The NHS orthopaedics backlog is a crisis that needs immediate and decisive action. Why must we spend another six years in pain?

UNFORTUNATELY, your very welcome NHS feature (“Medics express alarm at ‘full and bursting’ Scots hospital wards”, June 21) was barely able to scratch the surface of our current NHS emergency. Recent Public Health Scotland data showed 28,203 patients on an NHS waiting list for at least a year at the end of March, up 86.4 per cent from December 2020.

Yet this overall figure conceals an even worse position for chronically under-resourced areas like orthopaedics. Covid added to pre-existing shortcomings, creating a situation that can only be seen as a national disgrace.

More than 20% of people will suffer from arthritis, and in Scotland we currently need more than 17,000 hip and knee replacements annually, notwithstanding Scotland’s ageing population.

The 2011 Patient Rights legal commitment that “95% of patients should receive an outpatient appointment within 12 weeks; 100% of patients should receive their treatment within 12 weeks” was a lame joke as far as orthopaedics is concerned, long before the pandemic.

Arthritis needing surgery is most definitely not a “benign” condition. EQ-5D – the widely-used system which evaluates general quality of life – describes between 12% and 20% of patients awaiting hip and knee replacements as living in a health state “worse than death”. You go to bed in pain, you wake up in pain.

As of December 2018, almost 40% of the orthopaedics list had been waiting more than 18 weeks for a hip replacement in NHS Greater Glasgow and Clyde alone. In May 2019, one-third had been waiting longer than 18 weeks.

A prominent orthopaedics surgeon stated last year: “The Government will always deny the figures but the average waiting time for orthopaedic surgery around Scotland is between nine months and a year.” In my experience he is understating the situation. My latest estimate is for another three to four years’ wait, after a first GP referral nine years ago.

Recent research concludes that the very best case scenario is of a four-year timescale to break even, if all Scottish orthopaedic facilities worked at 12% of pre-Covid levels – but national hip and knee arthroplasty has averaged only 40% to 50% of “normal” since services restarted.

Pre-pandemic there were about 7,000 knee replacement and 7,500 hip replacement operations annually. This is reported as being 85% of capacity. As of post-Covid resumption, there have been 2,800 knee and 3,500 hip procedures (annualised rate).

For every month working at the current level, it will take an additional three to four months working at 120% to reduce the deficit. Every three months’ vacillation now adds another year of catch-up to resolve the backlog.

Asked about orthopaedic backlogs in February, Nicola Sturgeon stated: “I don’t want anybody to be waiting anything like six years for a knee replacement or any other operation.”

For the sakes of thousands of arthritis sufferers – Ms Sturgeon, do something. Your regular and repeated apologies are simply not good enough. We need catch-up not mitigation. This is a crisis needing immediate, decisive action – or the six-year wait will be the absolute minimum for many.

Tony Philpin, Isle of Gigha, Argyll & Bute.