North Wales Orthopaedic 5 Year Strategic Plan
Report from Stakeholder Group Workshop 1
(30th July 2010 – Optic Centre)
Introduction
This paper provides a summary of the key issues identified at the first Project
Stakeholder Group workshop on the 30th July 2010. An attendance register is
included in appendix 1.
High Level Summary
The following summarises the key outcomes from the first workshop of the
three cycle model. The purpose of the workshop was to support the
development of a 5 Year Strategic Plan which addressed two core strategic
questions:

What is the model for elective and emergency orthopaedic
services for North Wales?

Within the elective model, how should day case surgery be
configured?
Following presentations by Project Core Team leads, Project Stakeholder
Group members were asked to participate in facilitated break out groups to
consider the following key issues





Subspecialisation within Orthopaedic Services
Where and how to do in patient surgery
Where and how to do day case surgery
The role of English Providers
How to further improve efficiency
An outline ‘clinical and non clinical’ criteria for assessing service configuration
options was presented at the outset of the workshop. After group discussions,
each individual participant was asked to individually rank each criteria, the
outcome of the exercise was as follows:
1.
2.
3.
4.
5.
6.
Clinical Safety (Highest Rating)
Patient-Centred
Affordability
Sustainability
Deliverability
Accessibility (Lowest Rating)
Independent facilitators reflected discussions held in each of the four breakout
groups. The outcome of Project Stakeholder Group discussion was as follows:
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
It was felt that the ‘status quo’ option of maintaining a service model
which provided all sub specialties in all three hospitals should be
discounted, however, potential option/s will be compared against this
current model as part of the option appraisal process in workshop 2.

It was felt that developing a service model which directed all secondary
and tertiary care work to England should be discounted.
All groups supported a service model which enabled patients to access non
surgical services locally, with more complex procedures to be undertaken on
hospital sites which were adequately staffed and resourced. Specialist tertiary
services would be accessed via agreed tertiary providers. It was therefore
felt that the following service models should be considered further by
the Project Core Team:

3 sites undertaking a different range of sub-specialty elective
orthopaedic surgery;

2 sites undertaking a full range of elective surgery,

2 sites undertaking a different range of sub-specialty elective
orthopaedic surgery;

1 site undertaking a full range of elective surgery
In addition there was strong support for the consideration of delivering same
day surgery within dedicated facilities.
The purpose of the second workshop will be to critically appraise options
using the revised clinical and non clinical criteria. Following this a financial
and economic evaluation of the preferred models will be undertaken.
Detailed Feedback from Workshop 1
Session 1 – Plenary Welcome
Mr Mark Common, Director of Improvement and Business Support welcomed
those present to the workshop and outlined the reasons for the event. The
purpose of the workshop was to support the development of a 5 Year
Strategic Plan which addressed two core strategic questions:
1
What is the model for elective and emergency orthopaedic
services for North Wales?
2
Within the elective model, how should day case surgery be
configured?
It was noted that the SBAR report summarised progress of work undertaken
by the Project Core Team to date in collating and considering local, national
and international evidence to support the development of the plan. The
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purpose of the workshop was therefore to analyse and test the findings
identified in the SBAR.
Session 2 – Plenary Presentations
Mr Glynne Andrew, Consultant Orthopaedic Surgeon and lead clinician for the
5 Year Plan, provided a presentation which outlined “what we are aiming for
and what model/options might we consider”. Mr Andrews requested that
Stakeholder Group Members consider the following key issues:
a.
Subspecialisation within Orthopaedic Services
It was noted that subspecialisation was now the norm in orthopaedic
service provision and that future planning of services must be reflective
of these changes.
b.
Where and how to do in patient surgery (models to consider)







c.
Where and how to do day case surgery (models to consider)









d.
Admission to elective ward
Admission to specific area of elective ward
Admission to day case ward
Mixed lists in all 3 sites
Day case lists in all 3 sites
Centralised day case unit
All patients should be considered for daycase surgery
All daycase surgery should be done on a dedicated daycase list
All surgeons should have access to daycase lists when needed
The role of English Providers

