Orthopaedic surgery

During the pilot there was a marked reduction in "on the day" cancellations due to lack of beds. 

• Where Grantham was trialled as the site for elective procedures there were no recorded cancellations on the day. 
• 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 zero at Grantham & District Hospital
  • Length of stay reduced:
    • From 2.7 to 1.7 days at Grantham Hospital
    • From 2.9 days to 2.3 days across ULHT ​​​​​​

No extension to theatre capacity at Grantham’s hospital is required to make the proposal possible, although if funding was available to extend this, more patients would benefit from the model accordingly.​​​​​​

Importantly, the ULHT evaluation report of the pilot identified no negative comments in the feedback received relating to patient travel.

NHS does not provide transport for non-emergency procedures.  However, we recognise the challenges faced by those who are reliant on public transport and are working closely with Lincolnshire County Council to address the issue of transport infrastructure, for which they are responsible. Information is available for anyone needing public transport updates on the council website www.lincolnshire.gov.uk

We recognise that a proportion of people will have to travel further to visit friends or relatives in hospital for the relatively short period of care that involves hospitalisation. The pilot informs that it is an estimated 3-4 patients a day for planned orthopaedic care and c.1 patient a day for unplanned care (i.e. those who received unplanned care at Grantham previously) would receive care at a different hospital to now. Importantly, everyone in the county would benefit from shorter average length of stay in hospital, which would significantly reduce the associated visiting travel. And most important is the overall improved patient outcomes delivered by the service as a whole.

National evidence, gathered as part of the Getting It Right First Time (GIRFT) programme, suggests that separating emergency and planned care results in fewer planned care cancellations and improved patient experience.  This is because relatively high numbers of operations are cancelled on the day due to a shortage of beds, caused by emergency pressures needing these beds.

Locally, we have recently run a trial of moving planned orthopaedic procedures to Grantham and District Hospital (where there is a lower level of emergency pressure than our other hospital sites) and that has resulted in a significant reduction in the number of cancelled operations (down from an average of 10 cancellations per month due to a lack of beds to 3 a month across ULHT, and no reported cancellations due to a lack of a beds at Grantham hospital since the trial started).

ULHT does not provide spinal surgery. There would be no change to the process to support spinal problems under this proposal.

A patient who requires ‘planned’ spinal surgery should be referred by their GP to the specialist One Health Group in Sheffield.

A patient who arrives at ULHT who is believed to required ‘unplanned’ spinal surgery is initially admitted into hospital in order to ensure they receive urgent and appropriate care to stabilise them. The orthopaedic team will then work with colleagues at the nearest appropriate centre (Queen’s Medical Centre (QMC) in Nottingham) and manage the patient based upon the agreed advice. If the patient  does need surgical intervention, ULHT will transfer these patients to QMC. However, if it becomes clear that the patient’s condition can be managed without surgery, then we will continue to manage these patients safely in ULHT, as an inpatient.