New plan to improve orthopaedic services in Wales
People who smoke or are overweight will be supported to join a weight-loss or stop-smoking programme before having some routine operations as part of a new plan to improve orthopaedic services in Wales.
Orthopaedics, the specialty which includes injuries and diseases of bones, joints and muscles, is the biggest single planned care service in Wales. There are more than half a million trauma and orthopaedic outpatient consultations every year and around 40,000 routine – elective – treatments.
GP referrals to orthopaedic consultants have increased by 30% since 2005 – more than double the increase in all other specialities put together. Wales’ ageing population; growing levels of obesity and advances in clinical practice are behind the rise in referrals to hospitals for treatment.
Wales’ Planned Care Programme Board, which brings together representatives from key service areas and health boards and is led by Peter Lewis, the national clinical lead for planned care, was set up in 2014 to help devise and provide sustainable planned care services and improve patients’ experience of using services.
The National Orthopaedic Implementation Plan, which has been drawn up by the board and adopted by health boards, sets out a series of actions to develop sustainable orthopaedic services through measures to manage capacity and demand.
The plan is based on the prudent healthcare principles of:
- Do only what is needed, no more, no less; and do no harm – ensuring health boards do not undertake procedures which the National Institute for Health and Care Excellence (NICE) has advised should not be undertaken
- Provide care for those with the greatest needs first – all patients categorised as urgent should be seen within six weeks of GP referral
- Reduce inappropriate variation using evidence-based practises consistently and transparently – health boards currently offer patients a number of routine follow-up appointments. Health boards will now be expected to commission one surgical follow-up appointment after routine hip and knee replacement surgery between six weeks and three months after the operation unless there are exceptional circumstances. This is accepted practice in other UK health services. Ongoing outpatient review after this should not be routinely offered.
Lifestyle factors can have a negative impact on the results of some routine operations. Smoking, for example, is known to affect the outcomes of some foot and ankle procedures and many studies have shown the rates of post-operative complications and length of stay are higher in patients who smoke or who are overweight.
Under the new plan, all patients who smoke or have a body mass index of 35 or more and are being considered for referral to hospital for orthopaedic treatment should undergo smoking cessation support and weight reduction management before orthopaedic surgery. Health boards will be required to provide a suitable range of stop smoking and weight reduction support services and appropriate referral mechanisms for patients.
Another key aspect of the plan will be to develop patient reported outcome measures (PROMs) – these allow health boards to understand and report on patient outcomes following surgery.
At present there is no standard way to understand how effective orthopaedic surgery has been and whether surgical outcomes are in line with patients’ expectations. The development and implementation of these new measures will also allow Welsh hospitals to compare themselves against other hospitals elsewhere in the UK, which have are already using these measures.
Deputy Health Minister, Vaughan Gething said:
“The Welsh Government and NHS Wales have been effective in reducing waiting times for orthopaedic treatment over the last 10 years.
“A recent report by the Wales Audit Office concluded that orthopaedic services in Wales have become more efficient in the past decade but we want to go further to meet future demands.
“We have focused on securing immediate reductions in waiting times but less attention has been paid to developing more sustainable, long-term solutions to meet future demand.
“This plan sets out what NHS Wales needs to do to develop sustainable services so we offer the very best services to patients. It also sets out what people can do themselves to manage their own health – we know that preventing ill health occurring in the first place is far better than treating and curing ill health which has already happened.”
Mr Peter Lewis, Wales’ national clinical lead for planned care, who is also a Consultant Vascular Surgeon at the Aneurin Bevan Health Board said:
“This new orthopaedic implementation plan pulls together all service change requirements for orthopaedics into a single plan and presents the actions for health boards within the three drivers of the programme – integrated care, clinical value prioritisation and best in class.
“Understanding patient-reported outcomes and addressing the key issues that can impact on them, such as lifestyle factors, is a fundamental component of volume-based medicine and benchmarking Welsh healthcare systems against best-in-class organisations in the UK and abroad.”
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