Hip replacement delays on NHS Scotland mean one in three patients now waiting too long

Of those, 725 - or nearly one in three - have been waiting longer than 18 weeks, the NHS referral to treatment guideline for planned operations.

It is also a significant breach of the Scottish Government's own flagship 12-week 'treatment time guarantee', introduced in 2011, which is supposed to give patients a legal right to inpatient and day case treatments within 12 weeks.

Case Study: Seven months and counting - 'I'm having to do less and less, it's so painful'

Eva Arrighi has been waiting seven months for a hip replacement

In NHS Greater Glasgow and Clyde (NHS GGC), which was forced to cancel hundreds of planned operations at the end of 2018 after inspectors temporarily closed the sterilisation unit where surgical instruments are cleaned, 489 of the1202 patients currently on the list for a hip replacement - or two in five - have been waiting more than four and a half months.

A spokesman for NHS GGC said: "Orthopaedic waiting times currently represent a significant challenge both for us and across NHS Scotland.

"The Service teams are working as flexibly as possible to try and maintain prompt access for all patients.

"Work to maximise productivity across the service is ongoing and a number of improvement actions have been implemented to ensure the waiting list is robustly managed and all capacity is fully utilised."

He added that the health board made full use of its share of referrals to the NHS National Waiting Times Centre at the Golden Jubilee hospital in Clydebank, and that one-off funding had also been invested to increase surgeries within NHS GGC.

He said: "A number of additional sessions have been implemented this year in evenings and at weekends, patients with the highest clinical priority and patients with the longest waiting time are prioritised for these additional sessions."

Read more: Operations cancelled as Glasgow's sterilisation is temporarily shut down by inspectors 

Some health boards - NHS Fife, Forth Valley, Borders and Western Isles - have turned to the private sector to speed up turnaround times, spending £321,700 combined in the current financial year to enable 46 patients to undergo the operation privately.

Use of the independent sector varies widely, however. NHS Borders - where no patients are currently exceeding the 18-week benchmark - has spent £180,000 sending 24 patients for hip replacements in the private sector.

A spokeswoman for NHS Borders said high demand for acute beds from very sick patients between December 2017 and May 2018 had led to some elective operations, including hip replacements, being postponed.

It had turned to independent providers to clear the backlog, she added.

She said: “Our access policy aims to ensure that, where possible, no patient waits over 12 weeks and by the end of March 2019 we expect to meet this target for our orthopaedic inpatients.

To achieve this, we have had additional Scottish Government funding specifically aimed at reducing waiting times to utilise extra capacity in the system through available private providers when necessary.”

Read more: Agony for schoolgirl as health board axes all tonsillectomies amid surgical instrument shortage 

In contrast, larger health boards such as NHS Grampian and Tayside - which each have 85 patients currently on their waiting list for a hip replacement who have been waiting more than 18 weeks - have not paid for any patients to have the operation privately.

NHS GGC is also among the boards not to have used the private sector.

The total number of first-time hip replacements - including emergency surgeries - carried out on the NHS in Scotland has increased by 85 per cent, from 4219 in 2001 to 7786 in 2017.

Although obesity has been a factor in leading patients to require knee replacements earlier in life, the average age for a first hip replacement in Scotland has remained unchanged over the period at 67.

This suggests that the ageing population is the key reason behind growing demand.

Osteoarthritis accounts for 87% of first-time hip replacements in Scotland, followed by fractures.

Professor Derek Bell, President of the Royal College of Physicians of Edinburgh said: “Patients waiting for hip replacement surgery are often elderly and sometimes frail.

"Any delays to surgical intervention could have a detrimental impact on quality of care and patient experience.”

It comes as figures disclosed in a letter to Labour MSP and former Shadow Health Secretary, Neil Findlay, reveal that 107 patients had been waiting over a year for various day case and inpatient orthopaedic procedures as of December 31 2018.

This included 45 patients from NHS Highland and 21 from NHS Tayside.

The breakdown was detailed in a letter to Mr Findlay from Health Secretary Jeane Freeman.

Mr Findlay said: “More than 100 people had to wait over a year to get the procedure they need. That is simply not acceptable in any circumstance.”

A spokeswoman for the Scottish Government conceded that some patients "are waiting too long", but stressed that its £850 million Waiting Times Improvement Plan would "substantially, sustainably and progressively improving waiting times by Spring 2021". 

The investment will help fund extra staff, hospital capacity, equipment and additional clinics at evenings and weekends. 

She added: "NHS investment and staffing are at record high levels in Scotland, and the record high inpatient satisfaction rates are a testament to the hard work of our frontline NHS staff.

"Since the introduction of our treatment time guarantee, more than 1.7 million inpatients and day cases have benefitted – with 90% seen within the 12 week target."