Proportion of elective orthopaedics leaving N Wales should be
defined to permit:
Development of good tertiary services
Ongoing development of T&O in BCU
Stability for tertiary providers

Agreement required about model of delivering tertiary services and
SLAs
Need to develop collaborative approach

e.
Send it all to England
Do all subspecialties in all 3 hospitals
Do most subspecialties in all 3 hospitals
Do all subspecialties on 2 sites
Split subspecialties between 2 sites
Centralise elective on one site
Implication on Outpatient services
How to further improve efficiency
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




Process redesign by evolution
In theatres
On wards
In clinics
For follow up
Mr Robin Wiggs, Project Core Manager, provided a presentation which
outlined the sustainability gap, with detail on demand and capacity projections
for the next 5 years. Key messages included trend in referral growth over
2009/10 levels of circa 30% over the five year period of the plan with a range
of 25% > 33% growth. Maintenance of the status quo as a means to
managing these forecasted increases was neither feasible or an acceptable
strategy. In addition, reference was made to the 20% reduction in available
finance over the next 3 years.
Session 3 - Break Out Groups
The following provides a summary of discussions and outcomes captured by
group facilitators.
1. What are the clinical and non-clinical criteria for assessing service
configuration options? What is their relative weighting?
Facilitators requested that reference group members place a score for each of
the 6 individual criteria, scoring from 1 (highest rating) to 6 (lowest rating). A
total of 53 criteria forms were completed. The rating column in the following
table provides details of the allocated scores:
Criteria
PatientCentred
Clinical Safety
Accessibility
Definition
Ranking
 Services which enjoy the confidence of the
people they are designed to serve
 Services are provided to meet the needs of the
individual
 Services which are responsive to patient needs
 Services which support Social Care and Health
integration
 Services which eliminate avoidable duplication
and delay for patients
 Ability to provide safe, evidence based services
 Improved clinical outcomes and health gain
 Provide range of safe and effective treatments
which deliver high quality outcomes
 Services which promote, deliver and maintain
recognised / acknowledged competency based
standards of care
 Services reflects the health needs of the local
population
 Service model which supports timely and local
access to services
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2
1
6
 Services which promote access to day case
surgery
Affordability
Sustainability
Deliverability
 Proposals are which promote efficiency and
productivity
 Proposals which make the best use of finite
resources available to North Wales
 Services which maximise overall health gain of
the population.
 Services with access to best clinical equipment
with critical care facilities
 Ability to respond to the changes in the
population
 Ability to support any environmental changes eg.
economic, workforce
 Services which promote the retention and
recruitment of highly skilled professionals.
 Services which respond to future health needs
 Service models which are realistically deliverable
within a clear timetable
 Service models which minimise the risk to service
provision in the interim (i.e. before the full
changes are made)
 Proposals which support the agreed BCU HB
clinical model and strategic direction
3
4
5
The rating for assessing service configuration was agreed as follows:
Criteria
PatientCentred
Clinical
Safety
Accessibility
1
Ranked Votes
2
3
4
5
6
6
5
Weighted Scores
4
3
2
3
19
11
8
9
3
18
95
44
24
43
5
3
2
0
0
258
25
12
0
6
8
9
12
18
0
30
4
12
8
7
7
15
24
1
9
8
16
11
8
1
3
19
10
11
9
1
Total
Rank
%
18
3
202
2
18%
6
0
0
301
1
27%
32
27
24
18
131
6
12%
60
32
21
14
15
166
3
15%
6
45
32
48
22
8
161
4
14%
6
15
76
30
22
9
158
5
14%
Affordability
Sustainability
Deliverability
Stakeholders were requested to rank criteria from 1 (highest ranking) to 6
(lowest ranking). Weighted scores were subsequently calculated by allocating
stakeholders views to the relevance importance of each criteria. The above
table summarises the ranking allocated to each criteria as follows:
1
2
3
4
Clinical Safety (Highest Rating)
Patient-Centred
Affordability
Sustainability
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5
6
Deliverability
Accessibility (Lowest Rating)
2. Is the list of service configurations correct? Are there other options
and are the daycase options different?
Considerations for patients / carers in the development of service model
Feedback demonstrated expectations that patients and their carers
should be central to designing future models of care:



Involve carers (formal & informal)
More enhanced role for patients in planning options
Outcomes, people perspective v Clinical
While feedback suggested that appropriate care should be delivered as
locally as possible, there was also recognition that patients would be
willing to travel across North Wales for surgical treatment, and further
into England for specialised tertiary care.


