We want you to tell us what you think about our preferred change proposal to develop:
Orthopaedic surgery relates to planned surgery (e.g. hip and knee replacements) and unplanned surgery (e.g if a patient has been involved in an accident).
Planned surgery can be provided:
In August 2018 the orthopaedic surgery service provided by United Hospitals Lincolnshire NHS Trust (ULHT) became part of a national orthopaedic pilot to look at how service quality and patient outcomes could be improved.
Prior to the pilot beginning, planned and unplanned orthopaedic surgery was carried out at three hospital sites; Lincoln County Hospital, Pilgrim Hospital, Boston and Grantham and District Hospital. In addition, planned orthopaedic surgery was provided from County Hospital Louth.
Under the pilot all unplanned orthopaedic surgery is now carried out at Lincoln County Hospital and Pilgrim Hospital, Boston, and as much planned orthopaedic surgery as possible is carried out at Grantham and District Hospital.
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Before the pilot in August 2018 |
After the pilot changes in August 2018 |
Lincoln County Hospital |
• Planned surgery • Day case • Inpatient • Unplanned surgery |
• Planned surgery • Day case high risk patients • Inpatient high risk patients • Unplanned surgery |
Pilgrim Hospital, Boston |
• Planned surgery • Day case • Inpatient • Unplanned surgery |
• Planned surgery • Day case high risk patients* • Inpatient high risk patients • Unplanned surgery *some non-high risk patients also seen to manage day to day operational demands |
Grantham and District Hospital |
• Planned surgery • Day case • Inpatient • Unplanned surgery |
• Planned surgery • Day case non-high risk patients • Inpatient non-high risk patients |
County Hospital Louth |
• Planned surgery • Day case • Inpatient |
• Planned surgery • Focused on day cases non-high risk patients |
Lincoln County Hospital and Pilgrim Hospital, Boston continue to provide some planned orthopaedic surgery for high risk patients with multiple health problems, which is comparatively small in volume.
In addition, throughout the pilot Louth hospital has focused on day case planned orthopaedic surgery.
A summary of orthopaedic surgery provision prior to the pilot changes and after the pilot changes in August 2018 (pre COVID-19) is set out above.
This section sets out the challenges and opportunities for orthopaedic surgery and what we hope to achieve by making changes.
Challenges (pre pilot)
Opportunities
By making changes, we can look to ensure:
There has been ongoing engagement with the public throughout the Lincolnshire Acute Services Review programme, particularly through the ‘Healthy Conversation 2019’ engagement exercise.
Some consistent themes in relation to orthopaedic surgery have been shared by the public and stakeholders throughout our engagement to date:
Our proposal for change (which reflects the pilot arrangements) is to establish 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. Outpatient clinics would be unaffected.
This 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 orthopaedic surgery for high risk patients with multiple health problems, which is comparatively small in volume.
It is anticipated the change would affect on average:
If more planned orthopaedic surgery capacity became available at Grantham and District Hospital and County Hospital, Louth, more patients could be seen at these sites and benefit. This includes seeing more of the patients who receive their planned care in the private sector (much of which takes place outside of Lincolnshire) paid for by the NHS.
A key part of our evaluation of options to tackle the service challenges, was to hold a clinically led health system stakeholder workshop and four workshops with randomly selected members of the public.
For orthopaedic surgery, where only one solution remained following the shortlisting of options, attendees at these workshops were asked whether they agreed or disagreed that the changes proposed would help to improve the current situation and meet the challenges identified.
The table below summarises the level of stakeholder and public support for the change proposal.
Support for change proposal to consolidate planned orthopaedic services at Grantham and District Hospital |
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Support for change proposal |
Stakeholder |
Public Workshops |
Agree (strongly/ tend to) |
98% |
84% |
Disagree (strongly/ tend to) |
0% |
14% |
Neither agree nor disagree |
2% |
2% |
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: