Effective planned care summit: 22 October 2025

The Effective Planned Care Ministerial Summit bought together health boards, trusts, special health authorities, NHS Performance and Improvement and Welsh Government to share best practice, address barriers, and agree on actions to improve access to planned care across Wales. 

The summit highlighted the clinical optimisation frameworks and examples of service transformation that have been implemented at health boards in Wales. Progress in reducing waits over 2 years has been made with an 88% reported reduction, but further improvements are required. An additional £120 million in funding has been made available this year to accelerate progress towards targets and drive service transformation by March 2026, including:

• elimination of all waits over 2 years, not just achieving this at year end
• delivering over 200,000 new outpatient appointments, exceeding previous annual volumes
• ensuring no patient waits more than eight weeks for diagnostic procedures
• providing an additional 20,000 cataract operations, in addition to the 17,000 that are delivered
• transformation of services in line with the planned care programme’s expectations

The following themes were discussed:

• Streamlining pathways, addressing productivity challenges, and minimising variation through service transformation in line with the planned care programme and implementing best practice to improve service capacity.
• Addressing disparities in service access, patient experience, and patient outcomes to ensure equitable care across Wales.
• Utilising digital and data solutions to support virtual consultations, monitor outcomes, reduce variation, and to drive continuous improvement.
• Equipping staff with modern skills and resources to enable and enhance the delivery of quality, safe, and effective care to patients, and ensuring referrals are clinically appropriate to effectively support patient needs.
• Collaboration and input from clinical leaders, CIN representatives, primary care, triage roles and structured job planning across disciplines.
• Supporting the population of Wales to self-manage their health and to make informed decisions about their care.

The Chief Executive of NHS Wales and Welsh Government Director General of Health, Social Care and Early Years addressed attendees of the summit via a pre-recorded video message.

There has been an unprecedented rise in demand, with over 1.6 million new referrals in the past year, 20% higher than pre-pandemic levels. Health boards have a crucial role in shaping healthcare in Wales and were encouraged to review referral pathways, invest in advice and guidance, and make better use of community health services to ensure patients receive appropriate care in the right setting.

Health boards were urged to speed up the implementation of clinical models, streamline patient pathways, increase capacity, and review current processes to eliminate waste and boost productivity. Each investment and operational change should provide clear benefits for patients, staff, and communities. Embracing digital tools and artificial intelligence was identified as vital, with all boards encouraged to share best practice and technology-driven opportunities for greater efficiency and improved patient experience.

Promoting teamwork and a positive, open culture, including actively listening to staff and patient feedback was recognised as essential for ongoing improvement. 

The NHS Performance and Improvement National Director of Planned Care reflected that the effective planned care programme for 2025 to 2026 is focused on embedding optimised approaches to planned care, aiming to deliver a sustainable, productive, and efficient service model across Wales. 

In line with the 2025 to 2026 programme, NHS Performance and Improvement and national clinical implementation networks have developed a series of service optimisation frameworks. These frameworks act as practical guides for health boards and clinical teams to assess performance against national and international best practice and identify both strengths and areas of improvement within their services.

The enabling actions, which are integrated into the planning framework, include a total of 12 measures, some specifically focused on theatre implementation and that health boards are required to report their status on each. These actions are not static and will evolve as clinical practice and priorities change.

The Cabinet Secretary for Health and Social Care emphasised the importance of the summit noting a commitment to eliminating long waiting times and improving access to treatment for across Wales. It was recognised that targeted investments have been made in recent years to drive improvements, but there is still a need to implement change at pace to address the increasing demand on services. 

Key changes have been enacted in the planning framework and referral to treatment guidance to support both the NHS and those waiting for care. Areas where further improvement are required were highlighted, including the necessity of some referrals to secondary care with data reflecting that up to 50% are discharged at the first outpatient appointment and the continued need to review and optimise referral pathways. 