Being seen nearer home for non surgical or minor procedures
Patient will travel across North Wales and into England for surgical and
complex / tertiary care
Feedback suggested that patient expectations should be managed, with
a structured approach to sharing information in particular around
clinical outcomes and benefits of treatments, pre operative education
and timescales of treatment.

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
Structured patient expectations e.g. benefits, timescales
Managing patient expectations
Patient experience paramount
Patient friendly service & information
Patient education/needs/expectation
Patient safety and experience was identified as a key priority area,
feedback suggested that all aspect of the patient pathway should be
reviewed in developing the new model of care.


Need to look at all aspects of pathway that patient experiences”
Keep service model patient centred
Feedback identified the need to ensure that communication with
patients was robust.


Good communication in language of choice
Patient friendly service and information which is accessible
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Considerations for Workforce in the development of service model
Feedback suggested that training should play a central role in
supporting future service models. This would support training and
retention of staff, as well as providing a platform for attracting the best
clinical staff to North Wales.

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Academic model – need to consider attracting best staff
Training of orthopaedic staff to be addressed
Attract staff / surgeons, nurses, junior staff
Sustainable recruitment of staff
Will it attract & retain the best clinical staff
Feedback suggested that a revised competency framework should be
developed to support future service models.




Consultant designed & multi disciplinary delivered based upon
appropriate competency framework
Appropriately skilled staff
Training & competency
Succession Planning
Feedback suggested that the workforce should be allocated
appropriately to ensure maximum benefit and outcomes for patients.


Maximise deployment of scarce medical staffing resources
Staff- have we got the right grade of staff doing the right job
Location of Services in the development of service model
Feedback suggested support for relocation of services from the
Abergele Site. However, concerns were expressed regarding the
realisation of this objective.

Delighted by some actions e.g. Abergele, but assurance needed that
there will be a definitive and positive conclusion rather than ‘being
seen’ to go through the process again.
Feedback suggested that further consideration was required in
identifying location of services. Suggestions ranged from providing
Inpatient and Daycase services on 2 sites to developing a North Wales
centre of excellence on one site.

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

New model should deliver services from 1 or 2 sites
Consider the development of a Centre of Excellence for North Wales
Allocate staff on 1 or more sites - 2 sites maximum
State of the art facilities are required in North Wales
Feedback suggested that where possible, services should be rolled out
to the community, with Primary Care clinicians to play a greater role in
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minor procedures, pre operative assessments and rehabilitation. A
suggestion was made that outpatient clinics should be held in the
community.

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

Safe services as local as possible e.g. assessment, diagnostics and
follow up
Spread out other services closer to where people live e.g. Pre
Operative Assessment Clinics, rehabilitation, and initial assessment
following G.P. referral
Outpatient services closes to home, discharge & follow up better
planned
Use localised / community services e.g. Occupational Therapy &
Physiotherapy
Feedback identified the need to ensure that transport infrastructure
supported changes to location of services.

Accessible - within transport framework
Service Model Configuration
Feedback suggested that a unified model of care should be developed
for North Wales orthopaedic services.

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
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Inconsistencies across services/ practice resource
Subspecialty based at one site but undertake daycases in one of the
other sites
Differing clinical assessment on each site
Joined up services required between Health & Social Services Dept
Standardise care across N Wales
Social Care integration
Feedback suggested that future service models should be streamlined,
with services concentrated on fewer sites. Feedback also suggested
that North Wales would benefit from dedicated Day Case facilities.







