Improving planned orthopaedic surgery for adults in north central London

Improving planned orthopaedic surgery for adults in north central London
Improving planned orthopaedic
surgery for adults in north
central London
13 January to 6 April 2020
We are proposing changes to planned surgery for bones, joints and muscles (planned
orthopaedic surgery) for adults. This includes hip and knee replacements; and other
surgery of hips, knees, shoulders, elbows, feet, ankles and hands.
Any changes could affect residents of Barnet, Camden, Enfield, Haringey
and Islington and neighbouring boroughs.
We need your comments and advice.

  Closing date for feedback 6 April 2020

A consultation document published by North London Partners in health and care on
behalf of Barnet, Camden, Enfield, Haringey and Islington clinical commissioning groups.
Improving planned orthopaedic surgery for adults in north central London
                                                                         Helen Pettersen                                                                  Prof Fares Haddad
                                                                         North London Partners in                                                         Clinical Lead for the review, Clinical Director of the
                                                                         Health and Care Convenor and                                                     Institute of Sport and Exercise Health and a Consultant
                                                                         accountable officer of NCL’s                                                     Orthopaedic and Trauma Surgeon at University College
                                                                         five CCGs                                                                        London Hospitals

Hospitals across north central London have           North London Partners in health and care was established to tackle               As a surgeon, who provides this kind of care every day, I know the

proposed a new way to organise orthopaedic
                                                     some of the big health and care challenges we face in the coming                 difference it makes to patients. Damage to bones, joints and muscles
                                                     years. We are a partnership of health and care organisations who are             can be debilitating for people of all ages - whether it is a result of
                                                     working together to find solutions to address these challenges. Our              ageing or trauma - but with the right care at the right time, the

surgery for adults. We believe that planning         review of orthopaedic services is a good example of this.                        results can be life-changing.

together and sharing expertise and facilities will
                                                     We probably all know someone who has had a hip or knee replacement.              Whilst the results of surgery are generally good, by working together as a
                                                     Such operations can be life-changing for those living in pain or who find it     community of clinicians we can share knowledge and expertise to ensure that
                                                     difficult to get around. Demand for orthopaedic surgery is growing all the       every patient in north central London has world-class orthopaedic surgery. In
result in vastly improved care for local people.     time, but right now those who need care and treatment are not always seen
                                                     in a timely way.
                                                                                                                                      our proposals, we have also committed to giving patients access to the latest
                                                                                                                                      developments in orthopaedic care and clinicians, the opportunity to refine
                                                                                                                                      their skills, through the best quality education and peer support. All of this
                                                     We want this review of orthopaedic services to be an example of how              will result in a cycle of improvement for everyone.
                                                     we plan to work in future so that health and care professionals, working
                                                     alongside patients and residents, use their collective knowledge and expertise   We have learned from our peers around the country and have included their
                                                     to improve health and care for residents who are using these services. I hope    good practice into our plans. We have also spoken to hundreds of patients
                                                     that you will add your knowledge and experience to our work by taking part       about their experiences of our services to ensure that the future is shaped to
                                                     in this consultation.                                                            meet their needs. I believe that our proposed plan for the future is a good
                                                                                                                                      one, which offers the best solutions to the challenges the NHS faces today.
                                                                                                                                      I hope you will agree.

Improving planned orthopaedic surgery for adults in north central London
What is planned
orthopaedic surgery?
Orthopaedic surgery treats damage to bones,            Our proposals only affect                                                                        Introduction................................................................................................. 3
joints, ligaments, tendons, muscles and nerves         planned orthopaedic surgery                                                                      What is planned orthopaedic surgery?.......................................................... 4
(the musculoskeletal system). Patients may be          for adults                                                                                       About this consultation................................................................................ 6
referred to an orthopaedic surgeon for a long-term     The following orthopaedic services are not                                                       Why are we suggesting changes to orthopaedic surgery for adults?.............. 8
condition that has developed over many years, such     affected by our proposals:
as osteoarthritis or other non-emergency damage.       • Emergency care                                                                                 Our proposals..................................................................................... 10
Surgery, such as hip and knee replacements, is         • Children’s orthopaedic care                                                                    Our ambition............................................................................................. 11
the most common orthopaedic surgery offered in                                                                                                          Where would patients have their surgery under our proposals?.................. 12
                                                       • Spinal surgery
the NHS. However, other surgery of hips, knees,                                                                                                         Where patients would have their care in the future..................................... 14
shoulders, elbows, feet, ankles and hands also falls   • Specialist and complicated orthopaedic
                                                                                                                                                        What does this mean for patients?............................................................. 16
under this heading.                                      surgery
                                                                                                                                                        How the proposals could affect travel and different communities................ 17
Planned surgery is when patients have an               • Orthopaedic surgery for patients with
                                                                                                                                                        Benefits and challenges of our proposals.................................................... 18
appointment booked in advance. It is planned             complex medical conditions such as
treatment, following a referral to hospital by a         haemophilia
GP and an assessment by specialists. It is sometimes
                                                                                                                                                        The background to our proposals............................................... 20
                                                       • Local physiotherapy services for bones,
called ‘elective’ or ‘non-emergency’ care.                                                                                                              How planned orthopaedic services work today........................................... 21
                                                         joints and muscles
                                                                                                                                                        Evidence used in developing our proposals................................................. 22
                                                                                                                                                        How our proposals were developed........................................................... 24
                                                                                                                                                        Developing our proposals collaboratively.................................................... 26
                                                                                                                                                        How much would it cost?.......................................................................... .26
                                                                                                                                                        What has happened so far, and next steps................................................. 27
                                                                                                                                                        How our proposed changes support hospitals in north central London....... 28

                                                                                                                                                        How to feedback on our proposals............................................. 30
                                                                                                                                                        How will a final decision be made?............................................................. 31
                                                                                                    More detailed information about everything that
                                                                                                    is discussed in this document can be found on our   Ways to take part in the consultation......................................................... 32
                                                                                                    website at:    Appendices................................................................................................ 34
                                                                                                    consultation                                        Consultation questionnaire (insertion)......................................................... 35

