ORTHOPAEDIC patients who smoke or are obese will be asked to try to quit smoking or lose weight before surgery, with NHS Wales support, under bold plans announced today.

And though failure to engage with support services - to be provided for the purpose by health boards - will not bar patients from the surgery they require, they will be left in no doubt of the extra risks it entails due to their lifestyles.

The new approach is part of Wales' National Orthopaedic Implementation Plan, designed to create improved and more sustainable orthopaedic services.

Health boards will also have to report the numbers of orthopaedic patients they have who smoke or are obese, the proportion that complete a stop smoking or a weight reduction programme, and the proportion who successfully stop smoking or hit their weight reduction target.

The plan stresses that lifestyle factors can affect some elective surgery outcomes, many studies showing that, among smokers and the overweight or obese, post-operative complications are more common and lengths of stay in hospital are longer.

It also cites a study that concluded the death rate for patients in the first 10 years after major joint surgery is one-in-five, many being down to smoking and weight-related conditions.

Providing patients with the supported option of quitting smoking or losing weight prior to surgery chimes with the plan's proposed holistic approach to orthopaedic services.

There is a growing sense within healthcare that when a person presents with a musculo-skeletal problem, it is what the plan calls a "teachable moment" in terms of modifying lifestyles to improve outcomes and long term survival.

The plan also seeks to address the issue of orthopaedic treatment waiting times and a gap between demand and capacity in outpatient services.

Health boards will have to validate orthopaedic waiting lists, removing those who do not need an outpatient appointment or treatment.

Patients who have had routine hip and knee replacement surgery will have just one follow-up appointment, between six weeks and three months after surgery, unless there are exceptional circumstances. This is already accepted practice in other parts of the UK.

There will also be a drive to reduce fracture clinics referrals from emergency departments, as evidence suggests many are unnecessary.

Patients with non-specific lower back pain will be transferred to community-based back pain services, with only those exhibiting 'red flag' symptoms referred to a consultant.

A new 'urgent' assessment category will be created for elective orthopaedics, with health boards expected to ensure these patients are seen within six weeks of a GP referral.

The plan is designed too, to enable Wales' orthopaedic services to be benchmarked against the best in the UK and overseas, and to help reach those standards.

“This plan sets out what NHS Wales needs to do to develop sustainable services so we offer the very best services to patients," said deputy health minister Vaughan Gething AM.

"It also sets out what people can do themselves to manage their own health. We know that preventing ill health occurring in the first place is far better than treating and curing ill health which has already happened.”