Concentrate services with specific people – don’t try to do everything
everywhere – do operations & initial post operative care where your
(scarce) doctors are located
Simple operations – dealt with in locality, Intermediate operations dealt
with in DGH and complex operations dealt with in tertiary.
Orthopaedic surgeons to support within locality (visiting basis)
Concentrate services and equipment for sub specialties with critical
care facilities
Other professionals e.g. physiotherapy /nurses undertaking surgery to
be considered in models
Future requires a change in order to ensure sustainability of services
Consider clinical scoring e.g. Oxford and the role of GP to support this
in community.
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


Use of Extended Practitioners – do all patients nee to see a
consultant?
‘Simple’ ‘v ‘complex’ rather than ‘inpatient’ v’ ‘daycase’
Dedicated day case facilities required for North Wales
Feedback suggested that Primary Care should play an increasing role in
providing appropriate orthopaedic services within localities.


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
Need to look at Primary care input to the models ” upstream
prevention”
G.P. optimisation Blood Pressure monitoring/testing etc
Locality based services – run by GPwSI or Extended Scope
Practitioners (ESP) A locality ESP could see / filter all referrals pre
secondary care
Primary care – beefing it up so they can do minor procedures & more
pre-op & triage
Primary care are currently undertaking some of these procedures is
this factored in?
Can GP’s and practice nurses to do more?
Feedback suggested considerable support for improved pre-operative
care and assessment, this should be central to future service models.

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

Pre-op assessment – backbone of operations procedures and
multidisciplinary.
Timely preoperative care required - ideally local.
Standardisation of pre-op protocols.
Screening for fitness for surgery
Importance of good support services pre-op
Intra & post operative & aftercare
Pre operative & post operative care
Feedback outlined the need to identify the possible impact of a revised
service model on other supporting services, including the independent
sector. Possible impact on imaging was identified by many reference
group members as a key priority area.



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Independent / private practice (providers) not considered
Consider are there other specialties that are impacted / could be
involved e.g. haematology
Diagnostics – imaging
Unintended consequences on other (non ortho) departments e.g.
critical care, anaesthetics, must be able to manage these
consequences
Access to support services important
Supporting services (radiology) arranged effectively
Access & Outcome Issues in the development of service model
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Feedback suggested that unified access criteria should be agreed for
North Wales. Reference Group members noted that triage and referral
management processes should be streamlined and standardised.










Optimal triage system / patient to right place first time
Access criteria revision required
Rationing where necessary
Access to criteria / referral system needs to be review
A standardised referral process should be developed
Different triage systems in place
Signposting of patients to appropriate services
Services which are able to cope with demand
Accessibility – responsiveness missing
Centralised booking system for North Wales
Feedback suggested that the quality of outcomes for patients should be
a key driver in determining service provision and accessibility.







Quality of outcomes
Safety / effectiveness / range of treatments
Efficient & effective
Clinical safety – safety throughout patient journey
Links in with evidence based interventions
Best possible outcomes of procedures
Are we ensuring every intervention has demonstrable clinical and
patient outcomes
Finance, Productivity and Efficiency in the development of service model
Feedback suggested that with future reductions in available finance for
health services, significant emphasis should be placed on maximising
available health resources.





3.
Affordability – need to move to ‘best in class’/ ‘moving target’
Best value for North Wales population ‘v’ individual
Efficiency – to reduce length of stay & increase daycase rate
IT systems integration to support changes
Best use of available resources / eliminate waste
What is the nature of future collaboration with English providers?
Feedback suggested that there was support for targeted use of English
Provider services.


Recognising joint planning with English providers, not dismissing out of
hand
Gobowen survival dependant on North Wales
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


England collaboration must meet capacity/critical needs of North Wales
BCU should be grasping the opportunity to review relationships with
England
Value for mile – distance ‘v’ better service
Feedback suggested that further analysis of cost benefits of contracting
with English Providers should be considered and whether other options
could be considered.




25 % of North Wales T&O work undertaken in England
Is it cost effective to buy from England
What can NW ‘sell to England
Contracting with providers from outside NW to deliver services within
NW using NW facilities
Session 4 – Plenary Feedback & Early Discussion
1. All groups recognised that sub-specialisation was now the norm in
orthopaedic service provision and that future planning of services
must be reflective of these changes. There was consensus that the
‘status quo’ of service provision across all 3 main sites could not
continue in its present format as this would not support patient
clinical needs, address forecasted demand increases or support
future financial challenges. It was therefore felt that the option of
maintaining a service model which provided all sub specialties in all
three hospitals should be discounted.