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Improving planned orthopaedic surgery for adults in north central London
About this consultation                              To inform our decision-making, we’d like feedback
                                                     from anyone with an interest in these services,
                                                                                                         By inviting people to take part in the consultation
                                                                                                         we want to understand whether:
                                                                                                                                                               NHS services are better when patients and
                                                                                                                                                               healthcare professionals plan them together and in
                                                                                                                                                                                                                                    We are holding a public consultation
                                                                                                                                                                                                                                    between 13 January and 6 April 2020
                                                                                                                                                                                                                                                                                                     “To inform our decision-
We are reviewing planned orthopaedic
                                                                                                         • We have developed the best possible solution
                                                                                                                                                               autumn 2018 we shared our reasons for needing
                                                                                                                                                               to change the services with patients and others                      to get feedback on our proposals.                                making, we’d like feedback
                                                                                                                                                                                                                                                                                                     from anyone with an interest
surgery for adults in Barnet, Camden,                • Anyone who is currently having or has had           to the current challenges in providing planned      with an interest, and asked for their feedback. As                   There are several ways in which you can give your
Enfield, Haringey and Islington and we’d               experience of planned orthopaedic surgery           orthopaedic surgery for those who need it in        a result of these conversations, we have developed                   views during the consultation. Full details of each
                                                                                                                                                                                                                                                                                                     in these services”
like your views on our proposals.                                                                          north central London                                the proposals in this document. We’d now like
                                                     • Anyone who might need these services in future                                                                                                                               of these feedback routes are on pages 32 - 33. In
Two partnerships for orthopaedic surgery have                                                            • We are doing all we can to ensure that services     your advice again to ensure that our proposals are                   addition to this detailed consultation document,
                                                     • Families and carers of people who use, have
been formed by local NHS Trusts - UCLH and                                                                 are of the best quality                             right for the future.                                                we have produced a summary document, large-
                                                       used, or might use these services
Whittington Health and the North Middlesex                                                               • In developing our proposals, are we doing the                                                                            type, easy-read and audio versions. You can get
                                                     • Residents of Barnet, Camden, Enfield, Haringey,                                                         This consultation is being run by North London
University Hospital (North Mid) working with the                                                           right things to ensure everyone who needs care                                                                           these on the website, but if you would like a
                                                       Islington and neighbouring areas who might use                                                          Partners in health and care on behalf of Barnet,
Royal Free London. These partnerships have been                                                            can access it in a timely way                                                                                            printed copy sent to you, a braille or audio version,
                                                       hospital services in north central London                                                               Camden, Enfield, Haringey and Islington clinical
working together to develop the plans about                                                                                                                                                                                         or a translation into another language, please
                                                                                                         • There are more things we could do to make           commissioning groups*
how services could be improved and we are now        • Staff and professional representative bodies                                                                                                                                 contact the consultation team.
seeking your views on these ideas. Should these                                                            services responsive and tailor them for those       The independent evaluation of responses is being
                                                       such as trade unions, Local Medical Committees
                                                                                                           with specific needs                                                                                                      After we have heard people’s views, the North
be implemented, these partnerships would deliver       and Royal Colleges                                                                                      carried by Participate.
                                                                                                                                                                                                                                    Central London CCG*, the organisation which
the new improved services.                                                                               • You have any alternative proposals, and what
                                                     • Community representatives, including the                                                                                                                                     plans services on behalf of local residents, will
                                                                                                           they are
We believe that by organising services in a            voluntary sector                                                                                                                                                             decide whether to implement the proposals,
different way, we would be able to improve care      • Staff and partners in health and social care                                                                                                                                 update them, or find an alternative solution. This
and help more patients. The proposed changes                                                                                                                                                                                        consultation document and other related materials
could affect anyone who needs orthopaedic            • Relevant local authorities                                                                                                                                                   were developed with the support of patients, and
surgery in the future, who lives in our five                                                                                                                                                                                        local Healthwatch groups.
boroughs or in a neighbouring area and has care
in one of the hospitals involved in our proposals.
Around 3000 could experience a change to where                                                                                                                       Camden
their surgery would take place in future, when
compared to current arrangements.                                                                                                                                                                                                                                         Haringey

                                                                                                                                                               *On 1 April 2020 the five CCGs of Barnet, Camden, Enfield, Haringey and Islington will merge and become North Central London CCG.

                                                                                                                                                               Find out more at:
Improving planned orthopaedic surgery for adults in north central London
Why are we suggesting changes to orthopaedic surgery for adults?
Over 1.5 million people live in north central London and this number is expected to rise - as is the demand for planned                                          Patients’ experiences vary,                            The amount of time a patient spends in hospital varies from
                                                                                                                                                                                                                        hospital to hospital. Infections aren’t very common, but numbers
orthopaedic surgery. Whilst current services are of good quality, we know that patients’ experiences vary and could be better.
                                                                                                                                                                 depending on where they                                vary in different hospitals. The number of patients who need a
                                                                                                                                                                                                                        follow-up operation (known as ‘revision surgery’) also varies from

                                                                                                                                                                 have their surgery
                                                                                                                                                                                                                        hospital to hospital.

    Waiting times are too long                                             NHS targets are being missed                                        Too many operations                                                 Demand for planned
    In January 2019, over 10,500 residents in north central
    London were waiting for planned orthopaedic surgery.
                                                                           The NHS expects 92% of patients to have started
                                                                           treatment within 18 weeks of referral by their GP. However,         are cancelled                                                       orthopaedic surgery is
                                                                           on average between January 2018 and January 2019 only               In 2018/19 across north central London 530 orthopaedic
                                                                                                                                                                                                                   expected to rise

                                                                           79% of patients referred for orthopaedic surgery in north           operations were cancelled – 96% of these were cancelled on the
                                                                           central London started treatment within 18 weeks of being           day of surgery. This equates to 10 cancellations a week. The main   The demand for planned orthopaedic surgery, such as hip and knee
                                                     patients on           referred by their GP. In some of our hospitals, during the          reason why operations are cancelled is the demands of emergency     replacements, is expected to increase by around 9.5% by 2029. Within
                                                     waiting list          very busy winter months this fell as low as 65%.                    services which can result in the beds not being available or key    current arrangements, it would be very challenging for hospitals to cope
                                                     for surgery                                                                               staff being called away at short notice.                            with this demand, and as a result, waiting lists could increase further.

                                                                                        65%                                                    530
                                                                                                                     started treatment                                                                             The changes we are proposing will deal with the current situation and
                                                                                                                     within 18 weeks                                                                               also prepare for the future.
    Between January 2018 and January 2019, the number of residents                                                                                                       operations in
    waiting for surgery increased by 24% rising by over 2,200 patients.       18W                                    of GP referral in                                   one year                                                                                    increase in

                                                                                                                                               CANCELLED                                                                        9.5%
                                                                                                                     winter months                                                                                                                                   demand over
                                                                                                                                                                                                                                                                     next 10 years


                                                                               NHS TARGET                                                92%

                                                                                                                                               10 per week
                                                                               JANUARY 18-19                                   79%

                                                                               WINTER MONTHS                         65%                                                                                                0
      Jan 2018                                                Jan 2019
                                                                                                                                                                                                                         2019       2021       2023       2025        2027       2029

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Improving planned orthopaedic surgery for adults in north central London
Our                                       The NHS in our area currently pays for patients to
                                          be treated at 10 different hospital sites, both NHS
                                                                                                 • Care coordinators to support patients with
                                                                                                   conditions such as dementia or a learning           Our ambition                                 As a result of these proposed changes we would
                                                                                                                                                                                                    be able to:
                                                                                                                                                                                                                                                         • Offer access to comprehensive training and
                                                                                                                                                                                                                                                           development opportunities to all staff working

