More details on plans to only add people who are “fit and well” to surgery waiting lists and crack down on missed appointments are expected to be revealed on Monday.

Health Secretary Jeremy Miles will give a speech to health leaders on the Welsh government’s bid to cut waiting lists by around one quarter by March 2026.

Hospital volunteer John Timmons, 70, said he saw “a ridiculous number” of patients not turning up for appointments and would support the plans.

But health equality charity, Fair Treatment for the Women of Wales (FTWW), said “fear of weight stigma” could delay some people from seeking help.

The proposed changes are part of a number of Welsh government ideas being discussed to improve the NHS, which has recently seen small reductions in record waiting lists.

These include:

• Patients who miss hospital appointments twice or more being referred back to their GP, in effect placing them at the back of the queue.
• An improved Welsh NHS app, allowing patients to track their progress through the system and make or amend appointments.
• Increased levels of intervention to get patients fit for surgery, such as people being asked to lose weight or exercise more before they are placed on a waiting list.

The Welsh government said patients who were fit and well before surgery were more likely to recover quickly and support would be given to get them “in the best possible shape” for treatment.

Mr Timmons, from Cardiff, said he was broadly in support of the proposals, including the sanctions for missed appointments.

“Somebody else that’s desperate could be there – if they’re working age, they could get themselves back out to work,” said Mr Timmons.

He was referred by his physiotherapist to an exercise scheme at his local leisure centre to help him during the wait for his second knee replacement.

“Being fit definitely helps with recovery,” said Mr Timmons, adding that he had also experienced social benefits from exercise.

“In my past life I was seconded to work in the job centre and would put people on exercise referrals, and that was a good thing.

“It got them out of the house, got them fit and back into work too.”

Miles said 700,000 hospital outpatient appointments were missed or cancelled last year. On average this equates to about 2,700 every working day.

He also said patients should do more to improve their own health “to make the best possible use of scarce NHS resources”.

But FTWW raised concerns that blanket processes risked inadvertently penalising those who experienced “barriers not of their own making” and called for engagement with “diverse patient communities”.

They said one of the biggest issues reported by members was an inability to get hold of someone to cancel or reschedule appointments.

“We know, for example, that women in particular are more likely to be primary care givers in Wales, so appointments which are made without first establishing other responsibilities and commitments can be problematic.”

Annie Hillman is a community sport and health manager for the eight Better Leisure Centres across Cardiff.

The centres have co-delivered sessions with the NHS for several years, where patients with hip, knee and back pain can self-refer, or be referred by hospital physiotherapy teams.

NHS staff then deliver classes at the leisure centre instead of the hospital setting.

The centre’s own staff have also been trained to take sessions or assess patients referred by their GP.

“At the end of the six week programme where they would have left the hospital setting they’re already in the leisure centre, they’ve already broken down that barrier of coming through the door,” she said.

“They see people like themselves exercising, and that is the change of behaviour that they continue to have. It’s prevention – they don’t want to go back to the doctors, they don’t want to go back to the NHS, they keep active.

“There’s a huge demand but the lack of funding for us is a problem.”

It is a resource she wishes she had when a spinal injury caused her to have surgery in 2009.

“I had to learn to walk again,” said the 53-year-old former Wales netball player.

“I came out of hospital and was in a bit of a dark place. There was nothing like this going on where I could meet people who had gone through the same thing.”

Paul O’Sullivan retired 10 months ago and has filled his days with sessions at the leisure centre, after also being referred by his physiotherapist following a second knee replacement six months ago.

“My wife is here having been referred by a pharmacist for osteoarthritis in the hip – she loves it and comes for five hours a week,” he said.

The 70-year-old said he would support “a patient deal” where there is a greater expectation on people to remain active.

“I didn’t know what to do with my first knee two years ago, with the second I was back here after six weeks, because I’d done a lot of classes pre-op and I knew what to expect.

“It made a massive difference.”

He acknowledged it would not be as straightforward for everyone.

He also said those missing appointments may have valid reasons.

“Some days you get up and your energy levels are low, but I’ve got a hospital check-up next week and the letter clearly says if you can’t make it, please ring us.

“It’s about education, because it does cost money when you miss an appointment and extends the waiting list.”

Pat Mackie, 68, said she would support initiatives to reduce waiting lists, as her husband is currently on one.

“He has been waiting for a heart scan for a year and has still got another three months to go.

“He’s lost two brothers with a heart fault and unless he’s scanned it won’t be detected.”