Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership with provides the Committee with an update on the national and local context regarding the vision and strategy that will deliver an effective and accessible Trauma & Orthopaedic Service for patients in Lincolnshire, Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which provided the national and local context regarding the vision and strategy to deliver an effective and accessible trauma and orthopaedic service for patients in Lincolnshire.

The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust, Mr Kalundaivel Sakthivel, Consultant and Clinical Lead Trauma and Orthopaedic Surgery, United Lincolnshire Hospitals NHS Trust; and Catherine O'Dwyer, Consultant Anaesthetist and Clinical Director for Surgery, United Lincolnshire Hospitals NHS Trust.

The Committee were reminded that the Lincolnshire Acute Services Review had been undertaken to ensure that clinical services at the acute hospitals would be sustainable going forward.

The Committee was advised about a national pilot for trauma and orthopaedics entitled 'Getting it Right First Time' (GIRFT) which was a programme led by a consultant orthopaedic surgeon.  It was highlighted that the programme aimed to improve quality of medical and clinical care within the NHS through deeper insight of performance.  It was noted that ULHT had volunteered to be involved with the GRIFT pilot due to the high level of patient benefits that could be achieved.  The Committee noted further that ULHT had been part of Phase 2, which had included three other hospital trusts (King's College London, East Kent and Cornwall).  Details of the orthopaedic pilot arrangements commenced on 20 August 2018 were shown on page 56 of the report.  Appendix A to the report provided the Committee with a report of the Getting it Right First Time Pilot trial as at February 2019.

Page 57 of the report provided the Committee with details of elective admissions to the hospital sites for the first four months of 2018, prior to the start of the trauma and orthopaedic pilot.  It was highlighted that before the trial, ULHT had experienced extremely high cancellation rates, with up to 43 patients cancelling each month.  It was highlighted further that since the orthopaedic project commenced in August 2018, the Trust wide cancellation rate for non-clinical reasons had reduced to 19 cases for the month of February 2019.  The Committee was advised that the performance against the 18 week combined Referral to Treatment standard for all providers, for August 2019, the figure was 88.5%, compared to June 2018 when the performance was 85.8%.  It was also highlighted that the inpatient waiting list had also reduced to 2,758 at the end of July 2019, compared to 3,197 in June 2018.

The Committee noted that evidence so far had identified a strong case for change to the way in which Trauma and Orthopaedic services were delivered in Lincolnshire.  Paragraph eight of the report provided more details to this effect. 

It was highlighted to the Committee that there was one emerging option for sustaining general surgery services in Lincolnshire, details of which were shown at paragraph 9 of the report.  It was highlighted further that investment was not required to support the proposed option as theatre capacity was sufficient to absorb the proposed changes between hospital sites.  The Committee noted that the success of the pilot was down to the dedicated staff at Grantham and District Hospital who had been willing to embrace change.

A summary of the key themes received from the Healthy Conversation 2019 were shown on page 60 of the report for the Committee to consider.

The Committee were invited to comment on the case for change and on the emerging options for Trauma and Orthopaedic Services.  The Committee raised the following comments:-

·         Cancellation rates – The Committee noted that before the trial, ULHT had extremely high cancellation rates with up to 43 patients cancelling each month.  Since the trial, the cancellation rate for non-clinical reasons had reduced to 19 cases for the month of February.  It was highlighted that the high cancellation rates had impacted on the cost of the general surgery and orthopaedic service provision.  It was reported that for 2017/18, the service had made a loss of £15.67 million.  The Committee was advised that the loss for the service for 2018/19 would be made available to the Committee;

·         Current service provision – The Committee was advised that the current service delivery provision in operation for the trial provided for all appropriate elective cases to be undertaken at Grantham with dedicated ring fenced beds on Ward 2; all fractured neck of femurs managed by Lincoln and Pilgrim hospitals; and that trauma cases remained at Grantham Hospital for the duration of the trial;

·         One member asked whether the success of the pilot would encourage more people to the service.  The Committee was advised that the success of the pilot would help with publicity, as ULHT was being seen as a flagship trust; and the pilot was already helping with the recruitment of staff.   One member enquired whether the success of the pilot would bring in any additional funding.  The Committee was advised that any additional funding would have to be considered by NHS England;

·         A question was asked as to what was the lowest realistic level of cancellation rate.  The Committee was advised that the cancellation rate of 19 per month could be reduced further; and that all effort would be made to reduce the rate further;

·         The lessons learnt in getting the right level of information to staff concerning the changes and in terms of support needed.  The Committee was advised that lots of workshop had taken place, but there was still more to be done, particular reference was made to more time being spent with theatre teams at Grantham Hospital; and that more would be done with the whole team;

·         How ULHT was reviewing and monitoring the risks associated with the programme; and a request was made for the Committee to see the necessary documentation.  Reassurance was given that robust monitoring was in place, as part of the normal routine business of ULHT.  The Committee noted that the management team was now all in one place for all the sites and that monthly incidents and complaints were reviewed;

·         Results of the surgical site infection rates – The Committee was advised that these were monitored closely, including by internal audit.  The Committee noted that there had been two cases of 'deep infection', in the last six months.  Confirmation was given that infection rates were monitored closely; and

·         A question was asked as to whether Louth Hospital was now finding that their concerns around orthopaedics had now been addressed.  The Committee was advised that it was an evolving process; each patient was assessed as to what was the best place for them to receive care.  The Committee noted that more day care surgery was being planned at Louth.

The Chairman extended his thanks on behalf of the Committee to the representatives for their presentation and for their openness.  The Chairman welcomed the news concerning the success of the pilot and the positive publicity for Lincolnshire.

RESOLVED

That the Chairman be authorised to provide feedback on behalf of the Committee as part of the Health Conversation 2019 engagement exercise on the emerging option for trauma and orthopaedic services.