                                          and private. This is to ensure there is enough space     disability to understand their care and where it                                                                                                        in our partnerships including the chance to
                                          for everyone who needs planned orthopaedic               might take place                                    There are a number of benefits for           • Ensure all patients who need surgery could           work in different environments and learn from
                                          surgery.                                                                                                     organising care differently.                   access the care they need without a long wait        others
                                                                                                 • More complex surgery would continue at the
                                          We are proposing a new way to organise services          Royal National Orthopaedic Hospital, a super-                                                    • Organise these services to meet current demand     • Ensure that surgery offers patients top quality
                                          in the future, that would change this.                   specialist centre                                   * Access to consistently high-quality         and any predicted future increases                   pre-operative and post-operative education and
                                                                                                 • Patients with other complex medical conditions,        care for all patients across north        • Physically separate emergency surgery from           care; this would be the same no matter where
Our proposals for the future of           Our proposed service would have:
                                                                                                   such as haemophilia, will have their surgery at        central London                              planned surgery, so that planned surgery would       patients receive care in north central London.
planned orthopaedic surgery.
                                          • A choice of two NHS hospitals with dedicated           the hospital which specialises in their condition                                                  not be cancelled due to unexpected emergency
                                                                                                                                                       * The capacity to meet current and                                                               These changes are not being proposed to save
                                            operating theatres and beds, for patients who        • Emergency orthopaedic care would continue                                                          hospital admissions                                money or spend less on this kind of care. We
                                                                                                                                                          future demand
                                            need to stay overnight after their operation           at all local hospitals with an Accident and                                                                                                           believe that by organising services in a different
* A choice of two hospitals with                                                                                                                                                                   • Have specialist staff with the right skills in
                                          • Within each partnership, choice of NHS                 Emergency department                                * Physically separating emergency and         the right place to provide the best care and       way, we would be able to improve care and help
  dedicated operating theatres and                                                                                                                        planned surgery, to avoid last-minute                                                          more patients.
                                            hospitals for those needing day surgery                                                                                                                   experience for patients before, during and after
  beds, for patients who need surgery                                                                                                                     cancellations
                                          • Within each partnership, a choice of NHS                                                                                                                  their operation
  that requires an overnight stay
                                            hospitals for outpatient appointments                   We know that patients want to                      * Highly-specialist staff who focus on      • Provide high-dependency or intensive care
* A choice of hospitals for those                                                                  see the same surgeon throughout                       orthopaedic surgery, and become
                                          • Improved education classes for patients so                                                                                                                facilities for patients who need them
  needing day surgery                                                                               their care                                            increasingly skilled at carrying it out
                                            they understand their operation and what to
                                            do to before surgery to support their recovery          The new arrangement would ensure that                                                           • Learn from other services around the country,
* A named surgeon and team who                                                                     patients always have care from the same                                                           so that the care and surgery that local patients
                                                                                                                                                                                                                                                         “We believe that by
  will oversee a patient’s care,            afterwards
                                                                                                    surgical team, regardless of where their                                                          receive is based on the best, most up-to-date
  wherever it takes place                 • Appointments would be with a named surgeon,             appointment takes place. If a patient has their                                                   research and knowledge available
* A choice of hospitals for outpatient
                                            who, with their surgical team, would stay with
                                            patients throughout their care, regardless of
                                                                                                    outpatient appointments at one hospital and
                                                                                                    their operation at a different hospital, their
                                                                                                                                                                                                    • Have beds allocated for planned orthopaedic        organising services in a
  appointments                              where it takes place                                    surgeon and the surgical team would follow
                                                                                                    them to the other hospital to carry out their
                                                                                                                                                                                                      operations which would never be used for any
                                                                                                                                                                                                      other kind of care.                                different way, we would be
                                                                                                                                                                                                                                                         able to improve care and help
* A single approach to planned           • Rehabilitation support for patients after
  orthopaedic surgery across north          their surgery                                           surgery.                                                                                        • Provide staff with different ways of working, to

                                                                                                                                                                                                                                                         more patients.”
  central London, where staff learn       • Access to high dependency or intensive care                                                                                                               ensure care is more coordinated across north
                                                                                                    Doctors will continue to work on emergency
  from each other so patients receive       units for patients who need additional care after                                                                                                         central London, in and out of hospital
                                                                                                    care at local hospitals, as well as planned
  consistently high-quality care            their surgery                                           surgery, giving them broad experience and
                                                                                                    improving their skills. This would ensure that
                                                                                                    there would be no impact to the provision of
                                                                                                    emergency care at local hospitals.

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Improving planned orthopaedic surgery for adults in north central London
Where could patients have surgery under our proposals?
                                                                                                                                     North Middlesex University Hospital                                                                                                                                    North Middlesex University Hospital
 Overnight stay: Usually hip & knee surgery                                                                                          / Royal Free London Partnership          Day surgery: Usually shoulder, hand and foot surgery                                                                          / Royal Free London Partnership
                                                                                                                                     UCLH / Whittington Health                                                                                                                                              UCLH / Whittington Health
                                                                                                                                     Partnership                                                                                                                                                            Partnership

              GP                                                                                                                                   GP                                   GP                                                                                                                               GP

            GP &                       OUTPATIENT                           SURGERY                              FOLLOW UP                    COMMUNITY                               GP &                           OUTPATIENT                         SURGERY                         FOLLOW UP                  COMMUNITY
         COMMUNITY                    APPOINTMENTS                                                                                           POST-OPERATIVE                        COMMUNITY                        APPOINTMENTS                                                                                  POST-OPERATIVE
           CARE                                                                                                                                   CARE                                CARE                                                                                                                             CARE
                                       Barnet Hospital                                                       Barnet Hospital                                                                                          Barnet Hospital                                                  Barnet Hospital
                                         Chase Farm                         Chase Farm                         Chase Farm                                                                                               Chase Farm                       Chase Farm                      Chase Farm
                                         North Mid                                                             North Mid                                                                                                North Mid                        North Mid                       North Mid
                                      Royal Free Hospital                                                   Royal Free Hospital                                                                                      Royal Free Hospital                                              Royal Free Hospital
     Outpatient                                                                                                                                                                   Outpatient
     appointment                           UCLH                                UCLH                               UCLH                                                            appointment                             UCLH                             UCLH                            UCLH
     Overnight stay                  Whittington Health                                                     Whittington Health                                                    Day surgery                       Whittington Health               Whittington Health              Whittington Health

Two partnerships for orthopaedic surgery
have been formed by our local NHS Trusts –
                                                      regardless of where a patient receives their care, it is
                                                      of a consistently high standard.
                                                                                                                    operation, as would whether they need an overnight
                                                                                                                    stay, or have your operation and go home on the
                                                                                                                                                                             This is a general guide – and there are some
                                                                                                                                                                             exceptions to this. Examples of this are surgery for
                                                                                                                                                                                                                                      minimise the number of times that patients need
                                                                                                                                                                                                                                      to travel further away from where they would
                                                                                                                                                                                                                                                                                             “Your choice of hospital for
with UCLH and Whittington Health working
                                                      With the majority of orthopaedic surgery there are
                                                                                                                    same day (day surgery). (See page 14 for more            patients with haemophilia, which would remain at
                                                                                                                                                                             the Royal Free Hospital or patients with sickle cell,
                                                                                                                                                                                                                                      usually receive their hospital care.                   your outpatient appointments
                                                                                                                                                                                                                                                                                             would influence where you
together, and The North Middlesex University                                                                        information on this).
                                                      two elements to the care patients receive: the care                                                                    which would remain at the North Mid. because             Patients would be able to express their preferences
Hospital working with the Royal Free London
                                                                                                                    In most cases, hip and knee replacement surgery                                                                   to their GP or physiotherapist, before a referral is
                                                                                                                                                                                                                                                                                             have your operation”
(Barnet Hospital, Chase Farm Hospital and The         before and after surgery (outpatient appointments)                                                                     these hospitals specialise in the care of these
                                                                                                                    needs patients to stay in hospital overnight. For some   conditions.                                              made so that they could choose the partnership
Royal Free Hospital).                                 and then the operation itself.
                                                                                                                    people this might be two or three days. Shoulder,                                                                 of hospitals that is most convenient for them. The
The partnerships would be overseen by a network       A patient’s choice of hospital for your outpatient            hand or foot surgery is usually day surgery, and         In response to the feedback we have already              exact locations are shown on the next page.
                                                                                                                                                                             received from patients, we have organised care to
of health professionals who would ensure that         appointments would influence where they have their            patients can go home the same day.

