6. What actions are the Welsh government taking to reduce hospital waiting times in South Wales West? OAQ(5)0114(HWS)

I expect health boards to continually improve access to services, and reduce waiting times across the full range of services provided. Health boards should do so in accordance with their own integrated medium-term plans, including the measures set out in the clinician-led planned care programme.

Thank you, Cabinet Secretary. Wales spends significantly more on health per head than they do across the border in England. However, this has not led to significantly better outcomes. Welsh patients are generally waiting longer for treatment than English patients—twice as long for a cataract operation and nearly three times as long for a hip operation. Can you explain why, Cabinet Secretary, we are not as efficient when it comes to health spending?

There’s a range of different points to make in response to the question. The first, I’d say, is that actually you’re talking about waits, and that doesn’t necessarily translate into outcomes. Clinical outcomes for patients in Wales are generally very good, and we compare favourably to many parts of England in that regard. However, I do recognise that some people wait too long. That’s part of the point of the planned care programme: to make sure that we do something both to improve the quality, because quality is an important driver for improvement in our system, and it will remain so, but also we want to reduce the length of time that people can expect to wait. I fully expect that, by the end of this financial year, when we get to the end of March, our figures will see another improvement on waiting times within the service here in Wales, but, on some areas, we need to recognise there’s much more that we need to do. Hip surgery is one example. We compare in a way that I do not think is acceptable, but, on a range of other things, for example on kidney transplants and on heart operations as well, we’ve done remarkably well over this last couple of years, and we’re ahead of England in that regard. So, there’s a rounded picture here to recognise and to honestly reflect on areas where we outperform England and those where we need to do better—not simply because of a comparison with England, because it’s the right thing to do for our service in balancing the time people wait with the quality of that intervention and the outcomes that our patients do receive.

In a report in January 2015 into NHS waiting times for elective care, the Auditor General for Wales spoke of the Pareto principle, which calculates the number of bed days taken up by individual patients, and discovered that 5 per cent of patients use 51 per cent of bed days, and also discovered that that calculation wasn’t widely used by health boards generally. I wonder what conclusion the Cabinet Secretary reaches in relation to that and whether he feels that principle would be an important principle for health boards to take into account.

Yes, I think it’s a really important point about the detail and the data that we do have available to us and how they should be used to drive improvement. Those data should show, actually, for that small number of patients, an improvement around those people could release lots of bed days to make sure other people come through the system and receive care in a more timely manner. We need to understand what is the issue around that small cohort of patients and why they take so long. Is it about complexity, are there more improvements we can make system-wide, is it about clinician-to-clinician improvement as well? So, we always need to understand what the data tell us about that problem and then to understand what the answer to that is, and then to understand what times we expect to see improvement within. Again, it’s why I go back to this: the planned care programme isn’t an optional extra for health boards, it is what I expect them to deliver, and understanding data and understanding clinical agreement and leadership across the country on improving a whole range of these areas, in orthopaedics and ophthalmology in particular, where there are large numbers of people who are waiting—large numbers for whom we can improve their experience and we can also do something about their outcomes, too. So, I’m very interested in seeing that evidence properly deployed by health boards and demonstrating the improvement we all expect to see.

Yesterday, Care and Repair told me about their warm homes on prescription scheme, which uses the local intelligence of health and care professionals to help identify people at risk of health decline due to inadequately heated homes, and then they intervene to help with more efficient heating. If it works, it will reduce the number of people needing hospital care, which will include elective care for certain chronic conditions, and, of course, reduce the number of people experiencing delayed transfers of care as well. Now, the scheme’s funded from Welsh Government’s housing budget and is a good example of a non-health budget being used to solve a health problem. If it’s successful, will it continue to be funded from the health budget or will this sort of spirit of cross-portfolio budgeting be tested over much if this pilot is extended beyond the trial period that it’s now being used for?

I’m very grateful to her for highlighting this particular use of Welsh Government money to deliver improvements for people in their housing and their health. We recognise, in housing, in education, and in a range of other areas, there are significant links to the health of the nation too and how they impact across each other. We always need to understand why something has been successful and to what extent we can roll it out on a wider basis. So, I’m particularly interested in understanding the lessons from the particular pilot we funded and then what that means for how we use money across Government. Sometimes, we can get—whether in this party or in others—a bit too focused on where the sums of money are actually allocated rather than what they deliver. I am interested in the quality that we deliver, and the outcomes we deliver, for people. That’s why we’ve invested more money in the budget in improving the quality of housing and the numbers of houses that we have as well. We recognise there’s a real impact in quality across a whole range of things and not just about the housing factor as well. So, I expect that you’ll see from Government our own assessment with health boards and with housing partners of the success or otherwise of that scheme and what we’ll then want to do in the future.