Welsh Patients Face Long Delays

A Postcode Lottery of Pain: Welsh Patients Face Agonising Delays in English Hospitals

Powys residents needing vital surgery in England are being told to wait longer, a direct consequence of a Welsh health board's desperate attempt to balance its books. This move exposes a stark reality of cross-border healthcare, leaving patients feeling like victims of a system in crisis.

A Policy of Postponement

A controversial decision has been made by the Powys Teaching Health Board (PTHB). The board has directed medical centers in England to postpone surgeries for individuals living in Powys. The goal is to align their waiting times with the significantly longer queues common in Wales. This unprecedented move, effective from July 1st, aims to manage the severe financial strain the healthcare body is experiencing. However, patients, many of whom were not directly informed, are caught in the middle, their suffering prolonged by bureaucratic and financial maneuvering.

The Human Cost of Waiting

For many, this is not just an administrative change; it is a life-altering ordeal. The human impact of this policy is starkly illustrated by the case of Mel Wallace, a 59-year-old resident of Howey in Powys. Initially, she was advised that her wait for hip surgery would be approximately twelve months. Having already waited 59 weeks, she now faces an additional 45-week delay. The simple act of putting on her socks or getting out of a car has become a struggle for Ms. Wallace, who once enjoyed an active lifestyle of motorbiking and gardening. Her experience has left her wishing she had never moved to the area.

Discrimination Across Borders

The sense of injustice is palpable among affected residents. From Builth Wells, 65-year-old Stephen Evans was awaiting a double knee replacement. In May, he was told that his initial procedure would take place in Hereford within a few weeks. A follow-up call, however, brought devastating news: his delay would be for a minimum of twelve more months. Mr. Evans feels that he and others in a similar predicament are facing unjust discrimination. He asserts that his choice to live in Wales should not deny him the same level of medical treatment as someone living in England just across the boundary.

A Plea from the Elderly

The policy's impact is not confined to the middle-aged. John Silk, a 92-year-old from Talgarth, has also been left in limbo. An avid golfer who also frequented the gym, his life is now severely limited by osteoarthritis. A knee procedure in Hereford was scheduled for him in June, for which he had already attended preparatory consultations. A phone call shattered those plans, with a secretary apologetically explaining that budget cuts meant a further year's wait. Mr. Silk wishes to see the health board face the outcomes of its choices, emphasizing the needless discomfort and distress being inflicted.

A Health Board in Financial Crisis

The resolution from the Powys Teaching Health Board does not stem from malice, but from a desperate financial situation. The board is grappling with a staggering budget deficit, which stood at £15.8 million for 2024/25 and could escalate to £35.6 million without intervention from the Welsh Government. Hayley Thomas, the board's chief executive, has communicated that people in the locality should receive treatment on the same schedule as individuals in other Welsh regions. This, she contends, establishes a more equitable method that safeguards vital services for all.

The Escalating Deficit

The financial woes of PTHB are not new. In the 2022/23 financial year, the board recorded a deficit of £7 million, the first time it had failed to break even since 2015. For the current year, 2024/25, the submitted plan anticipates a £23 million deficit on an overall budget of around £400 million. This means the board is spending approximately £90,000 more each day than it can afford. This critical monetary condition has prompted the government in Wales to intensify its supervision of the health authority, moving to "targeted intervention" in the areas of finance, planning, and overall strategy.

Unpalatable Choices

The decision to extend waiting times is one of several "unpalatable options" the board has had to consider. The move is projected to save around £6 million by aligning treatment times with Welsh standards. However, this has been met with fierce criticism. Montgomeryshire MS, Russell George, has described the situation as "ludicrous," arguing that patients should not be forced to wait longer due to financial constraints. He has consistently opposed the move, insisting the priority must be to obtain sufficient financial support from the Welsh government instead of enforcing postponements that lead to unwarranted hardship.

The Cross-Border Conundrum

The situation in Powys throws a spotlight on the complex world of cross-border healthcare between Wales and England. A "Statement of values and principles" is supposed to ensure that patients receive care without confusion or delay, regardless of where they live. The overriding principle is that no treatment should be refused or delayed due to uncertainty over funding. However, the reality is far more complicated, with differences in how the NHS operates in each country.

A 'Knock for Knock' System

For primary care services like GPs and dentists, a 'knock for knock' arrangement is in place, where costs fall where they lie, on the assumption that they broadly balance out. For more specialized hospital care, the situation is different. When Welsh health boards commission services from English providers, they pay for them using the NHS Payment Scheme. The Welsh Government also makes an annual payment to the UK Department of Health to account for the higher number of English residents registered with Welsh GPs.

