Special report issued over health board’s waiting list failings

Mark Mansfield

A health board has been subjected to a rare special report after failing to carry out recommendations aimed at ensuring patients on an orthopaedic waiting list are being treated fairly.

The Public Services Ombudsman for Wales has taken the unusual step after Swansea Bay University Health Board failed to implement two recommendations arising from an investigation into a patient’s six-year wait for knee replacement surgery.

The case involved a man, referred to as Mr W, who had been waiting for a total knee replacement since August 2019.

An investigation published last year found his waiting-time clock had been inappropriately reset in October 2023 and the decision had not been communicated to him.

The Ombudsman found no documented clinical decision that Mr W was medically unfit for surgery at the time, while a subsequent scan confirmed he was fit to proceed.

By the conclusion of the investigation, however, his condition had deteriorated to the point where he could no longer undergo the operation.

The Ombudsman concluded that the opportunity for treatment had been lost, with Mr W experiencing pain, reduced mobility and continuing frustration during the delay.

Swansea Bay University Health Board accepted the findings and recommendations in full and subsequently completed two of four recommendations.

But two further recommendations, which were due to be implemented by February 2026, remain outstanding.

They required an independent re-audit of the orthopaedic waiting list to establish whether other patients had been treated incorrectly in the same way as Mr W and appropriate training for staff responsible for applying Welsh Government referral-to-treatment guidance.

The failure to carry them out is particularly significant because concerns about the management of the health board’s orthopaedic waiting lists date back several years.

In January 2024, the Ombudsman issued three public interest reports after finding patients had been treated unfairly because of errors in the management of their positions on waiting lists.

At the time, waits for orthopaedic surgery at the health board were more than four years, while problems identified included insufficient staff and suitable operating facilities as well as unclear management arrangements and processes.

Those investigations resulted in the health board being told to audit its entire orthopaedic waiting list to determine whether other patients’ waiting times had been incorrectly reset or whether they had been improperly removed.

Reliability

The subsequent discovery of errors in Mr W’s case despite that exercise led the Ombudsman to raise concerns about the reliability of the earlier audit.

There have also previously been concerns over the health board’s speed in implementing Ombudsman recommendations.

In an annual letter covering 2024-25, the Ombudsman said only 64% of 86 recommendations due to be implemented by Swansea Bay UHB during the year had been complied with within the agreed timescale.

The letter specifically noted “significant delays” in complying with some recommendations arising from the three earlier orthopaedic waiting-list investigations, although those recommendations had subsequently been completed.

Public Services Ombudsman for Wales Michelle Morris said: “I remain deeply concerned that other patients may still be at risk of their waiting time not being managed in line with the relevant guidance.

“Given my previous investigations into the Health Board’s orthopaedic waiting list, the audit that followed, and the lack of progress in implementing the outstanding recommendations from the complainant’s case, independent scrutiny of the waiting list and appropriate staff training remain essential.”

The Ombudsman has now imposed a series of further deadlines on the health board.

Within four weeks it must provide an amended case study and evidence of its distribution, set out the scope and timetable for an independent audit and present the special report to its board.

Training

Within 12 weeks it must provide evidence that training has been developed to address the failings identified in Mr W’s case.

The health board has then been given 16 weeks to provide the findings of the independent audit and evidence that any patients affected by incorrect waiting-time dates have received an apology and had their records corrected.

It must also provide evidence that updated staff training has been implemented.

The Special Report will be shared with the chair of Swansea Bay University Health Board, the Welsh Government’s health minister and Healthcare Inspectorate Wales.

The Ombudsman said the health board, in responding to a draft of the report, had agreed to implement the new recommendations.

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