Carpal Tunnel Surgery – Introducing the Lean, Green, More Efficient Pathway

Innovation Overview:

This initiative introduces a “lean, green” approach to carpal tunnel surgery (CTS), increasing efficiency, reducing costs, and minimising the environmental impact of surgery in this domain. By implementing a streamlined surgical process, the innovative practice achieves a more sustainable way of delivering care while enhancing surgical outcomes.

Strategic Case for Adoption:

Climate change is the biggest threat humanity has ever faced (United Nations, 2021). The NHS accounts for 4% of the UK’s greenhouse gas emissions (NHS England, 2020). The health care industry is the fifth largest contributor to greenhouse emissions globally (ARUP, 2021).  Medical equipment and instruments form the largest carbon footprint (13.2%) across the UK health and social sector (HSC data, 2017).  Surgical theatres form a small physical footprint within a hospital, yet cause 20%-30% of an institution’s waste (Kwakye et al., 2011). The largest carbon footprint within theatres comes from packaging and consumables which are often unused (30%) (Lee and Mears, 2012), poorly segregated and recycled (90%)(Lee and Mears, 2012) and incinerated or sent to a landfill waste site.

CTS is the most common surgical procedure in the UK, with over 80,000 cases performed annually. The “lean green” pathway halves procedure times and resource requirements, enables quicker patient turnover, reduces clinical capacity requirements, leads to fewer hospital visits for patients, and minimises clinical waste. It also significantly lowers costs, creating a sustainable and scalable model that can be extended to more complex surgical procedures. This initiative aligns with Wales’s commitment to sustainable healthcare and planned care recovery by addressing surgical efficiency and environmental impact simultaneously.

The lean, green approach has been adopted across all three sites in Betsi Cadwaladr University Health Board and by a number of private health providers. Over 300 procedures have been completed successfully via the lean green method to date!

Methodology:

The “lean green” pathway incorporates a combination of interventions, which includes taking CTS out of theatres into day case rooms, reducing staffing requirements to one third (theatre team of 2 instead of 6), reducing procedural times significantly and resource usage and costs through smaller theatre drapes and less surgical equipment used.

Impact:

• Sustainability: A substantial reduction in the environmental footprint, including a decrease of 22.14 kg of CO2 per case, translating to an 80% reduction in the carbon footprint of CTS.
• Efficiency: Faster surgeries improve patient throughput and reduce waiting times.
• Scalability: The approach can be adapted to other surgical procedures and implemented across health boards, increasing theatre capacity and resource efficiency.

Economic and Environmental Impact:

The lean and green pathway offers significant cost savings while delivering environmental and social benefits:

Annual National UK Savings:

• Environmental: Reducing 12 tonnes of CO2 emissions
• Financial: £1.33 million in annual savings
• Indirect savings: Reduced energy costs from less reliance on hospital infrastructure

By using smaller theatre drapes and fewer instruments there is a direct saving of £37.42 per procedure. By moving CTS into minor ops rooms and reducing the resource utilisation through reduced appointments and surgical time, the initiative lowers the resource utilisation for each carpal tunnel release by £1,120 per patient with no complications reported.

Key Benefits:

• Reduced Environmental Impact: 80% decrease in the carbon footprint per procedure.
• Economic Savings: Two-thirds reduction in costs associated with traditional surgical setups.
• Improved Surgical Efficiency: Shorter procedure times and reduced hospital visits free up theatre capacity.
• Upskilled Staff: Training on sustainable surgical practices enhances team capabilities.
• Lower Waiting Lists: Streamlined processes reduce backlogs and improve patient access.

The Lean Green Pathway offers a practical, low-resource solution to improve healthcare delivery across Wales. Combining environmental responsibility with greater surgical efficiency and cost savings, it presents a scalable model with clear benefits.

Wider adoption across health boards and surgical specialties could significantly reduce the NHS’s environmental impact while enhancing patient outcomes and service capacity.

