When official figures were published last year showing that one in every 200 people in England was waiting more than a year for NHS treatment, the number was rightly seen as a crisis. Yet in Wales, the figure was a staggering none in 200. As shocking as this disparity is, the reality for Welsh patients is far worse, hidden by a fundamental flaw that keeps huge delays off the books.

In England, the RTT (Referral to Treatment Time) clock starts ticking the moment a GP makes a referral to a hospital. In Wales, official guidance states the clock only begins upon receipt of that referral by the hospital service, with all care in the community not counted in Wales, accordingly. This crucial difference in measuring RTT between England and Wales allows for significant 'hidden' waiting times, which some GPs and patients report as being eight months or longer.

Consider the journey of an orthopaedic patient in Wales. A GP with concerns about a patient's knee often cannot refer them directly to a surgeon. Instead, they must refer to a CMATS (Clinical Musculoskeletal Assessment and Treatment Service) for assessment by an advanced physiotherapy team.

One may suggest that this is a good way of allowing patients to have prompt musculoskeletal assessment in the community by a physiotherapist with additional qualifications, but when the CMATS waiting list is as long as eight months, this sounds less attractive.

The real issue, however, is that this CMATS waiting period does not count towards the patient’s overall waiting time for treatment, because it is not within the definition of RTT in NHS Wales. For these patients, therefore, their 26 week RTT target – the time in which they are supposed to have their treatment initiated – can entirely elapse before their official RTT wait has even begun.

We cannot see this significant waiting list burden, because a 2022 data standards change means there is no longer any public record of these CMATS waits, effectively rendering them invisible. 

You cannot fix a problem that you don't understand and measuring the problem improves understanding. This is not just a statistical anomaly; it is a profound failure that prevents a true understanding of patient suffering and prevents any attempt at a meaningful remedy.

This is why the BMA passed new policy this June, because change is needed to make direct comparisons between the English and Welsh healthcare systems' performance.

NHS Wales must adopt the same RTT definition as NHS England, starting the clock at the point of GP referral. Furthermore, the 18-week RTT target in England must be matched in Wales. Until then, the performance data, which compares hospital waiting times between England and Wales, are essentially meaningless.

Iona Collins is chair of the BMA Welsh council