BIG improvements in the numbers of patients treated by Gwent's orthopaedic service will be expected by Newport Local Health Board before it approves future major investment, the board's chief says.

Earlier this month the Assembly announced that Gwent and Cardiff will share £10.7 million to provide extra orthopaedic capacity.

Gwent's share will fund two extra orthopaedic theatres, extra staff, and conversion of existing accommodation into a 30-bed ward, all at St Woolos Hospital. The Assembly will also provide £5m of recurring funding to support the Gwent and Cardiff schemes.

Newport Local Health Board (LHB) chief executive Kate Watkins, however, said a review of Gwent's trauma and orthopaedic services raises concerns about "current productivity".

The review was carried out for the Assembly by the Inter Authorities Comparison Consultancy, part of the Health Services Management Centre, based at the University of Birmingham. It assesses NHS trusts' performance in a range of clinical specialities.

Newport LHB is concerned about the potential running costs of proposed orthopaedic projects, which it may have to at least partly fund. Though the Assembly will help with those arising from the St Woolos scheme, Mrs Watkins is keen that orthopaedic service productivity be raised.

"As a result of the University of Birmingham review, there are concerns about the current productivity," she said.

"Although some initial work is under way on developing additional capacity, particularly at St Woolos, we would expect to see significant improvement in the productivity of existing services before asking the (LHB) board to approve any major investment in the service in future."

A Gwent Healthcare Trust spokesman said the study had raised issues similar to those highlighted in last January's Edwards Report on Gwent's orthopaedic services - the trigger for the Assembly's investment - which the figures in the study pre-dated.

These included a need to ensure that two joint replacements could be carried out per operating session, that short-notice cancellations of operations by the trust be reduced, and that orthopaedic beds be more firmly ringfenced against use by non-orthopaedic patients.

"These issues continue to be addressed, and productivity (in orthopaedics) has increased by 20 per cent in 12 months," said the spokesman.