Some patients in Powys are waiting for over five years for back surgery

Waiting list issues at the Robert Jones and Agnes Hunt (RJAH) orthopaedic hospital in Gobowen, near Oswestry in Shropshire, were highlighted at a Powys Teaching Health Board (PTHB) board meeting on Wednesday, January 28.

During discussion of PTHB’s performance report from November, Independent member flagged Mick Giannasi up the issues at RJAG as a performance “outlier.”

Mr Giannasi said: “My eye was particularly drawn to the spinal treatment waits at RJAH exceeding 300 weeks.

“It actually sound worse when you describe it as over five years.

“I appreciate the numbers involved are probably very small, but a wait of that length is clearly far beyond what could be considered acceptable even in the current context we’re operating.

“Are there any levers we can apply, what triggers more robust action?”

He wondered whether PTHB were looking at using alternative providers or using the private sector instead of RJAH.

Mr Giannasi continued “Not to put too blunt a point on it, in our private lives all of us if we had a service provider unable to deliver to an acceptable standard we would change that service provider.”

He also asked what support PTHB was offering to patients who were on this waiting list, both clinically and in terms of communication and wellbeing.

PTHB’s Executive Director for Planning, Performance and Commissioning Nicola Johnson said: “We have raised it with Welsh Government to see if there’s any possibility of mutual aid or provision within Wales.

“Unfortunately, the main provider in Wales has very similar issues and the feedback we’ve had is that it’s probably not available.”

She added that talks had also taken place to move their patients to another provider in England.

Ms Johnson said: “Again the feedback is that the capacity is not here and there are very few providers with that type of care – and it’s generally not suitable for private provision because of the risk to the patient.”

She believed this would need to be discussed again in more detail by the board after work had been done to work through all of the options and make choices.

Ms Johnson said: “They (RJAH) need to be able to rebalance how they are deploying their theatre capacity between the moderate and very complex ones.”

Executive Director of Primary Community Care and Mental Health Elaine Lorton added that PTHB does have a service which contacts those on the waiting list to provide “advice and guidance.”

She added that she would double check whether they had been in touch with this cohort of patients.

Board Chairman Carl Cooper asked whether the Finance and Performance committee could take the issue on board.

Independent board member and Finance and Performance committee Chairman Ronnie Alexander said he was happy to do this.

He pointed out that the report indicates that RJAH have some sort of recovery plan in place and wanted details of this.

Ms Johnson said: “It’s an important part of our commissioning plan for next year to have a look at what that provider (RJAH) is offering for our population and our options.”

The board agreed the moves and if any escalation is needed – the committee will bring the issue will back to the board.

The report to the board said: “The Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) remains the most challenged English provider for long waits with a growing trend of over 104-week waiters and with all key wait bands reporting special cause concern.

“RJAH continue to face challenges with regards to their capacity and ability to see all patients within the Welsh Government targets.”

The report added the number of breaches of the 104-week target had now gone up to 128.

The report said: “The breaches comprise of treatment waits for spinal, arthroplasty, knee and sports injuries and foot and ankle care.

“Very long waits now exceed 300 weeks for complex spinal surgery.

“The issue has been escalated to the provider, and a recovery plan has been requested against the agreed targets agreed.”