Agenda item

This report from Imperial College Healthcare NHS Trust sets out the proposal from the four acute NHS trusts in north west London to deliver routine, inpatient surgeries through an elective orthopaedic hub.

Professor Tim Orchard outlined the need for an elective orthopaedic hub that could efficiently handle a large volume of cases with clinically low complexity. A prioritised waiting list in terms of increasing deterioration of a patient’s condition was in place.  There would be capacity for treating life limiting conditions which could lead to other secondary issues.  A public consultation was ongoing, details of which had been shared with the committee and wider NWL communities.  It was important to recognise that the consultation would inform the process, to both understand and work to alleviate the integral concerns and views of the public.  Operationally, procedures would be undertaken at Central Middlesex Hospital, with follow-up treatment pathways identified locally.  Ensuring transport was a primary factor and an imaginative and sensible approach would be required.  Patients would have a choice as to where their procedures would be carried out, and not choosing the elective hub option would not result in a delay to receiving treatment.

Keith Mallinson, co-optee emphasised the importance of face to face consultations in Musculoskeletal (MSK) pathway (virtual fracture clinic for patients with acute bone injuries), with reference to two clients who had not found this approach helpful during recovery.  Professor Orchard confirmed that the MSK pathway was not one that Imperial delivered across the eight boroughs but concurred that effective triaging of patients through a video consultation was an issue.  It was acknowledged that there was variability in delivering the MSK pathway across NWL. An opportunity to address this would ensure a fully integrated pathway and would be welcomed by providers and also the council. Patient transport was fundamental to ensuring that patients were effectively triaged. It was noted that Linda Jackson was planning a letter to MSK on behalf of the council to seek clarification about this issue and how it could be resolved.

Councillor Genevieve Nwaogbe referenced page 20 of the agenda pack enquired about the use of the phrase “completely separated from Emergency Care” and used throughout the report.  The Central Middlesex hub would be used for elective orthopaedic care; however, clarification was sought about an example where a person experienced a non-life threatening accident and how they received their treatment.  Councillor Nwaogbe also sought funding information about the Trusts intention to make the most of digital and other advanced technologies, which although welcome, required significant investment.  A final comment was with regards to the travel cost and transport issues which could negatively impact some individuals and Councillor Nwaogbe asked how the Trust would overcome these.  

Councillor Lloyd-Harris sought clarification about the 4000 cases in NWL that would be treated at the hub facility and what the outcome would be for any additional capacity, once these had been resolved given the potential downtime in terms of capacity, and if these would be offered to other trusts.  Councillor Lloyd-Harris also asked if travel modelling realistically reflected accurate travel times which could vary significantly depending on traffic in a given locality.  Cross borough public transport links were not ideal, and it took far longer to navigate than realised.

Professor Orchard acknowledged that patient pathways were fragmented and although Imperial was not responsible for the MSK path way there was a question as to how effectively patients were being triaged.  He agreed that he could not envisage a cost disadvantage to putting in place the best digital solutions, as this could help generate greater inefficiencies. It was unlikely that the hub would be a major cost programme supported by the Targeted Investment Fund (TIF). Professor Orchard did not have a solution to the transportation issue but felt strongly that any solution offered must not disadvantage individuals by moving the service.  Addressing the issue of any spare capacity being offered to other trusts, Professor Orchard felt that there were several potential solutions to configuring services efficiently.  The hub was likely to operate 6 days per week and any additional capacity would be repurposed to other types of high volume elective care.

Addressing the difficulties of MSK virtual consultations, Councillor Ben Coleman agreed with Keith Mallinson and felt that post-pandemic consultations should return to in person contact.  He confirmed that the council would be writing to MSK advocating support for this.  Transport and travel were a concern for many patients and their families which needed to be resolved. Lisa Redfern queried that if clinical expertise was centralised at Middlesex how would this affect local diagnostic services? Also, transport solutions need to be considered.

  Professor Orchard responded that an imaginative solution to transport would be required, for example appointing a private transport provider or similar. He confirmed that orthopaedic services would continue to be delivered at other sites, recognising that while the new hub would efficiently tackle the backlog of cases, there would be vulnerable patients who would struggle.  Jim Grealy suggested that the Trust explored the potential of developing a dedicated transport service.   This was a solution that the trust had considered but there was a distinction between pre and post operative transport needs. There were efficiencies that could be achieved in developing a sector wide solution, but this was balanced against other competing priorities.

Professor Orchard clarified that pathways to the EOC would need to be properly integrated, which was separate to the issue of how services were commissioned.  The EOC would operate to a stringent criterion, identifying which patients could be included and that this would be widened as the service progressed.  It was noted that not all patients would be suitable for the EOC and that there would be a need to ensure that the provision was fully supported by trained and experienced staff. 

Merril Hammer (Hammersmith and Fulham Save Our NHS) confirmed that a submission about the proposal had been made.  Querying financial implications for the service she asked whether it would be financed by PFI (private finance initiative), and in addition, how the Trust intended to address the difficulties that some groups experienced in accessing digital information and services. It was confirmed that the proposal would not be PFI funded.  In response to digital inclusion, Professor Orchard explained that an in person offer would be in place to aim to not disadvantage people.  Councillor Natalia Perez highlighted the importance of reaching out to underrepresented communities.  Professor Orchard confirmed that significant work had ben undertaken with black and Asian minority ethnic groups. 

Councillor Perez thanked Professor Orchard and colleagues for the presentation.  While the EOC proposals were welcomed, the committee noted that the Trust recognised the need to resolve patient transport and travel issues, ensure access to information and clearly signposted pathways including initial, localised diagnostics and post-operative recovery.

ACTION

For the committee to pass along details of any groups that they were aware that could be contacted and supported.

RESOLVED

That the committee noted the report.