Hospitals struggle to hit targets before winter period

Health correspondent Mark Smith looks at A&E waits, ambulance response times and cancer treatment figures to determine how services are currently coping

THE WELSH NHS and social care system are edging ever closer to the tricky winter period.

A drop in temperature often leads to a rise in GP appointments, ambulance call-outs and hospital admissions across the country, putting services under greater pressure.

Ahead of these difficult few months, we have looked at latest Welsh Government figures and assessed how each health board and hospital is coping with current demand.

Accident and Emergency

The target

■ 95% of patients should spend no longer than four hours in A&E from arrival until admission, transfer or discharge.

■ No patient should be in A&E for longer than 12 hours.

■ If you live in the north of the country, you have the highest chance of a lengthy stay in accident and emergency.

A&E departments in Betsi Cadwaladr University Health Board, which has been under the highest level of government control since June 2015, have really struggled to meet targets.

In September, nearly half of patients at Wrexham Maelor and Ysbyty Glan Clwyd spent four hours or more in A&E departments before being admitted, transferred or discharged.

At the other end of the scale, the University Hospital of Wales had just 10.4% of patients spending longer than four hours in casualty before moving elsewhere.

In total, there were 85,590 attendances at Welsh A&E departments in September – an average of 2,850 a day – with 68,714 (80.3%) spending less than four hours there.

That was a slightly better performance than August (80%), but worse than July (81.4%), June (83.2%) and May (82%). It was also a poorer result than the 84.5% recorded 12 months earlier in September 2017.

When it came to the number of people spending longer than 12 hours in A&E, the three Betsi Cadwaladr A&E units came bottom of the pile.

A total of 741 out of 4,574 patients using A&E at Ysbyty Glan Clwyd spent 12 hours or more there in September.

Across Wales as a whole, 3,805 (95.6%) patients experienced such lengthy waits last month.

That’s despite the Welsh Government wanting no patient to spend that long in these units.

The Welsh Ambulance Service

The target

■ Only the most serious calls classed as “Red” (immediately life-threatening) are subject to a response time target.

■ The Welsh Government wants 65% of Red calls to be reached within eight minutes.

■ All other calls receive an appropriate response, either face-to-face or telephone assessment, based on clinical need.

■ All health boards managed to reach the 65% target for Red calls, but only just.

Hywel Dda and Cwm Taf University Health Boards were the worst performers in September, while Cardiff and Vale UHB smashed the target by reaching 81.3% of immediately lifethreatened patients in eight minutes.

Overall in Wales, 73.9% of Red calls were reached within eight minutes. However, the service recorded better results in August (78.1%), July (75.4%), June (75.6%), May (76.1%) and April (75.1%).

And, more importantly, the service performed better 12 months earlier, when 76.8% of Red calls were reached in eight minutes in September 2017.

Last month, 1,911 calls were classified as Red, while the second most serious Amber category – which is not subject to timed targets but includes those suffering from heart attacks or strokes – received 21,421 calls. Despite the seriousness of some of the Amber calls, 43.5% of these cases took more than 30 minutes to reach in September.

Referral to Treatment Times

RTT is the period of time from referral by a GP or other medical practitioner to hospital for treatment in the NHS in Wales.

The target

■ 95% of patients should wait less than 26 weeks (six months) from referral to treatment.

■ No patients should wait more than 36 weeks (nine months) for treatment.

■ According to the figures, patients in Hywel Dda UHB were the most likely to wait longer than six months for their treatment, followed by Cardiff and Vale.

Overall in Wales, 78.6% of patients waited less than six months for their treatment.

Cancer Waiting Times

Every month the Welsh Government publishes two sets of figures which reveal how long it takes to be treated for cancer.

One is the “urgent” route and the other is the “non-urgent” (which probably isn’t the best choice of words).

How the two targets work

■ Urgent

The official line: At least 95% of patients referred by their GP with urgent suspected cancer and subsequently diagnosed as such by a cancer specialist will start definitive treatment within 62 days of receipt of referral.

In the real world: Patient A goes to the GP complaining of back pain. The GP tells her she believes it’s cancer and refers her to a specialist. Patient A should start cancer treatment within 62 days of that first GP appointment. Or at least have a 95% chance of doing so.

But in August 2018, 87% (622 out of 715) newly diagnosed with cancer via the urgent suspected cancer route started treatment within the target time of 62 days.

This is below the target of 95 per cent but up 1.5 percentage points from July 2018.

■ Non-urgent

The official line: At least 98% of patients not referred as urgent suspected cancer but subsequently diagnosed with cancer will start definitive treatment within 31 days of diagnosis, regardless of the referral route.

In the real world: Patient B goes to the GP complaining of back pain. The GP says she doesn’t like the look of it, and refers her for a scan.

The scan discovers that the back pain is being caused by a tumour close to the spine. Patient B should start cancer treatment within 31 days of this scan (in 98% of cases).

A spokesman for Macmillan Cancer Support in Wales said: “We can see from the latest data that 120 people with cancer in Wales did not start their cancer treatment on time in August.

“This continues a worrying trend of cancer treatment targets being missed. More worryingly, it continues the trend of people with cancer and their loved ones being left to face the significant stress and additional anxiety that any such delay inevitably brings.

“We want people with cancer in Wales to be able to believe that when they hear the words ‘you have cancer’, that the system is in place to provide them with the best possible outcome. Providing early diagnosis, timely treatment and the right longterm care is the only way to achieve this.

“Failure to meet treatment time targets inevitably impacts on the outcomes that can be achieved and the quality of care people receive.

“Urgent action must now be taken to improve this situation for people with cancer and their loved ones in Wales.

“No-one can doubt the dedication of NHS staff, but we do need to see a firm commitment from Welsh Government to invest in the cancer care infrastructure that is needed, the staff required to operate it, and the governance structure needed to make sure it runs well.”