4. Will the Minister make a statement on hospital waiting times for patients in north Wales? OAQ53771

Yes. Whilst the health board has improved its 36-week position by 3 per cent between February last year and this year, I am disappointed with the number of people who are still waiting too long. I have made my expectations clear for the health board, and I expect to see further improvements in waiting times before the end of this year and into the next. To help that, the Welsh Government has provided additional funding to help achieve that improvement in performance.

Too many people are waiting too long for treatment in north Wales. People on orthopaedic waiting lists are typically waiting, now, for two years in order to get access to their treatment. You clawed back £1 million from the health board this year because of its failure to hit your waiting time targets, and £3 million was clawed back last year because of a similar failure in that period. The situation with the Countess of Chester hospital, which took a significant number of referrals from north-east Wales, is going to make waiting times even longer and more difficult to achieve in terms of the targets. When will you wake up, make sure that the Countess of Chester hospital gets the funding it needs to make sure that it can care for the Welsh patients that need access to that service so that we can get these waiting times down, and when will you sign off the orthopaedic waiting time plan, which has been sat on your desk for 18 months, in order that these patients can get access to the treatment they need within the waiting time target?

I think there are three particular points there, Llywydd. The first is that two years is not the standard wait for all orthopaedic patients. That is not even the average wait. But there are some specialities, in particular some forms of joint replacements, where the wait is of that order, and that is simply far too long and simply not acceptable.

The orthopaedic plan has not been sat on my desk for 18 months. I am yet to receive an orthopaedic plan from the health board that I can make a determination on, on whether to invest in that or not. It has taken more time than I certainly have wanted to get a joint plan that clinicians across Wales and the health board can agree will actually match the capacity now and in the future.

When it comes to the Countess of Chester, the Member is simply wrong to suggest that the Welsh system is refusing to make payments and that that is the reason, while the Countess of Chester took unilateral action. It is rather more complicated than that. The Welsh system has not behaved inappropriately, and I hope that people in the Countess of Chester will behave in a way that reflects the values that should exist right across the national health service in every one of the four nations and not disadvantage patients while discussions continue about an appropriate rate of payment. And each and every year, the Welsh system has paid its bills in full and on time.

You say that you’re disappointed that people are waiting too long. It’s worth taking a moment just to think what exactly 'too long' means in this context. I wrote to the Betsi Cadwaladr health board and received a response on 8 April. I wrote on behalf of a patient waiting for a new knee. The response said that some 2,200 patients were awaiting orthopaedic treatment and that waiting times for elective surgery was around 100 weeks. That’s two years. Now, a fortnight later, I got a response saying that waiting times for knee operations or hip operations were more than 110 weeks. Now, this at any level isn’t anywhere near what is acceptable to us. Isn’t it time for us now to realise that special measures in themselves are not enough and that we need to move to some sort of crisis measures for Betsi Cadwaladr, or to seriously consider whether the single health board model for north Wales is fit for purpose?

There's no suggestion that changing the organisational structure of Betsi Cadwaladr and having two or three different health boards would actually improve performance in this area. The challenge would still be about how different clinicians on different sites actually work to a unified plan to make better use of the resources that they share across the health board. That will require investment in capital facilities and require a change in practice. I expect to see both those things set out in the orthopaedic plan, when I am actually provided with it, for me to make a decision on whether to invest or not.

I recognise that people are waiting far too long in north Wales in particular. I recognise that we're spending money in a way, in actually providing additional capacity from the independent system or from England, that is not actually a long-term, sustainable way to use that resource. We need a more sustainable way to use that resource here in Wales and to only use capacity outside of the Welsh system when it is absolutely necessary. So, I am under no illusions about the unacceptable position that faces our staff and in particular our patients. I look forward to receiving the plan so I can make a choice on the next steps to be taken in orthopaedic services.