3. Will the Minister make a statement on waiting times for orthopaedic treatment in north Wales? OQ56314

Yes. The Welsh Government continues to work alongside Betsi Cadwaladr University Health Board to develop their orthopaedic plans and to support them to adapt their delivery to meet the changing needs brought about by COVID-19, including the significant increase in waits for orthopaedic treatment.

Thank you. This follows on, really, from my colleague Angela Burns and the concerns around what's happening with regard to treatment. So, I've been liaising with the chief executive of Betsi Cadwaladr University Health Board. Earlier this month, she sent me a letter that stated, and I quote,

'with the small volume of elective surgery that we've been able to perform over the past 12 months, waiting times have increased considerably'.

I was writing to her about a constituent who'd been waiting a long time in immense pain. She said one consultant, Mr Ganapathi, now has more than 450 patients waiting for treatment, and, according to the chief exec, over 350 of these have waited longer than my constituent who—just listen to this—was referred for double knee replacement in November 2017, long before our pandemic, Minister. So, whilst acknowledging the pressure caused by COVID-19 and welcoming the news that a new post-anaesthesia care unit has opened at Ysbyty Gwynedd, the evidence is clear that orthopaedic treatment is in crisis here in north Wales. So, please advise what steps you are taking to help facilitate more day-case and in-patient surgery, and whether consideration can be given to increasing the health board's partnership with English trusts, and coming to an arrangement with more than just two, for patients to be offered their surgery outside of this health board. Thank you.

I think there are several things there. The first is to acknowledge that there was already a challenge with orthopaedic delivery in north Wales before the pandemic. We were seeing an increase in activity in north Wales, but it wasn't keeping pace with demand coming in, so lists were broadly getting longer on orthopaedic treatment. That is undeniable.

The second point is that, during the pandemic, though, that has been exacerbated even further. As Members will be aware, there's been significant interruption of normal care and treatment, so the orthopaedic waiting list has grown even further over the course of the pandemic, not just in north Wales, but across the whole country. Our challenge is how we get to a sustainable system and how we deal with the big backlog that has built up as well. With respect, I don't think that partnerships with NHS trusts in England are likely to address the backlog or a sustainable service. The reason for that is that, actually, the system within England needs to get to a point where it is more in balance as well. We won't be able to buy our way through this by undertaking more activity in the private sector alone. We are going to need to have a proper approach that I think is consistent with NHS values here in Wales.

It's worth reflecting that England also have a significant increase in their orthopaedic waiting lists; there isn't going to be capacity in the NHS in England for us to make use of for some time to come. So, that means we need to find an approach here in Wales that understands the nature of our challenge, how we get to a sustainable part of our system and, at the same time, how, as to staff who are going to be exhausted when the pandemic crisis finally ends, we actually generate even more activity to deal with the backlog. This is not a straightforward challenge to address, and we'll need to move beyond a simplistic 'just work harder' or 'spend more money'. We're going to need to have some innovation in the way that our NHS continues to run a public service that delivers against the enormous challenges that confront it.  

As said by the previous two speakers, Minister, waiting lists are at levels that we haven't seen for years. Many on those waiting lists before too long will end up being emergency admissions after their quality of life has been obliterated by pain and disability. Constituents report a very patchy and hit-and-miss non-COVID health service across the region, which suggests that we are facing a very different sort of crisis for the NHS, but a crisis nonetheless. You've said there's a plan, that you have a plan. When will we see this plan to scrutinise it, and when will it possibly start to be implemented? Thank you. 

As I said, we're expecting to publish an NHS recovery plan before the end of March. I'd want Members to be able to see that plan before we move into the election period. I think that's the right thing to do. But more than that, in terms of then seeing that activity recovering, that really depends on the course of the pandemic. When we've still got critical care units that are at 115 per cent of their capacity, when we still have significant numbers of COVID patients in our hospitals, it isn't reasonable to expect the NHS to regenerate the same level of normal elective activity that we were used to more than a year ago.

We also, of course, have the additional PPE requirements that Jayne Bryant was referring to—PPE delivery—in her first question. That means that we can't undertake as much activity in the same day. So, we have a number of real handicaps for the NHS about keeping our staff and people safe whilst undertaking activity. So, this will be difficult. The plan, as I say—the recovery plan—you can expect it to be published before the end of March. Of course, the pandemic will help to determine when we can start to deliver some of this, as well as the work that our NHS organisations are already undertaking for planning and delivering that further activity.