Urgent and planned orthopaedic surgery at Imperial College Healthcare NHS Trust

2 Orthopaedic surgery Management of fractures and degenerative disease of bones and joints e.g. ankles (29%), hips (23%), arms and shoulders (20%), legs (10%), and spinal injuries (8%). Operations are generally:  Planned e.g. hip/knee replacements for osteoarthritis; or  Urgent e.g. trauma causing disrupted bone/soft tissue or bone crumbling

3 Orthopaedic surgery at ICHT Orthopaedic surgery accounts for only 7% of the 52,000 planned operations and 7.5% of the 20,000 urgent operations performed each year at Charing Cross and St Mary’s Hospitals Figures for Ealing residents in brackets Day case / admitted 2009/10 Planned surgeryUrgent surgeryOutpatients Charing Cross1,910 (109)740 (78)20,000 St Mary’s1,670 (469)760 (15)19,500 Total3,5801,50039,500

4 Efficiency: increased demands Older, heavier population needing orthopaedic procedures Treating planned care patients in 18 weeks is more challenging Quality: Separate facilities for planned and urgent care are recommended by Royal College of Surgeons: reduce infection rates such as MRSA improves care – surgeons specialising in certain types of operations planned ops are not cancelled by urgent work urgent work not delayed by planned work facilitates training and research – more patients in trials Case for change – efficiency and quality

5 Case for change – specific to ICHT Major Trauma Centre geared up with trauma specialist orthopaedic consultant input. All urgent orthopaedic care on one site would facilitate timely treatment by specialist staff – improve outcomes Day case facility larger capacity at Charing Cross than St Mary’s. If planned care all at CXH would allow greater proportion of day cases – reduced infection rates, more patient friendly. Achieving single sex accommodation at both sites will be easier (no need for separation of elective and trauma for both sexes each site) Continuation with current inefficiencies make the service uneconomic. Various options considered by clinicians

6 Preferred options with most benefits 1.Planned surgery at CXH and urgent surgery at St Mary’s –More day care (CXH day unit) – achieving better care and savings –Enables a critical mass of specialist orthopaedic trauma surgeons at StM –No conflict between elective and urgent duties –Most cost effective option: £1.2m capital –Clinicians’ preferred option 2.Planned surgery at CXH but urgent at CXH and SMH –More day care (CXH day unit) and improves planned care –Small capital cost –But does not improve urgent care

7 What does not need to change? The 40,000 outpatient appointments should, and will, continue unchanged on both sites – there is no advantage to changing their location The fracture clinics on each site should, and will, continue unchanged Urgent medical and surgical services at Charing Cross including HDU/ITU will remain unchanged