Overcoming orthopaedic backlogs in NHS Wales with insourcing solutions

With over 764,000 active pathways waiting for treatment in Wales, there is a real focus across the nation on what needs to be done to address the backlogs and ensure patients receive the treatment they require.

Although orthopaedic issues might not be life-threatening for patients, the lengthy waits that patients endure are producing a knock-on effect on their quality of life and mental health.

Factors such as the pandemic, winter pressures and staff shortages are all contributing to an ever-growing backlog, with many health boards focused on quickly reducing waiting lists.

There is still much to be done to tackle NHS Wales’ growing backlogs, and while tackling issues such as staff shortages at the core is imperative, short to medium-term capacity solutions should be considered to boost elective capacity in the interim.

The wait for orthopaedic surgery

Before the pandemic, the number of people on orthopaedic waiting lists was one of the biggest challenges facing NHS Wales. This was partly due to the success of recent orthopaedic procedures and shorter recovery times that resulted in increased awareness and more people keen to undergo them.

With many hospitals stopping their elective capacity altogether during the pandemic, the number of people awaiting orthopaedic procedures has only continued to grow with waiting lists increasing by over 50%. More than half of these patients are waiting over the 26-week target, and over a third are waiting over a year. An article by Audit Wales states that proportionally more than twice as many people are waiting in Wales for orthopaedic services as there are in England.

A recent report from Audit Wales has stressed that it could take three years or more to return waiting lists for orthopaedic services to pre-pandemic levels, and that urgent and sustainable action is needed to tackle the long waiting times.

Orthopaedic Consultant, Chukwuemeka Nnene said: “An additional adverse effect of the prolonged delays is the progression of the arthritic process with resultant loss of mobility, increased frailty and the eventual need for more complex and challenging surgical procedures.”

With the current cost of living crisis, the prospect of private healthcare for orthopaedic surgery is less of an option for many people with treatments costing anything from 10-20 thousand pounds.

In addition to the challenges brought about by the pandemic, service demand for orthopaedics is linked to an ageing population – a trend which is only expected to grow between 2020 and 2032, with the number of people aged 75 and over across Wales forecast to increase by a further 27%. This could create additional strain on a service struggling to recover.

Workforce challenges

According to an article published by Nursing Times at the end of 2023, it is believed there are currently 2,717 nurse vacancies across NHS Wales – a worrying rise of more than 50% compared to the previous year.

Staff shortages in NHS Wales aren’t just within nursing, with a BBC article from December 2022 stating that ‘workforce numbers might suggest all is well, but many staff are no longer working full time’.

Across surgery, theatre workforce capacity is one of the biggest factors that can help influence waiting lists.

When it comes to surgical backlogs, the less complex surgeries, such as cataract surgery which takes 30-45 minutes to perform, are often prioritised over the more complex surgeries, such as hip replacements which can take up to two hours.

The procedures which take longer to perform and aren’t life-threatening, such as those relating to orthopaedics, are frequently being pushed down the priority list as a result due to workforce capacity.

Through insourcing, highly skilled staff and teams can be mobilised with proper preparation, training, and equipment to provide services within the health board’s registration framework. This approach offers an extra advantage: as immediate capacity requirements are met in the short to medium term, the health board’s core team can dedicate their efforts to long-term recruitment strategies and enhancing the retention and skill levels of their current workforce.

Collaboration between NHS health boards and independent insourcing providers could be the key to relieving workforce challenges and reducing waiting lists. This in turn will help to improve patient outcomes and ensure that more patients are receiving the orthopaedic treatment they need to enhance their quality of life.

To find out more about our insourcing services, visit: xylaelectivecare.com/our-services

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