12                                                                                                                                                                                                                                                                                                                                          13
Improving planned orthopaedic surgery for adults in north central London
Where patients could                                                                                                                            We believe that by all hospitals working together all patients would receive a significant
                                                                                                                                                improvement in their care.
                                                                                                                                                                                                                                              Day surgery:
                                                                                                                                                                                                                                              Shoulder, hand and foot surgery

have their care in the                                 North Middlesex University Hospital /                                                    However, if our proposals were taken forward, some patients would have surgery in a
                                                                                                                                                different hospital, when compared with current arrangements:
                                                                                                                                                                                                                                              • 360 patients a year who would currently go to
                                                                                                                                                                                                                                                UCLH would have their surgery at Whittington

                                                       Royal Free London Partnership
                                                                                                                                                                                                                                                Hospital instead.
                                                       UCLH / Whittington                                                         Chase Farm
                                                       Health Partnership                                                         Hospital                                                                                                    • 80 patients a year, who would currently have
In the future, patients will have a choice of the                                                                                                                                                                                               NHS care in a private hospital, would over time,
two partnerships for their care. The table opposite                                                                                                                                                                                             have their surgery at UCLH instead.
shows where patients would go for different                                     Barnet                                                                                                                                                        • 1020 patients a year, who would currently
elements of their care.                                                        Hospital                                                                                                                                                         have NHS care in a private hospital, would over
The following orthopaedic services are not            SSC                                                                                                                                                                                       time, have their surgery at Chase Farm Hospital
                                                            Royal National                                                                                                                                                                      instead.
affected by our proposals:                                  Orthopaedic Hospital                                                                                          OUTPATIENT              DAY SURGERY            OVERNIGHT STAY
• Emergency care                                                                                                     North                                                                                                                    Overnight stay:
• Children’s orthopaedic care                                                                                                                                                                                                                 Hip and knee surgery
                                                                                                                 University                      NORTH
• Spinal surgery                                                                                                  Hospital                                              Barnet Hospital        Chase Farm Hospital      Chase Farm Hospital   • 400 patients who would currently go to North
• Specialist and complicated orthopaedic surgery,                                    BARNET                                                      UNIVERSITY                                                                                     Mid. would have their surgery at Chase Farm
   which will continue at the Royal National                                                                                                     HOSPITAL /                                                                                     Hospital instead.
                                                                                                                                                                      Royal Free Hospital      Chase Farm Hospital      Chase Farm Hospital
   Orthopaedic Hospital in Stanmore                                                                                                              ROYAL FREE                                                                                   • 360 patients who would currently go to
• Orthopaedic surgery for patients with complex                                                                        HARINGEY                  LONDON                                                                                         Whittington Hospital would have their surgery
                                                                                                                                                 PARTNERSHIP          Chase Farm Hospital      Chase Farm Hospital      Chase Farm Hospital
   medical conditions such as haemophilia                                                                                                                                                                                                       at UCLH instead.
• Local physiotherapy services for bones, joints
                                                                                                                                                                                                                            Chase Farm        • 560 patients who would currently have NHS
   and muscles                                                                                                                                                             North Mid                North Mid
                                                                                                                                                                                                                             Hospital           care in a private hospital, would over time, have
                                                            Outpatient                                   Whittington                                                                                                                            their surgery at Chase Farm Hospital instead.
                                                            appointment                                  Hospital
                                                                                                 Free                                            UCLH/                                                                                        • 40 patients who currently have NHS care in
                                                            Day surgery                       Hospital                                                                                         Whittington Health
                                                                                                                                                 WHITTINGTON                 UCLH                                              UCLH             a private hospital would over time, have their
                                                            Overnight stay                     CAMDEN          ISLINGTON                         HEALTH                                               UCLH                                      surgery at UCLH instead.
                                                            Super Specialist                                                                                                                                                                  • 225 patients referred to the RNOH for non-
                                                            Centre                                                                                                    Whittington Health       Whittington Health              UCLH             specialist care could be suitable for treatment at
                                                                                                  UCLH                                                                                                                                          Chase Farm Hospital instead.
                                                                                                                                                   Change to current arrangements                                                             • 75 patients referred to the RNOH for non-
                                                                                                                                                                                                                                                specialist care could be suitable for treatment at
                                                                                                                                                                                                                                                UCLH instead.

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Improving planned orthopaedic surgery for adults in north central London
What does this mean                                                                                                                                          How the proposals                                    • During our consultation, we should make sure
                                                                                                                                                                                                                    we seek the views of patients with disabilities,
                                                                                                                                                                                                                                                                          We are keen to explore ways in which these
                                                                                                                                                                                                                                                                          challenges can be addressed during the

for patients?                                                                                                                                                could affect travel and
                                                                                                                                                                                                                    carers, those living in areas of deprivation,         consultation. There are opportunities in the
                                                                                                                                                                                                                    people over 65 and transgender people. This           consultation questionnaire to give views and

                                                                                                                                                             different communities
                                                                                                                                                                                                                    will make sure that any possible disadvantage         ideas on this topic and we are actively seeking
                                                                                                                                                                                                                    can be minimised for these groups.                    opportunities to explore ways in which any

                                                                                                                                                             in north central London
                                                                                                                                                                                                                                                                          negative impacts can be minimised.
                                                                                                              Patient choice in the NHS                                                                           • For all patients needing an overnight stay in
                                                                                                                                                                                                                    hospital, there will be a small increase in journey   In developing the proposals, we already know
                                                                                                              All NHS patients have a choice about where
                                                                                                                                                                                                                    time for the majority of residents across north       that the impact of these changes for orthopaedic
                                                                                                              to go for their care. This is enshrined in
                                                                                                                                                             When the NHS proposes changes to services, we          central London. For most residents this increase      patients, carers and staff could be offset in a
                                                                                                              the NHS constitution and is your right.
                                                                                                                                                             need to make sure we take into account the needs       is likely to be 15 minutes at most.                   number of ways:
                                                                                                              Regardless of our proposals, patients would
                                                                                                                                                             of everyone who uses, or will use these services
                                                                                                              still be able to choose which hospital they                                                         • For patients in Enfield and Haringey choosing
                                                                                                                                                             in future. We spoke to hundreds of local residents                                                           • All patients will have a choice of two
                                                                                                              are referred to for orthopaedic surgery                                                               the North Mid/Royal Free London partnership
                                                                                                                                                             and shaped these proposals in response to their                                                                partnerships for their care and so could choose
                                                                                                              – just as they can today. As long as the                                                              for their care in future, we know that these
                                                                                                                                                             feedback.                                                                                                      the hospitals that are most convenient for them
                                                                                                              hospital offers the kind of care the patient                                                          proposed changes will potentially have a greater
                                                                                                              needs, they may choose to have surgery         We also sought advice on whether the proposed          impact on them than on others.                        • For patients and visitors longer journey times
                                                                                                              at a hospital in another part of London or     changes could affect some groups more than                                                                     are only likely to be apply to one or two
                                                                                                                                                                                                                  • For those choosing to have outpatient
                                                                                                              another area of the country.                   others. To do this, we asked independent experts                                                               journeys, getting from home to hospital and
                                                                                                                                                                                                                    appointments at the North Mid and surgery
                                                                                                                                                             to carry out an Integrated Health Inequalities and                                                             back for surgery, as outpatient appointments
                                                                                                              If patients need to be referred for                                                                   requiring an overnight stay at Chase Farm, this
                                                                                                                                                             Health Equality Impact Assessment and a Travel                                                                 will continue to be available at a wider choice of
Nisha needs surgery on her hand                      John needs a hip replacement                             orthopaedic surgery, such as a hip or knee                                                            could mean a more difficult journey if using
                                                                                                                                                             Analysis on our behalf.                                                                                        hospitals.
This can be done in a day. She usually prefers       He will need two nights in hospital. John speaks to      replacement, their GP would be able to                                                                public transport. The transport analysis found
                                                                                                              guide them, give them information about                                                               that there would be a maximum increase of             • For staff, any travel implications could be
to go to UCLH and so chooses the UCLH/               his GP and they decide that the most convenient                                                         These will help us shape the proposals further and
                                                                                                              the care at different hospitals and let them                                                          fifteen minutes to journey times using public           countered by more consistent rotas meaning
Whittington Hospital partnership for her care. Her   place for him to have his outpatient appointments                                                       help us to have conversations with specific groups
                                                                                                              know how long they are likely to wait. Once                                                           transport for these patients.                           less travel during the day between sites.
GP explains that under the new arrangements,         is North Mid. His GP explains that this means he’ll                                                     during the consultation, who might be affected by
she could also go to the day surgery unit at The     have all of his outpatient appointments, before          they have this information they would be       the proposed changes. The analyses highlighted                                                               The reports set out a number of recommendations
                                                                                                                                                                                                                  The report suggests that this may particularly
Whittington Hospital instead.                        and after his operation, and his education class at      able to make an informed choice.               that:                                                                                                        and further pieces of analysis that are needed to
                                                     North Mid, but his operation would take place at                                                                                                                                                                     fully understand the implications of the proposals
                                                                                                              Here is read more about patients’ right        • Most equalities groups, the groups set out         – those with a disability or a mental health
                                                     Chase Farm. This will mean that John has to travel                                                                                                                                                                   and address the challenges which have been
                                                                                                              to choose:                                       in the Equalities Act 2010, will experience a        condition, due to the challenges associated with
                                                     a little further when he goes to stay at Chase Farm                                                                                                                                                                  identified. You can read these reports on our
                                                                                                                  significant improvement in the quality of care       new or different locations.
We’ve produced a short animation which tells         for his operation, but there is virtually no risk that                                                                                                                                                               website.
                                                                                                              nhs/your-choices-in-the-nhs/                     they receive as result of the proposals.
Nisha and John’s story and what the proposals        his surgery will be cancelled last-minute.                                                                                                                   – some black and minority ethnic communities,           orth_consultation
mean for them and other patients.                                                                                                                                                                                   and people living in the more deprived parts of
                                                                                                                                                                                                                    Enfield and Haringey, because of the location of
Watch it at:
                                                                                                                                                                                                                    existing hospitals and the transport links in the
                                                                                                                                                                                                                    areas where these communities live.