Sustainable planned care is dependent on effective referral management, grounded in the core principles of delivering care closer to home and designing community-based services. Where clinically appropriate, patients should be treated by their GP or supported through alternative pathways, rather than being placed on waiting lists. To achieve this, further investment in advice and guidance is necessary, alongside greater utilisation of the hundreds of available but currently underused community health pathways. It was emphasised that everyone should receive timely, high-quality care tailored to their individual needs. To make this a reality, increasing productivity, reducing variation, transforming services, embracing innovation, and fostering a culture of continuous improvement must become standard practice, not optional enhancements.

Clinical leaders were recognised as leading the development and agreed upon models of care across various specialties, building on established practice, and these models are now ready for implementation in all health boards. 

Attendees were reminded that ambitious productivity targets set out in the national planning guidance must be achieved, supported by the enablers within the specialty optimisation plans. The speech concluded by reaffirming that delivering care within the community is the default approach for Wales and emphasised the need for transformative changes to ensure the best possible care for everyone.

Orthopaedics

Cwm Taf Morgannwg University Health Board shared their orthopaedic services transformation including how targeted reorganisation, data-driven improvement and multidisciplinary collaboration has worked to address longstanding challenge within the service. 

Over the last nine months, the number of patients waiting over two years has reduced by over 700 patients, from a peak of approximately 1,200, and activity levels have risen to 250 to 260 cases per month. Productivity has increased, with routine four-joint procedures per list and a target of 90% of sessions meeting ‘Getting It Right First Time’ (GIRFT) standards going forward, resulting in an anticipated 18% productivity improvement.

Cataracts

Cardiff and Vale University Health Board provided an overview of the redesign implemented within their cataract services, highlighting the strategic and evidence-based approach taken to enhance patient experience and ensure the sustainability of high-quality care.

The cataract service has moved to the University Hospital of Llandough, creating a dedicated high-volume any-complexity cataract hub with co-located admission and theatre facilities. The new hub has embedded GIRFT recommendations and digital innovations which enabled consistent delivery of at least 7 cases per list, including complex surgeries, without compromising safety or quality, and nurse-led telephone triage and strengthened links with primary care optometrists reduced unnecessary referrals and improved pre-op readiness. 

Productivity per list increased by 55%, theatre utilisation has increased by 25%, on the day cancellations reduced by 43% which has resulted in reduced patient waiting times and improved staff satisfaction. The health board reported this model is now being shared regionally, with ongoing audits and workforce planning to sustain and expand capacity, aiming for a purpose-built ophthalmology hub and further workforce development. 

The NHS Performance and Improvement National Clinical Director of Planned Care outlined the key challenges and priorities for planned care in Wales, citing high demand, persistent backlogs, and operational inefficiencies. The approach emphasised data-driven, collaborative strategies to enable sustainable transformation and consistent best practice across health boards.

Before the pandemic, most services were close to the 36 week referral to treatment (RTT) target. Since then, referrals have risen, with a monthly deficit of 40,000 outpatient appointments. 

Referral management is crucial; evidence indicates that about 30% of referrals do not meet secondary care thresholds. Professional triage, national referral standards, and routine advice and guidance are recommended with opt-in leaflets to support informed patient choices. Reducing inter-departmental variation and ensuring clinicians have dedicated triage time was also advised.

Waiting list validation can redirect 20 to 40% of patients to more suitable pathways, with ongoing checks potentially reducing lists by 8% annually, as shown in work undertaken by NHS Scotland. Frailty and pre-optimisation initiatives are improving outcomes by screening and preparing patients, minimising unnecessary or high-risk operations.

Pathway optimisation should prioritise upstream interventions such as straight-to-test, advice and guidance, and minimise unnecessary investigations to avoid poor early decisions. Theatre optimisation and surgical hubs remain priorities, with accreditation criteria being finalised. Standardised frameworks and self-assessment tools will support improvement.

Transforming outpatients is a major opportunity, and can be achieved by utilising allied health professionals, aligning demand and capacity, and structured job planning. The Welsh Government insourcing initiative to clear current backlogs will act as a system reset. Wider use of PIFU and SOS pathways, overbooking to match DNA rates, and standardised clinic templates are essential, noting that adding one case per clinic could deliver 10,000 extra appointments monthly, and a 30% follow-up reduction could free up to 738,000 appointments each year.

