Our work sought to answer the following overall question: ‘Are there effective arrangements to address long follow up outpatient waits and develop sustainable outpatient services in future?’

Key messages

The overall conclusion from our latest review is that the Health Board has made limited progress in implementing our previous audit recommendations on follow up outpatients and continues to carry significant clinical risks associated with delayed follow up appointments across a number of specialties.

Our fieldwork found that the Health Board has made some improvements to its follow up outpatient services.

In response to our previous audit recommendations, the Health Board has:

• ensured it is appropriately reporting its follow up outpatient wait figures to Welsh Government;
• improved the provision of management information on follow up outpatients to clinicians and managers; and
• started a programme of work to develop new approaches for, and improvement of follow up outpatients.

However, overall progress has been slow. Of the five original recommendations from our 2015 report, only one is fully complete and further work in required fully implement the remaining recommendations.

Our fieldwork identified that arrangements for reporting and oversight of clinical risks associated with delayed follow up appointments still require strengthening. There are significant and growing waiting lists with alarmingly long follow up outpatient delays within specific specialties such as ophthalmology. The Health Board should have clear plans for monitoring and managing these clinical risks at specialty level. These need to be overseen corporately and should provide regular assurance to the Board on the effectiveness of actions taken.

The Health Board’s outpatient improvement programme is successfully driving the ongoing implementation of the ‘See on Symptom’ and ‘Patient Initiated Follow Up’ pathways. These have the potential to increase efficiency and patient experience.

However, while the Health Board is continuing to invest in its outpatient improvement programme, there remain several challenges and risks that are inhibiting the levels and pace of improvement needed. These include lack of clinical leadership for the improvement programme, and lack of clarity on the recurrent resources available for improvement activity.

Since our 2015 report, the overall numbers of patients waiting for a follow up outpatient appointment at the Health Board have increased substantially. Most of those patients who are delayed are waiting at least twice as long as they should be (100% delayed). Many of those are in specialties where their condition could increase the risk of harm because of a delay.

The Health Board must work at pace to address the increasing follow up outpatient waiting lists and delays patients face in receiving a follow up appointment. As part of this there is a need to better manage clinical risks associated with delayed follow up appointments.

To do so, the Health Board will need to carefully consider how services become more efficient as well as what further, longer-term resourcing it will require to achieve sustainable improvements to follow up waits.