THOUSANDS of patients across Wales are having to wait longer for outpatient appointments, tests and operations, due to a tax and pensions issue for senior clinical staff that is now cited as causing "real damage" to the NHS.

During April-August, more than 2,000 outpatient, diagnostic, inpatient or daycase sessions were lost in Wales's hospitals, affecting more than 15,000 patients, according to figures provided by health boards to the Welsh Government.

Health minister Vaughan Gething, in a written statement to AMs which included the above figures, said health boards are regularly reporting that senior clinical staff are unwilling to do additional work and sessions due to a "potentially punitive tax liability".


"In certain circumstances this could lead to additional tax charges in excess of any additional income earned," he said.

The issue - concerning the application of Lifetime and Annual Allowances on senior clinical and non-clinical NHS staff - is affecting patients UK-wide.

Mr Gething said he has raised "significant concerns" over the issue, which the Welsh Government cannot do anything about because the necessary tax and pension powers are not devolved.

"This issue is causing real damage to our NHS," he said." I have made my view clear to the UK Government on a number of occasions over several months.

"I had previously requested an urgent review of these arrangements in the context of increasing clinical and other workforce challenges in the NHS of all four UK nations.

"Hospital consultant staff within NHS Wales, as with other parts of the United Kingdom, have been affected by the changes made.

"This has meant that a number of senior consultants and anaesthetists have been unwilling to carry out additional work above their contracted hours, as the additional work would trigger a tax liability."

The matter has been raised as a concern too by Aneurin Bevan University Health Board.

Director of finance and performance Glyn Jones told a meeting of board members in September that the tax and pensions issue "has knocked us significantly off course this year", in terms of trying to eliminate waits of more than 36 weeks for treatment.

The health board wants to eliminate these long waits by the end of next March, and continues to plan for that.

But Mr Jones warned at that meeting that "even if we can identify solutions to treat patients, the timing may mean we can't treat all patients (who have waited more than 36 weeks) by the end of March".


By August 31, 1,467 patients in Gwent had been waiting more than 36 weeks for treatment, from the time of referral, the highest amount for 20 months.

The senior staff tax and pensions issue is not the only reason for the rising numbers of long waits, it is a factor.

In his statement, Mr Gething said that due to "the very real concern over the additional tax implications", some senior clinical staff are not seeking additional responsibilities and clinical leadership roles, and some are bringing forward planned retirement dates, "thereby, in times of material levels of vacancies, reducing clinical capacity in the NHS".

He warned that clinical services have not yet felt the full impact of tax changes, and urged NHS bodies in Wales to use as soon as possible what flexibilities are available within NHS pension arrangements, "while the UK Government is consulting on NHS Pension legislation changes and reviewing the impact of the Annual and Lifetime Allowances".

"Our NHS staff do amazing lifesaving work every day. It is important they are not penalised and are rewarded appropriately for the extra work they do which is above and beyond," said Mr Gething.

"This is especially important so that NHS Wales can continue to deliver over the winter months."