Lincolnshire CCG Countywide Patient Participation Group Event – virtual

How has the service been improved?

As we have developed our proposals, we have considered the quality and equality impact of the preferred option for orthopaedic surgery.

We have also benefited from the evidence collated through the pilot (pilot evaluation is based on data for the period August 2018 to February 2020).

Through our equality impact assessment, we identified three groups of people, two of which are defined by protected characteristics that may be more likely to be impacted, positively or adversely, by this proposal.

These three groups are age, disability and those who are economically disadvantaged.

Our observations from the pilot evaluation and these assessments are set out below. We will continue to review and develop these, including the impact on different groups of people within our population, with independent support, through our public consultation in light of the feedback we receive.

Potential positive impacts

Evaluation of the pilot pre COVID-19 identified:

A reduction in waiting times for planned orthopaedic surgery, which means patients were getting treated quicker

Cancellations on the day of planned orthopaedic surgery due to a lack of beds reduced:

• From 10 a month to 3 a month across United Hospital Lincolnshire NHS Trust (ULHT)
• To 0 at Grantham and District Hospital

Length of stay reduced:

• From 2.9 days to 2.3 days across ULHT
• From 2.7 days to 1.7 days at Grantham and District Hospital

ULHT performed better than many other hospitals in terms of the length of time patients stayed in hospital after their planned surgery

An improvement in overall patient experience and satisfaction. In February 2020 a score of 95% was achieved in the ‘Friends and Family Test’

The number of patients going to the private sector for planned orthopaedic procedures, funded by the local NHS, reduced.

The pilot workforce model successfully removed the need for temporary staff to cover vacancies, and the service is more attractive to junior doctors which supports long term service sustainability

How has the pilot shortened hospital length of stay for planned orthopaedics at Grantham?

The evaluation of the orthopaedic pilot also identified a reduction in the average length of stay for elective (planned) orthopaedics at Grantham Hospital from 2.7 days to 1.7 days, demonstrating strong operational performance. An enabler to the reduced length of stay is the commencement of total hip and total knee replacements being undertaken at Grantham Hospital as day-case procedures. Patients having these procedures as day-cases are followed up by telephone to ensure their outcome is as planned.

During the pilot do patients have to be seen for follow up physio at Grantham or Louth?

The pathway following discharge will remain the same, with patients receiving ongoing physiotherapy locally, if required.

Why is an Urgent Treatment Centre was not being considered in the South of the county?

This consultation relates to four hospital services delivered by United Lincolnshire Hospitals as opposed to an urgent care generally. However, there is already an Urgent Treatment Centre at Stamford and Rutland Hospital.

The pilots are done deals, and the outcome of the consultation won’t influence decisions. What will happen if the consultation results do not show acceptance of the proposals?

The public consultation is not a vote, it is about listening to what people think about our proposals and the impact that any of the options would have on them and their family. Therefore, there is no quantitative ruling in place. All views will be taken into consideration as part of the decision-making process. They will also help inform what plans the CCGs put in place to help lessen any negative impact that any final decision may have on our communities.

This public consultation is important to enable the public to respond with their feedback on the proposals. The value of this feedback is not measured according to the volume of responses, but rather against assessment criteria, one of which for example is that any future service must be deliverable. Therefore, a single questionnaire that introduces a new factor that could alter a proposal or introduce an alternative proposal will impact the decision-making process more than a large volume of returned questionnaires that simply state opposition to a proposal.

Are there plans therefore for digital records to be shared properly between neighborhood teams/primary care and inpatient acute stroke care?

Yes, a lot of work has already taken place to give NHS staff access to the Lincolnshire Care Portal across a range of services. For example, the Stroke Transformation Team have been piloting a Stroke Progress Care Plan using the Care Portal with great success, across both stroke rehabilitation in a community setting the immediate treatment of stroke in hospital. The team have been exceptional in demonstrating managing change operationally and engaging their teams to deliver improved patient care. We are also making changes to their Stroke Care Plan based on their pilot feedback (user experience).  At present third sector staff are not able to access the Care Portal, but work is ongoing to resolve this. The main points to be resolved are Information Governance and providing a Virtual Desk Top environment to share the digital records.