The auditor general for Wales said in a report published today that, although orthopaedic services had become more efficient in the past decade, NHS Wales was “not well placed to meet future demand”.
Evidence suggested that health boards were using the decreasing number of 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.
But more recently waiting times had increased and people in Wales typically waited longer for diagnostic tests than those in England and Scotland, its Review of orthopaedic services stated.
It found that NHS Wales was struggling to meet the demand for orthopaedic services placed on it from an increasing rate of GP referrals.
This is down to the growth in GP referrals, which was rising faster than the growth in population, meaning patients had to wait more than 26 weeks for their first appointment. In some cases, between 10% and 20% of patients would have waited over 26 weeks by the time a decision is made to admit them for orthopaedic surgery, the report found.
The WAO showed that health boards were starting to develop lifestyle and exercise programmes, which had the potential to reduce demand for orthopaedic surgery.
It also noted that all health boards had introduced Clinical Musculoskeletal Assessment and Treatment Services (CMATS) to help direct patients to the most appropriate treatment for their condition.
However, these services needed to be expanded and better integrated with other aspects of musculo-skeletal care, the auditors suggested.
Huw Vaughan Thomas, auditor general for Wales, 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.”
The auditors recommended that the Welsh government seeks to clarify how the waiting time to access the clinical musculoskeletal assessment and treatment is measured and work with the health boards to develop a series of outcome measures, supported by robust information systems.
In 2011, the Welsh Government formed a national delivery board to improve orthopaedic services, and between 2011 and 2014, £65m of additional funding was made available to health boards to reduce waiting times and develop sustainable solutions for managing orthopaedic demand.
However, the work of the delivery board and the additional funding failed to achieve a short-lived improvement in waiting times.
No health board in Wales has achieved the waiting times target for orthopaedics since 2012, the auditors said.
A Welsh Government spokesman said: “We have been clear we will take action to bring down waiting times for treatment and we will work with health boards throughout the year to achieve this. The work of the Planned Care Programme and the launch of the orthopaedic plan, together with the work underway following the Wales Audit Office’s report into NHS waiting times, will address a number of the recommendations made today.”
