25 January 2016 Draft in progress | 1 Objective: We have been - - PowerPoint PPT Presentation

1

• 25 January 2016

Draft in progress |

2

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 |

3

AGENDA

Draft in progress |

Topic Speaker Time Slides

• 1. Introduction and

welcome Peter Gluckman, Independent facilitation 1.00pm 1-5

• 2. Introduction to the

programme Dr Amr Zeineldine, Clinical Chair, OHSEL Programme 1.15pm 6-10

• 3. Orthopaedic service

issues Sarah Blow, Chief Officer Bexley CCG and Planned Care SRO 1.45pm 11-15

• 4. Discussion

Table work and feedback 2.15pm

• 5. Some ideas on how we

tackle the issues Sarah Blow, Chief Officer Bexley CCG and Planned Care SRO 2.45pm 16-18

• 6. Discussion

Table work and feedback 3.15pm

• 7. Next steps and wrap up

Peter Gluckman, Independent facilitation 3.45pm 19

4

• 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 |

5

• 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
• n our website www.ourhealthiersel.nhs.uk for comment and

you can share this with colleagues

Draft in progress |

6

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 |

7

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 |

8

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 |

9

• 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 |

10

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 |

11 Draft in progress |

9 local hospitals provide orthopaedic care

500 1000 1500 2000 2500 3000 Guy's St Thomas' Lewisham Queen Elizabeth Queen Mary's King's PRUH Orpington Dartford Non-elective Day case Elective

12 Draft in progress |

2014/15 Elective Long Stay Elective Day Case Non- Elective Proportion of SEL elective activity (14/15) GSTT GH 2,571 2,111 37

23%

STH 19 6 895

0%

LGT UHL 676 1,474 716

11%

QEH 348 393 1,549

4%

QMS 177 737

• 4%

KCHT KCH 1,195 1,739 1,147

14%

PRUH 257 2,070 1,464

11%

Orp. 2,131 430

• 13%

DGT DVH 1,357 1,217 1,474

13%

QMS 286 1,221

• 7%

Total 9,017 11,398 7,282

100%

13

• 1. The demand for orthopaedic services is growing very fast

Draft in progress |

14,019 4,412 37,871 16,794 20,415 23,688 7,282 8,454 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20

Spells SEL Trauma & Orthopaedics Activity, historic vs projected

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.

14

• 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
• utcomes 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 |

15

• 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 |

16

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 |

17

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 |

18

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 |

19

• Feedback from groups
• Next steps
• Closing remarks

Draft in progress |