Subspecialisation is in its infancy but it will grow
Subspecialisation is key factor
Subspecialisation is here to stay
Current model not sustainable and varies across North Wales
Inconsistency in service provision within current model
The re-formation of NHS in Wales affords ideal opportunity for
developing a new service
2. All groups recognised the need to work effectively with English
Providers to ensure that patients have access to effective and high
quality Tertiary Services. It was therefore felt that developing a
service model which directed all secondary and tertiary care work to
England should be discounted.


Better planned & integrated service with England
Consistent and integrated service provision with England
3. All groups supported a service model which enabled patients to
access non surgical services locally, with more complex procedures
to be undertaken on hospital sites which were adequately staffed and
resourced. Specialist tertiary services would be accessed via agreed
tertiary providers.
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

Concentrate services with specific people – don’t try to do everything
everywhere – do operations & initial post op care where your (scarce)
doctors are located
Simple ops – dealt with in locality, Intermediate ops dealt with in DGH
and complex ops dealt with in tertiary.
It was therefore felt that the following service models should be
considered further by the Project Core Team:

3 sites undertaking a different range of sub-specialty elective
orthopaedic surgery;

2 sites undertaking full range of elective surgery,

2 sites undertaking a different range of sub-specialty elective
orthopaedic surgery;

1 site undertaking a full range of elective surgery
In addition there was strong support for the consideration of delivering same
day surgery within dedicated facilities.
Postcards Exercise
In order to ensure that all relevant issues, thoughts and questions were
captured, Project Stakeholder Group members were encouraged to complete
postcards to capture the following:

Issues which should be considered as part of the review for the 2
and 3 cycles.

Comments on the ‘constraints for improving productivity of the
current service configuration that must be resolved’ were also
requested.
97 postcards were submitted at the end of the workshop, these included
approximately 165 individual comments, questions or suggestions. In broad
terms the comments fell under the following headings:









Political support for planned changes
Adherence to governance and utilisation of benchmarking, evidence
based models
Public Health / Education
Provision of Enhanced Recovery models of care
Cross Border Management
Local Authority engagement (social services)
Demand and Capacity Management
Therapy services provision
Productivity issues
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


