Hip And Knee Patients Wait Longer In Face Of Claims Lists At Record Low

Patients are having to wait longer for routine operations such as hip and knee replacements, despite claims that waiting lists are at an all-time low. Figures obtained by The Scotsman show that since 1998, median waiting times have increased for 17 out of 25 common procedures.

In some cases, patients are being forced to wait for more than two years for surgery. And there are massive variations in the performance of individual health boards, with patients in some areas waiting twice as long, on average, as elsewhere in the country.

Patients’ groups said Scots waiting for routine surgery were paying the price as the NHS concentrated on treating killer diseases like cancer. But the Executive insisted that more patients were being treated more quickly than ever before on the Scottish NHS and said the official figures proved it.

The performance of the NHS is expected to be a key election battleground. In December, Andy Kerr, the health minister, announced that a target had been met, a year ahead of schedule, of no patient with a guarantee waiting longer than 18 weeks for an operation.

But the new figures, provided to The Scotsman by Information Services Division (ISD) Scotland, look at patients with and without a guarantee. Instead of concentrating on the maximum waiting time for a procedure, which Mr Kerr used, the NHS statisticians have looked at the median wait – the length of time the patient half way up the queue has to wait.

The ISD figures show that the median wait for all hip replacements has increased from 117 days in the year ending 31 March, 1998, to 157 to the end of March, 2006 – up 34 per cent. The statistics also showed that last year, patients with the longest waits could be on the list for up to 23 months before their hip operation.

Median waits for knee replacements increased by 17 per cent between 1998 and 2006, up from 142 days to 166 days, with a highest wait of two years. Varicose vein operations also went up by 17 per cent, from a median of 121 to 142, with a maximum wait of more than three years. Median waits for hysterectomies rose 36 per cent from 47 to 64 days, with a maximum wait of a year.

Regional variations can also be huge. For cataract operations, the longest median wait was in NHS Orkney at 177 days, compared to 70 in Fife. And one of the longest median waits for a knee replacement was in Lothian at 177 days, compared with 122 days in the Western Isles.

A leading surgeon said the statistics reflected what he was experiencing. “I probably have 100 patients on my surgical list who have been waiting in excess of two or three years because they are excluded from guarantees,” he said. They are kicked into the long grass until the NHS works out how it is going to treat them. Their waits are certainly not measured against the targets.”

Katherine Murphy, from the Patients’ Association, said while it was good that waits for cancer surgery and heart operations were falling, this was happening at the expense of other procedures. “With the orthopaedic operations these patients are living in pain and every day longer they have to wait is affecting their quality of life,” she said.

The difference between the official figures and those obtained by The Scotsman can be partly explained by the inclusion of patients with availability status codes (ASCs). These are issued to people who could not make their appointment for personal or social reasons, for other medical reasons or because treatment is deemed to be highly specialised.

When measuring progress against its target, the Executive excludes patients with ASCs. Shona Robison, the SNP’s health spokeswoman, said: “The Executive has been manipulating waiting lists for a long time. We know that a third of patients are on these hidden waiting lists, sometimes maybe for a good reason, but often this is not the case.”

Nanette Milne, Scottish Conservatives’ health spokeswoman, said: “What we want are targets that are driven locally, by local management and clinicians.”

An Executive spokesman said: “What matters most to patients is how long they wait for treatment, and huge progress has been made here. The 18-week target for in-patients and day-case treatments, including hip and knee joint replacement surgery, has been met a year ahead of schedule, out-patient waiting times are the lowest ever, and waiting times for key diagnostic tests have been slashed.

“Median waits simply don’t paint the full picture as they only relate to patients admitted for treatment from the waiting list – but over half of the patients treated in hospitals are admitted immediately and never join a waiting list.”