Relevant Policy/ Strategic Alignment:

NHS Wales Decarbonisation Strategic Delivery plan (2021):

Setting out “NHS Wales’ contribution towards a net zero public sector by 2030”

Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022):

Goals:

• Effective referral
• Treat accordingly

Priorities:

• Transformation of outpatients
• Eliminating long waiters at all stages of the pathway
• Building planned care capacity

Welsh Innovation Strategy (2023):

Priorities:

• Reducing waiting lists
• Supporting a talented workforce

Promote, prevent and prepare for planned care (2023):

Supports:

• Efficiency of care
• Increased service capacity
• Collection of data

NHS Wales Technical Planning Guidance 2025 – 2028

Supports the ministerial priority of timely Access to Care and planning guidance for the optimisation of theatre usage.Regional Treatment Centres:

Day case surgical theatres are an integral part of plans for regional treatment centres and hand surgery along with hand therapy would lend itself ideally to such an environment.

BSSH GIRFT GUIDELINES FOR OPERATING OUTSIDE MAIN THEATRES (FEB 2022)

These guidelines will prove instrumental in reducing the carbon footprint of hand surgery across the country by promoting sustainable surgical practices. Operating outside main theatres reduces energy consumption, improves the ability to treat patients more efficiently utilising smaller surgical teams.

Service Presentation Material:

CTS Lean, Green Pathway Presentation

Service Implementation Material:

Adoption Case for Change

Implementation material available upon request

Over 300 patients benefit as hand surgery in Minor Operating Procedure Rooms expands across the Health Board – Betsi Cadwaladr University Health Board

NHS Wales Performance and Improvement:

• The pathway is referenced in NHS Performance and Improvement Orthopaedic Strategic Programme documentation.
• It is cited in the All-Wales Orthopaedics Theatre Requirements Specification and the All-Wales Carpal Tunnel Syndrome Pathway.
• It has been incorporated as a standard in the NHS Performance and Improvement Orthopaedic Optimisation Framework.

Patient Testimony:

”I needed carpal tunnel surgery in my other wrist around a year ago but last time I was waiting on the ward before I went into theatre. This time was much more relaxed, I came straight into outpatients and I felt I was in and out of the procedure room very quickly and then I was fine to go home 45 minutes later. It’s fantastic that we have this available and I hope many more people like me benefit from this new way of working”.

Awards & Presentations

Shortlisted for an NHS Wales Award, October 2024

Bevan Commission Sir Mansel Aylward Award for Sustainable Working, June 2024

Winner – Betsi Cadwaladr University Health Board Sustainability Award, November 2023

Joint runner up in Green Surgery Challenge, 2021

Runner up in Green Health Wales, June 2022

Invited speaker at Welsh Orthopaedic Society in Chester, May 2024

Invited speaker at Federation of European Surgical Societies of the Hand, FESSH in Rotterdam, June 2024

Invited speaker, British Society for Surgery of the Hand in Leeds, April 2024.

Invited speaker at RSM – PLASTA Shaping the Future Congress, Oxford, July 2022

Invited speaker at Net Zero Operating Theatre (RCS) April 2022

Invited speaker at West Midlands Hand Society meeting, Birmingham, June 2022

Publications

European Journal of Hand Surgery Jan 2023 – Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.

Interested in adopting this service in your health board?

Building Capacity and Reducing Waits in Gasteroenterology Planned Care

Innovation Overview:

The initiative significantly reduces excessive gastroenterology waiting times by diverting approximately 20% of routine secondary care referrals identified as functional complaints to a specialised Gastroenterology Clinic led by an Advanced Clinical Practitioner (ACP) Dietician for assessment, investigations and treatment. This approach releases consultant capacity, enabling them to focus on more urgent cases while maintaining quality care.

Strategic Case for Adoption:

Routine gastroenterology waiting times have exceeded three years in BCUHB, creating a backlog and delaying care. Medically triaged functional cases that do not require surgery can be effectively managed by an ACP Dietician, thus alleviating pressure on consultant gastroenterologists. This innovative approach supports Wales’s priorities for planned care recovery by addressing capacity issues and reducing waiting times in gastroenterology services. Expanding the model across other health boards in Wales would standardise the approach to managing functional cases and optimise existing resources.

