LONG waiting times are worst in South-East Wales, a fact known prior to the NAO's report.

Within this region, Gwent has shouldered a heavy burden, particularly in orthopaedics, where problems were highlighted during the Edwards Review two years ago.

Waits of more than 18 months for such treatment have since been eliminated and since last summer Gwent's acute hospitals have, with the rest of Wales, worked towards a maximum 12-month waiting time.

This Assembly-set target applies to all specialties and is being tackled with the help of the controversial Second Offer Scheme. This gives patients who might otherwise wait longer than the maximum time the option of earlier treatment in England or in the private sector but paid for by the NHS.

Patients have travelled as far afield as Birmingham, Kidderminster, Bristol and Taunton, though many have declined, opting instead to wait for treatment in Gwent.

Capacity problems have dogged the delivery of orthopaedic treatments here. There are not enough operating theatres and consultants, though a 7m scheme due to open at St Woolos Hospital, Newport, next January will address that problem.

Its two dedicated orthopaedic theatres and 36 orthopaedic beds will be a good example of the ring-fenced elective facilities the NAO report says Wales lacks.

Targets for angiography (a heart test) and cataract surgery have been maintained in Gwent, though again with the latter treatment, outside help has been required.

Some parts of Gwent experienced problems with in-patient and day case patients having to wait more than 18 months for treatment.

The NAO reports that Blaenau Gwent had 3.5 patients per 1,000 population - more than 250 - in this category in December 2003, the highest proportion in Wales, while Caerphilly, Torfaen and Newport had more than two patients per 1,000 population in the same situation.

Much has been done to improve things since then however, and such long waits have now almost been eliminated across all specialties.

The problem for Gwent, as for all other trusts despite the improvements, is that the NAO report concludes much more must be done. The Assembly must take the lead and learn the lessons of the NAO's findings, but so too must Local Health Boards and trusts.