16                                                                                                                                                                                                                                                                                                                          17
Improving planned orthopaedic surgery for adults in north central London
Benefits and challenges of our proposals

Benefits                                                                                                                                                                                                                                         Challenges
We believe our proposals would improve services in the following ways:                                                                                                                                                                           We know that with any change there may
                                                                                                                                                                                                                                                 be some disadvantages for some people. We
                                                                                                                                                                                                                                                 think these are:
     Improvements for patients needing                  Improvements for staff working                  Improvements for the NHS                     Improvements in the consistency               Improvements for joined-up care
     an operation                                       in orthopaedics                                 • Hospitals would be able to manage          of care                                       Our proposals are focused on changes to
     • Patients would have access to two                • Surgeons would oversee the care of              waiting lists better because they would    Hospitals working together will result in a   planned orthopaedic services, however it is     • Some patients may have to travel
       hospitals that would carry out operations          patients who need planned care, but             know exactly how many beds would           consistent standard of care for everyone.     recognised that this surgery is one element       further to and from the hospital where
       requiring an overnight hospital stay, Both         also continue to work in emergency              be available. This means patients would                                                  of the care that patients might receive. In       they have their operation
                                                                                                                                                     The new arrangements in these proposals
       hospitals would carry out high-quality             departments. This would ensure that             spend less time waiting for surgery and                                                  developing these proposals, attention has
                                                                                                                                                     would be overseen by a network of                                                             • Visitors may also have to travel further
       surgery, in a relatively short distance from       surgeons retain skills in both kinds of         waiting lists would go down                                                              been given to how they will work with
                                                                                                                                                     specialist healthcare professionals.
       where they live.                                   surgery, and that our hospital emergency      • The dedicated operating theatres would                                                   GPs and alongside musculoskeletal (MSK)         • Some staff will have to work in a
     • For some patients, these hospitals would           departments have the specialist skills they     enable improved access to the latest       In practice this means:                       physiotherapy services so that patients           different hospital to where they usually
       be more accessible, due to improved                need to care for patients who need them         technology which would improve the                                                       receive the right kind of care, when they         work, on some days of the week
       access to parking or public transport –          • The teams – for example anaesthetists           results of surgery                         • Patients would all receive the same         need it.                                        • People with additional needs, (such
       depending on where patients choose to              and nurses – working in dedicated                                                            information before their surgery so that                                                      as those with a learning disability, or
                                                                                                        • Hospitals would be able to learn from                                                    You can read more about this on our
       go for their care.                                 operating theatres would become highly                                                       they know what to expect and are aware                                                        dementia), could find it confusing
                                                                                                          each other and share information                                                         website:
                                                          expert at what they do. This would result                                                    of the benefits and risks of surgery                                                          to go somewhere different for their
     • Fewer operations would be cancelled                                                                                                                                                         uk/orth_consultation
                                                          in better quality care for patients and       • The new arrangement would provide                                                                                                          surgery.
       because planned care would be                                                                      flexibility in how staff work together     • No matter where patients have their care,
       completely separate from emergency care            better results from surgery                                                                  it would be to the same consistently high
                                                                                                          across the area, creating more time                                                                                                      On pages 17 and 24 of this document
     • Everyone who needs surgery would have            • Staff would be able to plan how they use        and space to meet current and future         standard                                                                                    we describe the plans we are putting in
       equal access to services. Patients would           their time better, meaning they would           demands                                                                                                                                  place to minimise the impact of these
                                                          spend more of their time caring for                                                        For further information visit our website:
       have access to a high dependency or                                                                                                                                                                                                         challenges. We are also asking for your
                                                          patients                                      • The new arrangements would be    
       intensive care unit if they need additional                                                                                                                                                                                                 ideas when you answer the consultation
                                                                                                          overseen by a network of specialist        orth_consultation
       support following surgery                        • Staff and local people could participate                                                                                                                                                 questions or come to one of our events.
                                                                                                          healthcare professionals who would
     • For patients having operations                     in research and education programmes            ensure a consistent high-quality of care
       requiring an overnight hospital stay,              which could improve care for everyone
       physiotherapists would be available seven        • Staff would get better quality and
       days a week, to support patients in their          increased training as well as developing
       recovery more quickly.                             new and innovative ways of working into
                                                          the future, as technology and practice

18                                                                                                                                                                                                                                                                                              19
The                                                                                                                                         How planned orthopaedic
                                           Where patients have                                                                                                                                                In 2016/17, north central London hospitals carried
                                           surgery today                                                                                                                                                      out 23,000 planned orthopaedic operations. Around

                                                                                           The Kings

                                                                                                                                            services work today
                                                                                         Oak Hospital                                                                                                         12,000 of these were more routine orthopaedic
                                                                                                                     Chase Farm                                                                               operations. This review is only looking at these more
                                                                                                                     Hospital                                                                                 routine operations.

to our
                                                                                                                                                                                                              The NHS in our area currently pays for patients to be treated
                                                                                                        The Cavell
                                                                                                        Hospital                                                                                              at 10 different hospital sites, both NHS and private. Many of
                                                                                                                                                                                                              these sites undertake all types of planned and emergency

