A clear strategic plan is needed for the recovery of NHS services in Wales in the wake of mounting waiting lists caused by the pandemic.
That's according to leading medical experts who have voiced deep concerns about the huge volumes of patients needing non-Covid related surgery and other treatments.
According to the latest figures from the Welsh Government, in January 2021 there were 541,702 people waiting for planned treatment from the NHS - a record high.
Close to half of them (221,849) have been on the waiting list for nine months (36 weeks) or more, an astonishing rise when compared to the 27,314 recorded in January 2020.
In fields of expertise such as ear, nose and throat (ENT), ophthalmology and trauma and orthopaedics, more than half of all patients have been on the waiting list for nine months or more.
Since January 2020 the waiting list for planned hospital treatment in Wales has grown by more than 79,344 which is largely down to non-urgent care being postponed to deal with the surge of coronavirus cases in both the first and second waves.
It is understood that the backlog is estimated to take up to five years to clear - but some suggest that it could be reduced to two with "innovative, out-of-the-box" ways of thinking.
Here is a full list of all the different types of NHS treatment and their waiting times:
| ||Percentage waiting more than nine months (January 2020)||Percentage waiting more than nine months (January 2020)||Number of patients waiting more than nine months (Jan 2021)||Total number of patients waiting for NHS treatment|
|Clinical immunology and allergy||6.4||59.8||867||1,451|
|Ear, nose and throat||3.8||56.1||26,210||46,720|
|Trauma and orthopaedics||13.4||63.6||52,198||82,014|
Richard Johnson, director in Wales for the Royal College of Surgeons of England and consultant breast surgeon, said the recovery of surgical services is one of the biggest challenges facing the Welsh NHS. Under current Welsh Government targets created before the pandemic, 95% of patients should be treated within six months.
"We are calling for NHS Wales to carry out detailed modelling about the scale of the waiting times in Wales and set out a timescale for tackling it," he said.
"We need to have an honest conversation with patients about how much longer they will need to wait for surgery. In addition to our duty towards our patients, we also need to support our staff who are exhausted after a year of relentlessly fighting the pandemic.
"Opportunities must be given to trainees when hospitals systematically start getting to grips with their waiting lists. If there is no training made available now, we will have no surgeons tomorrow."
Mr Johnson has called on the next Welsh Government to establish "Covid-light" sites so planned procedures can be carried out safely and without the risk of infection.
"The next Welsh Government needs to send clear instructions to health boards to collaborate and plan strategically across regional boundaries to ensure equity of access to safe surgery for patients," he added.
"We would also like to see a strategic plan for the recovery of planned surgical services in Wales, overseen by a national planned surgery recovery taskforce and named clinical leader. Finally a review of the organisation of surgical services across Wales is needed so that we can plan for a resilient model of care that can withstand future pandemics as well as winter and flu outbreaks."
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Dr Phil Banfield, chairman of the BMA Cymru Wales' Consultants Committee, said the latest referral to treatment times (RTT) figures are a "stark reminder" that the health service remains "in an incredibly precarious state".
"With the waiting list for treatment reaching another record-high in Wales it is going to take a considerable amount of time to tackle this huge backlog," he said.
"Behind each of these shocking figures is an individual person - perhaps someone facing continued months of pain and anguish as they wait for vital diagnosis and treatment. We want so desperately to provide care to patients, and it distresses doctors to see so many people not getting the care they need and that we could otherwise give.
"Meanwhile, many staff are exhausted after spending a year battling the pandemic on the front line, so it is vital that their own health and wellbeing are protected – allowing them time to rest and recover - or we risk them leaving the NHS altogether. We already face an uphill recruitment crisis in many places so it is critical that we do everything we can to aid recruitment and retention of doctors and other care staff in Wales.
"We're going to need extra space and additional time when doing these procedures because we need to ensure patients are Covid free before they are treated, and more space is required to physically distance so that we don’t inadvertently restart a pandemic.
"Doctors will continue their collaborative approach with the new Welsh Government, but it will need meaningful engagement, considerable simplification of access to resources and flexibility all round. The NHS we left before the pandemic is not one we can return to, and the conversation about the future provision of health and social care in Wales must start with the public immediately."
Professor Keshav Singhal, a consultant orthopaedic surgeon, said the NHS should try to see this backlog as a positive challenge to change the way it operates.
"The pandemic has resulted in a severe problem with the elective waiting lists in various specialities," he admitted.
"There is virtually been no elective operating done for the last one year and a vast majority of patients have now been waiting for their surgery for over nine months.
"However, we should take this challenge as an opportunity in disguise and start thinking of out of the box and innovative solutions to help bring down the waiting list as quickly as possible.
"Various solutions include:
"It is likely that with newer ways of working, the backlog can be cleared in two years rather than the five years currently anticipated."