Herald on Sunday letters: NHS orthopaedics backlog is a crisis that needs urgent and decisive action

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 a 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 per cent 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.

STOP DEVALUING OUR EDUCATION SYSTEM

AS the dust begins to settle on the diplomatic but scathing OECD report, there seems to be emerging a suggestion that the Government could dispense with external examinations.

If that does not give immediate cause for alarm, it certainly calls for a pause for serious thought.

What credibility would an internally assessed system carry with receiving institutions and employers without the quality control derived from the validation provided by an external examination authority, applying national standards under recognised criteria?

Qualifications obtained on the basis of internal assessment alone would be suspect in the eyes of those looking for suitable students or employees to take up the opportunities on offer in their respective areas.

External exams adjudicated under national standards by outside markers are the internationally accepted medium through which the proficiency of the individual can be measured and established in the mastery and understanding of any subject, invigilated by outside personnel, so that the individual has to rely entirely upon the personal resources held within the mind without having access to support for advice to guide the examinee through the test on the table.

Working under the pressure of time constraints, grasping what the questions demand, quickness of thought and expressing the answers in satisfactorily coherent and succinct form, are the four elements which are being tested in external exams, the results of which then command approval from those who rely upon the nationally recognised certificates for the selection of candidates for their particular purposes.

I would hope that our Government is not in the market for devaluing our education system any further after the last 10 years of confusion.

Denis Bruce, Bishopbriggs.

MANCHESTER BAN IS OUT OF ORDER

I READ with interest and then astonishment the news that Ms Sturgeon has put a ban on visiting Manchester unless essential ("Burnham hits out at Sturgeon over travel ban", June 20).

At first I did not believe the statement but in reality, am not surprised that this woman had the audacity to make such a pompous statement.

We are all part of the same country. No one person, whether they be a politician or not has the right to tell any of us where not to go without a very good reason.

The same First Minister did not prohibit the Scottish football team and thousands of fans travelling to London for the European Championships. What is the difference between the two? Maybe because of the possibility of boasting that the Scottish team could beat England, which they did not do, and have not done for several years.

It is time the First Minister and her team started acting like grown-ups and realised that people in England are exactly the same as the ones in Scotland. We are all human and just as vulnerable to catching Covid-19. There is no boundary apart from the sea. Hopefully, Ms Sturgeon will not prohibit us from travelling by boat to Manchester.

I applaud Andy Burnham and hope that he receives an apology from the First Minister of Scotland for her slight on the city that he proudly represents. He did not deserve that stinging outburst.

Valerie Stewart, East Kilbride.

ZERO SUCCESS FOR THE SNP

NICOLA Sturgeon used to like the word "zero". Zero emissions, zero tolerance of hate crimes, zero low alcohol prices, zero attainment gap and so on. Now, however, her policy on coronavirus has registered a zero too.

The lure of the Scottish team being in the Euro 2020 finals at Hampden was just too great a prize to ignore. The result has been unfortunately not just a zero for the national team to progress to the next round for the first time, it has been a zero for the Health Secretary, who ignored the warnings over fan zones, pub opening times and more and turned a blind eye to 20,000 fans descending on Wembley when only 2,500 had tickets.

The resulting huge spike in Covid infections has been pinned on fans meeting indoors. This explanation gets a zero too as it is simply the SNP's attempt to deflect the blame from its own actions. The SNP mantra: if it is going well it's all down to us, if it is going badly it is always someone else's fault.

Dr Gerald Edwards Glasgow.

IS JOHNSON NEAR TO BEING BOOED OFF?

I WISH to thank Rab McNeil for his piece on Flower of Scotland ("What a weird country we are: Even the national anthem divides us", June 20). Perhaps we should console ourselves in the wake of honourable defeat to Croatia with the thought that Boris Johnson may be approaching his Harry Kane moment sooner than we think. When will his own supporters boo him off the pitch?

And Michael Gove – an Aberdonian who made a career sitting for a seat in Surrey: should we take any notice of his views on the timing of a Scottish referendum? His voters probably don't care that much, and if he lives in his constituency, he won't even have a vote himself.

Norrie Forrest, Kincardine.

WHY I'LL BE BACKING CASH

YOUR report outlining the drive towards a coinless society ("New trial to test a ‘coinless’ Scotland angers fundraisers and the homeless", June 20) leaves more questions than answers.

Doubtless while charities and homeless people will be disadvantaged by the move, card companies will be laughing all the way to the bank.

It may be easier to use a debit or credit card in a shop but the financial circumstances of some less well off people could make them ineligible for a card or even a bank account. Additionally a £100 contactless limit on a card may entice some to go beyond their means and lead to debt.

I think there is still room for a dual system and we shouldn't jump headlong into banishing coins. I, for one, have resolved to continue using cash at every opportunity in an effort to preserve this facility and manage my finances in the best way possible.

Bob MacDougall, Kippen.

* WHILST reading about the coinless trial, my first thought was “What an utterly stupid idea” and the more I thought about it, the more ridiculous it seemed. How many millions of people give their children a few pennies to buy a packet of crisps or a carton of juice on their way to school? What would happen if we were coinless? Would children have to carry a debit card?
Why don’t the pen pushers just leave thing as they are? We have managed perfectly well up to now. If it ain’t broke don’t fix it.
Eleanor Andersen, Larkhall.