PATIENTS referred for hip and knee replacements in Ayrshire will wait nearly twice as long for the operation if they live in the north, according to figures leaked to the Herald.

In the past three years, patients sent to Crosshouse hospital in Kilmarnock have waited an average of 143 days - around five months - for a hip replacement, and 153 days for a knee replacement.

In comparison, patients undergoing the surgeries at University Hospital Ayr waited an average of 82 days for both operations, just within the Scottish Government's 12 week waiting time guarantee.

Former clinical director at NHS Ayrshire and Arran, Dr Gavin Tait, said it was unfair that patients should have to wait longer for pain relieving elective surgery due to a "postcode lottery" within the same health board region.

Dr Tait, who worked as a consultant orthopaedic surgeon Crosshouse hospital for nearly 30 years until his retirement in 2016, said doctors at Crosshouse had repeatedly warned that planned operations were being delayed too often as a result of emergency orthopaedic admissions, such as car crash victims with multiple fractures or elderly people who broken hips from a fall.

These types of trauma patients are only handled in Crosshouse, not Ayr, but both hospitals currently provide elective orthopaedic surgery.

CASE STUDY: 'If I waited for the surgery at Crosshouse I'd be waiting a full year'


Dr Tait, who obtained the waiting time averages under freedom of information, said it was out of step with Scottish Government instructions that where a health board has two hospitals, one should specialise in trauma cases and the other in elective surgeries - such as planned hip and knee replacements.

Dr Tait said: "The figures show quite clearly that if you live in the north you get a worse deal than if you live in the south, and it's not fair really.

"Crosshouse takes most of the trauma and all of the paediatric stuff that doesn't get sent to the Royal Hospital for Children [in Glasgow].

"That doesn't happen in Ayr - they don't get trauma or paediatrics.

"So quite regularly what would happen [at Crosshouse] is that an elective list would be cancelled because they needed to use the theatre to fix broken hips, and the elective hip and knee operations are just postponed and postponed.

"You could understand if it was separate health boards, but to have a postcode lottery within the same health board seems a bit off."

Dr Tait said surgeons felt there was an agenda to keep waiting times compliant at Ayr to the detriment of Crosshouse.

He said: "There is a feeling that they want to have at least one hospital on target, and it's Ayr. But the waiting times at Crosshouse are a dead loss because once someone breaches the waiting times guarantee, they don't have a guarantee after that and no effort is made to match them.

"People can languish for ages after that because there is no pressure to get them done."

READ MORE: One in three patients waiting longer than 18 weeks for hip replacement

He said doctors had encouraged health board bosses to look into buying the Carrick Glen private hospital as way to drive down waiting times in Ayrshire. The BMI-owned facility is a stone's throw from Ayr hospital with 22 beds and an operating theatre.

"Add on another theatre and you could have eight operations a day, 40 a week," said Dr Tait. "If they did that they could clear the waiting lists in a year and a half. But they refused to do that."

Some health boards, including NHS A&A, can ease waiting times by sending a certain number of orthopaedic patients each year to the NHS Golden Jubilee hospital in Clydebank, which specialises in elective work.

Quotas are quickly used up, however, leaving patients facing long waits or being sent to the private sector instead.

Figures obtained by the Herald earlier this year revealed that nearly one in three patients in Scotland was waiting longer than 18 weeks - the standard referral-to-treatment target - for a hip replacement.

NHS Fife, Forth Valley, Borders and Western Isles spent £321,700 in 2018/19 to send 46 patients for hip replacements in the private sector.

However, other health boards - including NHS Grampian, Tayside and Grater Glasgow and Clyde - did not fund any private operations, despite hundreds of patients facing excessive delays.

Pressure on orthopaedics has exploded as Scotland's population ages.

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

At the end of December 2018, there were 107 patients in Scotland who had been waiting over a year for various day case and inpatient orthopaedic procedures.

READ MORE: Seven months and counting on hip replacement waiting list 

A spokeswoman for NHS A&A said it is "aware of challenges in meeting our orthopaedic waiting times and we are currently reviewing our model of care for orthopaedic services".

She added: We recognise that separating emergency inpatient services from elective inpatient services may result in improvements in care for patients requiring either emergency or elective services."

A Scottish Government spokeswoman said: “We understand that NHS Ayrshire and Arran are reviewing their orthopaedic services to ensure that they can deliver the best care for their patients.

“We are supporting the health board to improve services across a number of specialities, including trauma and orthopaedics, through the £850 million Waiting Times Improvement Plan, with NHS Ayrshire and Arran receiving more than £7 million this year.”