Agenda item

(To receive a report from NHS Lincolnshire Integrated Care Board, which provides the Committee with an Orthopaedics and Stroke Services Implementation update.  Peter Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board and representatives from United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

The Committee considered a report from the NHS Lincolnshire Integrated Care Board, which provided an update on the implementation of the changes relating Orthopaedic and Stroke services.

The Chairman invited Pete Burnett, Director of Strategic Planning, Integration and Partnerships NHS Lincolnshire Integrated Care Board and the following representatives from United Lincolnshire Hospitals NHS Trust (ULHT): Dr Sameedha Rich-Mahadvar, Director of Improvement and Integration, Vel Sakthivel, Consultant Orthopaedic Surgeon and Divisional Clinical Director and Rebecca Johnson, Business Case Manager, to present the item to the Committee.

The Committee were reminded that following consultation, on the 25 May 2022, the NHS Lincolnshire Clinical Commissioning Group Board had approved key changes to the reconfiguration of four NHS services, and that the report presented was the second implementation report the Committee had received concerning Orthopaedics and Stroke services, the first one being in December 2022.

Orthopaedics 

The Committee noted:

·       That the service was performing well against its performance indicators, reducing the length of stay for Orthopaedic elective admissions to 1.9 days;

·       The Trust was one of a select few hospitals in the country being able to carry out the specialist SuperPath keyhole procedure, the results of which had seen significantly quicker recovery and a shorter hospital stays;

·       Referral time to treatment for the Trust had been ranked first in terms of performance against its peer hospital trusts, and seventh out of all 132 NHS Trusts;

·       That patient experience had been very positive.  Some comments received from patients were detailed on pages 53 and 54 of the report pack for the Committee to consider.  As a result of the improvement in the Trust’s referral time to treatment, the Trust had been able to provide mutual aid to neighbouring trusts when they had been struggling with their performance;

·       Access to the outpatients services remained across all sites, with all new patients being seen face to face, with follow up appointments being offered virtually;

·       Grantham and District Hospital had delivered 1,110 elective Orthopaedic procedures to patients;

·       Since the orthopaedic pilot started in 2018, only three patients had required post-operative transfers from Granthan and District Hospital to Lincoln County Hospital (as these patients required intervention from other specialities, for example cardiac input was required);

·       Two new theatres had opened at Grantham and District Hospital in November 2022, and that there was a clear plan for continuing improvements to be made.

Stroke

The Committee noted:

·       That stroke provision for patients were being developed to expand the current provision for stroke patients at Lincoln County Hospital, with support from an enhanced Community Rehabilitation Team;

·       A Joint Stroke Board had been set up with community partners and other key partners to look at key processes and to work through the best approach to implementing the remainder of the service proposal within the Acute Service Review public consultation;

·       A number of workshops had taken place to identify what was needed to improve the stroke service and bring down the length of stay for patients;

·       That following the loss of two locum consultants, the implementation of a single stroke service had been accelerated, and as a result from 4 September 2023, all new patients suffering a stroke in the county and needing acute specialist care, including rehabilitation were now being taken to Lincoln County Hospital. It was noted that outpatient appointments linked to the stroke service were continuing to be held at Pilgrim Hospital, Boston, as this would then ensure that patients could continue to access their ongoing care closer to home;

·       That £3 million had been secured to develop Lincoln County Hospital to increase the stroke unit to provide an additional seven beds, bringing the overall total on the ward to 35 beds;

·       Work continued to reduce the current 18-day Length of Stay to the required 10 day target; and

·       That as a result of industrial action a dedicated improvement programme was in place, looking at productivity and improvements for waiting lists.

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

·       Reassurance was provided that improved performance was having an impact on the service patients were receiving.  It was highlighted that before the reconfiguration two joints were being operated on in a day, but now on most days four joints were being operated on daily, which was an improved service.  The Committee was also advised that weekend operations had also restarted at Grantham, to help with the waiting list;

·       The Committee was advised that as part of the acute service review, staff consultation had taken place to make staff aware of the changes. That in relation to the concerns raised by a member of staff, further information would be provided outside of the meeting, once any investigation had been concluded;

·       That the focus of the stroke service was to enhance the current service, as it was still fragile with a single consultant.  The Committee noted that a strong stroke service should see over 650 patients a year.  It was highlighted that Lincoln County Hospital had seen that growth, but Boston even with projected growth would not have the level of strokes being presented.  This would result in the down skilling of staff, which was why the consolidated approach was taken, having staff practising stroke care daily at the right level of care.  The Committee noted further that the consolidation of stroke services followed the national strategy for stroke services and also followed the Trusts integrated stroke delivery network, improving patient outcomes and patient safety;

·       One member from personal experience welcomed the improvements to stroke services;

·       The Committee was advised that the elective orthopaedic service was highly resilient, as a dedicated elective hub, and having gained national accreditation.  The service had ring fenced elective resources that would not be impeded by winter pressures.  It was therefore expected that the same number of patients would be treated as a result.  The Committee noted that the service had been impacted by industrial action, and that steps were being taken to address this i.e., with weekend operating to help catch up with backlogs;

·       The Committee was advised that stroke patients had been coming in through A and E since 2020, and as a result there was a robust workforce in place to meet the patient at the front door, commence diagnostics and treat patients as quickly as possible to improve patient outcomes;

·       The Committee noted that until the new stroke unit was constructed, some beds on the Lincoln site had been consolidated which provided 28 beds and then eight beds on the Burton Ward to keep outliers together to ensure there was patient safety and making the best use of the resources available to the service;

·       It was reported that a recruitment drive was still in progress and that it was hoped by September 2024, additional staff would have been recruited.  It was highlighted that the Trust was actively working with neighbouring trusts in this regard as there was a national shortage of stroke consultants. In relation to orthopaedics, the Committee noted that following the reconfiguration of orthopaedics, the service had been able to recruit senior clinical fellows, who were pre-consultant level and could operate independently. The Committee noted that they only needed minor input before taking up consultant roles as well as middle grade doctors; and

·       The Committee was advised that the term ‘medical outlier’ referred to a patient who was not situated on a ward specialising in their ailment, for example a ‘stroke medical outlier’ was a patient who was not on a stroke unit.  It was highlighted what had been done within stroke services was that medical outliers were being put together onto one ward, rather than being in based in lots of other medical wards.

RESOLVED

1.      That presenters from the NHS be thanked for providing information on the implementation of the orthopaedic and stroke services following the acute services review.

2.      That in relation to orthopaedics, United Lincolnshire Hospitals NHS Trust be commended for the high levels of performance and positive patient feedback.

3.      That in relation to stroke services, a further update be received in twelve months on the impact of the closure of the stroke ward in Boston, including any plans for improvements in advance of the construction of the new unit at Lincoln County Hospital.