NHS Wales

As a result of the Government of Wales Act 1998 the National Assembly for Wales was formed which took responsibility for NHS Wales under the political stewardship of the Minister for Health.

NHS Wales is divided into seven Local health Boards that are responsible for the provision of delivering all healthcare within a geographical area; to include primary, secondary and tertiary care.                                                                                  

There are three NHS Wales Trusts

Public Health Wales

Velindre NHS Trust on behalf of NHS Wales hosts the following services:

Public Health Wales has statutory functions which include:

Trauma & Orthopaedic Services in Wales

The 2020 Vision Welsh Orthopaedic Society national survey was conceived in November 2019, undertaken in 2020 and released in January 2021. It had three elements, manpower, service and clinical governance. The purpose of the survey was to form a baseline – a snapshot in time – from which remedial pragmatic productive discussions, both locally and nationally, could take place regarding the provision of Musculoskeletal trauma and Orthopaedic services in NHS Wales. The survey was commissioned by and the results being approved by the core group of hospital representative to the Society. Key findings include:-

There are 172 T&O Consultants in Wales, an average of one per 18,1330 population. (In 2004 the ratio was 1 per 34,258). 7% are female and 97.1% work full time. 4 (2.3%) have academic positions.

The spread of subspecialty interest bears no relationship to the demand and shows a significant variation throughout current Health Board configuration in Wales.

129 (75%) of consultants are on call for unscheduled trauma care;there is a huge variation between Health Boards as to the number of population per on call consultant.

The inpatient trauma bed provision is extremely variable and bears no relationship to the service demand; the service in outlying units has the potential to be compromised. There appears to be no consistency in terms of trauma list provision; the service is of particular concern in a number of outlying units, most noted where there is no weekend trauma list provision.

With the exception of hip fracture patients captured by the National Hip Fracture database, there appears to be very limited knowledge of the volume of both inpatient and outpatients trauma care in Wales.

Despite the duties placed upon them within the Civil Contingencies Act 2004 Category 1 bodies such as the NHS hospitals receiving trauma in Wales, it is noted that one hospital had T&O service department involved in a Major Incident Plan over three years ago. No other department in Wales has reported being involved in planning or exercise.

The spread of elective inpatient beds ranges from 14 to 67 in individual hospitals. A lack of in-house data available in each hospital relating to elective service provision means that most departments do not know the frequency and number of referrals, the numbers seen, and rely on National Joint Register or Surgical Site Infection to approximate number of cases performed.

There are areas in Wales where there isn’t enough clinical space for the current number of clinicians. This coupled with the limited access to theatre sessions are the main limiting steps to the appointment of new colleagues in order to service increasing demand.

The survey highlights the paucity of meetings between Clinicians and their non clinical managerial colleagues. This unfortunate finding is of particular concern when considering the work required post the Covid Challenge, to manage the waiting lists within the funding envelope available, when teamwork will be decisive.

The survey revealed the significant variation in the format and what is discussed at Clinical Governance meetings throughout Wales. Review of antibiotic and chemical DVT prophylaxis protocols showed more variation than expected.

Click here to view a full copy of the survey.