1.148 Consultees proposed several mitigations that could strengthen any chosen model:
- fund more surgeons and additional radiographers, and more radiography equipment.
- enable cross-boundary referrals, including to hospitals in England.
- partner with private providers to clear backlogs.
- pool staff resources and waiting lists across the region to reduce inequity of access.
- ringfence orthopaedic services to protect elective activity from seasonal pressures.
- patients checking in overnight to help predict surgical complications earlier and ensure earlier start times for surgery.
1.149 Consultees proposed other potential alternatives and suggestions, including the following:
- create a single dedicated orthopaedic ‘centre of excellence’ for Hywel Dda.
- create several dedicated orthopaedic hubs with protected elective beds to prevent cancellations and reduce infection risk.
- reinstate Ward 9 at Withybush as a dedicated elective orthopaedic unit.
- provide fracture clinics and orthopaedic services in the community, such as at Cardigan ICC.
- invest in same day joint surgery at the Prince Philip Day Surgery Unit for patients who meet the criteria.
- a hybrid of all four options (i.e., increased inpatients and day cases at Bronglais [Option D], extended hours at Withybush [Option B], additional beds and investment at Prince Philip [Option C], but as part of a regional working approach [Options A, B and D], and a regional/local hybrid surgical hubs network working with Neath Port Talbot [Options A, B and D]).
- Other combinations of options, e.g. extended hours at Withybush (Option B) in addition to increased inpatient services at Bronglais (Option D)
1.150 For further details, see the orthopaedic sections in the individual consultation method chapters.