Written Statement - Waiting Times and Orthopaedic Services update

Our One Wales commitment to reduce waiting times to a maximum of 26 weeks was delivered at the end of December 2009. Many people said that this could not be delivered, but thanks to the hard work of NHS staff, it was. Five years ago, there were nearly 72,000 patients in Wales waiting over six months for treatment. Of these, nearly 7,300 patients were waiting over 12 months for definitive treatment.

The latest figures for January 2011, demonstrate that for all medical and general surgical specialties, waiting time performance continues to remain above 95% against the 26 week target and has done so since October 2009. However, the All Wales position has deteriorated slightly to 92.8% due to significant pressures within orthopaedic services across Wales.

The figure reflects in part the knock-on consequences of the severe weather in November and December (the worst in over 100 years) and the 20.2% increase in trauma and 999 cases attending our Emergency Departments. It is now vitally important that if patients are given appointments that they attend them, or if they are not able to, to let the hospital know so that they can offer the appointment to someone else.

My latest management information for February / March indicates that the overall waiting time position is once again improving, however the challenge continues within orthopaedics.

Members have raised with me issues over performance at Aneurin Bevan Health Board. You will be pleased to note that Aneurin Bevan Health Board has made significant improvements in reducing orthopaedic waiting times and sustaining the 26 week target for January.  By the end of March, the Health Board are reporting that they are close to eliminating the majority of 36 week breaches, and are benefitting from the extra investment that has been made to orthopaedic services to ensure long term sustainability.

Since 2007 the number of GP referrals to orthopaedic departments in Wales has increased by 30.8%, which is more than double that for all other specialties combined over the same time period.

This week my officials have undertaken work which confirms that this trend can be expected continue over the next 5 - 10 years due to changes in the nature and demographics of our population and as the range of treatment possibilities available increase.  This is particularly evident in the need for hip and knee treatments, where the volume of procedures is likely to increase by a further 30% overall and hip fracture trauma by 10% over the next 5 years. This continuing growth in demand reflects the impact of a number of factors which include; a predicted 29% increase by 2033 in the population of pensionable age, the consequent increase in the number of joint revisions, increasing joint disease and the impact of increasing obesity. 

Population projections to 2019 for people aged 65-74 suggest an increase of 36% in Wales (compared to 30.5% in the UK as a whole). Longer term projections to 2029 indicate a continuing increase suggesting that orthopaedic conditions associated with old age are likely to continue to rise.

These demographic changes are likely to be exacerbated by the increasing levels of obesity and reduced fitness levels across the population.

An Approach to Developing Sustainable Services

We will ensure that orthopaedic services become “Best in Class” in regards to efficiency, productivity and clinical outcomes. We will further improve our length of stay and day of surgery admissions, and ensure full implementation of the agreed clinical pathways for hip and knee pain, fractured neck of femur and non-specific lower back pain. These pathways have been designed by clinical teams to deliver effective clinical care in a productive and efficient manner. 

All appropriate capacity will be used to the best potential, and we will increase the productivity of our operating theatres and day case suites.

We will maximise the range of alternative treatments to surgery, and the information given to patients in respect of the impact of undergoing surgery. Some LHBs have introduced lifestyle programmes and therapeutic interventions, which are reducing the need for orthopaedic surgical referrals for hip and knee by up to 20%.

We will introduce a Public Health campaign, with a concerted effort on obesity prevention, weight loss management and increased fitness levels, focussing on all ages and all parts of the country. Lifestyle changes will have a material effect over time on reducing the need for orthopaedic surgery.

However, even with these initiatives in place, all the above actions are unlikely to meet our population demands for the next 5-10 years, so we will need to create additional orthopaedic capacity.

I have therefore asked my Officials and Clinical Leads to commence work on developing plans to increase orthopaedic capacity, including any requirements for additional theatres and diagnostic facilities.

I will be submitting these plans to the Minister for Budget and Business, and intend to expand on these options and their implications in greater detail.