MONEY will be made available to start to tackle the crisis in orthopaedics in Gwent - but we will have to wait a month to find out how much.

Assembly health minister Jane Hutt said targeted investment will form part of her response to a hard-hitting report on orthopaedics in Gwent, by waiting times troubleshooter professor Brian Edwards.

But it will have to wait until February 26, when Ms Hutt will address the Assembly's health and social services committee.

Gwent's head of orthopaedics, however, has warned that without substantial investment - and quickly - the service will soon be "in free-fall" and dealing only with emergencies.

Surgeon Andy Grant, director of orthopaedics with Gwent Healthcare Trust, agreed with Professor Edwards' findings that management of the orthopaedic service needs to be tightened. "But there is a large capacity gap in Gwent and we need investment to bridge that. This is only the latest of a series of reports to have said that," he said.

"It is inescapable and if there is not an announcement of financial support on February 26 the service will soon be in free-fall in Gwent and will become an emergency only service very quickly."

Professor Edwards' report presents Ms Hutt with a dilemma. She called him in amid much fanfare in November as the numbers of orthopaedic patients waiting more than 18 months for treatment increased in Gwent.

Professor Edwards was brought in because, of the 205 patients in Wales who had waited more than 18 months for such surgery by the end of October, 173 - 84 per cent - were from Gwent.

Big surges in emergency medical admissions at the area's hospitals since the end of August, coupled with problems caused by a virulent stomach bug, forced the cancellation of scores of operations and closed many surgical beds.

These issues have made worse an already difficult situation caused by an underlying lack of capacity in orthopaedics.

He has said that targeted investment - around £8m centred on Nevill Hall Hospital, Abergavenny, and St Woolos Hospital, Newport, is essential as part of a medium to long-term solution.

"The investment that is going to be required in the short and long-term, I am confident we will be able to deliver," said Ms Hutt, though she stressed the importance of the NHS in Gwent sharpening up its act, too.

"This report can change the face of orthopaedic care in Gwent, but it is not just up to me, it is up to those who deliver the service. Unless everyone grasps the opportunity, it will be wasted."

His report on the first external review of its kind in the NHS in Wales also proposes a better deal for thousands of patients who wait far too long on orthopaedic waiting lists They must be kept far more closely informed of their waiting list status, their need for treatment or assessment should be regularly monitored, and they should be made aware of the waiting times to see individual surgeons.

Professor Edwards says there is much room for improvement in Gwent Healthcare Trust's management of orthopaedics - and of waiting lists within the specialty - and the trust, the new local health boards, GPs and social services must work more closely together. But ultimately, he says, extra funding is vital.

The cost of extra beds for Nevill Hall is £1m, with running costs of £2.2m. (This proposal could be operational within eight months of approval and could provide 600 more operations and 1,000 outpatient consultations.)

Demountable theatres and extra beds for St Woolos would cost £2-2.5m, with running costs of £3-3.5m.

These could be set up within a year and could provide 840 more operations and 2,000 more outpatient consultations a year. Five extra orthopaedic surgeons are needed. The aims are to eliminate waits of longer than 18 months by the end of February.