Access to services & relocation of services to Primary/Community care
Workforce modernisation and efficiencies
Radiology services provision
Questions raised via the postcards are attached as appendix 2 and will be
answered via the Project Core Team. Feedback will be provided via the web
site. (Access to all original postcards is available via the Programme
Manager)
Equality Feedback
Equality Feedback – From a total of 69 attendees, 23 feedback forms were
submitted. These will be reviewed by the Programme Manager to ensure
future equality needs are met. No concerns or complaints were made
regarding equality during or after the workshop event.
Overall Event Feedback
All present were provided with Event Feedback forms, these provided the
Stakeholder Group with opportunity to comment and express views in respect
to the format and contents of the workshop event. From a total of 69
attendees, 41 forms were submitted.
Very Good
Good
Satisfactory
Poor
Not
completed
7
24
9
0
1
All comments and questions raised via the feedback forms will be considered
by the Programme Manager. Feedback will be provided via the web site.
Next steps
The feedback gathered during the first Project Stakeholder Group workshop
will be shared, with further responses to be received by members within 14
days of the first workshop – this will be facilitated via an electronic method.
This will allow stakeholders the opportunity to record their comments and
submit them to the core team. Responses will be recorded in an electronic
format which allows all interested parties to view the comments from all
stakeholders and members of the ‘expert’ group. The next Project
Stakeholder Group workshop will be held on the 3rd September 2010, in the
Optic Centre, St Asaph Business Park. This event will now take place
during the entire day, with Registration between 9.00 and 9.15am.
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Contact us
If you would like any further information regarding the Orthopaedic 5 Year
Strategic Plan work, please contact:
Mr Glynne Andrew – Clinical Lead / Consultant Orthopaedic Surgeon
[email protected]
Mr John Darlington – Programme Manager
[email protected]
Mr Robin Wiggs – Project Core Team Manager
[email protected]
Appendix 1 – Attendance Register (Workshop 1)
Name
Aled Hughes
Alexandra Kraus
Amir Hanna
Anne-Marie Rowlands
Barbara Marcus
Barry Williams
Bethan Wyn Owen
Bijaya Roychowdhury
Carol Williams
Carys Norgain
Chris Lindop
Christine Pierce
Cindy Wakenshaw
Clare Jones
Clive Cook
Councillor J Ann Davies
Craig Barton
Dafydd Pleming
Danny Jones
David Counsell
David Williams
Dawid De Jager
Debbie Duffy
Dr Jay Nankani
Dr Nia Jones
Dr Nick Archard
Dylan Williams
Elaine Sturman
Representing
Senior Public Health Policy Officer
Consultant
Orthopaedic Consultant
Assistant Director of Nursing
Orthopaedic pharmacist
Acting DGM
Radiology Services Manager
Consultant Rheumatologist
Deputy Chief Officer (CHC)
Head of Physiotherapy
Performance Analyst
Patient Representative
Senior Physiotherapist
Assistant Director Primary & Community
Head of Podiatry
Chair of Denbighshire County Council's Social
Services and Housing Scrutiny Committee
Associate Chief of Staff – Surgical & Dental
CPG
Theatres
Theatre Manager
Chief of Staff & Consultant Anaesthetist
Vice Chair CHC
Consultant Anaesthetist
Head of Physiotherapy Services
GP
GP
Consultant Radiologist
Engagement Manager
Directorate Lead Pharmacist (SATCH)
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Emma Hosking
Glynne Andrew
Graham Alexander
Gwyneth McBurney
Gwyneth Rowlands
Helen Hughes
Himanshu Patel
Hywel Hughes
Ian Harvey
Ian Johnson
Jan Ellis C
Jeremy Jones
Jill Newman
Jo Charles
John Darlington
Kathryn Williams
Lesley Cotter
Lesley Law
Lorretta Lloyd
Marion Ayrton
Mark Common
Mr Niall Graham
Mr Ron Evans
Nia Vaughan
Nicholas Archard
Pam Lewis
Paula Jefferson
Peter Roberts
Rachel Williams
Richard Waterson
Robin Wiggs
Roz Evans
Salah Bastawrous
Sandra Silcock
Sandy Jones
Stephen Morris
Stephen Phillips
Sue Webster
Sylvia Clutton
Phil White
Sian Lews
CD Anaesthesia
Consultant Orthopaedic Surgeon
Associate Chief of Staff ,Anaesthetics, Critical
Care and Pain Services.
Locality Manager Adult Services
Sister
Imaging Manager
Consultant Radiologist
Associate Specialists in Emergency Medicine
Clinician
Consultant Anaesthetist
Assistant General Manager
Rheumatology
Assistant Director Performance Analysis
Assoc LPH Director Gwynedd and Anglesey
Assistant Director Planning
Information Analyst
Head of Occupational Therapy
Welsh Assembly Government
Countess of Chester
Patient Representative
Director Improvement & Business Support
Consultant Orthopaedic Surgeon
Patient Representative
Daycase Theatre Manager
Consultant Radiologist
Head of Therapy Services
Divisional Manager
Patient Representative
Staff Nurse Theatres
Manager for DC
Head of Planning (Project Core Team Manager)
Theatre Sister
Orthopaedic Consultant
Senior Sister Daycase Ward
Staff Nurse
Patient Representative
Consultant Orthopaedic Surgeon
Arthritis Care
Social Services
Chair – Local Medical Committee (N Wales)
Older Peoples Strategy
T&O 5 Year Summary Paper Workshop 1 v 3.5
For Reference Group and Core Project Team
29/07/2017
