Hywel Dda Health Board plan to halt some elective orthopaedic surgery

Bronglais Hospital in Aberystwyth Bronglais Hospital is already cancelling operations due to staff shortages

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Health chiefs plan to halt some non-urgent surgery at four major hospitals in mid and west Wales over the winter.

Hywel Dda Health Board said it would not carry out some elective orthopaedic operations like hip and knee replacements while it dealt with increased pressure on services.

Hospitals in Carmarthen, Haverfordwest, Llanelli and Aberystwyth are affected.

The health service union Unison criticised the move saying it would result in longer delays for patients.

The health board said if the plans were backed it would review its proposals at the West Wales General, Withybush, Prince Philip, Llanelli and Bronglais, Aberystwyth hospitals "towards the end of the winter surge".

Dr Phil Kloer said emergency cases and operations already booked would go ahead

But Unison claims the board is cancelling all non-urgent orthopaedic surgery until April 2014.

Dr Phil Kloer, director of clinical services at Hywel Dda, told BBC Wales that emergency cases and people already booked for elective orthopaedic surgery would not be affected, but the four hospitals would take no new elective surgeries from November.

Earlier, he said: "In past years, there have been too many operations cancelled at the last minute due to emergency admissions.

"In previous winters, we had up to 160 additional beds in place often being managed by temporary staff. This is not a position we can sustain this year."

THE HEALTH BOARD'S PLANS INCLUDE

  • Using theatres for those with the highest clinical need
  • Reviewing and re-profiling patients on orthopaedic waiting lists
  • Increasing day surgery cases
  • Maximising alternative non-surgical treatment methods
  • Undertaking work in outpatients to monitor patients on surgical lists
  • Monitoring the position on a weekly basis and reviewing the position towards the end of the winter surge
  • A non-emergency surgical shutdown for two weeks over Christmas
  • Source: Hywel Dda Health Board

"To address this, we propose to manage our bed stock and elective surgical lists in a better way during the busiest months this winter to ensure we have the staff capacity to manage emergencies and the most urgent patients.

"We would like to reassure patients that if they have an urgent clinical need they will be seen. Emergency and cancer procedures, the vast majority of orthopaedic day surgery and other elective procedures will also continue."

'Distress'

The health board said people on a waiting list for surgery who had not been given a date for their operation might be offered another form of treatment or day surgery, depending on how urgent their situation was.

Unison branch chairwoman Wendy Evans said: "The health board already has a waiting time of 15 months for patients awaiting orthopaedic surgery.

"This will clearly add at least another five to six months to their waiting time, causing further distress and possibly further complications to their condition."

A Welsh government spokesperson said: "We have been reassured by Hywel Dda Health Board that, at this stage, it is simply exploring options to ensure it is best placed to respond to demands on emergency care services this winter.

Analysis

Unison's claim that planned orthopaedic operations will be cancelled at all four of Hywel Dda's general hospitals until April has caused a great deal of confusion.

Was the decision set in stone? Or was it a plan to be put in place if the hospitals found themselves struggling to cope due to winter pressures?

The health board has attempted to clarify the situation. People already booked for elective surgery or emergencies won't be affected. But they'll take in no new planned orthopaedic surgery cases from November. However the situation will be reviewed week by week.

The aim apparently is to plan ahead - to minimise the distress caused in previous years, when operations had to be postponed at short notice when there was a surge in demand for emergency care.

But the Welsh government insists it has been working with all health boards to make sure hospitals have plans to cope if this winter turns out to be as busy as the last one.

What's obvious from today's announcement is that managers at Hywel Dda don't think they will be able to maintain the normal level of non-urgent care this winter.

The question patients facing longer waits will be asking is 'why not?'

"One option involves proposals to re-schedule some planned orthopaedic surgery, so it has the capacity minimise the distress caused by last-minute cancellations. We are assured that all urgent, cancer and day surgery would continue.

"The health board will give careful consideration to this proposed option and discuss it widely with staff and stakeholders before any final decision is taken."

However, the Welsh Conservatives' health spokesman Darren Millar said the decision had been forced upon the health board by "Labour's inability to recruit permanent staff and properly invest in the health service".

He added: "Carwyn Jones's legacy of health budget cuts continues to heap untold pressures on frontline staff and - yet again - it is patients who will suffer.

"There should be absolutely no suggestion of cancelled operations.

"The health board should work with the independent sector to ensure that patients can access the treatment they need."

William Powell, Lib Dem AM for mid and west Wales, said he had asked for the Health Minister Mark Drakeford to answer an urgent question about the issue in the Senedd on Tuesday.

Meltdown

Last week Hywel Dda said it was postponing some operations at Bronglais Hospital in Aberystwyth for up to a month because of staff shortages.

The board said it was also cutting six beds on a general surgery ward because of the shortages.

Plaid Cymru's Ceredigion AM Elin Jones claimed the management of the health service in west Wales was approaching meltdown.

She added: "The sudden cancellation of all elective orthopaedic surgery outside Carmarthen, on top of the bed closures last week at Bronglais and persistent rumours of the run-down of services elsewhere, is undermining the confidence of people in Ceredigion and across west Wales."

Last January non-emergency operations were cancelled in north and south Wales due to a seasonal rise in winter illnesses putting pressure on NHS hospitals.

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