§ Dr. Vaughan
The report is being published today, and a copy has been placed in the Library. It contains a full analysis of the problems which confront those responsible for the organisation of orthopaedic services within the National Health Service hospital and primary care services. I particularly welcome the emphasis the report places on the need for collaboration between doctors, other professionals and management teams in evaluating the efficiency of their existing services and in studying how they may be improved within the resources available to them. In my view the approach proposed by the working party should be studied also by those in other surgical specialties. I hope the report will be widely read.
The report refers to the increasing proportion of orthopaedic beds occupied by elderly people, and points out that an important factor in the length of present waiting lists is that elderly patients often remain in hospital longer than necessary because effective arrangements have not been made for their follow-up care. It describes the part which can be played in overcoming this difficulty by a system of shared orthopaedic-geriatric care. I strongly support the collaboration which the report recommends between geriatricians and orthopaedic surgeons and hope that this will be achieved wherever it does not already exist.
The report also emphasises the important part which the community services can play in making possible the earlier discharge of orthopaedic patients from hospital. I welcome its recognition of the important contribution the voluntary services can make in this as in so many other fields of social care.
In another important recommendation, the working party says that no specialist orthopaedic hospital, however 415W small or isolated, should be closed unless at least as good a service is guaranteed to replace it. The report recommends that the larger specialist orthopaedic hospitals should be retained, but that they should complement the neighbouring district general hospitals.
The report identifies a need for more complete and comparative statistical information to help health districts in assessing their own perfomance. This recommendation has been brought to the attention of the steering group on health services information chaired by Mrs E. Korner.
In our handbook for health authorities,"Care in Action", which was published last month, we have emphasised the importance we attach to the effective use by health authorities of the resources available to them. I hope that they and their staff will make the fullest use of the working party's report as a basis for practical action in their own districts to reduce waiting times for orthopaedic out-patient appointments and in-patient treatment.