Facing the increasing pressures on elective surgical services, Swansea Bay and Hywel Dda University Health Boards have taken a proactive and clinically led approach to exploring innovation.
As part of their shared commitment to delivering high-quality, patient-centred care for the people of Wales, the two Health Boards jointly led a pilot project to assess the potential value of OpenPredictor, an AI-driven risk stratification tool, within orthopaedic total joint replacement pathways.
In collaboration with industry partner OPCI, the pilot represents the start of an exciting journey towards a more intelligent, equitable, and sustainable model of healthcare delivery, placing Southwest Wales at the forefront of exploring digitally enabled pathway redesign in NHS Wales.
Partners and funding
- Swansea Bay University Health Board
- Hywel Dda University Health Board
- OPCI LTD
- Welsh Government
Project aims
This project represents a collaboration between Swansea Bay University Health Board, Hywel Dda University Health Board, and OPCI, working together to explore new ways to strengthen elective surgical care pathways.
The aim is to showcase both Health Boards’ commitment to continuously improving care for the people of Wales, even amidst significant service pressures and complex system demands. It focuses on how frontline NHS teams are leading transformation in a way that is values-led, patient-focused, and aligned to both local service needs and national strategic ambitions.
While the pilot involved the use of OpenPredictor, an AI tool provided by UK-based partner OPCI, this case study is very deliberately health-led, not product-led. The technology is presented as a supportive thread within the broader narrative, the primary story remains the leadership, innovation, and vision demonstrated by NHS Wales teams.
Challenges and Opportunities
Like many NHS organisations, Swansea Bay and Hywel Dda University Health Boards face significant challenges: growing elective backlogs, limited capacity, and the imperative to safeguard patient safety while ensuring fair and timely access to care. Patients can deteriorate while waiting, increasing surgical risk and the likelihood of cancellations, particularly critical in high-volume services such as orthopaedics.
Both Health Boards recognised that, while maintaining the important principle of treating patients in chronological order wherever clinically appropriate, there is also a need to enhance how surgical waiting lists are managed by taking patient health and clinical risk into account. Together, they identified an opportunity to explore new approaches that could strengthen patient safety, support early intervention where appropriate, and ensure services remain fair, responsive, and personalised to individual patient needs.
Clinicians and operational leads from both Swansea Bay and Hywel Dda Health Boards undertook a joint pilot of OpenPredictor, designed to explore how AI-driven stratification could support improved elective pathway management.
Importantly, the pilot was shaped and governed by NHS teams themselves, ensuring that the technology was used thoughtfully to complement, not replace, professional clinical judgement.
The pilot focussed on:
- Exploring the proactive identification of high-risk patients for targeted optimisation or specialist review
- Understanding how lower-risk patients might be safely prioritised for earlier treatment in high-throughput or lower-complexity units (High Volume Low Complexity HVLC)
- Evaluating dynamic waiting list management approaches within governance frameworks
- Testing the detection of silent deteriorations to improve health equity
- Strengthening shared decision making between clinicians and patients through enhanced understanding of risk and outcomes
Project outcomes
Initial findings and insights from the pilot suggest considerable opportunity to support safer, more efficient, and patient-focused care:
- Early identification of deteriorating patients provides opportunities for timely intervention or adjustment to treatment plans
- Lower-risk patients were highlighted for potential streamlined pathways, reducing delays and preserving surgical standards
- Real-time visibility of clinical risk profiles strengthened multidisciplinary team (MDT) discussions and waiting list management
- Enhanced shared decision-making support more transparent conversations with patients about the risks and benefits of proceeding with surgery
These early insights demonstrate how responsible digital innovation, driven by clinical leadership, can help address some of the most pressing challenges in elective care.
Driving Innovation: Teams Committed to Better Care
The success of this pilot reflects the outstanding leadership, collaboration, and continuous improvement culture within both Swansea Bay and Hywel Dda University Health Boards. Clinical teams, operational managers, analysts, and support staff across both organisations showed remarkable commitment in balancing innovation with the ongoing pressures of service delivery.
Their shared determination to explore opportunities for safer, fairer, and more efficient care, despite operational challenges, demonstrates the values-driven leadership at the heart of NHS Wales.
Partnership and National Vision
This project stands as a powerful example of what can be achieved through genuine NHS-industry partnership, underpinned by local leadership, clinical rigour, and shared values.
The foresight of the Welsh Government in supporting digital innovation and data-led health transformation must also be recognised. Their commitment to elective recovery and sustainable service improvement has created the environment where pilots such as this can thrive.
Above all, this work reinforces that innovation in the NHS must always be about improving patient care, not technology for its own sake, but technology as a tool for safer, better healthcare, underpinned by clinical oversight to ensure it is never used in isolation.
Professor Mike Reed, Founder of OPCI and Consultant Orthopaedic Surgeon said:
“The clinical engagement from both Swansea Bay and Hywel Dda has been outstanding. Their teams approached this pilot with clear purpose, curiosity, and a deep sense of responsibility to their patients. It’s been a privilege to contribute from a research and clinical innovation perspective, and to support the Health Boards as they explored how digital tools could complement professional judgement. This has been a truly collaborative effort, grounded in shared learning and mutual respect.”
Dr Justin Green, Founder of OPCI and Orthopaedic Surgeon said:
“It has been a privilege to work alongside the teams at Swansea Bay and Hywel Dda University Health Boards. Their openness, leadership, and commitment to using technology to support service improvement have shaped this project from the outset. Patients and clinical priorities have remained central throughout. We’ve greatly valued the collaboration and shared spirit of innovation across the Health Boards and Government, a strong example of how healthcare and technology can work together respectfully to explore new approaches to care."
Next steps
Both Swansea Bay and Hywel Dda University Health Boards are now considering how best to build on the insights gained from the pilot within orthopaedic services. The immediate focus is on evaluating the potential adoption of this approach across orthopaedic joint replacements, as this is the area currently covered by OpenPredictor’s regulatory licence. Ensuring the tool is embedded safely and effectively into orthopaedic joint replacement pathways is a necessary first step.
The technology is capable of supporting other surgical specialties, and the long-term intention, working closely with the Health Boards, is to validate and develop its use more widely as part of a broader, clinically governed approach to surgical pathway transformation.
The pilot experience is also contributing to reflections on how digital risk stratification might support national strategies for elective recovery, service transformation, and health equity in Wales. By learning from the pilot and considering the investment made, the Health Boards are helping to inform future thinking about the potential for broader digital innovation across NHS Wales.
Swansea Bay and Hywel Dda are demonstrating that with the right leadership, clinical engagement, and partnership, there is a real opportunity to shape a smarter, fairer future for planned care services across Wales. Visit https://sbuhb.nhs.wales/ / https://hduhb.nhs.wales/ to find out more.
Acknowledgements
Swansea Bay and Hywel Dda University Health Boards would like to extend their sincere thanks to the many teams across both organisations who contributed to this work. The success of the pilot reflects the dedication and expertise of clinical, operational, digital, and research colleagues, all working together under significant service pressure to explore new ways of improving care.
We also recognise the valuable contributions from academic partners, including Professor David Beard (University of Oxford), Northumbria NHS Foundation Trust, and Swansea University School of Business. Their early input and continued collaboration have helped shape and inform the pilot, strengthening its academic foundation and clinical relevance.
This has been a truly collaborative endeavour across health and academic settings, and we are grateful to all those who supported this work in pursuit of safer, smarter, and more sustainable patient care.