Are NHS patients waiting longer in Wales?

Orthopaedic patients make up more than a quarter of the longest waits in Wales

Prime Minister Rishi Sunak has singled out hospital waiting times in Wales as being worse than in England in his first head-to-head debate with Sir Keir Starmer.

Sunak said people in Wales waited 40% longer for NHS treatment than people in England.

When you compare the average waiting times across NHS England with Wales, then there is currently a 46% difference.

The average wait in Wales after referral for treatment in March was 21.8 weeks, compared with 14.9 weeks in England.

The figures show there has always been a gap between the average wait in Wales compared with England.

But the divide got markedly worse in the summer and early autumn of the Covid pandemic in 2020.

Waiting lists had built up.

Routine surgery had been cancelled as hospitals coped with the influx of patients with Covid.

By October 2020, the average wait was 11 weeks in England but more than 29 weeks in Wales.

Although the average wait has crept up in England since then, the fall in Wales has not been consistent and the gap remains.

Underlying the problem is the issue of longest waits in Wales - again a consequence of the Covid impact.

About 21% of patient pathways on the waiting list have been there for more than a year.

This compares with only 4.1% of the waiting list in England.

There are also more than 20,600 patient pathways with waits of more than two years; England has managed to almost eradicate these longest waits, with just 232 waiting that long.

More than a quarter of the two-year waits in Wales are for orthopaedic surgery.

Sunak claimed in debate that one in four were on a waiting list in Wales.

The figure of actual patients on a waiting list is closer to one in five of the population.

There are about 591,600 patients waiting for treatment.

But some of these are waiting on more than one list for different types of treatment - which brings the number of "patient pathways" to 768,899.

Sunak also claimed that accident and emergency waiting times in Wales were “the worst in Great Britain”.

These are comparable when we look at major emergency units in Wales and so-called type 1 A&E units in England.

Currently, Wales has a slightly worse performance record than England but it has been a better performer for eight months over the last year - a point highlighted by the Welsh health secretary.

The figures show neither nation has met targets for 95% of patients being dealt with within four hours.

Sunak also pointed to a worst performance for ambulances in Wales.

We can look at the average response times to the highest category of emergency calls - and it was one minute 47 seconds longer in Wales in April, an average of nine-minutes 57 seconds to reach a so-called "red" call.

Wales has been comparatively higher for three quarters of the period since the start of 2019.

Previously, the Welsh government conceded that "ambulance performance is not where we want it to be."

However, it maintains that the Welsh and English figures aren't completely comparable and that there are methodologial differences in how they are drawn up.

Labour leader Sir Kier Starmer did not address the claims about the Welsh NHS in Tuesday's live ITV exchange.

However Wales' Labour health secretary has previously admitted that the Welsh NHS is not performing "well enough" in reducing the longest waits.

Eluned Morgan also indicated health boards could be "sanctioned" unless performance improves.

What has been the response?

A Welsh Labour spokesperson said: “In a debate where Rishi Sunak told barefaced lies, it’s no shock that he has misled people on the NHS in Wales.

“In eight of the last 12 months, performance in major A&E departments was better in Wales than England against the four hour target."

They accused the Tories of being "desperate" and said they were taking action to create new services so people did not need to go to A&E in the first place.

The Welsh Conservatives said: “Keir Starmer has said that Labour in Wales is his blueprint for the rest of the UK.

“This should be a stark warning to anyone thinking of voting Labour. After 25 years of Labour running Wales, we have over 20,000 people waiting more than two years for treatment, a 50/50 chance of an ambulance arriving in time in an emergency and a Labour government wanting to spend money on more politicians than doctors or nurses."

Plaid Cymru said: “The only mention of Wales in that painful hour was as a punching bag by Rishi Sunak on the NHS, while Starmer denied his party’s responsibility.

“Labour in Wales have consistently rejected Plaid’s achievable plans to save the NHS."

A spokesperson said this included fair pay for NHS workers and improving the interaction between health and social care.

The Welsh Liberal Democrats said neither Conservatives or Labour could be trusted with the NHS.

A spokeswoman added: "The Liberal Democrats are the only party who have provided a clear plan when it comes to saving our NHS, by increasing the amount of funding available for health and social care through reversing Tory tax cuts for big banks and increasing the levy on social media companies."

Analysis

On some metrics the Welsh NHS is struggling in comparison to England.

But a simple comparison between Wales and England does not take into account that the population of Wales on the whole is older poorer and sicker than across the border - meaning an increase demand for care and an extra burden on the health service.

Nor do simple comparisons take into account differing policy priorities - such as prioritising patients based on clinical need rather than length of wait or investing in social care.

What is also clear is that waiting lists were lengthy in Wales not only pre-pandemic but also before devolution. So this is a long-standing problem.

It's no surprise, during this campaign statistics like these will be seized upon by Labour's political opponents - to question the party's record in the nation where it has been running the health service for 25 years.

But what's the truth? Is the Welsh NHS so much worse than across the border?

Perhaps the most definitive analysis came in 2016 when the long-established international policy organisation, the OECD, concluded that "no consistent picture emerges of one of the United Kingdom's four health system performing better than another".

It argued all four could learn from each other and make big improvements.