                                                                                                                                                                                                              care, including day surgery and surgery that needs an
                                                                                                                                                                                                              overnight stay.
                                               Royal National
                                               Orthopaedic Hospital                                                                                                                                           • North Middlesex University Hospital NHS Trust
                                                                                                        Middlesex                                                                                             • Royal Free London NHS Foundation Trust
                                                                                                        University                               OUTPATIENT           DAY SURGERY         OVERNIGHT STAY
                                                                                                                                                                                                                – Chase Farm Hospital
* How orthopaedic surgery works
  today                                                           BARNET                                                                                                                                        – Royal Free Hospital
                                                                                                                                            Barnet Hospital       Chase Farm Hospital   Chase Farm Hospital
                                                                                                                                                                                                                – Barnet Hospital
* The evidence upon which our
  proposals are based                                                                                      HARINGEY               WALTHAM   Royal Free Hospital   Chase Farm Hospital   Chase Farm Hospital   • University College London Hospitals NHS Foundation Trust
                                           HARROW                            Private                                              FOREST                                                                        – University College London Hospital
* What local residents told us, and how                                   Hospital
                                                                                                                                            Chase Farm Hospital   Chase Farm Hospital   Chase Farm Hospital     – National Hospital for Neurology and Neurosurgery
  proposals were shaped in response
                                                                                                                                                                                                              • Whittington Health NHS Trust
* How hospitals worked together                                                                                       HACKNEY              North Mid             North Mid             North Mid
                                                                                             Hospital                                                                                                         • Royal National Orthopaedic Hospital NHS Trust
* The impact of our proposals
                                                         BRENT         CAMDEN                                                               UCLH                  UCLH                  UCLH                  • The Cavell Hospital (BMI Healthcare)
                                                                                Royal Free
                                                                                Hospital           ISLINGTON                                                                                                  • Highgate Private Hospital (Aspen)
                                                                                                                                            Whittington Health    Whittington Health    Whittington Health    • The Kings Oak Hospital (BMI Healthcare)
                                                                                                                                            Private hospitals     Private hospitals     Private hospitals

                                                                                                          National Hospital for
                                                                                                          Neurology and Neurosurgery

20                                                                                                                                                                                                                                                                      21
Evidence used in                                                                                                                                            Review by the London Clinical Senate
                                                       Further information on the evidence behind                                                           and other experts                                      “Having to cancel a
developing our proposals
                                                       our proposals can be found on our website.
                                                                                                                                                                                                                   patient on the day
                                                                                                                                                            The London Clinical Senate supports development
                                                       This includes:                                                                                       of health services by providing independent,

                                                                                                                                                                                                                   of their surgery is
                                                       • A national review of adult elective                                                                advice from senior health professionals, patients
Evidence in the UK and around the world shows
                                                         orthopaedic services in England                                                                    and other bodies.
that doing surgery in operating theatres dedicated
to orthopaedics, with specialist staff, is likely to
result in better quality of care for patients. This
                                                       • Getting It Right First Time (GIRFT 2015).                                                          While proposals were still in development, a           probably one of the
                                                                                                                                                                                                                   worst bits of my job. It      “I’d been in pain for
                                                                                                                                                            senate panel reviewed our suggestions and found
evidence also shows that the results of surgery        • Separating emergency and surgical care:                                                            that there was a “clear case for change, based on

                                                                                                                                                                                                                   makes me feel like I’ve
are better for patients when surgeons carry out
                                                                                                                                                                                                                                                 over a year and having
                                                         recommendations for practice                                                                       national best practice and consideration of the
operations regularly and in greater numbers,             Royal College of Surgeons (2007)                                                                   local issues”. They also made recommendations
                                                                                                      One current example of this is
                                                                                                                                                                                                                   let the patient down          to wait even a few more
allowing them to refine their skills.                                                                                                                       where our work could be developed. Their
                                                       • Reconfiguration of clinical services: what   South West London Elective                            recommendations have informed further work.
                                                         is the evidence?
                                                                                                                                                                                                                   and haven’t done my           hours is too long, let
                                                                                                      Orthopaedic Centre
  Evidence shows us that:                                The King’s Fund (2014)                                                                             We also asked for advice from senior staff at
                                                                                                      SWLEOC (South West London Elective

                                                                                                                                                                                                                   job properly.”
                                                                                                                                                            SWLEOC (see opposite) and other senior staff
  • Care is improved when emergency and
    planned care are physically separate, and
                                                       • International Society of Orthopaedic
                                                                                                      Orthopaedic Centre) is a NHS centre providing
                                                                                                      planned orthopaedic surgery services for patients
                                                                                                                                                            running orthopaedic services around the UK.                                          alone being cancelled.”
    delivered in places designed specifically                                                         in south London. This includes inpatient, day cases   More information can be found on our website
    for the purpose. This also results in less         • Examining new options and opportunities      and outpatient care.                                  at                Staff nurse in north London   Patient in north London
    hospital-acquired infections                         for providers of NHS care.                                                                         consultation
                                                         The Dalton Review (2014)                     It was established by four south west London
  • M
     ore operations in one place – with                                                              acute trusts in January 2004, and has earned a        If we do not change these services, it is unlikely
    clinical staff seeing more patients with                                                          reputation as a centre of excellence for planned      that local hospitals will be able to reduce waiting
    similar conditions – leads to in better                                                           orthopaedic surgery with outstanding results, low     lists, the number of cancellations will continue to
    results for patients                                                                              complication rates and high patient satisfaction.     grow and we will not be well-prepared to deal
                                                                                                      SWLEOC is recognised as the largest joint             with the expected increase in demand for services.
                                                                                                      replacement centre in the UK and one of the           Access to services and the quality of those services
                                                                                                      largest in Europe, performing around 5,200 each       will continue to be variable with some patients
                                                                                                      year. It was rated as outstanding by the Care         having to wait a long time
                                                                                                      Quality Commission in November 2015.                  for surgery.
                                                                                                      For more information, visit            The NHS is currently experiencing staffing
                                                                                                                                                            challenges, however our proposals could help
                                                                                                                                                            to ensure that staff who currently work in
                                                                                                                                                            orthopaedic services can use their skills more

22                                                                                                                                                                                                                                                                         23
How our proposals were developed                                               What local residents told us                                                      How our plans changed
We have worked with patients and residents, doctors and nurses
and other health care professionals, like physiotherapists, from
                                                                               People with additional health and social care needs, such as learning
across our boroughs, to design and agree the way in which we’d                                                                                                    We developed a new role of ‘care coordinator’ to support these                           Rosemary Arnold,
                                                                               difficulties, might need some extra help to understand the different and
like planned orthopaedic surgery to work in the future.                                                                                                           patients throughout their care.                                                          patient representative
                                                                               new places they would go for their care.
We talked to a wide range of people and staff to test our reasons for                                                                                                                                                                                      “As a patient rep, I have found the process
changing. We developed our ideas through workshops with the healthcare         We need to carefully consider how the right information about a patient’s
                                                                                                                                                                  Hospitals are joining up their digital patient records securely so that                  fascinating as I had no idea the NHS thought
professionals and patients who currently run and use these services. In        health and social care needs is shared to make sure care is well managed
                                                                                                                                                                  information can be shared more easily.                                                   so carefully about change. I have been able
these workshops we looked at how services could be improved and heard          and coordinated across different hospitals.
                                                                                                                                                                                                                                                           to ask questions at every stage and felt
from other parts of the NHS from across the country about how they run                                                                                                                                                                                     there was a real effort to think about the
similar services. We also looked at the impact that any changes might have                                                                                        In our proposals, the hospitals that would undertake surgery requiring an
                                                                               Some patients needing orthopaedic surgery might also have other health                                                                                                      process from a patient’s point of view.”
on NHS services that work alongside orthopaedics, such as trauma care and                                                                                         overnight stay would also have high dependency or intensive care units. This
                                                                               conditions that might have an impact on their surgery. This could mean             means anyone with complex medical needs would get the care they need.
paediatrics. Patients told us about how the current way in which services      that their surgery comes with additional risks or that they need other
work has impacted on them and their thoughts on how services could                                                                                                A small number of patients with very complicated health conditions would
                                                                               specialists to be involved in their care.
be improved.                                                                                                                                                      be cared for at the most appropriate specialist hospital for their needs.