Methodology:

Gastroenterology triage secondary care referrals and refer routine patients identified with functional complaints to be seen in a gastroenterology clinic, run by an ACP Dietician. The ACP Dietician will provide an assessment, refer the patient for necessary investigations, review medication requirements, and provide dietary and lifestyle guidance. The ACP Dietician will discuss and if required escalate any complex cases to the Consultant and upon discharge provide a discharge report to the Consultant and referring GP.

Clinical & Systems Impact:

• Reduced Wait Times: Routine gastroenterology waits have been shortened from over three years to just three months.
• Improved Service Delivery: During the pilot, 500 consultant appointment slots were made available, and 318 patients were removed from the Wrexham secondary care waiting list.
• Enhanced Clinical Outcomes: The ACP Dietician’s assessments have led to the detection of some serious conditions, such as lung and breast cancers, through timely investigations, thereby improving patient outcomes.
• Increased Consultant Capacity: Releasing consultant time allows for a higher volume of urgent cases to be addressed, improving overall service efficiency.

The success of the project has led BCUHB to request the scale-up of this model to its other two sites, with the potential for significant benefits if expanded nationally.

Economic Impact:

The initiative presents a cost-effective solution for addressing gastroenterology waiting lists:

• Cost Savings: The initiative has already released £108,000 in consultant time savings at Wrexham Maelor Hospital alone over the pilot period.
• Consultant Support: Gastroenterology consultants are fully supportive of this model, as it effectively optimises their workload.

Key Benefits:

• Reduced Waiting Times: Significant reduction in routine gastroenterology waiting times improving patient access to care.
• Early Intervention and Diagnosis: Prevents delayed or misdiagnosis
• Improved Clinical Outcomes: Timely assessments by the ACP Dietician improving patient safety and care quality.
• Increased Capacity for Urgent Cases: Freeing up consultant time enables quicker access for more urgent referrals (especially important where there is a shortage of Gastroenterology Consultants)
• Enhanced Multidisciplinary Team (MDT) Efficiency: Optimised workflows enhance collaboration and service delivery.
• Staff Upskilling: The ACP Dietician role provides opportunities for professional development within the team.

By reducing routine service pressures through an ACP Dietitian-led clinic, the model has demonstrated success in significantly reducing waiting times, optimising consultant capacity, and improving clinical outcomes. Its proven, scalable approach offers a compelling opportunity for sustainable, system-wide improvement in planned care.

Resources for Health Boards

Relevant Policy

Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022).

Goals:

• Effective referral
• Treat accordingly

Priorities:

• Transformation of outpatients
• Prioritisation of diagnostic services
• A focus on early diagnosis and treatment of suspected cancer
• Implementation of a fair and equitable approach to patient prioritisation
• Eliminating long waiters at all stages of the pathway
• Building planned care capacity
• Appropriate information and support

Welsh Innovation Strategy (2023)

Priorities:

• Diagnostics
• Reducing waiting lists
• Supporting a talented workforce

Promote, prevent and prepare for planned care (2023):

Supports:

• Advice and guidance to patients and individualised care along the pathway
• Efficiency of care
• Increased service capacity
• Collection of data

NHS Wales Technical Planning Guidance 2025 – 2028

Supports the ministerial priority of timely Access to Care

Service Presentation Material:

ACP Dietician Gastroenterology Service Presentation

ACP Dietician Gastroenterology Service Poster

Service Implementation Material:

Available upon request:

• Business Case
• Adoption Case for Change
• SBAR
• SOP

Planned Care Innovation Programe

This initiative was selected for piloting as part  of the Planned Care Innovation Programme. It was rigorously evaluated with proven substantial benefits (service, staff and patient level).

ACP First Contact Dietitian Led Gastroenterology Clinics – Bevan Commission

NHS Wales Technical Planning Guidance 2025- 2028:

The proven innovation from the Planned Care Innovation was recognised for its potential to support and  modernise pathways for outpatients by delivering care within a multi professional team.

