We also have analysis for NHS pressures in England, Scotland, and Northern Ireland. Note that available data is not always comparable across all nations.

NHS backlog

Waiting lists remain high

Waiting lists were already high before the pandemic but grew substantially after March 2020 and have still not recovered. In March 2023, there were more than 734 thousand people waiting for NHS treatment in Wales.
People are also waiting for longer: in the same month, the number of people waiting over 36 weeks for treatment was 8 times higher than it was in March 2020.

Cancer targets are not being met

The percentage of patients starting treatment within 62 days after first suspicion of cancer has been worsening over the past 3 years and stood at 55% in March 2023. This is well below the 75% compliance target – and even further below the 80% target set for 2026 in the Planned Care Recovery Plan. Performance has been below 75% since records began in June 2019.

A&E attendances and waiting times

Waiting times at A&E are generally rising, with fewer people being seen within 4 hours and more people waiting over 12 hours.

Between April 2013 and April 2023, performance has never reached the 95% target for under-4-hour waits. The proportion of people waiting under 4 hours during this timeframe decreased from 86% to 70%, and the proportion of people waiting over 12 hours increased from 3% to 10%.

Waiting times in Emergency Departments are fluctuating, but generally have been growing over the past decade. The mean time spent in an ED has increased by 81% in the last decade, increasing from 2.8 hours in April 2013 to 5.1 hours in 2023.

Within the same decade, the median time spent in an ED increased by 33%, from around 2.0 hours to 2.6, which suggests that the increasing average waiting time is caused by a smaller number of people waiting for a very long time.

Diagnostics

Diagnostic waiting lists have been growing since before the pandemic and have increased ever more sharply since. In March 2023, there were over 116 thousand patients waiting for a diagnostic test.

Waiting times for diagnostic tests also shot up dramatically after the start of the pandemic. Median waiting times remain well-above pre-pandemic levels, standing at 5.3 weeks in March 2023, almost doubling from to 2.8 weeks in March 2019.

Workforce

The secondary care workforce is growing, but so is the population

The secondary workforce in Wales has grown steadily over the past few years, both in terms of headcount and FTE (full-time equivalent). In March 2023, NHS Wales employed the equivalent of full-time 7,788 medical staff.

At the same time, however, the population of Wales is growing and ageing, resulting in a growing burden of disease. The ONS estimates that, between 2001 and 2021, the proportion of Wales residents over 75 increased from 8% to 10%. It expects this figure to increase to 15% by 2024.

Since older people tend to have higher needs for healthcare, doctors’ workload continues to rise due to an increasingly elderly population and an increasing prevalence of chronic diseases, such as type 2 diabetes. A growing secondary care workforce, therefore, does not mean demand is met.

Wales has fewer secondary care doctors per 1000 people than the OECD average

Compared to other OECD nations, the number of (headcount) secondary care doctors in Wales is below average: there are around 2.5 secondary care doctors per 1000 people in Wales, compared to the OECD average of 2.7. To meet this average, Wales would need an additional 647 secondary care doctors.

Growth in the GP workforce is stagnating

The number of fully qualified, permanent GPs (headcount) has seen little growth since 2016.

At the same time, the population continues to grow and age. This means that the workload of GPs continues to increase, and individual GPs are responsible for more patients. In September 2022, the average full-time GP was responsible for 2,210 patients, compared to 1,676 in 2013. This represents an increase of 32% in the number of patients per full time GP – a significant workload increase for each individual practitioner.

Wales also has fewer individual GPs per 1000 people than comparable nations. In 2022, there were 0.87 GPs per 1000 people in Wales, compared to an OECD average of 1.08. This means that Wales would need around 663 additional GPs to meet the OECD average.