NO patient deemed fit enough to undergo hip, knee and other bone surgery has now waited longer than 18 months, the target set by Assembly health minister Jane Hutt.

Now Gwent Healthcare Trust must ensure no patients breach the target time - and until projects to provide new surgeons, operating theatres and beds are up and running, it must continue to rely heavily on waiting list initiatives, such as weekend operating sessions, and use of the private sector to keep the figure at zero.

The last time there were no patients in Gwent waiting more than 18 months for orthopaedic treatment was at the end of last July, Ms Hutt's deadline.

During late summer and early autumn, however, a combination of factors - emergency pressures, bed closures caused by infections, and a temporary requirement to take orthopaedic patients from a neighbouring trust - sent the figures up.

By the end of October, 173 orthopaedic patients in Gwent had waited more than 18 months for treatment, more than 80 per cent of the all-Wales total.

Ms Hutt appointed NHS troubleshooter Professor Brian Edwards to review the orthopaedic service in Gwent. His findings were published late in January and one month later Ms Hutt announced £6 million of extra funding for the area, based on his recommendations.

Since October, the number of over 18-month waiters has gradually fallen, with the trust using waiting list initiatives and the private sector - primarily the BUPA hospital in Cardiff and Medinet - to supplement the work done by its own surgeons.

The £6m coming to Gwent from the Assembly will fund two major projects - temporary orthopaedic operating theatres and more surgical beds at St Woolos Hospital, Newport, and an extra ward of orthopaedic beds at Nevill Hall Hospital, Abergavenny. More orthopaedic surgeons will also have to be appointed.

These schemes will begin to address the gap in orthopaedic capacity that reports over several years, culminating in the Edwards Report, have identified in south east Wales. But it will be six to eight months before the first of these is ready to go, and in the meantime, the trust must strive to keep treatment waits under 18 months.