Allied Health Professions Conference in Wales in 2024.

This initiative was recognised for its exemplary role in transforming planned care by Ruth Crowder, Chief Allied Professions Adviser for Wales.

Awards:

Advancing Health Care Awards Wales (2023)

BCUHB Innovative Care (2023)

Testimonials:

Dr Mathialahan, Consultant in Gastroenterology

”The Dietitian First Clinic has been very helpful in reducing the waiting time for this group of patients and therefore reduced the time experiencing impaired quality of life and poorly controlled/undiagnosed symptoms”.

Dr B. Ahmad, Consultant in Gastroenterology

”Data presented  including  patient feedback both strongly suggest that we should continue this service and even try to recruit more to this service.  It has also helped in improving staff skills and have given department an extra reliable support for outpatient work”.

Dr P George, Consultant in Gastroenterology

”Dietician led services off load the overstretched gastroenterology service with a waiting time of more than three years. These patients do not need consultant input and are best managed by dieticians.  We can triage the right set of patients to this essential service.  It is the most cost effective and efficient way to run the clinical service in Wrexham. Failure to do so will result in complete collapse of GI service at Wrexham”.

Interested in adopting this service in your health board?

Radiology Pathway Navigation – A New Direction

Strategic Case for Adoption:

Innovations in cancer pathways are imperative to address the significant demand (CT and MRI scan demand is growing by 11% annually), the urgent turnaround of referrals and to reduce inequalities in access.  Additionally, Wales has just 6.1 radiologists per 100,000 population—the lowest among UK nations—with a 30% staffing shortfall (RCR, 2023).

Since its implementation in 2022, the Radiology Pathway Navigation model at Princess of Wales Hospital (POWH) has demonstrated significant improvements in both the lung and colorectal National Optimal Pathways (NOPs) for cancer by addressing key bottlenecks in radiology processes.

Currently, radiology services across modalities collaborate well, but there is no continuous pathway linking each stage of the patient’s diagnostic journey. The lack of a cohesive, streamlined process results in delays, repeated hospital visits for investigations, and duplication of efforts in vetting referrals. The Navigator role addresses these inefficiencies by creating a more integrated pathway, thus reducing wait times for investigations, optimising clinician time, and enhancing staff productivity. The model aligns with national priorities for planned care and cancer services by improving diagnostic efficiency and patient outcomes.

New Service Approach:

The Radiology Pathway Navigation initiative introduces a Specialist Band 7 Radiology Cancer Navigator to streamline the radiology referral process, a role previously handled by radiologists, service managers, radiographers, and support staff. This redesign of the Single Cancer Pathway (SCP) for radiology aims to improve patient experiences and service efficiencies by expediting referral vetting, optimising imaging capacity, and providing a dedicated point of contact.

Methodology:

The innovative work focuses on patients referred for chest X-ray, MRI, and CT imaging for colorectal cancer. The role of the Navigator is to ensure coordinated care across these modalities, reducing delays and enhancing the overall patient journey.

Clinic & Systems Impact:

In 2024 alone, the Radiology Navigator facilitated 710 additional staging CT appointments in POWH — an average of 60 per month.

• Colorectal Cancer: Staging CT waiting times have decreased by 69% since 2022. Currently, 69% of patients diagnosed with a colorectal malignancy at colonoscopy receive their CT scan on the same day.
• Lung Cancer: Since 2022, there has been an 84% reduction in Chest X-ray (CXR) reporting times, a 29% decrease in the interval between CXR and staging CT, and a 67% reduction in time from initial GP suspicion to first multidisciplinary team (MDT) discussion.
• Shortening waiting times: Lowering the average wait from colonoscopy referral to CT staging from thirteen days to four days.
• Streamlining radiology pathways: Reducing the vetting process from five days to two and decreasing staff touch points from seven to four.
• Increasing radiology capacity: CT scanning capacity increased to 118%, with 530 extra patients scanned during the project period.
• Providing coordinated care: Facilitating seamless transitions for patients needing multiple examinations and procedures.
• Enhancing patient experience: Offering a dedicated point of contact and improved access to pre- and post-procedure information, including online resources

Economic Impact:

The project demonstrated significant resource optimisation and potential for cost savings:

• Resource impact: During the nine-month implementation period, the navigator role freed up 996 hours of radiology and management time.
• The navigator role has since been embedded into Cwm Taf due to its evidence of impact in releasing staff capacity, improving service efficiency, patient flow and outcomes.

