• 25 January 2016 Draft in progress | 1
Objective: We have been thinking about opportunities to improve orthopaedic services. We have reached the stage where we want to test our thoughts with a wider group of service users. Our objective today is to test these ideas and get a response. If these ideas develop further we may wish to formally engage or consult with the public on them. At this stage we want to: - raise awareness of the issues - get an initial reaction to them Draft in progress | 2
AGENDA Topic Speaker Time Slides 1. Introduction and Peter Gluckman, Independent facilitation 1.00pm 1-5 welcome 2. Introduction to the Dr Amr Zeineldine, Clinical Chair, OHSEL 1.15pm 6-10 programme Programme 3. Orthopaedic service Sarah Blow, Chief Officer Bexley CCG and 1.45pm 11-15 issues Planned Care SRO 4. Discussion Table work and feedback 2.15pm 5. Some ideas on how we Sarah Blow, Chief Officer Bexley CCG and 2.45pm 16-18 tackle the issues Planned Care SRO 6. Discussion Table work and feedback 3.15pm 7. Next steps and wrap up Peter Gluckman, Independent facilitation 3.45pm 19 Draft in progress | 3
• We have brought together through this group of members of the public to discuss some issues with how we deliver planned care orthopaedic services in SE London and how we might address them. • Today is about discussion, not decisions. • We will meet again as a group when we are nearer to finalising ideas • Today we will: • Discuss the overall context: the NHS in South East London • Discuss why we think planned orthopaedic care needs to change • Discuss our emerging ideas and ask for your feedback on them Draft in progress | 4
• Mobile phones to silent • First half of session is information- giving – please be patient as we will ask for your views • No jargon!- shout out if you don’t understand • Listen to others – one person speaking at a time • This meeting is a starting point: information will also be shared on our website www.ourhealthiersel.nhs.uk for comment and you can share this with colleagues Draft in progress | 5
Our Healthier South East London is a partnership between the 6 NHS clinical commissioning groups (CCGs*) for SE London – Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark – working with NHS England, local provider trusts** local authorities, patients and members of the public to develop a future strategy for health services in our area. *CCGs are responsible for paying for and coordinating health services in their area. **Provider trusts – local hospitals, mental health trusts and community services – are those who deliver the services. Draft in progress | 6
Planned care (sometimes called elective care) is an operation or clinical procedure that is arranged in advance for a certain date – e.g. a hip replacement operation Orthopaedics is the medical specialty that focuses on injuries and diseases of your body's musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles, and nerves and allows you to move, work, and be active. Draft in progress | 7
Context: the NHS in SE London • Why things need to change • Developing our 5 year strategy • Key themes from the strategy Planned care • Why planned care orthopaedic services need to change • Discussion in groups Emerging ideas • How we might improve planned orthopaedic services by organising them differently • Discussion in groups • Plenary/questions Draft in progress | 8
• Too many people live with preventable ill health or die too early • The outcomes from care in our health services vary significantly and high quality care is not available all the time • We don’t always treat people early enough to have the best results • People’s experience of care is very variable and can be much better • Patients tell us that their care is not joined up between different services • The social care system is under increasing pressure • The money to pay for the NHS is limited and need is continually increasing Draft in progress | 9
We published a document setting out our thoughts on how things could be improved in September 2015 – this was developed following engagement with local clinicians, NHS and local authority staff, local hospitals and local people. Six areas of healthcare have been identified as priorities for improvement: • Community-based care • Urgent and emergency care • Maternity • Children and young people’s services • Cancer • Planned care Today we concentrate on planned orthopaedic care Draft in progress | 10
9 local hospitals provide orthopaedic care Dartford Orpington PRUH King's Non-elective Queen Mary's Day case Elective Queen Elizabeth Lewisham St Thomas' Guy's 0 500 1000 1500 2000 2500 3000 Draft in progress | 11
2014/15 Proportion of SEL Elective Long Elective Non- elective activity Stay Day Case Elective (14/15) GH 2,571 2,111 37 23% GSTT STH 19 6 895 0% UHL 676 1,474 716 11% LGT QEH 348 393 1,549 4% QMS 177 737 - 4% KCH 1,195 1,739 1,147 14% KCHT PRUH 257 2,070 1,464 11% Orp. 2,131 430 - 13% DVH 1,357 1,217 1,474 13% DGT QMS 286 1,221 - 7% Total 9,017 11,398 7,282 100% Draft in progress | 12
1. The demand for orthopaedic services is growing very fast SEL Trauma & Orthopaedics Activity, historic vs projected 40,000 37,871 35,000 30,000 25,000 23,688 20,415 Spells 20,000 16,794 14,019 15,000 7,282 10,000 8,454 4,412 5,000 0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 Elective and Day Case (Historic) Emergency (Historic) Elective and Day Case (High Case Projection) Emergency (High Case Projection) Elective and Day Case (Low Case Projection) Emergency (Low Case Projection) The dashed line shows what will happen if we carry on growing at current rate- (13% a year for elective, 18% for non-elective). The dotted line shows what would happen if it just grew at the rate of population growth. Draft in progress | 13
1. The worsening capacity problems caused by increasing referrals are leading to waiting list problems and costly outsourcing to independent hospitals: 2. Evidence of surgeons undertaking low volumes of specific activities that may well result in less favourable outcomes as well as increased costs. 3. Length of stay and efficiency measures below the London average. 4. Evidence that a model of intensive rehabilitation during the acute phase achieves better outcomes when delivered seven days a week, but there must be sufficient investment to fund this, instead of simply stretching five day services over the longer period. 5. Elective orthopaedics requires an environment in which the infection risk is minimised. This will involve ‘ring - fenced Beds’, which not every unit in SEL has 6. Better procurement could save costs- standardisation of prostheses. Draft in progress | 14
• Do the challenges that we have set out match your own experience? • If you do not have direct experience do these problems sound a cause for concern to you? • Should we do something about them? Draft in progress | 15
We have been working with a group of clinicians, managers and patient and public representatives to think about these issues no decisions have been taken but this is where the groups thinking has got to: 1. We think all local hospitals should retain their emergency orthopaedic services to support A&E departments 2. We think all local hospitals should retain their out patient and day case services to preserve local access to care 3. We think provision of planned orthopaedic care needs to increase to meet waiting time standards, reduce cancellations and stop us having to outsource work outside local hospitals 4. We should look at the feasibility of creating one or two expanded centres for planned care to take all the of this activity in south east London: i. We could deliver care to consistently high quality and efficiency ii. It might be the cheapest way to increase capacity iii. It might bring specialist services together Draft in progress | 16
A centre of this type has already been established in South West London- ‘South West London Elective Orthopaedic Centre’ at Epsom hospital • Transport provided to the centre by taxi • Very high patient satisfaction • Good quality outcomes • Fast treatment In south east London we could have one or two centres Possibly one would focus on specialist and complex procedures We have not taken any view on where these centres would be located yet. Draft in progress | 17
What are your thoughts on our ideas? Do our ideas address the problems? Do you think that we should keep these services local: - Emergency - Outpatient - Day case operations What do you think are the advantages and disadvantages of centralising inpatient elective work? Draft in progress | 18
• Feedback from groups • Next steps • Closing remarks Draft in progress | 19
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