Published: 12/08/2004, Volume II4, No. 5918 Page 7

Troubleshooters are being sent into 40 trusts at risk of missing crucial inpatient waiting targets because they have too many people waiting for orthopaedic surgery.

The Department of Health national orthopaedic project has identified 40 trusts it believes will struggle to meet the December 2005 six-month inpatient target.

Progress against this target is seen as crucial to the government's election strategy.

So far the project has sent teams into nine trusts to establish the scale of the problem and help draw up plans to meet the target.

Project lead Matthew Kershaw said there was 'a lot more work to do'. And he admitted that orthopaedics remained 'a very significant challenge'.

The project is working with the British Orthopaedic Association to address the difficulties in orthopaedics, which are rooted in a lack of surgeons and operating facilities.

In December 2003, a DoH report on progress towards the target warned that 'even after the focused efforts of several programmes orthopaedics still has by far the largest number of six (plus) month waiters compared to other specialties...the majority of trusts have a clearance time for orthopaedics greater than six months'.

The report was explicit about the threat to the 2005 target: with a year to go, several trusts had 'clearance times of nearly 12 months and are very unlikely to hit the target without extra help'.

And it warned that 'with the current number of waiters even if all the orthopaedic activity in the country was perfectly matched to demand and the queues were treated in strict chronological order it would not be possible to meet the six-month targets at current levels of activity'.

It also urged the national orthopaedic project to make 'rapid progress'on a 'new operating model for orthopaedics' as part of its orthopaedic review strategy. Since then the project has been embarking on troubleshooting visits.

Mr Kershaw said other central initiatives to tackle the problem included collecting monthly return data from SHAs to monitor the number of waiters; ensuring policy drivers such as patient choice, independent treatment centres and funding flows helped reduce the problem; and attempts to increasing awareness in the NHS on the size of the challenge.

Chris Linacre, director of service development at Sheffield Teaching Hospitals trust, one of those 'at risk', said that although the project had given the trust some help, it had been asked to give 'hard reassurances that the workload and lists will be met'.

One director of service development at another high-risk trust visited by the project said:

'Politically the trust will meet the target'. But she admitted this was likely to mean using capacity from other trusts, and running up a financial deficit in order to do so.

When the progress report was compiled in December, DoH director of programmes and performance Duncan Selbie and director of access Margaret Edwards wrote to strategic health authority chief executives warning them that the total number of six-month waiters needed to be reduced by 80 per cent by March 2005, from a March 2002 baseline of 65,000 patients.

Latest published figures for January-March 2004 show that there are just under 36,000 patients waiting over six months:

this needs to be reduced to approximately 13,000 by March 2005 to be on track for December success. This week Mr Kershaw confirmed the biggest risk to this target remained orthopaedic waits.

Mr Kershaw said all SHAs are now submitting a detailed position statement showing 'on a monthly trajectory basis, plans and the deliverability of plans to meet the target'.