EVERY hospital in Scotland has been ordered to re-think the way they look after patients with broken bones and worn joints amid fears waiting times for common operations will soar in the next five years.

Experts are recommending operating on more people in a day, discharging patients more swiftly and centralising some services after touring the country and drawing up a plan to increase capacity and improve care.

Their report highlights a range of issues with the way orthopaedic services currently work including equipment problems, staff shortages and wide variations in the way patients are looked after in different areas.

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The report says: "The reliable supply of sterile, complete and functioning equipment is a big issue at a number of hospitals leading to delays and cancellations and should be addressed urgently."

Issues with the recruitment and sickness absence of theatre staff are described as "acute in several health boards".

Concern is also raised that some surgeons are carrying out small numbers of complex operations - less than five a year - and it has been recommended that departments carry out a ‘family and friends’ test where they consider if they would be happy for their own relations to be treated by these consultants.


Orthopaedic surgeon Dr Colin Howie, clinical leader for the report, said: "We need to build an NHS for the future not repeat the errors of the past.

"In many areas in Scotland orthopaedic surgeons are redesigning services and improving the way patients are looked after.

"There are already many good examples of this, just not everywhere in Scotland.

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"There have been many reports in the past, most of which have been consigned to the dustbins of history without action.

"Managers and colleagues should support this radical clinical-led plan to improve quality and efficiency throughout Scotland."

The report, which has not been publicised, was commissioned by John Connaghan, chief operating officer of NHS Scotland. Mr Howie, past president of the British Orthopaedic Association, and Professor Tim Briggs, a leading surgeon and director of quality and efficiency for the department of health in England visited every acute hospital in Scotland gathering information for the project.


The work was commissioned at a time when the queue of patients waiting longer than 18 weeks for treatment in Scotland is rising steadily and it is understood there is concern the situation will be even worse by the next election without rapid action.

The report notes the number of people over the age of 65 in Scotland is expected to increase 59 per cent in the next 14 years and demand on fracture services will increase as more people with weakened bones suffer breaks and "baby boomers" refuse to "accept the limitations of arthritic joints".

In a foreward, signed by Mr Connaghan, the report says "to achieve quality improvements and efficiencies in delivery, many services and pathways will require to be redesigned..."

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Advances in treatment - which mean more highly technical procedures are on offer - have not been matched by changes in the way services are delivered, according to the report. It says"...in a number of regions the provision of a full service at all hospitals with an orthopaedic unit has led to inefficient use of resource, with units struggling to provide quality care and failing to attract and retain staff of all grades."

Moves are currently being made to centralise emergency fracture services in NHS Lanarkshire and questions have also been raised about the pattern of services in NHS Ayrshire and Arran.

The report, called Addressing Core Capacity Everywhere in Scotland Sustainably, found that up to half the orthopaedic consultants appointed in Scotland in the last five years have already left their jobs – with 13 out of 16 leaving the country.

It highlights wide variation in the length of time patients spend in hospital after hip fractures, with some sites discharging 80 per cent within 30 days but others as few as 30 per cent.

It also suggests shortening the time joint replacement patients spend recovering in hospital as a way to free-up beds.

In addition the report notes that if more operating theatres could turn around four joint replacements in a day, instead of three, it would help reduce waiting lists and recommends visiting units in England which manage five such procedures in a day.

Every orthopaedic department in Scotland has been asked to draw up an action plan by the experts behind the report and update it based on their findings.

A Scottish Government spokesperson said: “This report recognises the considerable progress that has been made in improving the quality of trauma and orthopaedic services across Scotland over the last ten years, however we recognise there is more to do.

“The findings from this report will feed into the work already underway, through our National Clinical Strategy, to improve treatment for all patients, particularly around ensuring that where possible, patients are treated as close to home as possible.

“In addition, we have committed to investing £200m in a new elective care strategy, which includes five new elective centres to help cope with increased demand, and will include orthopaedic services. And we are committed to creating a major trauma network over the lifetime of this Parliament, utilising sites in Aberdeen, Dundee, Edinburgh and Glasgow.”