since the start of the pandemic, as we have had to move staff and resources elsewhere, the number of people waiting more than 36 weeks has increased to more than 220,000 people as of the end of December.

“Around 60% of the overall waiting list relates to outpatient appointments not operations.”

How long will it take for waiting lists to return to the levels they were at pre-pandemic? Are we looking at years? Will it ever happen?

■

“In March 2019 we had made significant progress reducing waiting times, to one of the best positions for many years including for diagnostics and therapies. But it had taken a few years to get to that position.

“Clearly, there has been an enormous impact on these waiting times due to the impact of the pandemic.

“Waiting times have deteriorated as a result of the pandemic and it will take some time for these numbers to be addressed. The NHS has not yet been able to resume its full range of activities.

“Even today we still have more Covidrelated patients in hospital beds than during the peak of the first wave last April.

“For this reason, and as the Health Minister has said previously, we expect that it could take the next Senedd term to fully recover. However, we will make sure that we address waiting time urgently. We will build on the new ways of working that we have introduced.

“For example, a third of outpatients are currently being seen virtually and if we maintain this after the pandemic, there may be opportunities to deal with some of the waiting list differently and more quickly.”

Are you at all persuaded by the arguments made previously by the Royal College of Surgeons for Covid-light hospitals in order to work through the backlog?

■

“We support the concept of Covid-light and designated areas for non-coronavirus patients.

“We have introduced Covid-light areas across the NHS in Wales and have made physical changes to introduce these and support staff in their care and treatment of patients, including using streaming of patients, testing and PPE.

“Health boards have designated sites for Covid-light surgery or safe separation of facilities within a hospital, such as having red and green pathways in place, where Covid and non-Covid patients are kept apart and for these to be flexed as necessary.

“Achieving a Covid-light hospital is difficult – the virus doesn’t look at the label of a hospital, it simply finds any weakness to transmit and infect people.

“A Covid-light hospital only remains “Covid-light” up to the point when either a patient or a member of staff tests positive for Covid and we know that this can lead to transmission rapidly in health facilities.

“Our experience has unfortunately shown us that when community levels for coronavirus are high, it is inevitable that this will translate into hospitals and health facilities, whatever their status.

“We also need to consider what does Covid-light mean for a local hospital?

“Does it mean that a hospital would have to stop all the other services it normally provides?

“Does that mean it would no longer admit emergency patients and A&E attendances, for example? What would this mean for the local population served by that hospital?”

How do you respond to a call for an all-Wales approach to tackling the backlog of procedures in order to avoid a postcode lottery?

■

“Throughout the pandemic we have ensured that the NHS has worked together across Wales to develop plans, including making national decisions when these have been necessary to support the availability of local services.

“We have focused on priority and essential services during this time, recognising there are other NHS functions to be delivered aside from coronavirus.

“This is why I have taken part in press conferences to ensure the NHS Wales approach and pressures have been described to the public.

“We will maintain this national approach in responding to the growth of waiting lists across Wales and ensure there is a national framework in place.

“We are developing an NHS Wales recovery plan with specific expectations for planned care where we are looking at local, regional and national approaches to tackling the backlog of patients.

“This could involve the development of treatment centres, such as a cataract centre or an orthopaedic centre, and these could be based to serve a wider geographical area other than just one particular health board.

“Health boards are submitting their plans to us for the year ahead and beyond to allow local plans and decisions to be supported.

“We will also want health boards to continue to change and improve their local services with new ways of working, including changes made during the pandemic response.”

Can you outline what the strategy of the Welsh NHS is for working through the backlog of procedures?

■

“I have been really proud of the extraordinary way in which health boards have supported the response to coronavirus and I know that they will want to support our plans to address waiting times in a similar way. We are working alongside the NHS to develop plans to address the backlog. This must reflect local circumstances for each health board area including taking into account how each health boards started in a different positions before the pandemic.

“It is really important to ensure that it is developed with the support of our clinical teams and staff across Wales.

“The Health Minister will be setting out the broad approach later this month as we move towards recovery and we see some of the NHS pressures reducing.

“We are looking at a local, regional and national approach to tackle the backlog, as well as looking at what additional capacity can be accessed elsewhere.

“It is important to note that we will not be doing more of the same – we will build on the transformation that has already taken place, making use of technology available, changes in clinical practice and looking at alternatives to treatment.

“While we still have coronavirus in the community, the amount of activity we can undertake remains around half what it was prior to the pandemic.

“I am also concerned that NHS staff have had a very difficult year with little respite and it will be difficult to require our staff to move straight from dealing with the public health emergency into fully restoring NHS services.”

How much do you expect demand on mental health services to increase following the pandemic?

■

“It was really important that we designated mental health as an essential service during the pandemic response and have developed services and responses accordingly and since the start of the pandemic we have been monitoring a range of information and population surveys to understand the impact on mental health.

“However, predicting actual levels of new mental health needs is complex but we continue to monitor the evidence very closely.

“We know levels of anxiety are higher now than before the pandemic and some groups have felt a disproportionate impact and to support this, we have already invested in a range of support to respond to the increased need for low-level mental health support, including the roll-out of online cognitive behavioural therapy and strengthening our CALL helpline so we can provide support as concerns arise rather than when they become a crisis.

“Services are planning locally to meet an increase in mental health needs. To support this, the minister for mental health and wellbeing has announced an additional £42m for mental health services next year. I believe we will all need to reflect on the pandemic experience which has impacted so much on our personal lives and across our communities.

“A multi-agency response is needed due to the broad range of social and welfare factors that may be the cause of mental health distress. It will need a collaborative approach between the NHS, the public sector and third sector to respond to this anticipated increase in mental health needs.”