In commenting on the latest figures, Edwina Hart, the Assembly’s Health and Social Services said: “this is a significant achievement, and one of which staff should be proud” and that “the priority now for the NHS must be to sustain these targets”.

While many will share these sentiments, we need to be cautious not to underestimate the challenge of maintaining our progress. A lot of money has been thrown at waiting times to fund a sterling effort to get where we are. From a political and public point of view, it was right to bring waiting times under control – the reputation of health policy and the effectiveness of the NHS was at stake.

But many working in the NHS have had concerns about this initiative distorting clinical priorities, applying short-term fixes, and paying over the odds. This is not to deny that innovation, improved efficiency, and best practice have also played a big part in the success. But there is a danger that the waiting time programme could be seen as one off event rather than a coherent strategy with underlying policies, systems and processes aimed at maintaining, acceptable and sustainable waiting times.

As with all publically funded services, the NHS is facing a decade of intense pressure on its funding. One way or another the health pound will be increasingly stretched. This not only challenges the maintenance of existing waiting times, but it underlines the fact that the range and infrastructure of today’s health services is unsustainable.

The local plans emanating from the Welsh Assembly Government’s 2006 strategy, Designed for Life, were not well received by the public, the authors would likely present them differently today. But their direction and themes remain essential if we are to provide sustainable health and social care services through the 21st century. To be fair, all this is writ large in the documents that led to the restructuring of the NHS in Wales, and the new Local Health Boards are clear about what they have to do. They must deliver a patient centred care approach, with patients able to exercise as much or as little influence over their care as they choose, except where strong evidence advises against it. They must also provide services that are efficient, effective, timely and safe in a health service that changes the balance of care into people’s homes and communities, and away from traditional hospital care. The implementation of Dr Chris Jones’ primary and community services strategic delivery programme will be the precursor of a major review of what hospitals do and where they are strategically placed. What is clear is, things cannot go on as they are.

Fortuitously, a byproduct of all this talk about the cutbacks in public money, citizens may be softened up for change, but with health and social care, we can’t take that for granted.

To put the service changes now envisaged in context, if you keep people out of hospital, then they won’t have to wait to go in!

Written by Mike Ponton, Senior Fellow, WIHSC