If you need a knee operation on the NHS in Yorkshire right now, is it likely to happen? Jim Newman, Lead Surgeon for Elective Orthopaedic Surgery at Mid Yorks NHS Trust, explains the current situation.
In late September, the British Orthopaedic Association issued a message to people waiting for joint replacement and other orthopaedic surgery. It’s a good statement and you can read it in full here.
If you live in Yorkshire, however, you’ll likely have one big question once you’ve read it – and that is: ‘what’s the situation here?’ So in this piece, I’ll try to give you an honest account of the state of knee replacement in Yorkshire, with particular focus on my own NHS Trust, Mid-Yorks.
I’m writing this on 9 October and this is inevitably a snapshot of a specific moment. With the situation changing rapidly, please bear in mind that things may not remain as I describe them below.
How close are we to ‘business as usual’ for orthopaedics?
Across Yorkshire, the picture is mixed. At Mid-Yorks, however, we are pleasingly close. We aren’t at pre-Covid levels, but with some very recent changes just starting to take effect now (which is why I don’t have official figures for you) I would estimate levels are at or close to 80% of ‘normal’ levels.
To try and give some meaning to that statement, here’s what a typical day might look like across Mid-Yorks, first in terms of the lists of patients we would have been seeing pre-Covid:
- 1 list daily (Monday – Friday) at Dewsbury
- 1 list daily (Monday – Friday) at Pinderfields
- 2 lists daily (Monday – Friday) at Pontefract
Now we are working to the following arrangement:
- 1 list daily (Monday – Friday) at Pontefract (but an additional 2 lists on Sat & Sun)
- 0-1 lists daily at Pinderfields
- 0-1 lists daily at Dewsbury
- 2 lists daily (Monday – Friday) at Methley Park
As you can see, the total numbers now aren’t far from their previous levels.
Why can’t you just do more operations?
The BOA statement covers a number of the reasons that hospitals can’t simply throw a switch and get back to normal levels immediately – but it only briefly touches on the biggest issue of all: staffing.
Like every other organisation, hospitals have to deal with staff falling sick with Covid and other illnesses. And they are affected by the need to self-isolate should a family member fall ill with suspected Covid. In addition, however, there are some factors that particularly affect hospitals:
- We have established ‘green’ routes (the most Covid-free routes). To maintain these, we can’t simply switch staff from one role in another part of the hospital to a green route, because that compromises the Covid-security. This is a significant issue in trusts with a single hospital. It’s less of a problem at Mid Yorks as we are fortunate to operate from multiple sites.
- Hospitals can’t use agency staff as they once did because there’s a quite natural reluctance to pull in staff for a day or two who may have been working in other locations that week.
- If hospitalisations increase to beyond the existing intensive care unit (ICU) capacity, we’ll need to open up additional capacity. Those additional beds will need nurses, anaesthetists and more, and no hospital operates with a pool of reserve staff. Instead, those people will be drawn from other areas – and orthopaedics is the likely first port of call.
Are you prioritising patients?
Yes, although right now this isn’t as common as it was when we were just restarting procedures. At that point, we had to take the extremely difficult decision of ‘stratifying’ the extremely urgent from the merely very urgent.
We may still push the most serious cases to the front of the queue, but ‘serious’ can have many meanings. There’s the medical need which, because of pain and deformity, may be acute. But there’s also the wider need to consider. Is the need of someone who is unable to work because of their knee pain any less serious – even if the physical pain itself is marginally less than another patient?
These aren’t easy decisions, and the better we are able to keep things running at close to business as usual, the less we’ll need to make them.
What should I do if I have knee pain?
We don’t know what will happen next, although we can all look at the latest headlines and draw our own conclusions. As a knee surgeon, I desperately hope the current measures have an effect and that the R rate drops. If it does, we should be able to maintain and perhaps even improve current service levels.
If you are suffering with knee pain, my advice would be to see your GP as usual. Get a referral. And we will do our very best to see you. Waits are long on the NHS right now. As the NHS’s contracts with private hospitals draw to a close over coming months, the chances are those waits will increase further.
But knee operations are taking place in my hospital. They are not happening at ‘normal’ rates, but at present they are not far off. And if you want to minimise your wait, I’d suggest you book a GP appointment now.
Consultant Knee Surgeon at the Yorkshire Knee Clinic
“I couldn't recommend him highly enough.”
Charles Turner, YKC patient
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