Active engagement from health boards and clinical teams is needed to reduce unwarranted variation, embed evidence-based pathways, and ensure accountability for sustainable improvements going forward. 

Swansea Bay University Health Board provided an update on its health board wide planned care transformation, highlighting a data-driven, systematic approach. Their work is underpinned by an evidence-based methodology, starting with mapping patient pathways using a healthcare systems engineering framework. This breaks down processes into microsystems and meso-systems, supported by digital feedback for real-time performance visibility. Staff also undertake structured training to ensure consistent, systematic management.

A key part of the strategy is the use of "vitals charts" to track metrics such as demand, activity, and waiting list sizes at both general and sub-specialty levels which enables precise planning and resource allocation.

Targeted redesigns have delivered significant gains such as a 50% increase in nursing pre-assessment productivity, a 30% rise in theatre case activity from January 2025, and nearly doubled gynaecology throughput, all evidenced by digital dashboards. General surgery and trauma & orthopaedics also saw reduced waiting times, aided by increased activity and mega clinics.

Operational enablers include enhanced governance, efficient scheduling policies, induction for insourced and outsourced staff, robust validation to ensure necessity, and digital resource booking. The transformation was characterised by scientific methodology, digital integration, and a focus on data-driven, real-time planning and improved monitoring.

Throughout the summit and during the group discussion, the following themes and discussions were covered: 

• overcome resistance and reduce unwarranted variation by focusing on fewer, well-delivered priorities, using policy and best practice, with clinical leaders involved in co-creating plans
• early engagement of staff, planners, and clinical leaders is vital to align national aims with local delivery
• protected time and job planning for staff and clinical leaders are essential for embedding national work locally and driving transformation
• job planning should include all professional groups, and infrastructure must be developed to support patient access
• deep, focused change and strong links between health boards and CINs are necessary to ensure compliance and reduce variation
• concerns exist about shifting workload to primary care without accompanying resources, enforced thresholds, and increased GP workload from returned referrals, primary care leads are actively involved in planning, with emphasis on consistent electronic referrals and teamwork
• introduction of AHP-led pathways and systems to signpost patients away from primary and secondary care
• digital teams support virtual clinics to optimise staff time, with moves towards consistent methodology and data alignment across Wales
• including patient education and self-care in planned care pathways helps patients make informed choices and reduces unnecessary appointments
• improved communication and engagement with patients through initiatives such as joint schools
• early intervention, managing comorbidities, and targeted pre-optimisation are strategies to improve patient readiness and reduce complications
• patient-focused outcome measures for cataract surgery are being used, including PROMs and QR feedback forms
• focus on every ophthalmology sub-specialty is important, with national clinical reference groups playing a key role

The system priorities for 2026 to 2027 will be on consolidating progress in planned care and driving sustainability. Embedding optimisation frameworks and enabling actions across all health boards will be essential for maintaining improvements. Continued collaboration between national programmes, health boards, and clinical networks is needed to address unwarranted variation.

There must be a focus on digital integration, including the rollout of a digital pre-assessment platform to enhance patient readiness for surgery and streamline pathways. The importance of data-driven decision-making; improved clinical coding at referral and predictive analytics for operational planning was also stressed. 

Workforce planning, including job planning for clinical leads and ensuring adequate time and resources for transformation was discussed.

On closing the summit, the Deputy Chief Medical Officer reflected that meaningful progress is possible through strong collaboration among managers, clinicians, and multidisciplinary teams, even without significant new funding.

Participants were encouraged to take the learning away, engage actively with the planned care programme, share ideas, and focus on implementing established best practices, such as preoperative optimisation, improved specialist-community communication, straight-to-test pathways, and efficient follow-up processes. 

At the close of the summit, all health boards were requested to identify 5 areas of improvement to be delivered by March 2026, aimed at delivering a sustainable whole pathway approach as per the national improvement priority areas: 

• robust referral management (30% may not meet thresholds)
• validation (20% to 40% redirected to alternative pathways)
• pre‑optimisation
• straight‑to‑test pathways.
• surgical hubs and theatre optimisation. 
• improved outpatient models (AHP use, PIFU/SOS, overbooking aligned to DNA)