Our response to NHS Wales' Independent Review

Waiting times, cancer treatment and emergency care were all cited as areas that needed addressing in a Ministerial Advisory Group report published today on Tuesday 29 April.

The 68-page report - alongside the Welsh Government’s response – makes 29 recommendations, including suggestions for improving waiting times and swifter cancer treatments.

We welcome the recommendations, saying the arrangements must be fit for purpose well into the future. 

In response to the cancer-related recommendations:

• Recommendation 6: Capsule sponge should be rolled out with a view to reducing demand for intervention endoscopy. Timescale – within 6 months. 
  
  We have called for this since our 2023 report ‘A Burning Issue’ revealed increasing pressures on endoscopy services, potentially contributing to later stage diagnoses.
  
  
• Recommendation 9: No additional cancer performance plans should be produced for 2025/26 and 2026/27. Instead, there should be an immediate focus on implementing a narrow but nationally mandated set of deliverables drawn from existing policy proposals.
  
  While the clarity from such an approach is welcomed, the system must be primed to apply any learning from focusing on the five priority cancer sites to other areas, especially the less survivable cancers where outcomes are especially poor.
  
  
• Recommendation 11: The Welsh Government should establish financial incentives in primary care to improve cancer performance, focusing on in-depth diagnostic work-up and subsequent safety-netting in order to reduce referral volumes and provide more diagnostic information for patient triage in secondary care.

We’re pleased to see an acknowledgement of the need for safety netting, especially as changes are currently being made to the referral criteria for post-menopausal bleeding whilst on HRT. These changes are being done to reduce the volume of referrals being sent to secondary care for investigation and to improve overall waiting times for gynaecological cancer.. This also needs to occur alongside GP training on Gateway C, so GPs know how to refer to vague cancer symptom pathways and rapid diagnostic centres. We also need to move away from the patients representing with unresolved symptoms over periods of months and sometimes years , without testing for cancer. We hear too many stories of misdiagnoses and poor experiences from our clients and through Claire’s Campaign.

• Recommendation 12: The Cancer Network and the cancer arm of the Planned Care Recovery Programme should formally merge to create a single team responsible for setting the strategic direction of cancer care in Wales and directing improvement activities to support this, led by a senior clinician and senior managerial lead, reporting to the Managing Director of the proposed Performance and Productivity Unit and the National Medical Director.
  
  We hope this approach will lead to greater, more consistent and productive engagement with the third sector and greater clarity and accountability within the NHS Exec concerning roles and responsibilities for cancer service guidance and delivery.
  
  
• Recommendation 13: Digital Health and Care Wales (DHCW) should develop a plan to begin collecting and publishing more granular tumour-level performance from the beginning of the 2026/27 financial year at the latest.

We expect this data to include the collection and publication of ethnicity data, as our insight revealed this is captured for as little as 15% of patients in some health boards. We want this data to be available to the third sector, in particular those charities providing services to the NHS.

The publication of the report comes after the Health Secretary, Jeremy Miles, delivered a major speech about leadership and accountability in the NHS, which also set out the plan to continue to cut long waiting times and the overall size of the waiting list in 2025-26.