Some Powys patients are in danger of waiting more than five and a half years for surgery at a hospital just over the border in England.

Waiting list issues at the Robert Jones and Agnes Hunt (RJAH) Orthopaedic Hospital in Gobowen, near Oswestry in Shropshire, were highlighted at a Powys Teaching Health Board (PTHB) meeting on Wednesday, January 28.

During discussion of PTHB’s performance report from November, independent member Mick Giannasi flagged the issues at RJAH as a performance “outlier.

Mr Giannasi said: “My eye was particularly drawn to the spinal treatment waits at RJAH exceeding 300 weeks. It actually sounds worse when you describe it as over five years. I appreciate the numbers involved are probably very small, but a wait of that length is clearly far beyond what could be considered acceptable even in the current context we’re operating. Are there any levers we can apply, what triggers more robust action?”

He questioned whether PTHB was considering alternative providers or using the private sector instead of RJAH.

Mr Giannasi continued: “Not to put too blunt a point on it, in our private lives all of us, if we had a service provider unable to deliver to an acceptable standard, we would change that service provider.” He also asked what support PTHB was offering patients on the waiting list, both clinically and in terms of communication and wellbeing.

PTHB’s Executive Director for Planning, Performance and Commissioning, Nicola Johnson, said: “We have raised it with Welsh Government to see if there’s any possibility of mutual aid or provision within Wales. Unfortunately, the main provider in Wales has very similar issues, and the feedback we’ve had is that it’s probably not available.”

She added that talks had taken place to move patients to another provider in England.

“Again, the feedback is that the capacity is not here and there are very few providers with that type of care – and it’s generally not suitable for private provision because of the risk to the patient,” Ms Johnson said. She added that the issue would need further board discussion after options were fully explored.

Ms Johnson said: “They (RJAH) need to be able to rebalance how they are deploying their theatre capacity between moderate and very complex cases.”

Executive Director of Primary, Community Care and Mental Health Elaine Lorton added that PTHB has a service contacting those on the waiting list to provide “advice and guidance” and said she would double-check whether this cohort of patients had been contacted.

Board Chairman Carl Cooper asked whether the Finance and Performance Committee could review the issue. Independent board member and committee chair Ronnie Alexander agreed, noting the report indicates RJAH has a recovery plan in place and requesting details.

Ms Johnson said: “It’s an important part of our commissioning plan for next year to have a look at what that provider (RJAH) is offering for our population and our options.”

The board agreed that any escalation needed would be brought back to the full board.

The report stated: “The Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) remains the most challenged English provider for long waits, with a growing trend of over 104-week waiters and all key wait bands reporting special cause concern. RJAH continues to face challenges regarding their capacity and ability to see all patients within Welsh Government targets.”

The report added that breaches of the 104-week target had now risen to 128, covering spinal, arthroplasty, knee and sports injuries, and foot and ankle care. “Very long waits now exceed 300 weeks for complex spinal surgery. The issue has been escalated to the provider, and a recovery plan has been requested against the agreed targets,” it said.