British Orthopaedic Association statement on Comprehensive Spending Review

The Government has announced an additional £1 billion for the NHS in England next year “to begin tackling the elective backlog, including continuing to prioritise the most urgent patients and enabling catch-up for long waiters”. This funding is expected to deliver up to one million extra checks, scans and operations.

The BOA welcomes this additional funding for elective care, but we are concerned that this will not go far enough to deal with the enormity of the size and scale of the current waiting lists.

Waiting lists in our specialty have been hit particularly hard by Covid-19:

• The total waiting list for Trauma and Orthopaedics in England: 566,752
• The number of people waiting over 52 weeks: 31,074
• The number of people waiting over 18 weeks: 271,320
• Each of these figures is larger than for any other single specialty.

Because of the extended delay for many of those on the waiting list, the operations are becoming increasingly complex as patients have deconditioned and deteriorated while waiting.

The current situation is increasingly desperate for many patients, as they await their surgery in enormous pain and with increasing levels of disability.

We believe there must be urgent investment in elective orthopaedic centres to address the backlog and continue to provide efficient and timely access to highly-cost effective orthopaedic procedures.

Elective surgery is not optional surgery. Patients suffer major effects on their physical and mental health as their bones crumble and deteriorate and they struggle to undertake everyday activities. These delays really matter. Patients suffer before and after treatment. There is clear evidence that when arthritis patients deteriorate to lower functional levels before surgery, they can still be improved by joint replacements but achieve lower post-operative function. An extended wait can resulting in muscle wasting due to immobility, reduced cardiovascular fitness, osteoporosis due to immobility and adverse effects on the patient’s mental health and motivation caused by chronic pain; the delay may result in permanently impaired mobility in some cases.

Bob Handley, President of the BOA warned: “The current situation is intolerable. There are very large numbers of patients on the orthopaedic waiting lists whose physical and mental health is deteriorating and who are coming to harm as a result; their need for their operation is becoming more and more urgent. We want to stress the urgency of ensuring that these waiting list backlogs are addressed to avoid further harms to these patients.”