Review of adult elective orthopaedic services - evaluation reports.

From 13 January to 6 April 2020, we ran a consultation inviting views on proposals to change planned surgery for bones, joints and muscles (planned orthopaedic surgery) for adults.   Information relating to the outcome of this consultation is presented on this page.

The feedback from the consultation was independently evaluated by Participate Ltd and the evaluation report has been published. The headlines from the feedback were:

Support for the proposals:

  • Over three quarters of respondents supported the proposals
  • They thought they were likely to lead to improvements in elective orthopaedic care
  • Service delivery developments such as the development of a ‘care coordinator’ were seen as positive and likely to improve patient experience
  • Separation of emergency and elective services was viewed as positive

Concerns about the proposals:

  • Concerns were raised around travel and accessibility especially for older people, those with disabilities and individuals on low incomes
  • Also raised was inconvenience of staff travelling between sites, leading to productivity issues and dissatisfaction

Approach to consultation:

  • Consultation itself was praised, with participants feeling there had been a wide scope of influence

More on the consultation exercise and findings

You can read the full consultation report below. Summary information is provided by clicking on the boxes

The breadth of consultation was welcomed by participants. There were:

  • Three open deliberative events
  • 1205 people attended 66 meetings with community groups
  • 12 outreach sessions in community locations
  • 595 people completed the consultation survey
  • 24 responses from professional bodies
  • 31 other pieces of correspondence (emails, letters etc)

Of these activities, many were developed or specifically targeted to seek the involvement of those identified in our stage 2 Integrated Health Inequalities and Equalities Impact Assessment (IHIEIA) as being impacted by the proposed changes. Some face to face events were cancelled as a result of the coronavirus pandemic, however additional activities were planned using the telephone and online, to involve groups who hadn’t taken part earlier in the process. 

595 people completed the consultation survey

  • Overall 75% of respondents were in agreement with proposals, 8% in disagreement and 14% either had no view or didn’t answer
  • 23% thought it would FULLY address the challenges laid out in the consultation document, 53% PARTIALLY address the challenges, 9 % NOT address the challenges
  • 54% would be happy to travel further to receive the best orthopaedic surgery with outpatient appointments close to home, 23% would have concerns about potential travel and access issues if services are changed, but felt that if they needed this kind of care, they would benefit from the proposed changes, 18% would prefer all their orthopaedic care, including surgery, to be at their local hospital even if it meant they had to wait longer
  • Approx a third were not concerned about travel, 20% felt it could be easier as public transport options will be improved /easier to drive and park. Approx a third were concerned about potentially undertaking a more complex journey / parking Cost of travel, travelling further and additional travel time were also chosen by around 20%
  • When thinking about accessing healthcare information, In person at appointments was preferred by 64%, by telephone was preferred by 56%, and responding to an email from the hospital was preferred by 46%
  • When asked about the role of the care coordinator, most comments were positive with focusing on communication needs and language/format, clear communication with patients, their family and carers to help join-up care and explain procedures such as discharge and making assessments and providing reasonable adjustments being highlighted as the most important

We held three open deliberative events, 1205 people attended 66 meetings with community groups and 12 outreach sessions in community locations

  • The majority of groups agreed that the changes outlined in the proposal make sense. Over a quarter of these groups believed that the changes would provide a faster service and therefore reduce waiting times for patients.
  • In 35 of the groups, it was felt that some further detail or clarification on aspects of the proposal would be useful. Those areas were wide-ranging.  Clarification was sought around the details of the implementation plan and over what timescale these changes would be introduced.  Points to clarify included how teams will work logistically across several different sites and the definition of who makes the referral, questioning whether it would be the GP.
  • Clearer and more detailed information for patients post-surgery was identified as an area that could improve patient results, by empowering them to self-manage their rehabilitation.
  • On the subject of travel and access, participants spoke about travel for those who were vulnerable or living in deprived areas, better bus services and public transport were needed to some sites, Chase Farm Hospital being difficult to access on public transport for some patients and the need to consider travel time and distance.
  • There was wide support for the care coordinator role. There was a lot of agreement for developing an education programme for patients prior to surgery to advise them about what to expect, how to attend and what they were expected to do.
  • Support was given for face-to-face sessions with the additional provision of written materials or booklets, which could be produced in several languages and easy to read versions.

In addition to the consultation, a three stage IHIEIA was undertaken that looked at the opportunities to advance equality and fairness by removing barriers.  

Aims of the IHIEIA

  • Consider whether the process successfully incorporated the suggestions made in Stages 1 and 2 and to identify any gaps which might still need filled in terms of identifying, including and considering the needs of the protected characteristic groups
  • Compile a ‘long list’ of mitigations put forward throughout the entire process, including the consultation, from which a ‘short list’ of mitigations would be considered for validation
  • A validation workshop took place in July 2020 in an online workshop attended by a cross-section of stakeholders
  • Identifying patient needs – early and comprehensively
  • Using systems for patient held documents – for example carers’ passports, carers’ packs and my health matters passports
  • Ensuring the care coordinator role has the necessary scope
  • The provision of accessible information: making information accessible to everyone who needs it, at the right time and in the right place
  • Leading at network level to ensure consistency, avoid duplication and lead on high-level negotiations with partners

Decision-making process

  • The evaluation of the consultation and Integrated Health Inequalities and Equalities Impact Assessment (IHIEIA)was shared with the Joint Health Overview and Scrutiny Committee on Friday 4 September. 
  • The CCG Governing Body Meeting on 24 September 2020 received a full business case for decision-making and agreed to proceed to implementation.
  • Implementation assurance will take place from September 2020 to March 2021, subject to agreement by the CCG Governing Body.

Evaluation report and IHIEIA report

Evaluation of consultation report

An independent report which summarises the findings from the consultation and draws out the themes from all forms of dialogue. Download here

Integrated Health Inequalities and Equalities Impact Assessment (IHIEIA) – stage 3

An assessment to ensure any decisions made will advance equality and ensure fairness by removing barriers and engaging patients and the community. Download here

Integrated Health Inequalities and Equalities Impact Assessment – mitigations workshop

Report from the stakeholder workshop arising from the IHIEIA – Stage 3, to develop suggested mitigations.

Mayor of London's response to the proposals

In 2017 the Mayor announced six tests he expected to be met before he would give his support to any major health and care transformation or service reconfiguration proposals in London. The Mayor’s office published a response to these proposals.

Additional reports from the consultation – targeted interviews with key communities

Feedback from interviews with transgender participants

A report on the key themes raised by transgender participants in a series of telephone interviews. Download here

Feedback from interviews with carers

A report on the key themes raised by carers in a series of telephone interviews. Download here

Feedback from telephone interviews with residents

The consultation was completed during the Coronavirus pandemic through a series of telephone interviews. Download here

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