Reducing waiting times in Wales

The number of people on NHS Wales waiting lists for treatment has reached record levels. This problem has worsened since the Covid-19 pandemic, with the average wait time for treatment more than doubling since December 2019. Data on waiting times are captured by Local Health Boards and reported to Welsh Government in the form of ‘referral to treatment times’ (RTT). These figures describe the total time waited from referral by a general practitioner (GP) or other medical practitioner, to the receipt of NHS-funded hospital treatment, such as outpatient appointments, diagnostic tests, therapy services, and inpatient or day-case admissions.

While performance against the Welsh Government’s waiting times targets has worsened, the underlying causes pre-date the pandemic, and can be attributed to changing population health needs, workforce shortages, and increasing demand for NHS services. Ensuring a sustained reduction in waiting times from referral to treatment will therefore require a system-wide change which addresses issues relating to funding, service delivery, staffing, and patient care. This will include changes to governance and financing structures, as well as ways of working.

Through a review of literature and discussion with healthcare providers, researchers, and government officials, the Wales Centre for Public Policy has identified five key areas in which policy could be developed to improve outcomes and reduce waiting times. These areas target the underlying factors causing increased waiting times, and are likely to both improve the overall performance of the health system, and impact outcomes which matter to patients, resulting in a more patient-centred approach:

  • Workforce capacity
  • Digital technology
  • Reimagining primary care
  • Systems collaboration
  • Follow-up care

Waiting times remain a highly salient political issue, and while policies setting targets for waiting times can be enacted and implemented quickly, these targets can distort and incentivise behaviours. This may subsequently lead to unintended consequences including reduced quality of care and increased health inequalities. Policies setting targets should also include a way of measuring progress that supports delivery of long-term goals, which offer patients both improved experience and outcomes.