Patients could face seven-year wait for orthopaedic operations, study suggests

Orthopaedic patients could face a seven-year wait in one of Scotland’s health board areas if surgical rates do not increase, according to research.

The study, from the University of Aberdeen, also said the average wait across the country will climb to more than two years and three months if the current pace of operations being carried out persists.

The predictions are based on orthopaedic patients listed in July this year.

Luke Farrow, clinical research fellow at the University of Aberdeen, was one of the authors of the study which aimed to determine the mismatch between current supply and demand, and assess the feasibility of the Scottish Government target of one-year wait time by 2024.

The team calculated four possible different scenarios, ranging from “worst-case scenario”, where activity remains at current levels for the foreseeable future, to “best-case scenario”, where activity returns to pre-pandemic volumes by November 2022, bolstered by proposals for the National Treatment Centre (NTC) programme.

The NCT project is an investment by the Scottish Government to support a national network of purpose-built healthcare facilities across Scotland for planned and diagnostic care, with four set to open in 2023.

According to the study, there would be significant variation in waiting times between health board areas if the surgical rate remained the same as it is now, with an almost six-year difference in potential waits.

The figures showed orthopaedic patients in NHS Highland are predicted to wait up to seven years for an operation in the worst case scenario.

The research also showed the extensive challenges in meeting the current Scottish Government targets, with an immediate “more than doubling” of current activity required to achieve a one-year wait by September 2024.

Scotland-wide averages determine that in the “best-case scenario”, the average predicted wait across Scotland for a patient listed for surgery in July 2022 would be almost one year and four months, compared to more than two years and three months for the “worst-case scenario”.

Authors of the study said the backlog of patients waiting for orthopaedic surgery has accumulated since the cessation of routine surgical activity during the pandemic.

Farrow said: “Our key findings suggest that there is a significant, current, annual case deficit that will not be resolved even in best-case scenario conditions, which specify a return to pre-pandemic activity coupled with a 22% uplift in capacity should the full additional planned National Treatment Centres’ capability be applied.

“Waiting lists are therefore anticipated to continue to grow annually, further adding to the significant backlog already present.”

He said current admissions for routine treatment are only just over half (52.2%) of what they were in 2019, adding: “So a return to a pre-pandemic level of operative output will require a significant change from current practice, with return of core operative capacity that has been significantly curtailed by financial limitations, staffing shortages, access to private healthcare infrastructure, and urgent-care pressures.”

This, the authors say, is even before consideration of increased future demand for hip and knee arthroplasty services which anticipate a rise from pre-Covid levels by up to 28% and 34% in 2038 respectively.

Mr Farrow added: “Prolonged waits for certain orthopaedic procedures can have a major negative impact on patient health.”

A Scottish Government spokesperson said: “We introduced ambitious targets in July for NHS Scotland to address the backlog of planned care, undoubtedly exacerbated by the pandemic. We are working with NHS Boards to maximise capacity to meet these targets and recognise the impact long waiting times can have on patients.

“Since the introduction of the targets, the latest statistical data shows progress on tackling the long waits continues, with almost 53,500 patients seen in the quarter to the end of September – the highest number in one quarter since the start of the pandemic.

“We have four National Treatment Centres due to open over the next year: NHS Fife, NHS Forth Valley, NHS Highland and the second phase of the NHS Golden Jubilee. These four centres will over provide over 12,250 additional procedures, the majority of which will be in orthopaedics.”

The calculations were made using publicly available data from Public Health Scotland and based on the previous year’s activity for routine orthopaedic surgery, the number of currently waiting patients as of June 2022 and the number of patients added to the waiting list over one year.

The figures also account for potential changes in future operative activity, for example additional capacity provided through the proposed launch of National Treatment Centres in 2023.