Essex and Suffolk Elective Orthopaedic Centre public engagement 2024

[Music] Welcome to the Essex and Suffolk Elective Orthopaedic Centre, housed in the Dame Clare Marx building on the ESNEFT site of Colchester. I’m Andrew Dunn, Clinical Director of the Centre here. I’m an orthopaedic surgeon from West Suffolk Hospital in Bury St Edmunds. This is the reception area so patients will arrive and be dropped off here by their um uh relatives and loved ones. They’ll book in here at our reception uh area and then um transfer uh to get changed uh into some holding pods and bays just down the corridor here before they walk to theatre and have their procedure. Here is one of our anaesthetic rooms in one of our new operating theatres of the Centre and this is where the patient will be anaesthetized once they’re anaesthetized uh they’ll come into the operating theatre to have their surgery. These theatres are state-of-the-art ultra-clean orthopaedic theatres. we’ve got a separate um prep room where instruments for the uh next case, so as the team are finishing one operation some other members of the team can get ready for the next uh you know procedure so we’ll be able to work in a very efficient and you know highly organised manner and really make the uh Centre you know very productive to get through the 10,000 operations we’re aiming to deliver here every year. This is a corridor that links the uh Centre to the main hospital building on the Colchester site at ESNEFT and um it’s obviously to uh allow uh access for staff but also um access will be restricted for uh infection prevention and control measures. So around 60% of our accommodation uh in our ward areas are uh single rooms with en-suite facilities so you can see this is one of the um patient you know rooms here uh with a large space uh with a walk-in en-suite you know small wet room you know facility. Here we’ve got um one of our um smaller nursing stations where nurses can monitor patients in some of the single rooms and then we’ve got a larger nurses station you know here where the rest of the staff are able to work. So this is one of our large training MDT rooms um that’s going to be kitted out with all the latest audio-visual technology so colleagues can either meet face to face or in a hybrid format on Microsoft Teams. MDT meetings are really important from an educational point of view but also we want ESEOC, alongside other Hub sites across the country, to be high volume training and teaching centres. I hope you’ve enjoyed your whistle stop tour of the Essex and Suffolk Elective Orthopaedic Centre um you can see it’s going to be a fantastic resource for uh the whole of Suffolk and north east Essex. One of the largest elective orthopaedic hubs in the country and uh you know come back and see us when the building’s nearly finished. [Music]

The reason why um I’m here today is to talk about The Hub because the Board approved a proposal for West Suffolk Hospital in the ICB to conduct a public engagement exercise with he community and patients that use West Hospital orthopaedic services because um the part of the proposal is that around 55 to 60% of elective orthopaedic activity currently being delivered at West Hospital uh will be moved to the centre so next slide please. So we all know that there’s been unprecedented levels of disruption on elective care across the country due to the Covid pandemic and you know nationally waiting lists have surged by 61% from 4.57 million before the pandemic to 7.47 million in you know the start of this yea. So waiting lists have risen dramatically and this was because during the pandemic routine elective care was was stopped and reducing the backlog is one of the government’s national priorities and certainly within the region, and I’m sat in the council offices at Breckland Council with the team from Norfolk and Waveney and with colleagues from James Paget, Norfolk and Norwich and QEH discussing the challenges that you know they face which is similar to the challenges we face in SNEE. So ministers set up elected recovery task force to tackle the growing waiting list to ensure all capacity is put to best use. Professor Tim Briggs who’s the national director of improvement for the NHS and elective recovery and chair of the GIRFT programmes sits on that committee and Professor Briggs for many years has been promoting the use of elective hubs because he’s shown through the GIRFT program that trusts that have access to hub sites significantly reduce their day-of-surgery cancellation rates and can really reduce the waiting times for their local patients. So at national level one of the considerations has been to establish elective surgical hubs across the country. 