Agenda item

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the details provided on the Lincolnshire Acute Services Review of Orthopaedic Surgery; and to highlight any areas which the Committee’s working group might wish to explore in further detail.  Mr Vel Sakthivel, Consultant in Trauma and Orthopaedic Surgeon and Pete Burnett, System Strategy and Planning Director, Lincolnshire NHS will be in attendance for this item)

The Chairman invited Mr Vel Sakthivel, Consultant in Trauma and Orthopaedic Surgeon and Peter Burnett, System Strategy and Planning Director, Lincolnshire NHS, to remotely, present the item to the Committee.

Appendix A to the report detailed an extract (pages 22-26) from Lincolnshire NHS Public Consultation Document – Relating to Four of Lincolnshire’s NHS Services – Orthopaedic Surgery; and Appendix B provided a copy of Chapter 9 of the Pre-Consultation Business Case for the Lincolnshire Acute Services Review for the Committee to consider.

Page 43 of the report pack provided details of orthopaedic services before and after August 2018, when the service had become part of the national orthopaedic pilot which looked at how service quality and patient outcomes could be improved.

The Committee noted that the challenges pre-pilot had included: a lack of ‘protected’ planned orthopaedic surgery beds across United Lincolnshire Hospitals NHS Trust; that around 28 patients each month had their planned orthopaedic surgery cancelled on the day of their surgery, due to a lack of available beds; failure to consistently meet nationally set referral to treatment time targets; that the service had high doctor and nurse vacancies;  that over 3,000 patients from Lincolnshire each year received a planned orthopaedic procedure in the private sector (funded by the NHS), much of which took place outside of Lincolnshire.

The Committee noted that the proposal for change (which reflected the pilot arrangements) was to develop a ‘centre of excellence’ in Lincolnshire for planned orthopaedic surgery at Grantham and District Hospital, and a dedicated day case centre at County Hospital Louth, which would mean Grantham and District Hospital would not provide unplanned orthopaedic surgery. Lincoln County Hospital and Pilgrim Hospital, Boston would continue to provide unplanned orthopaedic surgery and some planned surgery for high-risk patients with multiple health problems.  Details of the anticipated change for patients were shown on page 45 of the report.

It was noted that there had been on-going engagement with the public and details of the consistent themes raised in relation to orthopaedic surgery were highlighted on page 45 of the report and included: acknowledgement of the current situation with regard to the number of cancelled operations and the number of people choosing to go out of county for treatment; the principles for separating planned and un-planned care; further information regarding where any unplanned/planned sites would be located; concerns regarding the distances needed to be travelled, with transport infrastructure and rurality being identified as major challenges; the need to improve ‘step down’ care and integrate more closely with social care and being able  to work within existing resources.

It was highlighted that the overarching theme from the patent experience was that patients had been impressed and happy with the level of care and treatment received from all staff involved.

Details of the evaluation of the pilot pre-Covid had identified that there had been a reduction in waiting times for planned orthopaedic surgery, the number of cancellations on the day of planned orthopaedic surgery had reduced; the average length of stay had reduced from 2.9 days to 2.3 days across the Trust and from 2.7 to 1.7 days at Grantham and District Hospital; the Trust had performed better in terms of length of stay and time patients stayed in hospital compared to other hospitals; better overall patient experience; the number of patients going to the private sector for planned orthopaedic surgery, funded by the local NHS had reduced and the pilot workforce model had successfully removed the need for temporary staff to cover vacancies; and the service was now more attractive to junior doctors which supported the longer sustainability of the service.

In conclusion, it was highlighted that the success of the pilot had meant that more patients were choosing to go to Grantham and District Hospital for their surgery treatment.

During consideration of this item, the Committee raised some of the following points:

·       Some concern was raised with regarding to the staffing numbers for the increased number of beds at Grantham and District Hospital.  The Committee was advised that there were enough staff to deal with the current bed situation;

·       Travelling distances for patients.  Some concern was expressed on the travelling time for patients on the east coast; and that transport provision was not consistent for the elderly population on the coast.  It was reported that travelling distances had been taken into consideration for the pilot; and that to date, the Trust had not received any complaints regarding travelling distances and that staff had been commended by patients for the quality of service they had received.  The Committee noted that the service patients had received at Grantham & District Hospital had meant that operations were being done quicker, and there had been fewer cancellations; and that patient stay time had been reduced.  Reassurance was given that the issue of travelling time had been considered and that the threshold for this had been agreed by the local health system.  It was also highlighted that some patients qualified for patient transport.  The Committee was further reassured that if a patient was to have mobility issues, then transport would be provided, ensuring that the right vehicle was provided after surgery, and that transport would also be provided for the carer; 

·       Discharge of patients. Some concern was expressed regarding the timing of when a person was discharged; whether a day case patients time would be extended; and who was clinically responsible for the patient after they were discharged.  Reassurance was given that a patient would not be discharged if it was not clinically safe to do so and that various factors were always taken into consideration prior to the discharge of a patient, such as safety implications, social implications, travelling etc.   The Committee was advised that following discharge, a patient would be contacted by a senior nurse to check if they had any issues and that the patient remained the responsibility of the department/surgeon who operated on the patient.  It was confirmed that a patient having had their operation at Grantham and District Hospital would be able to have their follow up appointments at County Hospital Louth.  It was noted that the number of patients who had chosen to go out of county for their surgery was around 55%.  It was noted further that aim of the Trust was to improve its status and encourage patients to have their surgery back in county, and to offer elective surgery to patients from neighbouring health areas.  The benefit of the pilot had shown both the length of stay and the number of cancellations had been reduced. Reassurance was given that the care and welfare of the patient had improved significantly and that the backlog of patients because of the pandemic was not as high as in neighbouring health authorities.  Some members commended the local NHS for its continued work on reducing the backlog.  The Committee noted that Healthwatch had been reassured by the changes;

·       The reluctance of some patients to approach primary care with their orthopaedic issues and whether this would cause more complex cases as a result.  The Committee was advised of a new NHS England/Improvement initiative for patient care in the community;

·       The confirmation of funding for the two new laminar theatres.  The Committee was advised that there had been extra theatre capacity at Grantham Hospital, as it had been a green site and that the theatres had been used for speciality operations. Also, due to seven day working arrangements the extra theatre capacity was needed to catch up on elective orthopaedic surgery; and 

·       If the additional beds and the extra 2.5 theatre space (Out of scope of the current business case) did not progress, whether this would affect the plan of repatriation of patients from private or neighbouring trusts.  The Committee was advised that it would influence the proposal, but it was hoped the situation would not arise.  It was highlighted that there were funds available to implement the four proposals in the Lincolnshire Acute Services Review and that the proposal was to make the pilot for orthopaedic surgery arrangements permanent.

The Chairman on behalf of the Committee extended his thanks to the presenters.

RESOLVED

1.      That the details presented on the Lincolnshire Acute Services Review of Orthopaedic Surgery be noted.

2.      That the Committee’s initial findings on the proposal be recorded for consideration by the Committee’s working group.