The Powys Predicament

Powys is in a unique and challenging position. Lacking a local district general hospital, the board directs a substantial part of its funds—nearly forty percent—toward services beyond its boundaries. For scheduled procedures, patients are regularly referred to medical facilities in Oswestry, Hereford, Telford, and Shrewsbury. This dependency on English medical providers, who typically offer quicker treatment schedules, has become financially unmanageable for the cash-strapped health board.

Image Credit - LBC

National Pressures on NHS Wales

The financial crisis in Powys is a symptom of a wider malaise affecting the entire Welsh NHS. Immense pressure is on the government of Wales to shorten patient queues, which have grown uncontrollably in recent times. In a bid to tackle this, a £120 million funding package was announced in June 2025. The ambitious strategy seeks to eradicate delays for care that stretch to two years by March 2026 and reduce the overall waiting list by 200,000.

Missed Targets and Broken Promises

Despite these goals, the track record of the Welsh government in achieving its own targets is poor. Senedd Research shows that key ambitions set in 2022, such as eliminating one-year waits for a first outpatient appointment, have been missed. As of May 2025, there were still thousands of patient pathways exceeding two years for treatments like trauma and orthopaedics. This has led to accusations from opposition parties that the Labour-run Welsh Government is failing to get a grip on the crisis.

A New 'Patient Deal'

As part of an effort to enhance conditions, a new "patient deal" has been unveiled by the government in Wales. This includes giving people the ability to track their place on the waiting list via the NHS Wales app and offering two appointment dates, which if missed without good reason, will result in removal from the list. The government hopes these measures will make more efficient use of resources and reduce the 700,000 outpatient appointments that are missed or cancelled each year.

The Wider Economic and Social Scars

The impact of long waiting lists extends far beyond physical pain and discomfort. For individuals, it can mean anxiety, distress, and financial hardship, particularly if their condition prevents them from working. The King's Fund, a leading health think tank, has highlighted the structural, economic, and social factors that can lead to inequalities on waiting lists. Their findings indicate that individuals from England's most disadvantaged areas have a twofold greater likelihood of waiting beyond a year for treatment as those in the most affluent areas.

A Sicker, Older Population

These inequalities are particularly pronounced in Wales, which has a proportionately older, sicker population with higher levels of deprivation than England. This places an extra strain on health services and contributes to the longer waiting lists. The challenges in social care also have a significant knock-on effect, making it difficult to discharge patients from hospital and freeing up beds for others. This vicious cycle exacerbates the problem, leading to poorer outcomes for patients.

The Political Fallout

Inevitably, the resolution made by the Powys Teaching Health Board has turned into a political flashpoint. The policy has been condemned as "unacceptable" by the Welsh Conservatives, who attribute it directly to "25 years of Labour running the NHS in Wales." They have called for a health emergency to be declared to tackle the "postcode lottery in healthcare." Potent ammunition for their arguments comes from the stark figures revealing more than 10,000 instances of two-year waits in Wales, contrasted with only 158 such cases in England.

A Liberal Democrat Response

Concern has also been voiced by David Chadwick, the local MP for the Liberal Democrats. He finds the decision difficult to understand given that a priority has been placed on shortening patient queues by the governments in both Wales and the UK, which are both Labour-led. He has urged the government in Wales to supply Powys with essential funds for quicker treatment, contending that the present circumstances are inadequate.

Concerns from English Providers

It is not only in Wales that the policy is sparking anger; apprehension is also growing among NHS trusts in England. The managing director for the Wye Valley NHS Trust, Jane Ives, has cautioned that the change could impact ten thousand scheduled consultations or elective treatments, characterizing it as a proposal with exceptionally low value and tangible effects on individuals requiring care. Meanwhile, dialogue continues with the Shrewsbury and Telford Hospital NHS Trust, alongside a growing potential for the situation to intensify.

A System at Breaking Point

The situation in Powys is a microcosm of a health system under immense strain. Decades of underfunding, coupled with the long-lasting effects of the pandemic and the specific demographic challenges in Wales, have created a perfect storm. While the healthcare body for Powys attempts to navigate these difficult circumstances, its choices are forcing vulnerable patients to suffer the consequences of a system that appears to be failing them.

The Road Ahead

The future for patients in Powys and across Wales remains uncertain. Although a pledge for significant new funding has been made by the government in Wales, the challenge's scale remains immense. The British Medical Association has welcomed the investment but has questioned whether it will be enough, pointing to the huge health board deficits and a depleted workforce. The need for a radical rethink of how healthcare is delivered and funded has never been more apparent. For patients like Mel Wallace, Stephen Evans, and John Silk, any change cannot come soon enough.