Despite last month's announcement by the Department of Health that waiting-lists have been reduced by 20 per cent, waiting times for some specialities have actually increased.
In orthopaedic surgery for children, 68 per cent of those now on waiting-lists are waiting longer than the Government-recommended six months.
The situation in the North is no better. An 18- to 24-month waiting time to see an orthopaedic surgeon is the norm, with a further wait to follow if you are assessed as needing surgery.
Dr Christine Hunter and Dr Hubert Curran, two Belfast GPs, have set up a musculoskeletal review group in an attempt to address the problem. A scheme to ration orthopaedic referrals in the Eastern Area Health Board was partially successful and there are three waiting-list initiatives about to begin in Belfast.
The first involves a specialist nurse, working in the community, who will focus on patients referred with back pain in the first instance. With the support of the local pain specialist, the nurse will prioritise patients based on several categories. One of her main tasks will be to identify patients who need urgent investigation and treatment. Other patients may be referred for physiotherapy or to a joint injection clinic. Dr Hunter is closely involved in another, GP-led project. The Community Trust for South and East Belfast will collate orthopaedic waiting-lists in its area. GPs and physiotherapists will be trained to examine these patients in the community with the aim of tightening up referral guidelines for back, hip and knee problems.
To ensure quality of decision-making, the first 100 cases will be assessed jointly with an orthopaedic specialist. Patients on the original list will be "restratified": some will be redirected to a pain clinic, some will be treated by the newly skilled GPs/physiotherapist, and some referrals will be sent back to their GP with a recommendation for a non-orthopaedic approach to their problem.
The third initiative involves development of referral guidelines and stylised referral letters for urgent back problems. This is to ensure people with serious back complaints are not "lost" in the waiting-list.
With only 27 orthopaedic surgeons in the North, Dr Curran says that "there is obviously a limit to what we can do without a doubling in specialist numbers". However, Dr Hunter adds: "We hope to reduce the number of inappropriate referrals, increase appropriate referrals and, in particular, the speed at which they are seen and also to increase the skills base for dealing with musculoskeletal problems in primary care."
Meanwhile, at the Regional Orthopaedic Centre in Croom, Co Limerick, Dr Ross Kingston has demonstrated the value of a hospital-based orthopaedic waiting-list initiative. Each patient waiting for hip or knee replacement surgery was invited to attend a dedicated assessment clinic, where they were evaluated according to an international scoring system. Those with the lowest score, indicating the severest disability, were moved to the top of the waiting-list for surgery.
As well as improving transparency and efficiency, validation of the hip and knee replacement waiting-lists reduced them by 20 per cent and 11 per cent respectively.