Key Requirements:

The initial investment required includes funding for a Band 7 Radiology Cancer Navigator (1 FTE) and a Band 3 administrator to increase capacity, although it is anticipated that there may be opportunities to draw upon and train existing workforce capacity.

Benefits:

• Reduced delays: Streamlined processes significantly shorten the time from referral to appointment, improving patient flow.
• Optimised staffing: The reduction in staff touchpoints and vetting time allows for more efficient use of clinical resources.
• Improved patient coordination: The Navigator ensures a continuous pathway for patients undergoing multiple investigations, reducing the need for repeated visits.
• Patient-centred care: Enhanced communication and access to information improve the patient experience and support shared decision-making.
• Positive staff feedback: 100% of surveyed staff reported that the Navigator role benefits the service.

The Radiology Navigator role has proven to be a cost-effective, scalable model that accelerates access to diagnostic imaging, enhances patient outcomes, and alleviates workforce pressures. The model not only improves the quality and timeliness of cancer care, but also contributes to prudent resource use, generates significant time savings for consultant radiologists and modality leads, which enhances job satisfaction within the radiology workforce. Clinical teams also have considerable time savings by having a single point of contact within radiology. This concept is well-positioned for national adoption.

Resources for Health Boards

Relevant Policy

Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022).

Goals:

• Effective referral

Priorities:

• Transformation of outpatients
• Prioritisation of diagnostic services
• A focus on early diagnosis and treatment of suspected cancer
• Implementation of a fair and equitable approach to patient prioritisation
• Eliminating long waiters at all stages of the pathway
• Building planned care capacity
• Appropriate information and support

Welsh Innovation Strategy (2023)

Priorities:

• Diagnostics
• Reducing waiting lists
• Supporting a talented workforce

Promote, prevent and prepare for planned care (2023):

Supports:

• Advice and guidance to patients and individualised care along the pathway
• Efficiency of care
• Increased service capacity

NHS Wales Technical Planning Guidance 2025 – 2028

Supports the ministerial priority of timely Access to Care

Service Presentation Material:

Radiology Pathway Navigator Presentation

Radiology Pathway Navigator Poster

Service Implementation Material:

Available upon request:

• Adoption Case for Change
• SOP
• Job description

Testimonials:

“Having a Radiology Cancer Navigator assists us with reducing patient pathway delays and also having a point of contact so that we can high light patients who may have additional needs. We care for many patients on their cancer journey with learning disabilities and dementia, patients with these additional needs have in the past been significantly delayed to miscommunication. Having a point of contact is so beneficial, reducing unnecessary anxiety to our patients at this stressful time, and ensuring their investigations are done and discussed in time in the MDT. Any concerns we have had are escalated either by email or in person to Sarah (Radiology Navigator) and are always acted on immediately, always approachable and ensures appointments are speeded up preventing any unnecessary delays. In my opinion the role of the Radiology Cancer Navigator is invaluable, and improves the patient’s cancer journey.”

 (CTMUHB – Macmillan Gynaecological Nurse Specialist)

”I just want to thank you again for all your efforts in getting this service up and running. We find it very beneficial to our patients and cancer service pathway!”

(Upper GI Clinical Nurse Specialist, POW)

Interested in adopting this service in your health board?

Fracture Liasion Service (FLS)

Strategic Case for Adoption:

Between 2011 and 2021, Wales saw a significant demographic shift, with a 17.7% increase in the population aged 65 and over. This ageing population is particularly vulnerable to osteoporotic fractures, a condition that affects 1 in 2 women and 1 in 5 men over the age of 50, primarily impacting the hip, spine, arm, and forearm.

