Bold action is urgently needed on waiting times
THE BBC programme highlighting the physical and emotional pain of patients on the apparently never ending NHS waiting list for surgery contained an interview with the recently appointed Health Secretary Jeanne Freeman. To her credit, for the first time an SNP minister admitted that the present situation was unacceptable, and that it was her and the Government’s responsibility to resolve; no more claims of “but it is worse in England”.
Apparently there is a plan, costing £800 million over three years, that will solve the problem. As a recently retired consultant orthopaedic surgeon and former clinical director who struggled to reduce waiting times, I must ask: what is the plan? I know all the tricks tried in the past but we remain were we are, and waiting times continue to lengthen.
Long waiting lists for orthopaedic surgery have been extant for decades and the usual response has been to throw money at the private sector, which has never worked. Doctors doing that work are not at their NHS duties, often as there are no resources there.
The Golden Jubilee is very effective as an orthopaedic factory performing a limited range of repeated operations well, protected from the normal load of emergency patients in surgery and medicine, and no A&E. It is a success and a model for the future, but I am aware the pressures are telling on the staff even there.
Nothing has been heard of a vaunted £200m plan for four or five other such centres, possibly because the orthopaedic establishment knows there are not enough surgeons, theatre staff, anaesthetists, nurses, or physiotherapists on the NHS to staff these new units. From where are they to come, when Scottish doctors are leaving the NHS, as may many EU doctors?
Furthermore, to clear a backlog of nine to12 months the NHS would have to double the productivity over a one to two-year period, just to get back to normal guaranteed times; that is, clear the waiting list while dealing with all the new presentations.
Repeating the same actions, which do not work, is a sign of madness. I can only hope Mrs Freeman has a new plan or she will be out of a job in three years. Without radical changes in the way NHS services are provided – separating elective surgery from acute hospitals, training more staff, rationalising the types of operations performed and embracing day surgery over in-patient stay – matters will not improve. Blocking of surgical beds for two to three months every winter with acutely ill medical patients rapidly reverses reduced waiting times, notwithstanding the loss of training opportunities for young surgeons.
I would be the first to welcome a time when no one waited for a hip replacement. I spent my career trying to make it so. It is one of the best and most effective life changing operations we do. I know the orthopaedic community is of a like mind, but we need to know Ms Freeman’s plan in detail, and to know she will have the courage to face down political and occasional medical resistance to changes in practice, for the good of all.
Gavin R Tait FRCSED,
37 Fairlie, East Kilbride.