We are continuing to test and refine our ideas with local people and staff.                                                                                       We are looking carefully at the transport options available to patients who
All of the hospitals involved are in agreement with the proposals in this      Some patients may need to travel further than previously for their surgery                                                                                        Helen Andrews,
                                                                                                                                                                  cannot get to hospital independently to see how any inconvenience could
consultation document and each of the hospitals involved are signed up to      or education before surgery. This additional travel could also affect visitors,                                                                                   patient representative
                                                                                                                                                                  be minimised. We have commissioned a travel and transport report to help
them. You can read more about our partners in appendix 1.                      family and carers.
                                                                                                                                                                  us understand the potential impact of our proposals.                           “When looking at the options for the future,
The feedback we received has helped to shape the proposals that we have                                                                                                                                                                          we ensured that patients’ voices were heard.
                                                                                                                                                                  The money that supports planned orthopaedic surgery would be fairly
put forward in this document. A full report of what we heard from local                                                                                                                                                                          For me, it was important that those who
                                                                                                                                                                  distributed across all hospitals whether they undertake surgery or not.
people between August and October 2018 can be seen on our website.             By moving services around, some people were concerned that their local                                                                                            find it difficult to use NHS services were
                                                                                                                                                                  Hospitals who will delver planned orthopaedic services in future are           considered.”
A summary is provided opposite.                                                hospital might lose services or money.
                                                                                                                                                                  supportive of these proposals and do not believe there would be any
                                                                                                                                                                  significant financial impact in making these changes.
 From August - October 2018 we spoke to over 600 patients to help us
 develop our plans.                                                                                                                                               Patients would always have choice of where they have their care – this is
                                                                               Moving services would result in less choice for patients.                          part of the NHS constitution.
 Patients also participated in 13 workshops alongside potential service                                                                                                                                                                                 The full report of what we heard from
 providers, to develop ideas for how the services could work in future.                                                                                                                                                                                 local residents during the planning of our
                                                                               There were concerns about the practicalities of separating emergency and           We asked specialists in emergency care to look carefully at our plans and
 Patients made up 50% of the panel that evaluated the proposed partnerships.   planned orthopaedic surgery, such as how staff might work.                         confirm that these would not undermine emergency care.                                proposals as well as background to how
                                                                                                                                                                                                                                                        these proposals were developed, can be
                                                                                                                                                                                                                                                        found at:

24                                                                                                                                                                                                                                                                                                        25
Developing our proposals                             • The option must demonstrate a favourable
                                                       income and expenditure impact for the system
                                                                                                           In July 2019 a panel of patients and residents,
                                                                                                           healthcare professionals and commissioners             What has happened so                                 December 2018
                                                                                                                                                                                                                       • The JCC approved the principles of how services
                                                                                                                                                                                                                                                                              January to April 2020
                                                                                                                                                                                                                                                                              • Consultation: We will ask local people and

collaboratively                                                                                                                                                   far and what are the
                                                       after two years of operation                        considered the proposals. They decided that the                                                               could work in future and heard feedback from           stakeholders their views on the proposals
                                                                                                           two options were complementary, that both met                                                                 the earlier public engagement exercise                 that have come out of the pre-consultation
                                                     In May 2019, NHS Trusts were asked to put

                                                                                                                                                                  next steps?
                                                                                                           the criteria and were better than current services.                                                                                                                  and business case stages
                                                     forward options for the future. Two were received
The proposals in this consultation document were                                                           It is this preferred option which forms the basis of                                                        January 2019
                                                     – both partnerships:
developed in an innovative, collaborative way                                                              this consultation.                                                                                          • The JCC reviewed the timeline for next steps,
between the providers of health services in north    • North Middlesex University Hospital NHS                                                                    These are the phases and timeline for the              revised governance arrangements and how the        Summer 2020
                                                                                                           More detail can be found on our website:
central London.                                        Trust and The Royal Free London NHS                                                                        development of our proposals to change                 NHS would contract and oversee the services in     • The outcome of the consultation and the
                                                       Foundation Trust                                                                                           health services for patients who need planned          future                                               development of a decision-making business
Drawing on the feedback from clinicians,                                                                   consultation
NHS Trust, local patients, stakeholders, and a       • University College London Hospitals NHS                                                                    orthopaedic surgery.                                                                                        case. The NHS will consider the responses to
                                                                                                                                                                                                                       May 2019                                               the consultation and decide about progressing
                                                                                                           How much would
number of workshops with all of these groups           Foundation Trust and Whittington Health
participating, an agreement about how services         NHS Trust.                                                                                                 1 February 2018                                      • The JCC agreed plans for how services might          the proposals or changing them. This includes
should look in future (clinical design principles)                                                                                                                • The Joint Commissioning Committee (JCC) of           look and the process for making decisions on         consideration of our equalities impact

                                                                                                           it cost?
                                                     The trusts who had put together these proposals                                                                the five CCGs in north central London, agreed        who might provide them, and where they
were developed and agreed by the JCC in                                                                                                                                                                                                                                       assessment and travel analysis.
                                                     had looked at all of the options available within                                                              that orthopaedic surgery should be reviewed          could be
December 2018.
                                                     the criteria, and ruled out a number as not being                                                              to see if there were opportunities to improve                                                           Assurance and implementation from autumn
In January 2019 the JCC agreed that because          possible, including: a single centre for north                                                                                                                    • Hospitals were asked to develop proposals for
                                                                                                           We believe that by organising services in a              services for local patients                                                                             2020 onwards
of the interdependencies with other services -       central London; a centre at Whittington Health                                                                                                                      the future
                                                                                                           different way, we would be able to improve care                                                                                                                  If permission is granted to implement our
particularly emergency care high dependency          for planned orthopaedic surgery that required         and help more patients.                                August to October 2018                               July 2019                                            proposals, we would begin to put our plans
provision - that these services should remain        an overnight stay; and centre at the North Mid                                                               • We undertook an analysis of which patients         • A panel made up of local patients and residents,   in place.
within the NHS as a variation to contracts.          for planned orthopaedic surgery that required an      If our proposals were approved, we would                 could be affected if the service changed in
                                                     overnight stay. The Royal National Orthopaedic        continue to spend the same amount of money                                                                    doctors and NHS managers looked at the
In May 2019 the JCC agreed both the essential                                                                                                                       future                                                                                                  Future developments
                                                     Hospital chose not to submit a proposal, preferring   (around £37 million) on orthopaedic services as                                                               hospitals, proposals and agreed the potential
clinical elements of the proposed future service                                                                                                                  • Local patients, residents and other stakeholders     new way in which services would be organised       We will continue improve these services in future,
                                                     to focus on supporting local hospitals as a super     we currently do. By changing the way we deliver
and three key tests which needed to be met:                                                                                                                         were asked their views on a draft case for           in future                                          and maximise the benefits of our proposals, if
                                                     specialist centre.                                    orthopaedic services we would make better use of
                                                                                                                                                                    change: our thoughts on why services needed                                                             implemented. We will monitor:
• The provider must already be a provider of                                                               this money and improve patient care. Over time,
  planned orthopaedic surgery                                                                                                                                       to change and some ideas for the future            August to December 2019                              • Waiting Times
                                                                                                           this new way of working should be able to
                                                                                                           save money.                                                                                                 • A document called a pre-consultation business      • Cancellations
• The dedicated operating theatres and                                                                                                                            • Patients, doctors, nurses and other NHS staff
                                                                                                                                                                                                                         case (PCBC) was developed to test proposals,       • Length of stay
  supporting facilities for orthopaedic care, must                                                                                                                  took part in five workshops to explore how
                                                                                                           You can read more about this on our website:                                                                  whether they would be affordable and would         • Surgical site infection Rates
  be located on a site operated by members of                                                                                                                       services might look in the future
                                                                                                                                                                           meet the needs of our communities. The PCBC        • Emergency readmission within 30 days
  North London Partners in Health and Care                                                                 consultation                                                                                                  takes account of feedback already received from    • Revision rates
                                                                                                                                                                                                                         patients and stakeholders                          • National patient reported outcome measures
                                                                                                                                                                                                                                                                            • Friends and family test results to ensure that the
                                                                                                                                                                                                                       • We worked with NHS England as they tested
                                                                                                                                                                                                                                                                              proposed changes have been effective.
                                                                                                                                                                                                                         whether our plans would provide safe and
                                                                                                                                                                                                                         effective care for patients and would make sure
                                                                                                                                                                                                                         public money is spent wisely.