Notably, the incidence of fractures has risen, with a fragility fracture occurring every minute, compared to every two minutes in 2013. Across the UK, over 300,000 fragility fractures occur annually, costing an estimated £2 billion. In Wales alone, 20,000 fractures are expected each year as a consequence of osteoporosis, which now affects 3.8 million people across the UK.

The scale of the problem: only 9.3% of individuals in Wales who experienced a fragility fracture were identified in 2020 and only 64% received specialist care within 90 days, despite these fractures being a key indicator of increased risk for future breaks. Additionally, only 5.3% of those identified were commenced on treatment and only 20% of these patients were followed up at 52 weeks. This means that only 3.3% (n=222) of patients identified in 2020 received the recommended treatment to guidance (taken from the FLS database).

A 2004 study on fracture risk following an initial osteoporotic fracture found that 34% of individuals aged 60 to 80 years experienced a subsequent hip, clinical vertebral, forearm, or shoulder fracture within the first year. Over a five-year follow-up period, this risk gradually declined to 9% by the fifth year (Johnell O et. Al. 2004).

A study conducted in 2019 among women aged 65 and older found that, in the absence of appropriate secondary prevention, the risk of refracture remained alarmingly high—reaching 10% at one year, 18% at two years, and 31% at five years (Balasubramanian A et. Al. 2019).

A more recent systematic review and meta-analysis in 2024 assessing the effectiveness of FLS in adults aged 50 and older found moderate-certainty evidence that FLS significantly reduces the risk of secondary fragility fractures at follow-up periods of two years or more. Hence stronger partnership and collaboration with Primary Care for an extended follow-up is particularly beneficial due to the time required for bone remodelling as a result of osteoporosis medications (Danazumi MS et. al. 2024).

Proactive care can prevent many fragility fractures, yet the consequences of fractures remain severe and often unmeasurable. Hip fractures are associated with a 20% mortality rate within one year, 50% are unable to walk unaided and 15% require discharge to nursing homes. Additionally, 66% of patients with vertebral fractures develop chronic back pain with 20% risk of dying within five years. Beyond the physical impacts, these fractures also contribute to a loss of confidence, fear of falling, loneliness, and depression.

The economic burden of all fragility fractures in Wales is substantial, amounting to £133,062,444 annually. This figure underscores the importance of addressing osteoporosis and fragility fractures on a national level through preventative strategies and timely interventions.

New Service Approach:

The Fracture Liaison Service (FLS) aims to deliver ROS 80% identification/50% treatment/80% monitoring model for preventable osteoporotic re-fractures. The approach is scalable to all health boards and meets national guidelines.

Methodology:

• Digital identification: An administrator completes an initial triage of a live digital record, identifying patients over 65 years who have sustained a fragility fracture,  (the FLS ultimate aim is to identify patients over 50 years). A bone health nurse practitioner/ advanced clinical practitioner (ACP) completes the next review to identify patients who would benefit from a specialist bone health review, whereby patients are referred to a consultant geriatrician.

•  Treatment: Suitable patients are contacted for a bone health assessment which includes falls risk and community care. Bone therapy is recommended for suitable patients.

• Adherence to Treatment: Patients will be monitored in their understanding of the risk of osteoporosis, lifestyle modification requirements and their adherence to bone therapy at 16 and 52 weeks.

The service is integrated with radiology, rheumatology, emergency and trauma and patients are seen by the FLS team within days rather than the traditional referral model of weeks to months before their first clinical review.

Clinic & Systems Impact:

• As a result of the service transformation in Aneurin Bevan UHB, fracture case identification improved from 25% (2021) to 44% (2022). Identification of fracture cases increased further to 53% in 2023, reaching 70% in 2024 (National benchmark=36%).
• 64% patients were treated to guidance (national benchmark=55%). Treatment and monitoring achievement in AB-FLS is now higher than the national average.
• These advancements have ensured that more patients receive timely, high-quality osteoporosis care, preventing missed treatment opportunities.
• FLS is spreading across all parts of Wales and there is an observed increase in case identification of 46.5%, from 16.8% (3,537 cases) in 2023 to 25% (5,200 cases) in 2024.

