Between 2011 and 2014 the Welsh Government invested £65m into orthopaedic services and former Health Minister Lesley Griffiths AM pledged that long waiting times for orthopaedic surgery would be “all but eliminated”.
However a recently published Wales Audit Office report on orthopaedic services has revealed that people in Wales are waiting for too long for orthopaedic surgery and that waiting times are getting even longer. It stated that no health board in Wales has achieved its waiting times target for orthopaedics, which includes treatment for broken bones, replacing joints and managing degenerative disorders, since 2012.
The report concluded that demand for orthopaedic services has increased significantly in recent years and that NHS Wales is not well placed to meet this future demand. Much of this increased demand has been driven by an ageing population, growing levels of obesity and advancements in clinical practice as well as increased patient expectations.
Perhaps most disappointingly for Welsh patients, the Auditor General also found that waiting times here are significantly longer than in either England or Scotland, and are getting longer, and that the biggest factor being the lengthening waits for a diagnosis.
Indeed, there has been a sharp rise in the number of patients waiting more than eight weeks for diagnostic tests and more than 14 weeks for physiotherapy, which impacts on overall orthopaedic waiting times.
Despite shorter stays in hospital for patients, the Welsh hsopitals are being swamped by an increasing rate of GP referrals. Outpatient capacity, and in particular consultant staffing levels, have increased to meet demand yet it is clear from the growing number of patients waiting more than 26 weeks for their first outpatient appointment, and more recently, that the capacity of services is far from meeting demand and by the time a decision to admit a patient for orthopaedic surgery is made, currently between 10 and 12 per cent of patients will have waited more than 26 weeks.
The Auditor General’s report underscored findings from previous value for money studies. Earlier this year a report into NHS Waiting Times for Elective Care in Wales also revealed that Scotland and England are performing better against more stringent referral to treatment time targets for planned care.
Health boards across Wales are starting to develop lifestyle and exercise programmes to potentially reduce demand for orthopaedic surgery and all seven regions have introduced Clinical Musculoskeletal Assessment and Treatment Services (CMATS) in a bid to direct patients to the most appropriate treatment for their conditions, but the report found these services were inconsistent, need to be expanded and better integrated with other aspects of musculoskeletal care.
As the Auditor general for Wales has said: “In order to drive maximum value out of the significant additional investment in orthopaedic services there needs to be a clearer focus on the entire musculoskeletal pathway and better information on service delivery and patient outcomes.”
Whilst it is encouraging to note improvements in the efficiency of some aspects of orthopaedic services, it is worrying that waiting time performance is not meeting the Welsh Government’s targets and is now deteriorating.
It is particularly disappointing that previous national initiatives have not resulted in sustainable service improvements and it is imperative that the Welsh Government works very closely with health boards to ensure that demand for orthopaedic services is better managed so that patients receive timely and appropriate treatment.
It is wrong that so many people in Wales are currently languishing on orthopaedic waiting lists. Many do so in pain, with poor mobility and this has a significant impact on their quality of life. It is no wonder that many of them look in envy at shorter waiting times elsewhere in the UK, or at significant personal expense to the private sector in a bid to shortcut their wait for treatment.
The Welsh Labour Government chose to cut spending on patients which has resulted in longer waiting times. We have seen years of unmet targets in many areas of our health service, a clear sign that it is not performing to the best of its ability. We need to address this issue as a mater of urgency to ensure that the people of Wales are able to get timely access to the best level of health care that taxpayers can afford.