Are patients in Wales twice as likely to be on an NHS waiting list as those in England?

We know people are twice as likely to be on a waiting list in Wales as in England.

At health questions in Parliament last month, health secretary Steve Barclay claimed people in Wales were twice as likely to be on a waiting list compared to England.

This echoed similar claims he made earlier in October in a post on X (formerly Twitter) and at the Conservative Party conference.

We can’t be certain what figures Mr Barclay based his claim on—we asked the Department of Health and Social Care (DHSC), and haven’t had any details from them. There are different ways you can count the waiting lists in the two nations, but the best comparable data we can find suggests that in August 2023 those in Wales were around 60% more likely to be on a waiting list than those in England.

Statistics on their own have limitations and the way they are presented is a crucial part of how they are interpreted and understood by the public. If data is presented without context or caveats, it can give an incomplete or misleading picture. 

As the Office for Statistics Regulation states in its Regulatory Guidance, selective use of data or use of data without appropriate context can lead to misuse which damages public trust.  

What do Wales and England’s waiting list figures count?

NHS England publishes monthly data on what it calls consultant-led referral to treatment (RTT) waiting times. This is often referred to as the NHS waiting list, with NHS England also referring to it as “the overall waiting list” in its elective recovery plan last year. 

Stats Wales also publishes RTT data each month.

RTT data counts the number of cases at the end of each month where a patient is waiting to receive some kind of elective treatment. These figures are for the number of pathways, not patients, which means some people may be waiting for multiple treatments for separate conditions.

A pathway in both nations begins when a referral is made, and it ends when their treatment begins, or when the decision is made that they won’t be treated, or if they don’t respond when contacted.

But while Wales and England’s data seems to count very similar things, the overall figures are not directly comparable. 

Wales’ chief statistician Stephanie Howarth wrote in 2022 that there were some “significant differences” between how England and Wales measure the total waiting list. 

While in England only “consultant-led” pathways are counted, other pathways are included in Wales. Ms Howarth wrote: “We believe that most of these pathways in Wales fall into two groups: direct access diagnostics and Allied Health Professional therapies.”

She added that removing these pathways from the total would make the figures “more comparable” with England’s.

How do Wales and England’s waiting lists compare?

The latest NHS England data shows that there were 7.75 million incomplete pathways at the end of August this year. This compares to 760,285 overall in Wales, though if allied health profession service and diagnostic service incomplete pathways are removed as Ms Howarth suggested to make the data more comparable, the figure is 673,865. 

The latest population estimates show that there were around 56.5 million people living in England in mid-2021 and about 3.1 million in Wales. Therefore the number of incomplete patient pathways as a proportion of the population was about 14% in England as of August, and about 22% in Wales using the most comparable available data (or about 24% overall).

This suggests the proportion of incomplete pathways in Wales is not quite twice as high as in England, as Mr Barclay appeared to claim when he talked about patients being twice as likely to be on waiting lists. 

Put another way, the best available comparable data suggests people in Wales are around 60% more likely to be on a waiting list than those in England, rather than 100% as Mr Barclay effectively suggested.

Where does the ‘twice as likely’ claim come from?

As the DHSC hasn’t come back to us, we can’t say for sure what data Mr Barclay’s claim was based on. But he may have been referring to figures first reported in the Sun in February this year. 

An article headlined “NHS patients in Wales are twice as likely to be stuck on waiting lists”  said: “An analysis found there were 660,271 Welsh patients waiting for treatment after referral by a consultant doctor in November. This equals 21.3 percent of the 3 million population.” It then noted the equivalent figure for England was 7.2 million, or 12.8% of the total population. The article also included a quote from a Conservative Party source saying people were “twice as likely to be waiting for treatment in Wales”.

These figures for England were broadly correct based on data for November 2022, though as noted above, NHS data records pathways rather than patients, and more recent figures have since been published. We aren’t completely certain what’s included in the 660,271 figure for Wales the Sun cites, as we haven’t been able to replicate it exactly. But rather than being the overall figure for Wales, it appears it may be a figure discounting diagnostic and therapy pathways which would make it more comparable if so. We’ve asked the Sun and will update this article with more information if it responds.

If the English and Welsh percentage estimates are broadly correct, however, there remains a question over the Sun’s claim that Welsh patients were “twice as likely” to be stuck on waiting lists (which is later caveated as “nearly twice as likely” in the article). In fact, the figures quoted in the Sun back in February suggest Welsh patients were then around 70% more likely to be on a waiting list. 

Image courtesy of the House of Commons