IT is time we stopped pretending the official NHS waiting list figures in Wales tell the whole story. They don’t. They are a sleight of hand that hides the true scale of patient suffering.
On paper, the difference with England already looks bad enough. One in 200 patients in England is waiting over a year for treatment. In Wales it is nine in 200. But even those shocking figures understate the reality. Why? Because in Wales, large chunks of delay are simply not counted.
In England, the “referral to treatment” clock starts the day a GP makes a referral. In Wales, the clock only starts when the hospital receives it. Everything that happens before then – all those months of waiting in community services – disappears into thin air.
We see it most clearly in orthopaedics. A patient with a knee problem cannot usually be sent directly to a surgeon. Instead, they are shunted into CMATS – the Clinical Musculoskeletal Assessment and Treatment Service – to be seen by physiotherapists. In theory, this is a good idea. In practice, CMATS waiting lists can be eight months long. Yet those eight months don’t count towards the 26-week target for treatment. A patient can wait most of a year before their “official” waiting time has even begun. The reality is hidden behind the numbers.
This isn’t just a quirk of the system. It looks like a conscious decision to make things look better than they are. Since 2022, CMATS waiting lists aren’t even published. They have been made invisible.
Worse still, as The Herald reported last month, patients are also being struck off hospital waiting lists for no reason. Some in Pembrokeshire only discovered the truth when they chased their appointments, only to be told they were no longer on the list and would have to start all over again. For them, months or years of waiting were effectively wiped away. Try telling those patients the system is fair. Try telling them that statistics matter more than their pain.
The whole point of measuring waiting times is to understand the pressure on the system and drive improvement. But what we have in Wales is a measurement system that flatters the figures, hides the truth, and leaves patients to suffer in silence. It is not good enough. If the NHS is here to serve patients, then it must be honest with them. Honesty starts with the data.
The solution is not complicated. NHS Wales must adopt the same referral-to-treatment definition as England: the clock should start the day a GP makes a referral. Wales must also match the 18-week target used in England, not the watered-down 26-week version. And the practice of quietly removing patients from waiting lists must stop. Every hospital should be required to explain and justify any removal in writing. Anything less looks like manipulation.
Every hidden wait is a hidden person. Every delay off the books is a patient left in pain. If we don’t even measure the suffering, how can we ever fix it? It is time for Welsh Government and NHS managers to stop hiding behind definitions and confront the reality. Our readers, our families, and our neighbours are living with these waits. It is their lives, not political spin, that matter.
