THERE could be as many as 550,000 “missing referrals” for outpatient appointments in the Welsh NHS, a review has found. 

The Auditor General for Wales has carried out a review of how the NHS in Wales is tackling the backlog of patients stuck on waiting lists. 

In February it was confirmed there are 691,885 people on an NHS waiting list in Wales, which is up 50 per cent from February 2020 the month before Wales, and the UK, went into lockdown. That figure includes 56,516 people who have been waiting for two years or more for surgery. 

Over half of the people currently waiting have yet to receive their first outpatient appointment which means that they may not know what they’re suffering from and their care cannot be effectively prioritised. 

The Welsh Government has made £185 million available per year to help health boards tackle the backlog but the Audit Wales review has found that during the last financial year just £146.1 million was allocated and £12.77m returned to the Welsh Government. 

NHS bodies cited staff capacity, lack of physical space and limited private capacity to carry out planned care as barriers to spending the additional funding. 

Modelling by Audit Wales has shown it could take up to seven years or more to return waiting lists to pre-pandemic levels. 

The review has also warned how the backlog could be further complicated by a drop in referrals since the pandemic began. 

Referrals for a first outpatient appointment had been rising steadily before “dramatically dropping” off at the start of the pandemic. 

Audit Wales estimate that, compared to pre-pandemic numbers, there are 550,000 ‘potentially missing’ referrals that could find their way back into the system.  

It warns if just half of the potentially missing referrals need treating, this will have a major effect on waiting list recovery and would increase the risk of harm from delays in patients accessing the care they need. The Welsh Government has put this figure at 500,000 but the auditor says it has used more up to date monthly figures. 

While the Welsh Government has set waiting list recovery targets, between 2022 and 2026, and guaranteed the additional funding up to the end of 2025/26 the reviews says this extra funding on its own will not be enough to clear the backlog. 

It says the NHS must also overcome issues, including the on-going impact of COVID on services, reducing the impact of emergency care on planned care service delivery and long-standing staff shortages and recruitment issues. 


It has made five recommendations to ensure the Welsh Government, working with health boards, should implement to deliver its national plan to reduce waiting lists. 

Those are  producing a clear funding strategy including long term capital investment; developing a workforce plan so it can build and maintain planned care capacity; improving leadership and ensuring it manages clinical risks associated with long waits and supports patients as they wait. 

Adrian Crompton the auditor general said: “The COVID-19 pandemic will leave the NHS with many enduring legacies not least the significant impact it has had on waiting times for planned care. Just as the NHS rose to the challenge of the pandemic, it will need to rise to the challenge of tackling a waiting list which has grown to huge proportions.” 

Welsh Conservative health minister Russell George MS claimed the report showed a need for stronger leadership from the Welsh Government. He also said it showed the Welsh Government is wrong to attempt Senedd reform. 

He said: “No one blames the hard-working doctors and nurses but the poor lack of planning from the Labour Government that occupy their time prioritising more politicians in Cardiff Bay than resolving the cataclysmic state of NHS waiting lists and the increased cost-of-living.” 

He added: “Hopefully, this report is a wake-up call for the Labour Government to get a move on and show some leadership instead of leaving health boards to do all the heavy lifting. Labour need to get a grip on the NHS and stop breaking all the wrong records.” 

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