Economic Impact – Local to National Transformation:

The FLS has been communicated as a ministerial priority and has received £1,000,000 funding for national roll out based on its evidence in providing high-value, high-quality patient care. Health boards are expected to consider formal FLS business case to ensure the sustainability of the prudent value based service.

To date, the FLS has recruited an additional 13 ACP/ bone health nurses and 11 administrators/ FLS coordinators.

The FLS has demonstrated a best return of value for services, with expected annual cost benefits of £11,047,324 across Wales.

Key Requirements:

The ROS recommends 1 WTE nurse/ ACP with 0.5 administrator to serve a population between 40,000-46,000.

Key team members:

• FLS administrators/ co-ordinators
• Clinical specialist nurses/ ACPs
• Booking clerks and directorate support officers
• Radiographers
• Consultants (bone health specialists and radiologists)

Benefits:

• Reduced risk and rate of fragility fractures for Wales
• Reduced rate of post fracture mortality and complications that would usually occur in the frailer population
• Reduced demand for primary and secondary services
• Improved patient self management, outcomes and quality of life in older years
• National equitable value-based service with significant return on investment through resource release
• Meeting national standards of care
• Political support for adoption, scale and spread (quality statement and national mandate)

Resources for Health Boards

Relevant Policy/ Strategic Alignment

Quality statement for osteoporosis and bone health [HTML] | GOV.WALES

Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022).

Goals:

• Effective referral (most clinical needs seen in the right setting)
• Advice and guidance (to aid informed decision making by secondary and primary care)
• Treat accordingly (right place, right time)
• Follow up accordingly
• Measure what’s important

Priorities:

• Transformation of outpatients
• Prioritisation of diagnostic services
• A focus on early diagnosis and treatment of suspected cancer
• Implementation of a fair and equitable approach to patient prioritisation
• Eliminating long waiters at all stages of the pathway
• Building planned care capacity
• Appropriate information and support

Welsh Innovation Strategy (2023)

Priorities:

• Diagnostics
• Reducing waiting lists
• Reduced time in hospital
• Supporting a talented workforce

Promote, prevent and prepare for planned care (2023):

Supports:

• Advice and guidance to patients and individualised care along the pathway
• Efficiency of care
• Population health and prevention

NHS Wales Technical Planning Guidance 2025 – 2028

Supports the ministerial priorities – ‘timely access to care’ and ‘population health and prevention’

Nationally Available Information:

Royal Osteoporosis Society – Better Bone Health for Everybody

Osteoporosis Risk Checker

Osteoporosis Online Community

Service Presentation Material:

Dr I Singh Welsh FLS Presentation

FLS Poster

Service Implementation Material:

Case for change (full business case available on request)

ROS National Clinical Standards

FLS-Reporting Benchmarks 2020

Fracture Liaison Service Database (FLS-DB) | RCP

FLS-DB resources for services | RCP

FLS-DB resources for service improvement | RCP

FLS-DB resources for primary care | RCP

FLS-DB resources for patients | RCP

Written Statement: Quality Statement for Osteoporosis and Bone Health (6 December 2024) | GOV.WALES

Media:

Videos

Patient’s Voice – Melinda’s Story – YouTube

Articles:

Elderly falls: Wales action to cut costly home fractures – BBC News

Wales: Fracture Liaison Services rolled out across the country | International Osteoporosis Foundation

£1m investment in FLS for Wales!

Quality care for everybody – Fracture Liaison Service: an all-Wales approach | RCP

A vision for better bone health in Wales | RCP

Royal Osteoporosis Society | Working together to close the care gap

Awards:

NHS Wales Awards 2025 winner: Leadership catergory ” Let the First Fragility Fracture be the Last!”

First Minister announces finalists of St David Awards 2025 | GOV.WALES

Inderpal Singh | GOV.WALES

Shortlisted for NHS Sustainability Awards 2025

MediWales Health and Care Judges Award 2024

Interested in adopting this service in your health board?