26                                                                                                                                                                                                                                                                                                                           27
How our proposed                  North Middlesex University Hospital/Royal Free                                                               UCLH/Whittington Health Partnership
changes support                   London Partnership
hospitals in north
central London
                                  Chase Farm Hospital                                    North Middlesex University                            University College London Hospital                    Whittington Health
As well as significant benefits   (part of the Royal Free London                         Hospital NHS Trust                                    UCLH is in the process of building a new facility     The Whittington’s day treatment centre is a new
for patients, each of the NHS     group of hospitals)                                    The North Mid. has a well-established day-            on Tottenham Court Road, which will be complete       healthcare facility, providing planned surgery for
hospitals in our partnership
                                  The new Chase Farm Hospital was completed in           surgery unit and an active A & E department. Our      in late autumn 2020. This will contain dedicated      NHS patients. The centre has four state-of-the-art
would see other benefits as a                                                            proposals will improve bed capacity at the hospital   facilities for planned orthopaedic surgery, as well   operating theatres and provides orthopaedic day
                                  July 2018 and is at the forefront of pioneering new
result of our proposals.          ways of working to deliver better, safer and more      and therefore minimise cancellations for a range of   as a new proton beam therapy for cancer patients      surgery for patients in north central London.
                                  efficient care to the local population. The addition   care that the Trust offers patients.                  and a centre for the treatment of blood disorders.    These proposals would widen access to this
                                  of a dedicated orthopaedic operating theatres                                                                                                                      modern facility.
                                  would make even better use of the investment
                                  made by the NHS.

28                                                                                                                                                                                                                                                        29
How to feed   How to give your views                                                                                      How will a final decision                                                                                  Complaints
                                                                    There are several ways to join in this consultation                                                         Timescales for post-consultation decision-making,
                                                                    and give us your views on the proposals which                                                               subject to the volume and content of responses
                                                                                                                          be made?
back on our
                                                                    include completing the consultation questionnaire,                                                          received:                                            If you have a complaint relating to the way
              We want to receive the views of as many patients,     attending one of our meetings or drop-ins                                                                                                                        in which this consultation is being managed
              residents, staff and partners as possible to inform   or writing to us with your own feedback or            This consultation will start on 13 January and        May 2020
                                                                                                                                                                                                                                     please contact the North and East London

              our plans during our public consultation – running    proposals.                                            finish on 6 April 2020 (subject to volume and         Stakeholders will have the opportunity to
                                                                                                                                                                                                                                     Commissioning Support Unit (NEL CSU) Patient
              between 13 January and 6 April 2020.                                                                        content of responses). This consultation period       comment on the draft report of the consultation
                                                                                                                                                                                                                                     Experience and Effectiveness Team, which is an
                                                                    All feedback will be evaluated by Participate         may be extended if it would be helpful to hear        evaluation together with the review of the
              Taking into account your views, as well as other                                                                                                                                                                       NHS organisation who manage the complaints
                                                                    Ltd, an independent company who have been             more views. The phases of the programme will          equalities impact assessment.
              evidence for service change and value for public                                                                                                                                                                       process on our behalf.
                                                                    engaged to receive and evaluate feedback              depend on what decisions are made at several key
              money, commissioners will decide whether the          regardless of how it is submitted.                                                                          June 2020
                                                                                                                          stages but the following outlines what the timeline                                                        They can be contacted on 0203 688 1666 or by
              proposals should proceed to the next stage of                                                                                                                     The evaluation of responses, feedback from
                                                                                                                          may look like:                                                                                             email:
              planning. We would like to hear your views on:        Please let us know your comments and views on                                                               stakeholders and impact assessments will be
                                                                    these proposals by completing the consultation        9 January 2020                                        shared with the Joint Health Overview and            NEL CSU will retain personal information for the
              • Whether we have developed the best possible         questionnaire and returning it in the post using                                                            Scrutiny Committee (JHOSC).                          purpose of this complaint investigation only. In
                solution to the current challenges in providing                                                           Joint Commissioning Committee of the five
                                                                    the Freepost address provided.                        NCL CCGs to be asked to i) approve the pre-                                                                order for us to make improvements to the services
                planned orthopaedic surgery for those who                                                                                                                       June 2020
                                                                                                                          consultation business case and ii) consider the                                                            you receive, anonymous information about your
                need it in north central London, as described in    You can also complete the consultation questions                                                            A decision-making business case (DMBC) will be
                                                                                                                          decision to move to a public consultation.                                                                 complaint may be shared as part of our reporting
                this document                                       using our online survey at:                                                                                 developed outlining the recommended decision
                                                                                                                                                                                                                                     process. Should you have any concerns with this,
                                                                            13 January 2020                                       as a result of the consultation evaluation, impact
              • Are we doing all we can to ensure that services                                                                                                                                                                      please contact us on:
                                                                    consultation                                          Public consultation starts (12 weeks)                 assessments and feedback from the JHOSC.
                are of the best quality
                                                                                                                                                                                                                                     Information on how to make a complaint
              • In developing our proposals, are we doing the       If you attend any of the public meetings or drop-in   6 April 2020                                          June/July 2020
                                                                                                                                                                                                                                     can be made available in other languages, on
                right things to ensure everyone who needs care      events, your views will also be captured and fed      Consultation finishes                                 Patients and NCL CCG will have the opportunity
                                                                                                                                                                                                                                     audio cassette or CD, in large print, Braille and
                can access it in a timely way                       into the evaluation.                                                                                        to review the evaluation together and discuss any
                                                                                                                                                                                                                                     in illustrated format. Interpreters can also be
                                                                                                                          April/May 2020                                        implications. The final DMBC presented to NCL
                                                                                                                                                                                                                                     arranged, including sign interpreters. Please
                                                                    “We want to receive the
              • Whether there are more things we could do to                                                              Following consultation, all responses from            CCG for decision (TBC).
                make services responsive and tailor them for                                                                                                                                                                         contact us if you need this support:
                                                                                                                          members of the public and local organisations will                                               
                                                                    views of as many patients,
                those with specific needs                                                                                 be independently evaluated and a draft report         July to November 2020
                                                                                                                          produced.                                             Assurance of implementation plans and trust
              We are also interested to receive alternative
                                                                    residents, staff and
                                                                                                                                                                                internal governance processes.
              proposals to the solutions we have laid out
              in this document.                                                                                                                                                 After 1 April 2020 there will be a single CCG for
                                                                    partners as possible to                                                                                     north central London.

                                                                    inform our plans”

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