Orthopaedic services are more efficient and waits are shorter than a decade ago

25 Jun 2015 - 4:32pm

But performance against waiting time targets has deteriorated recently, and more sustainable plans are needed to meet rising demand for services

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In a report published today, the Auditor General for Wales has concluded that orthopaedic services have become more efficient in the past decade, but NHS Wales is not well placed to meet future demand. This is because there has been a focus on securing immediate reductions to waiting times, and less attention has been paid to developing sustainable long-term solutions to meet demand for services.

Auditor General for Wales, Huw Vaughan Thomas said today:

Despite improvements in the way orthopaedic services are being delivered in Wales, there is still more that can be done to improve the efficiency and effectiveness of these services. 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.

Although waiting times for orthopaedic treatment have reduced over the last 10 years, more recently waiting times are increasing and people in Wales typically wait longer than those in some other parts of the UK. Access to diagnostic tests is having a negative impact on the overall waiting times for many patients and the way in which data for initial assessment and treatment is recorded means that published figures do not always capture the totality of patients’ waits.

Today’s report found that  although the numbers of orthopaedic beds are decreasing, health boards are using the remaining beds more efficiently, largely due to patients staying in hospital for shorter periods of time and more patients having surgery on a day-case basis.

However, despite improvements in efficiency, NHS Wales is struggling to meet the demand for orthopaedic services. There is a growing number of patients having to wait over 26 weeks for their first outpatient appointment, and often by the time a decision is made to admit a patient for orthopaedic surgery, between 10 and 12 per cent of patients will have already waited over 26 weeks.

In 2011, the Welsh Government took the positive step of forming a national delivery board to improve orthopaedic services, and, between 2011 and 2014, £65 million of additional funding was made available to health boards to reduce waiting times and develop sustainable solutions for managing orthopaedic demand. The work of the delivery board and the additional funding did achieve a short-lived improvement in waiting times, however, this has not been sustained and no health board in Wales has achieved the waiting times target for orthopaedics since 2012.

The report points to evidence that health boards are starting to develop lifestyle and exercise programmes that have the potential to reduce demand for orthopaedic surgery, and all health boards have introduced Clinical Musculoskeletal Assessment and Treatment Services (CMATS) that should help direct patients to the most appropriate treatment for their condition. However, these services need to be expanded and better integrated with other aspects of musculo-skeletal care.

The report makes a number of recommendations including:

  • Welsh Government seeking to provide clarity on how the waiting time to access the clinical musculoskeletal assessment and treatment services is measured.
  • Health boards ensuring clear referral guidelines are implemented and adhered to, and that appropriate alternative services are available and accessible.
  • Welsh Government ensuring that the factors that led to weaknesses in the delivery board are considered and actions are put in place to mitigate those weaknesses being repeated in the new Planned Care Programme.
  • Welsh Government and health boards working together to develop a suite of outcome measures, supported by robust information systems, which provide comprehensive management information as to whether orthopaedic services are demonstrating benefits to patients and minimising avoidable harm.