Are NHS knee replacement waiting lists rising or falling? And what’s likely to happen in the future? YKC’s Jim Newman, Head of Clinical Service for Trauma and Orthopaedics at the Mid Yorkshire NHS Trust, looks at a challenge that simply won’t go away.

Let’s start with the good news. In July, NHS England reported that the overall NHS waiting list fell for the first time in 17 years.

In response to a question raised in Parliament earlier this year, Baroness Merron revealed there were 49,509 patients waiting for a knee replacement with a mean average NHS waiting time of 28.7 weeks. Which, relative to where we were, sounds rather encouraging.

If you need a knee replacement, though, this figure might surprise you. You’ve probably been waiting longer than that already. And this is where the good news crashes into reality, because we see lots of patients who, by their own reckoning, have been waiting far longer than 28.7 weeks. It all comes down to who’s doing the counting and what’s being counted.

When is 52 weeks not 52 weeks?

Even getting onto the system can take time. For knee pain, current data suggests you’re likely to have to wait around two weeks to see your GP. From there, and assuming they agree that things need to be investigated further, you’ll progress to musculoskeletal (MS) triage.

There’s real value in this – the triage system can help alleviate pain and give you tips and techniques for coping with your osteoarthritis, but it also adds delay. By the time you’ve been through MS triage and referred to a consultant, you’re likely to be three to six months down the line and it’s only at the very end of that process that you join the official knee replacement waiting list. Add in the average 28.7 week wait stated in Parliament, and you’re back at a total of 52 weeks, give or take.

That is incredibly frustrating for patients. It’s incredibly frustrating for those who feel pushed towards private surgery even though they struggle to afford it. It’s even more frustrating for those who have no other option but to wait.

New pressures

The really frustrating news is that driving down numbers is perhaps even more challenging than you might first imagine. For every new technology or process improvement that helps to chip away at the waiting list, there’s a growing number of people waiting to join it.

Right now, according to The King’s Fund, overall referrals outstrip treatments by a significant margin. As the population grows and ages, we can expect that trend to continue. Inevitably, if you treat fewer people than you refer, your waiting list grows.

Ringfencing knee replacement

I’ve spent the best part of six years setting up the elective orthopaedic hub at Pontefract. This is consistent with the strategy of NHS England and the Getting It Right First Time programme, and aims to ringfence knee replacements so that they aren’t derailed by annual winter pressures. It protects capacity and prevents cancellations – and it’s having a positive effect.

But there’s still a backlog. And given what we know about likely patient numbers for the future, that isn’t likely to change dramatically.

As someone who spends most of his time in the NHS, we continue to explore new ways of cutting delay, backlogs and waiting lists. But the reality is that knee replacement on the NHS continues to require a long wait and a lot of patience.

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