An Orthopaedic Plan for Wales - Health in Wales

1 An Orthopaedic plan for WalesGetting Wales MovingISBN 0 7504 3469 4 July Crown copyright 2004 Designed by Graphics Unit G/090/04-05 INA-15-02-667 Typesetting by Text Processing Using Our Capacity Our Staff Adding Informing the 135 Membership of the Orthopaedic GroupWelsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for WalesWelsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for Wales1 FOREWORD This plan follows a very extensive analysis of the need fororthopaedic services in Wales . I have adopted the resultsof that analysis and the recommendations flowing from itas the vision for reducing Orthopaedic waiting times andimproving access to trauma and Orthopaedic services forthe people of Wales . This vision is based on partnership:partnership between different organisations in providingtrauma and Orthopaedic care, and partnership in terms of responsibility forachieving the vision and improvement in service to patients.

2 It will involveconcerted and continuous actions across the whole care system, involving LocalHealth Boards and NHS trusts, primary and secondary care professionals,community and rehabilitation services and the Welsh Assembly Government. I am committed to driving down waiting times in Wales , especially fororthopaedic services, where there are still long waiting times in some areas. Wehave made significant improvements in recent years. The number of patientswaiting over 18 months for an Orthopaedic inpatient/daycase operation hasreduced from 1,356 in April 1999 to 9 in April 2004. However, the numbers waitingover 18 months for their first outpatient appointment has risen during this increase is despite the hard work of the NHS and its staff to address thisproblem, and in part reflects the fact that demand for Orthopaedic services iscontinuously increasing.

3 Thus, although we are actively tackling the long waitingtimes, there are still large numbers of people who need to access ourorthopaedic services. Because of my concerns, I commissioned this plan from Health professionals andAssembly officials to advise me of the way forward. The plan has beendeveloped by the Orthopaedic Group, which includes consultants andprofessional advisors. It sets out the steps needed to rebalance our orthopaedicservice in Wales , and I am pleased to receive and endorse the strategic directionand key actions that it a sustainable Orthopaedic service is not confined to adding capacity tomeet growing need. It is also about making better use of the resources that wehave, by improved management, and innovative ways of working that will ensurethat patients are treated by the right professional, in the right place, at the righttime, first time.

4 For the plan to be implemented successfully, a strong partnershipbetween government and the NHS is required. I am therefore expecting healthWelsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for Wales2organisations to take forward their responsibilities to improve and develop theirservices locally, with strong leadership and new ways of working. For my part, I will increase investment for new capacity. I have alreadycommitted substantial investment for South East Wales where the waiting timesare longest. This is part of a phased approach, and further investment will Hutt AMMinister for Health and Social Services Welsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for Wales3 Welsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for plan is not simply about doing more of the same.

5 It is about rethinking theways in which we provide trauma and Orthopaedic services across the whole caresystem, to ensure that we see the right people, in the right place, at the righttime. It is not confined to adding capacity; it is about managing demand andincreasing supply, whilst making full use of all the resources available to improvepatient access. This will ensure sustainable delivery of a high quality and timelyorthopaedics service for improvements have been realised in recent years, and considerableinvestment has been made to impact on long waiting times. Despite theseachievements, currently the system is out of balance. Trauma and orthopaedicdemand is increasing and, in Wales , the activity rates are not keeping pace withcurrent levels of need. The impact of a growing number of elderly people, whoare significant users of trauma and Orthopaedic services, added to the latentdemand, will continue to place increasing pressures on services.

6 Added to this,the impact of emergency trauma on elective Orthopaedic care can cause animbalance in the service when emergency work displaces routine activity/capacity gap in trauma and Orthopaedic services in Wales isevidenced by the long waiting lists. Whilst the NHS, its consultants and otherstaff have done much to address this problem, with a maximum wait of 18 monthsfor an operation now being guaranteed, access rates vary by region and by LocalHealth Board area. There is also variation in the service models in place andexisting levels of capacity in each locality. These variations need to be overcometo ensure optimal services in all localities and equity of patient care. A whole systems approach is critical to the success of this plan , involving allpartners at all levels across primary and secondary care, with the Local HealthBoards playing a pivotal role in commissioning services.

7 All elements of the planare set within the context of the wider strategic change agenda, specifically theemerging Health , Social Care and Well Being strategies, the Wanless action plans and the Health gain targets for plan is based on three cross cutting themes to be applied across the wholesystem. These are: Tighter management processes and good practice; Service improvement and innovation; Adding capacity where necessary, with an associated culture of working indifferent concepts must be applied simultaneously for them to achieve maximumimpact. The themes will need to be addressed at the local level dependent onlocal circumstances, based on the overall direction set out in this this context, the core elements of the plan are: Managing demandPrevention;Point of contact treatment;Alternative referral pathways. Using our capacity efficientlyTrauma management; Waiting list management;Bed management and patient flows;Theatre utilisation; Discharge and rehabilitation.

8 Using our staff effectivelyWorking differently;Extended roles (particularly therapists);General practitioners with a special interest (orthopaedics);Increasing training numbers and skills mix. Adding capacityBuilding upon existing NHS services, using localexpertise where possible;Protected from trauma;Culture of working differently and rethinking care pathway. Informing the processRobust and timely data and management information;Secondary adopting this approach across the whole system, the plan is intended tosecure long term sustainable solutions to meeting current and future levels ofdemand for trauma and Orthopaedic services, and to allow equity of patientaccess. Some aspects have already been actioned in order to make some earlyimpact on identified hot spot areas with long waiting Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for Wales5 Welsh Assembly GovernmentHealth and Social Care DepartmentAn Orthopaedic plan for plan is intended to bring about change: change in the way in which aspectsof trauma and Orthopaedic services are delivered, and change in the time thatpatients have to wait to access these services.

9 Whilst a great deal has beenachieved in recent years, there is more to be done, building upon thesedevelopments. Short-term actions are essential to achieving early gains, whilstlong term approaches will ensure sustainability. All need to be planned from theoutset and implemented incrementally in order to achieve steady and sustainableimprovement. They can only be delivered through common understanding,partnership working and a whole systems approach. They will be delivered at thelocal level dependent on local circumstances, with overarching policy directioncoming from the Welsh Assembly Government. The aim of this plan is to develop a detailed methodology for the delivery of ahigh quality and timely orthopaedics service across Wales , taking into account theimpact of emergency trauma on elective capacity. This includes early actionstowards providing a sustainable service solution, including compliance withnational waiting times targets.

10 The evidence in support of this plan is provided in a separate source document scopes the issues, including the epidemiology and the factorsgoverning demand. Copies of the Orthopaedic plan : Source Document (WelshAssembly Government, 2004) may be obtained from the Waiting Times andEmergency Care Branch of the Welsh Assembly Government and will be available on HOWIS( ).All elements are considered within the context of the wider strategic changeagenda, specifically the emerging Health , Social Care and Well Being strategies,and the Wanless action plans . The plan will also contribute to the achievementof the national Health gain target to reduce the European Age Standardised Ratefor hip fractures in the 75 and over age group by 10 per cent by plan focuses on three themes: that better use should be made of theresources available; that innovation in practice will have a positive impact andshould be encouraged and rewarded; and that where additional capacity isneeded, it must be provided but with an associated culture of working differently.