Orthopaedics & Autumn Budget

Is the chancellor’s budget bodging orthopaedic surgery?

Added: November 2017

This year’s Autumn budget has done little to alleviate the concerns of NHS bosses over the worsening situation regarding waiting times for key services, according to BBC News.

As part of the budget, chancellor Philip Hammond said the NHS would be given extra financial support over and above the rises already set out by government spending plans made in 2015. This extra funding includes an immediate £350m boost for this winter, £1.6bn in 2018-19 and £850m in 2019-20.

However, the £1.6bn for 2018-19 falls far short of the £4bn that independent experts have said is necessary to meet demand effectively. NHS England boss, Simon Stevens, has warned that without adequate action on funding, waiting times for key services would continue to get longer.

So what does this mean for orthopaedic treatments?

The waiting list for non-urgent orthopaedic referrals, such as hip and knee operations, increased by a quarter between 2008 and 2016, according to the Telegraph newspaper, rising from 376,000 to 505,957.

What’s more, of these 505,957 referrals, over 60,000 of them were not treated within the 18-week maximum guaranteed by the NHS constitution.

However, despite the pressure on orthopaedic services in the UK, the orthopaedic speciality has actually been at the vanguard of looking at ways to improve quality of care, whilst also identifying savings resulting from more efficient practice.

This is because in 2016, the British Orthopaedic Association undertook at pilot scheme, which looked at available evidence to establish the quality and efficiency of orthopaedic services in England.

Entilted A National Review of Adult Elective Orthopaedic Services in England: Getting it Right First Time, the findings are of particular interest for all surgical disciplines for two reasons.

Firstly, as with some other types of surgery, demand is increasing due to an aging population. In fact, according to the report, orthopaedic referrals from GPs to secondary care providers are already increasing by 7-8% per annum. What’s more, this situation is likely to get worse as by 2030 over 15.3 million people in the UK will be over 65 years of age.

Secondly, as trauma and orthopaedic surgeons make up 33% of the surgical workforce, any improvements that can be made to care in this specialism must be achievable in other areas of surgery that have less or equal demand upon their services.

As Consultant Orthopaedic Surgeon, Professor Tim Briggs, points out in the Foreword to the report, with the provision of care accounting for 80% of NHS costs, looking at ways of providing care differently and uniformly, is a good way to improve quality, save money and do more for less.

Improving orthopaedic surgery in challenging times

The pilot report found a number of ways in which outcomes and efficiencies can be improved despite budget cuts and spiralling demand.

For example, it found that significant variation exists in practice around the country and within the same population/catchment areas.

This variation seemed to be attributable to several key factors, one of which is where surgeons carry out low numbers of specialist procedures, as there is a lot of evidence to show this results in less favourable outcomes.

For example, it was found that 73.3% of surgeons performing unicondylar knee replacements performed 10 or fewer of these procedures every year. Also, of the surgeons performing hip replacements, almost a quarter of these (23.7%) undertook 10 or fewer procedures per year.

There was also found to be ‘huge inexplicable variation’ in the choice and cost of implants, which was thought to be in part due to failure of surgeons to follow the evidence of the National Joint Registry and other registries in decision making concerning implant choice.

The report flags up many other indicators for enhancing quality of care and cost efficiencies, making it an important blueprint for clinically driven improvements in orthopaedic care and a useful resource for all surgical disciplines.

At a time when budgets are tight and demand expanding rapidly, internal collaboration and rationalization seem to be the most powerful ways in which the NHS can tackle the many challenges it is facing.