Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

Orthopaedics is the speciality of bone and joint which is collapsing most under the strain of todays Regional Reorganisation or the former National Health Service. As far back as 1982 Prof Robert Duthrie (1925-2005) of Oxford University produced a report for the Government of the day: Orthopaedic services : waiting time for out-patient appointments and in-patient treatment ; report. (Robert B Duthie; Great Britain. Department of Health and Social Security. Working Party on Orthopaedic Services.1981. The full report has been scanned  for NHSreality and is at bottom of page) Duthrie was deeply involved in the Nuffield Orthopaedic Centre. As we all live longer most of us will need some sort of Orthopaedic operation during our lives..

This report points out that “cold” or “non-urgent” orthopaedic centres can plan ahead, guarantee a certain output without interference from “emergencies” which trump everything else in the DGH (District General Hospital) theatre, and reduce complication (Unmonitored superbugs) and litigation rates.

Despite this report, several of these cold orthopaedic hospitals (such as Standish) (“Appalling care” in Gloucestershire hospitals due to mismanagement, warns whistleblower)  have been closed, and access to those that remain is not universal – patients in Wales used to be able to choose Oswestry (Rationing overtly: Hywel Dda Health Board plan to halt some elective orthopaedic surgery) or Llandough, but are now restricted to their own Trust services.

Hansard records some of the information and decision making around this long-term problem in Parliament:

14th April 1981 Hemel Hempstead when over 40% of cases were waiting over 12 months.

13th May 1981 Lichfield and Tamworth 40.6% waiting over 12 months

3rd December 1982 Bournemouth (waiting time 12-24 months).

This was followed up in 1988 by “reshaping the public sector” edited by Robert Maxwell

Wales waiting times are even worse than England’s and now a knee replacement can wait over 18 months…

The situation is compounded for the future by inadequate and sometimes too short and broad a training, partly owing to the European Working Time Directive. (Training standards under pressure due to European Working Time Directive: and intensive working reduces caring .) It is also made worse by recruiting undergraduates rather than graduates. At undergraduate level women outperform men for Medical School entry, but at graduate level they perform equally. Men are more likely to do surgery….(Medical Student debt – time for government to change policy on doctor recruitment ) The long wait is made worse by the risk of cross infection since 1/5 of Hospitals are under standard – in England and that’s not counting the rest of the UK!

In the The Information Age, things can go round and round again, until an informed public embarrasses it’s leaders to make the necessary change. The French say “plus ça change, plus c’est la même chose“…. Does the English system continue to compare the cross infection rates of Hospitals, or are they amalgamated into “Trusts” so that the gain which Duthrie aimed for is obscured? Does the government of Wales believe in empowering patients and a Patient Centred Health Service? If so it needs to give it’s patients choice… and if that is politically unacceptable, make the unit of provision bigger. Wales is only 3 million people. How about one Trust? (One West Wales Trust please, and The Centre of Excellence in West Wales should be in Pembrokeshire ) Ask an Orthopaedic Surgeon where he would choose to have his knee done? The rationing and Post-Code lottery issues make it imperative that Orthopaedic Surgeons speak out. Why not give them a gong for doing so Ministers? And why not give encouragement to commissioners to contract for “cold orthopaedic care”?


Update 30th Jan 2015: Orthopaedic Services: Waiting time for out-patient appointments and in-patient treatment. Report of a Working Party to the Secretary of State for Social Services. If you only have time to read one part read the summary and recommendations.

Duthie 1981 Orthopaedics 1

Duthie 1981 Orthopaedics 2

Duthie 1981 Orthopaedics 3

Duthie 1981 Orthopaedics 4

Duthie 1981 Orthopaedics 5 (summary)



This entry was posted in A Personal View, Commissioning, Gagging, NHS managers, Post Code Lottery, Rationing, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

4 thoughts on “Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

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