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Already long waits for orthopaedic services have been made significantly worse by the pandemic

02 March 2023
  • Urgent and sustainable action is needed to tackle the long waits and the adverse impact these are having on patients’ physical health and mental wellbeing.

    Although there’s a clear commitment to improve waiting times, it could take three or more years to just return the orthopaedic waiting list to pre-pandemic levels.

    Orthopaedics is the branch of medicine specialising in the musculoskeletal system - bones, joints, ligaments, tendons and muscles. Prior to the pandemic, the number of people on the orthopaedic waiting list was one of the biggest challenges facing NHS Wales. Even with additional monies from the Welsh Government to develop sustainable solutions, orthopaedic services had never met national targets for waiting times.

    The impact of COVID-19 has only made the position for orthopaedic services significantly worse. Since the impact of the pandemic has lessened, orthopaedic services have been slow to restart and the number of people now waiting has increased by 56% from March 2020. More than half are now waiting more than the 26-week target, and just over one third are waiting more than a year.

    Although orthopaedic and musculoskeletal problems are not, in themselves, life threatening, long waits can have a significant impact on people’s physical and mental health and have wider implications on the NHS in Wales. Our updated modelling shows that it could take three or more years for the waiting list to get back to pre-pandemic levels. But that will require a significant drive on community-based prevention and an increase in activity and capacity levels over and above those in place prior to the pandemic.

    Welsh Government and NHS Wales understand the scale of the challenge facing them and there is a clear commitment to improve and transform orthopaedic services. However, more needs to be done to make services sustainable for the longer-term. Both a renewed focus on efficiencies to maximise resources and a whole system focus is needed to drive real improvement, although this may take time to achieve.

    Our report outlines several recommendations for Welsh Government and for Health Boards, some of which focus on:

    • Preparing a clear national delivery plan
    • Placing significant and constant focus on improving efficiencies and productivity in orthopaedics
    • Putting arrangements in place to monitor people waiting, providing communication, support and advice when needed
    Securing timely treatment for people with orthopaedic problems has been a challenge for the NHS in Wales for many years, with COVID-19 making this significantly worse. It is positive to see that there is a clear commitment to improve orthopaedic services, but urgent action is needed to secure short-term improvements in waiting times to minimise how long people wait in pain and discomfort, as well as creating more sustainable longer-term improvements. Adrian Crompton, Auditor General


    Throughout this press release and our report, we talk about patients waiting for treatment. Our figures are based on NHS Wales’s ‘open’ referral to treatment measure. The measure counts the number of pathways which have started but not yet completed treatment, rather than people. Each pathway represents a patient waiting but patients may have more than one health condition and therefore be on the waiting list more than once. As a result, the total number of people waiting for treatment will be lower than the total number of pathways.


    Related Report

    Orthopaedic Services in Wales – Tackling the Waiting List Backlog

    View more