3. Will the Cabinet Secretary make a statement on orthopaedic care in North Wales? OAQ(5)0140(HWS)

Yes. I expect all patients to be seen in a timely manner based on clinical need. I expect the health board to continue to work closely with the planned care programme to develop a sustainable service.

Thank you, Cabinet Secretary. I understand that much of the routine orthopaedic surgery in the north Wales region is outsourced to the Robert Jones and Agnes Hunt hospital in Oswestry. May I just read from a letter I have received from a consultant orthopaedic surgeon in the Betsi Cadwaladr University Local Health Board, which, as I’m sure you’re aware, is under special measures? He says that not investing in elective orthopaedic services for decades has created a situation where the health board is trapped and now cannot even protect these elective orthopaedic services. He goes on to say that this poor investment planning, lack of vision and short-term arrangements that have gone on for probably over two decades is now encroaching on the quality of life of many chronic joint pain sufferers, who are waiting scandalous times for their treatments.

Do you know, Cabinet Secretary, how much money is going over the border for orthopaedic treatment? Do you agree that this money is better invested in north Wales? In reply to Mark Reckless, you said that you respect doctors and want to have a genuine conversation with them. In light of that, would you agree to meet with me and several orthopaedic surgeons in north Wales to help you to better understand what the actual problems are, but also to look at positive outcomes and how we can address these problems?

Of course, I recognise the challenge of orthopaedics as a speciality in north Wales in particular. It makes up the greater number of those people waiting too long, and waiting beyond our waiting time standard, in the north Wales area. I also recognise that we commission care on a regular basis from providers within England. In fact, the spinal surgery speciality is commissioned from Robert Jones and Agnes Hunt, and we’re currently commissioning additional places and additional procedures over the border as well, and that’s because we do have a problem and some people waiting too long. We can either say that we’re prepared to invest some money in the here and now to try and make sure that we bring those numbers down, or we say that we’ll only spend that money within the system. It’s a balancing act, of course, and what I’ve been really clear about is that we need to maintain and improve the level of performance in the here and now, because it isn’t in a place that I or any other Member would say is acceptable. That also means, though, that the health board have to, with the clinical community, come up with a plan for the future.

I actually met the orthopaedic team in Ysbyty Glan Clwyd on my last trip to north Wales, just a few weeks ago, and they too recognise there’s a need for improvement. There’s a need to have a view across north Wales, rather than three or four centres competing with each other about what a new service might look like, so that it’s not just about the operative end where people go in for procedures, but also about the care in the community—so, primary care, the musculoskeletal service. We’ve got to look at the whole picture. I’m expecting that there will be a plan that will come to the health board within a matter of weeks, as opposed to several months, setting out proposals on what the future could look like. So, I’ve met surgeons in the past, and I’m sure I’ll meet members of the orthopaedic team in the future, but I’m looking forward to receiving that plan to then understand what the timescales are for success, and what they believe success could and should look like for people in north Wales.

Can I just ask you, Minister, given that this health board is in special measures—? We are almost two years into those special measures and one of the reasons it was put into special measures was because of the performance against referral-to-treatment waiting times, including on orthopaedic waiting times. Over the period it’s been in special measures, run, effectively, by the Welsh Government for those services, those waiting times have gone up. Do you accept some responsibility for the poor performance at the Betsi Cadwaladr university health board, and will you apologise to those constituents in my constituency who are waiting 112 weeks for routine appointments at Glan Clwyd for their orthopaedic surgery?

I’m ultimately responsible for everything that happens within the health service as the Cabinet Secretary for health. That means all the things that don’t go well, where people wait too long, as well as those things where people want to praise the service too. I don’t shy away from my responsibility in any regard whatsoever. In the discussion that I had recently with surgeons in Glan Clwyd, they were clear that they wanted to get over that those long waiters have not been waiting for routine appointments; they’re actually at the more complex end. But the challenge is, and they accept that—

One hundred and twelve weeks is the routine waiting time.

[Continues.]—regardless as to whether it’s routine or complex—and these are complex patients that we’re talking about—they’re still waiting too long. And, actually, it’s the job of the health service to come up with a plan to resolve that, and that’s what the surgeons say they’re committed to doing, and that’s why, in response to Nathan Gill’s questions, I was able to indicate I’m expecting that plan to be delivered and discussed with the board over a matter of some weeks, and I look forward having a proper briefing on what that plan contains and the measures of success to be delivered within that. As you’ll know from our previous conversation in the last questions, Darren Millar, there’s been an 83 per cent increase in demand over the last four years against a one third increase in the number of operations carried out. We clearly need to do something to better manage the demand and the ability to meet that demand within north Wales.