Draft in progress | 1 1. Why planned care orthopaedic services need - PowerPoint PPT Presentation

Draft in progress | 1

1. Why planned care orthopaedic services need to change - Discussion around the challenges 2. What could be done to improve planned care services Discussions on: - whether our thinking to date addresses the problems - which services should be kept local (facilities to deal with emergency orthopaedic cases, orthopaedic outpatient appointments, orthopaedic day case operations) - advantages and disadvantages of centralising inpatient elective orthopaedic work - Overall, participants agreed that their experiences matched the challenges facing local planned care services as highlighted during the meeting. But there was a desire to know the data/evidence behind them - People noted that they would be prepared to travel if there were more certainty about the quality of their care (procedures not being cancelled, higher quality services, more confidence in treatment given, better preparation and aftercare) - When looking at future models of care the status quo should be included - Careful consideration should be given to location of sites and transport/access links - Further work needed to ensure that IT systems are compatible across the health and care system - Provide a deeper level of detail about the challenges being faced and evidence behind the suggested solutions - Further information on SWLEOC its effectiveness and how its quality has been measured - More information about how decisions will be made Draft in progress | 2

Topic Time Introduction and welcome 0945 Elective orthopaedics in south east London 1000 • Why do we need to change planned orthopaedic care? • What are we changing? • How these changes could happen? Expert panel Q&A 1020 South West London Elective Orthopaedic Centre (SWLEOC) – Presentation 1035 and Q&A Comfort/refreshment break 1100 Draft evaluation criteria and the Committee in Common (CIC) 1110 Table discussion 1125 Plenary 1210 Wrap up and next steps 1225 Draft in progress | 3

– Mobile phones to silent – No jargon!- shout out if you don’t understand – Listen to others – one person speaking at a time – Information will also be shared on our website www.ourhealthiersel.nhs.uk for comment and you can share this with colleagues/contacts – We will be tweeting throughout the session #OHSEL @ourhealthiersel – We would like to take photos – please let us know if you would prefer not to be photographed Draft in progress | 4

• Why do we need to change planned orthopaedic care? • What are we changing? • How these changes could happen? Draft in progress | 5

Elective procedures delivered at these sites can be defined as either complex or routine: • Complex procedures: Complex procedures are more challenging. They include revision surgery, hip procedures with infections and ankle replacements amongst many others. • Routine procedures: High volume procedures, such as primary hip replacements, that have been standardised. For the purposes of this work any procedure not included in the complex category has been categorised as routine. Orpington Hospital (as part of KCHT) is within 2-3 mile radius of PRUH “If orthopaedic services, within a certain geographical area and with an appropriate critical mass were brought together, either onto one site or within a network… and worked within agreed quality assurance standards, not only would patient care improve but billions of pounds could be saved .” Getting it right first time: Improving the Quality of Orthopaedic Care within the National Health Service in England Draft in progress | 6

• Demand for elective orthopaedics care (EOC) is increasing • Waiting times for EOC are often longer than other specialties and more people wait longer than 18 weeks for their treatment • Feedback from the public, patients and clinicians that experience and practice is variable across SEL • National work recommending different models for orthopaedic care- “Getting it Right First Time” • Availability of evidence and good practice from other models such as SWLEOC (South West London Elective Orthopaedic Centre) • Trusts are struggling to manage existing capacity which impacts waiting times • While length of stay has improved it remains below the London average at most sites in south east London Draft in progress | 7

*Source: Orthopaedic related activity data is provided by the SEL CSU for the period Jan-Dec 2015. This data is used as a proxy for FY16 from which demographic and non-demographic growth is applied until FY21. PLEASE NOTE: The activity shown above is for all orthopaedic activity conducted by SEL providers. Draft in progress | 8

Number of incomplete (admitted and non-admitted) Waiting times for T&O RTTs at the end of September 2015 patients waiting more than 18 weeks by the end of 25 September 2015 in T&O (Backlog) 600 556 (*%) 20 Waiting times (weeks) 500 415 (9.8%) 15 Number of patients 378 (12.3%) 400 10 300 5 200 102 (4.0%) 0 100 GSTT LGT DGT KCHT* 92nd percentile waiting time (weeks) 0 GSTT LGT DGT KCHT* Median waiting time (weeks) SEL Trusts London average (11.6%) Target Source: NHS England, based on “Incompletes” Unify2 Data, September 2015.. *KCHT are not submitting data to Unify2, backlog numbers were provided by the CSU, but please note that these DO NOT included “non - admitted” patients , i.e. those who had an outpatient appointment. Overall patients were not provided so a percentage could not be calculated. Please also note that KCHT data is more recent (October 2015). **SWL waiting times are based on a weighted average of median/92 nd percentile waiting times, weighted by number of patients at each trust. Draft in progress | 9

Average length of stay for Elective T&O 7 5.99 6 5 4.60 4.45 Average length of stay (days) 4.13 4 3.43 3.11 3 2.56 1.96 2 1 0 Orp. QMS GH DVH PRUH QEH UHL KCH SEL Sites London Average Chart Data Source: HES, September 2014 – August 2015 (Latest 12 months of data available) Draft in progress | 10

 Consolidate elective inpatient services from the current eight sites to two sites while retaining outpatient, day case and trauma services locally at base hospitals  Create an orthopaedic network approach for procurement and service design  A business model which ensures the financial benefits of consolidation benefit all providers rather than creating “winners and losers”  All elective specialties are in scope apart from spinal This new model – devised to provide a higher quality and more efficient planned care pathway - to be evaluated against the status quo/ do minimum option. We will explore the case for consolidating specialist and complex cases. Draft in progress | 11