North London Partners in health and care

Review of adult elective orthopaedic services


We are reviewing Adult Elective Orthopaedic Services and we'd like your views

 
Please scroll to the bottom of this page to give your feedback using our questionnaires
Prior to giving your feedback, please read our draft case for change, which explains our thinking so far

A large print version is also available

Key Points

  • We are launching a review of adult elective orthopaedic services across north central London (NCL) following agreement at the NCL Joint Commissioning Committee meeting on 01 February 2018
  • We think there may be opportunities to improve adult elective orthopaedic surgery in north central London by consolidating services onto fewer sites
  • We are undertaking a review of these services to see if these improvements can be achieved
  • The review has been established by North London Partners in Health and Care
  • A review group led by local clinicians, involving patients, commissioners and those who currently carry out these operations is coordinating the development of how this kind of care could be delivered in the future
  • Clinical commissioners will make decisions on where and how this happens
  • The review covers services in Barnet, Camden, Enfield, Haringey and Islington

Current adult elective orthopaedic services

In 2016/17, north central London hospitals carried out over 23,000 adult elective orthopaedic operations across 10 sites. Adult elective orthopaedic surgery is planned (non-emergency) surgery of bones and joints, such as hip and knee replacements.

There are already many areas of good practice in adult elective orthopaedic care in north central London which include falls prevention schemes, how people access musculoskeletal care and people staying in hospital for a shorter time but we think they can be improved further.

Opportunities for improvement

We are aiming to improve outcomes and experience for patients.  This includes:

  • Less time spent in hospital
  • Much less risk of operations being cancelled
  • Shorter waiting times for an operation
  • Improved clinical outcomes

We believe that there are a number of areas of current care that could be improved upon, and a desire to realise these improvements is driving our review: 

  • Patients report different experiences and outcomes at different hospitals
  • Some hospitals carry out small numbers of some operations, leading to inconsistent approaches ( for example elective knee replacements in those who had an arthroscopy)
  • There is variation in ‘revision rates’ (a follow-up procedure being needed if the first one didn’t work as expected)
  • There are variations in the length of a patient's hospital stay, following an operation
  • Rates of readmissions (a patient who has been discharged is admitted back to hospital) vary (but are low) 
  • Infection rates vary (but are low)
  • Waiting times vary and targets are being missed

Our current thinking

No decisions have been made and our thinking is at an early stage. Learning from the best, we believe that by consolidating adult elective orthopaedic surgery from multiple hospitals to a smaller number of larger units we could further improve care:

  • By separating elective (planned) surgery from emergency surgery services could be more efficient and we could improve quality 
  • By separating elective (planned) beds from emergency beds we could reduce cancellations and reduce the incident of hospital acquired infections
  • We could expand 'joint school'* to improve the quality of care through greater patient engagement and education. This could lead to faster recovery and improve our patients' experience of the care they receive
  • We could provide the best possible aftercare, promoting faster recovery and better outcomes and less time in hospital
  • A co-located specialist high dependency unit would enable all cases to be done on one site
  • We could develop access to innovations such as robotic surgery that are likely to deliver improvements in outcomes
  • Links to research could be extended and there would be much greater potential for clinical trials 

*Joint school is a service specifically for people who are about to undergo a hip or knee replacement. It focuses on patient education and lets patients know what to expect through the various steps they will experience, from preparing for admission through to recovery at home.

Engagement

So far local surgeons, local hospital representatives and managers, patient representatives, clinical commissioners and our programme team have been involved in developing our draft case for change.  We are now sharing our thinking with anyone who is interested and inviting comments.

Ensuring appropriate engagement, in accordance with NHS guidance and aligned with the Gunning Principles of involving patients and the public, clinicians and other staff is critical. We would also welcome feedback from all providers with an interest in this service area to help us develop a proposed model of care.

Engagement event

Thursday 18 October, 2pm - 4pm.   Arlington Centre,  220 Arlington Rd, Camden Town, London NW1 7HE. 

[See location on Google Maps]

On Thursday 18 October from 2pm - 4pm, we are inviting local people to hear more about our work, and give their thoughts on the future of these services.

The event will comprise a short presentation, followed by round table discussions and an opportunity to ask questions. Anyone with an interest in these services is welcome to attend.  

We are working in partnership with Healthwatch Camden to organise this event and anyone wishing to attend can book a place in advance.   Details of how to book will be released shortly. 

If you have any concerns or feedback about any specific personal orthopaedic treatment you have already received, or you are waiting to receive, please speak to your GP or the hospital who provided this service.  

How to feed back 

Before giving your comments, we would invite you to read our draft case for change, which clearly describes our current thinking, the opportunities for improvement, and the research and evidence that we've looked at to guide us. 

Download the draft case for change
Download a large print version of the draft case for change

The draft case for change document contains links to a series of illustrative graphs and tables hosted on our website. If you read the case for change on your computer or device, the link will take you to the relevant graph or table.

However, if you intend to print the draft case for change, you should also print the accompanying graphs and tables.

If you would like a printed version of the document sending to you in the post please contact us at nclstp.orthopaedics@nhs.net, including your full name and address in the email.  

When you have read this you can:

  1. Complete our online questionnaire, which asks a number of questions about the case for change and invites your views.  We have different questionnaires for different groups.  Please choose the right questionnaire for you:

    Questionnaire for patients and local residents
    Questionnaire for providers of healthcare
    Questionnaire for commissioners
  2. Email usnclstp.orthopaedics@nhs.net
  3. Send a letter in the post to: North London Partners in Health and Care, 5th Floor, 5 Pancras Square, London N1C 4AG
  4. Come to one of our events (see above)
  5. Contact your local Healthwatch group

We have provisionally set 19 October as the closing date for feedback, however we will review the range of responses received and may extend this if necessary. 

Should you have any questions or want to find out more about the review, please email the Review Team at nclstp.orthopaedics@nhs.net

 You can read the papers presented to the North Central London (NCL) Clinical Commissioning Committee meeting on 1 February 2018 here.