1.138 For some consultees - especially in the questionnaire and resident workshops, where most of the direct comments on the orthopaedic options were received - the relative similarity of the options and a lack of information around which would best increase capacity made it difficult to decide between them. The Health Board was advised to select the one that would reduce waiting lists most and fastest; and to ensure that site selection reflects clinical safety, workforce sustainability, and capacity to manage higher-risk patients.
1.139 Options with regional working were preferred by many in the questionnaire, and some in the resident workshops, who felt that orthopaedic patients would be willing to travel for faster access to specialist care. In this context, regional working with Swansea Bay University Health Board was largely viewed positively across many consultation methods in potentially increasing capacity, reducing waiting times, allowing opportunities for integration with other services, and improving recruitment.
1.40 Conversely, a minority of consultees across the consultation methods feared that regional working could lead to increased competition for appointments, as the service would be catering to a larger population. It was also noted that it appears to place increased financial pressure on patients who are dependent on public transport, if they would need to travel further in future.
1.141 While there were very few comments on Option A, for questionnaire respondents whose nearest hospital is Withybush and in the Pembrokeshire resident workshop, Option B was favoured because it increases care at Withybush via extended hours, as well as offering the perceived benefits of regional working. A few consultees did question whether a longer day and a third operating theatre session was efficient, and whether it could risk negatively impacting staff retention.
1.142 A limited proportion of questionnaire respondents felt that additional beds within the Health Board would reduce waiting lists more quickly than regional working, and would involve less travel between sites, especially for Llanelli residents. There was very little support for Option C at the resident workshops, mainly as participants were generally well-disposed toward regional working.
1.143 Option D received the most support among questionnaire respondents whose nearest hospital is Bronglais, as well across the residents’ workshops as a whole, driven largely by unanimous support among Ceredigion participants. This was due to its proposal to increase inpatient orthopaedic activity at Bronglais, and what consultees saw as the potential to effect the largest decrease in waiting times through regional working and enhancements at an additional hospital (Bronglais). Moreover, Ceredigion and Powys consultees, and Betsi Cadwaladr Health Board, were pleased that this option would improve access for patients and their families across mid and north Wales.
1.144 On the other hand, the higher cost of this option was acknowledged, as was its potential negative impact on concentrating expertise and building critical mass.