Access to healthcare – Welsh Government assessment

There is evidence that certain groups experience persistent inequalities in accessing healthcare in Wales, but a lack of data separated by protected characteristic makes it difficult to fully understand these disparities. Though the Welsh Government has introduced services to improve access to healthcare for some groups, there is very limited evidence of improved outcomes. The coronavirus (COVID-19) vaccination programme has achieved widespread coverage, but the pandemic has severely exacerbated existing delays in treatment for other conditions.

• NHS waiting times in Wales have not improved in recent years. Prior to the COVID-19 pandemic, the percentage of people waiting more than 26 weeks to start treatment remained largely stable between 2016 and 2019, and the number of people waiting more than 36 weeks for hospital treatment almost doubled between 2018 and 2019.
• Several groups face specific barriers in accessing healthcare. Older people face barriers, such as availability and accessibility of transport options when travelling to health services. Gypsies, Roma and Travellers experience poor access to healthcare provision. Migrants, refugees and people seeking asylum experience barriers in accessing services, though there is some evidence of good practice in Wales, with links between the asylum system and healthcare providers resulting in continuity of care.
• Little information is available about progress in implementing and evaluating actions in the healthcare policies for Gypsies, Roma and Travellers and migrants, refugees and people seeking asylum.
• Transgender patients who are 18 and over can access services at the Welsh Gender Service. There were delays in opening the gender identity clinic, with restrictions during the COVID-19 pandemic increasing waiting times further.
• Those living in rural areas have to travel longer distances to access services than those in urban areas, and homeless people face difficulties accessing healthcare.
• A two-years-on progress update (2020) notes achievements in implementing A Healthier Wales, including programmes set up through the Transformation Fund to improve access to services. However, the Wales Audit Office has noted that change needs to happen more quickly, with the 2020 Future Generations Report noting a number of barriers to accessing healthcare.
• Between February 2020 and February 2021, waiting times of more than 36 weeks increased by 749%. There is an estimated funding shortfall of, on average, £360 million per year that would be required to restore waiting lists to pre-COVID levels.
• There are concerns about the impact of the COVID-19 pandemic on non-coronavirus healthcare, including delays in cancer treatment leading to backlogs, reductions in the take-up of vaccinations among children, failures to meet the healthcare needs of people with learning disabilities, and difficulties in accessing mental health services.
• The COVID-19 pandemic has increased the waiting list of more than nine months for dental work by 4,230%.
• By the end of August 2021, 83% of adults in Wales had received both doses of the COVID-19 vaccine, and 90% had received their first dose.
• The vaccine roll-out may not have reached everyone equally, with some groups having particular access difficulties such as single parents, asylum seekers, refugees, homeless people and ethnic minorities.
• In response to the COVID-19 pandemic, the Welsh Government expanded virtual video medical consultations to 11,000 GP consultations and almost 62,000 secondary and community care appointments in Wales. However, more than one in 10 people is digitally excluded and unable to access the internet, which could affect access to healthcare.