§ Mr. Steen
To ask the Secretary of State for Health what the waiting times are for orthopaedic (i) initial consultation and (ii) operations in(a) Dorset, (b) Somerset and (c) Bristol; and if he will make a statement on the procedures for the referral of a patient for an operation to a hospital outside his health authority area. 
§ Mr. Denham
The latest information available on inpatient and outpatient orthopaedic waiting times in Avon, Dorset and Somerset Health Authorities is shown in the tables:
Percentage Avon Dorset Somerset Waiting time for trauma and orthopaedic inpatients—Quarter 4 1998–99 0–5 months 57 100 70 6–11 months 34 0 25 12–17 months 9 0 5 18 months plus 0 0 0 Waiting time for trauma and orthopaedic outpatients—Quarter 4 1998–99 0–3 weeks 25 20 20 4–12 weeks 30 46 29 13–25 weeks 19 32 29 26 weeks plus 26 2 22
Under the new arrangements for commissioning patient services, general practitioners and consultants will retain the clinical freedom to refer patients for the most appropriate treatment and will base their decision on their professional judgment and assessment of the case.
Where there are consistent patterns of referrals to a service, whether a specialised service or more locally, these are being built into service agreements. Cases that do not fit this will be covered by the new arrangements for out of area treatments. Unlike the extra contractual referral arrangements, there is no formal prior approval mechanism for out of area treatments, so the process for such referrals is simpler.
All out of area treatment referrals will be covered by the standards for quality and effectiveness specified in the main commissioner's service agreement and will be treated under the same agreements and on exactly the same basis.