ALMOST 850 patients in Wales - including 130 in Gwent - who turned down operations in England or privately, had waited longer than the target 12-month maximum treatment waiting time by the end of March.

Investment of millions of pounds in the under the Second Offer Scheme - which gives patients who might otherwise wait longer than the maximum treatment time the opportunity of earlier treatment in an English hospital or in the private sector but funded by the NHS - has delivered earlier treatment for thousands of patients.

But the scheme has proved controversial, not least because the production of two sets of waiting times figures, with and without those who decline second offers, has been interpreted in some quarters as the Assembly shifting the onus for earlier treatment onto the patient, instead of focusing on providing solutions to long waiting times in Welsh hospitals.

Many hundreds of patients have declined the second offers, opting to wait longer for treatment closer to home, and the scheme has failed to eliminate waits of more than 12 months, as Assembly bosses hoped it would.

Even if those patients who declined second offers of treatment are excluded from the figures, there are still 108 across Wales who had not been treated within 12 months by March 31, though none of these was in Gwent.

But if those who turned down a second offer are included, the figure rises to 845 Wales-wide.

The 130 in Gwent are orthopaedic and general surgery patients. Thirty-one patients in Wales had waited longer than the 18-month maximum waiting time for a first outpatient appointment by March 31. None of these was in Gwent, where a focus on long outpatient waits has put the area's hospitals ahead of the target.

Apart from orthopaedic patients, no-one in Gwent has been waiting more than 15 months for a first outpatient appointment, an internal Gwent Healthcare Trust target.

This gives Gwent clinicians a little breathing space as they set about bringing outpatient waits down to a maximum 12 months by the end of March 2006.