Page 15 of 17
Appendix 2 – Postcard Exercise Questions (Workshop 1)
Political
Governance &
Benchmarking
Research
Public Health
Enhanced
Recovery
Cross Border
Social
Services
Demand &
Capacity
Therapies
Productivity
Access
It there political willingness to pursue the changes?
Are the current outcomes from all treatments delivering effective clinical outcomes? How is it measured?
What % of capacity of a consultant should be subspecialisation V’s general (including trauma)?
Is there a limit to subspecialisation delivering benefits in terms of improved quality etc? (concept of optimality – Donabedian)
Where are the most effective T&O service in the UK/Word and what are the key enablers?
Has the data for future trends been validated by Public Health? Is the demand for orthopaedic services linked to size of
population as well as demographics by age etc?
How will Rapid Recovery programme (hips & knees) fit within the projected BCU projected scope?
Why not develop a “North Wales orthopaedic hospital”? Overtime Gobowen cold assimilate more English work as North Wales
developed as centre of excellence.
What is perceived future place/role of Countess of Chester in provision of services?
RJAH orthopaedic Hospital values our patients from North Wales. Will North Wales continue to support Welsh orthopaedic
activity at RJAH?
Getting more surgery done is one thing – what about the rehab/aftercare needed? Are we jointly planning for this with (1) other
parts of BCU (2) LA/Social service colleagues?
Are we delivering a managed service or a consumer service? Can we do both?
What is the difference between 29% increase in referrals in 5 years against what Public Health says regards % of population
being treated by orthopaedics?
Do you feel that CAT could be more effective?
Is CAT really necessary? Does it not delay the aspirations?
Is radiology to be co-located with orthopaedics?
Will specialised physiotherapy services be part of “package” of services in centralised operation centres e.g. shoulder, knee
specialists
What consideration has been given to the involvement or support of Occupational Therapy Services in Health & Social Care in
the strategy e.g. splinting, rehabilitation, manual handling, risk assessment, accommodation issues, assessment & provision of
specialist equipment? Care in Flintshire (East) has also risen in line with orthopaedic referrals.
How will changes impact on radiology?
How do we provide equity of services to patients in rural areas?
T&O 5 Year Summary Paper Workshop 1 v 3.5
For Reference Group and Core Project Team
29/07/2017
Page 16 of 17
Workforce
Efficiency
Imaging
Change
Management
Patient
Programme
Board
How do we best utilise the therapists & specialist nurses in achieving the increased capacity required & fill the gap left in junior
doctors?
Increase daycases may increase need for support at home. How do we achieve this over the decrease in monies & condensing
increasing pressure on beds?
What outreach model for clinics will be commissioned? i.e. sending surgeons out of hospital to local clinics
Concerned that the 5 year plan is developed in isolation. How does it connect to falls strategy, Hospital @ Home etc?
Can we empower primary care colleagues to perform “home” or local hospital services for pre/post op care?
Could we free up consultant time by taking the surgeons’ out of the pre-assessment & consent clinic to perform other more
appropriate roles?
Almost every patient who has an elective orthopaedic outpatient appointment has some form of imaging. Therefore the predicted
increase in demand will require equal increase in radiology services. Has this been considered?
How can we be more likely to deliver any changes? Is there a need to “burn the books” or will evolution do the trick?
How will the problem of travel for patients be overcome in elective surgery bearing in mind the distance the BCUHB covers and
where is central?
How far are patients happy to travel to get elective surgery & elective OPD?
How will you know that services will “enjoy the confidence of people” and “meet the needs of the individual” – i.e. what are the
benchmarks & evaluation Models
Has the view of the ‘user’ been/will be considered – particularly if services are to be carried out on only the one site/two sites?
Why wasn’t there an orthopaedic surgeon in each of the break out groups?
Why was there no mention of private practice?
In terms of programme and project management which model is being used to ensure the project is delivered?
Have stakeholders been invited so that BCU HB can tick a box? Assurance needed that voices will be heard.
Why is the forecast for the East rising so much? Is it for inward movement of people from England Liverpool/Chester/Manchester
workers living in the North Wales or aging population or just population growth?
Constraints – Increase in demand, waste of resources, cuts in resources. Impossible to meet the targets. Why not be honest &
accept the inability to meet the targets, why raise peoples expectations?
How can Social Care Services support pre/post operative assessment – i.e. SW, OT?
T&O 5 Year Summary Paper Workshop 1 v 3.5
For Reference Group and Core Project Team
29/07/2017
Page 17 of 17