1.6 billion pounds of funding was secured for hubs sites and there are currently hundred across the country that are operational March of 2025. There’ll be 135 of which ESEOC will be one of the larger. So it’s going to be a fantastic resource for our system to have. so what’s the situation in SNEE? So as far as West Suffolk Hospital’s concerned we can see that the waiting list is increasing and this data from Model Health System suggests that if your waiting list is increasing then you haven’t got sufficient capacity to manage the demand. So next slide please. And also the number of operations we’re performing are smaller in number than before the pandemic so we can see that prior to Covid the West Suffolk Hospital was performing on average around 450 hip replacements a year and around 350 knee replacements. Clearly that activity level and the numbers of operations we perform decreased significantly during Covid and for a variety of reasons that I will go into in more detail about shortly uh we’re still not delivering the same number of joint replacements that we we were prior to the pandemic. Next slide please. And one of the reasons behind that is that our trauma workload is increasing and we perform trauma surgery on patients with fractures and this shows the number of hip fractures being treated at West Suffolk has increased from 2015 to 2023 by about 30% in in 8 years and we use the same operating theatres performing trauma surgery as we do for joint replacement surgery. So it illustrates that challenge of trying to provide acute care, emergency care – trauma – and planned care on one site without a surgical hub. Next slide please. So where are those patients going? What’s happening locally is that we’re becoming increasingly reliant on capacity in the private sector and we’re hearing in Norfolk and Waveney how colleagues in Norfolk and Waveney are also increasingly reliant on the capacity in the private sector so this is is the number of joint replacements from the national joint registry database showing that the number of hip replacements performed at our local private hospital in Bury St Edmunds now exceeds the number of private, sorry, hip replacements being performed at West Suffolk and 60% of these are NHS funded. Next slide please. So in April 2022 a business case was approved which enabled our system to construct an elective orthopaedic centre containing six theatres and two wards and three months later the case was approved to expand the centre’s original footprint to eight theatres and three wards so it’s going to give us a huge amount of capacity. We always know, we already know, that there’s good synergy between West Suffolk and ESNEFT and it’s important as uh you know healthcare partners within the same system that we’re collaborating and pooling resources in the best interest of our patients. So the plan based on the capacity available to West Suffolk at ESEOC is to move approximately 60% of its elective orthopaedic surgical procedures from West Suffolk Hospital in Bury St Edmunds to the Dame Clare Marx Building on the Colchester site and this would leave approximately 1,300 procedures at the West Suffolk Hospital including all paediatric orthopaedic surgery. All pre-op assessment would be carried out at West Suffolk Hospital still for those patients and their postoperative care in terms of their outpatient care but obviously their hospital stay – their inpatient stay – would remain at the Centre. They wouldn’t be transferred back to West Suffolk following surgery and West Suffolk will continue to see patients and all its pre-existing peripheral clinics so next slide please. So what’s the case for change? So under the proposal this would leave approximately 1,300 procedures per year on the West Suffolk site including all paediatric orthopaedic activity as we’ve already mentioned it’s proposed that all pre-op and post-op outpatient visits will continue at West Suffolk and its peripheral clinics but there’s a clear need for increased elective surgical capacity for orthopaedics because of the predicted growth rates and our elderly population and more elective surgical capacity is required to reduce waiting times for patients. Next slide please. So what will be the benefits for patients by moving some elective activity to ESEOC? So by moving patients to ESEOC we we may see wait times reduced by four weeks. We will see a significant reduction in waiting times of patients and I’ve got some more data to support that statement I’ve just made. The primary focus is on elective care which is what elective surgical hubs do best and it will enable our teams to focus on delivering an excellent elective service and reducing length of stay. ESEOC is going to be one of the two hubs for a major revision surgery for knee replacement surgery in the region. The Norfolk and Norwich Hub will be the be the other one and it will be a centre of excellence. We’re going to have between 50 and 60 surgeons from the West Suffolk, Ipswich and Colchester sites all working there in what will be one of Europe’s largest orthopaedic centres and we’ll have increased capacity because as well as using the capacity at ESEOC this will free up capacity in the main theatre complex at the West Hospital. There are ongoing discussions with the executive team and the surgical division at West Suffolk as to how this capacity will be used to enable more patients to be treated. And the other thing that the hub will be is a high volume training centre because currently our surgical trainees and other trainees are not getting the training opportunities within the West Suffolk Hospital and other hospitals throughout the country whereas hubs sites will change all that. And as we’ve mentioned it will free up an operating theatre at West Suffolk Hospital. So this is data from um the project that GIRFT and the Health Foundation and the Improvement Analytics Unit at the Health Foundation have been undertaking. We can see the graph on the left shows that when you look at all activity performed at elective surgical hubs or new hubs, which is the blue line, compared with the control group or trust that don’t have hubs, which is the red line, there doesn’t appear to be a significant increase. But when we just look at HVLC activity so that’s high volume low complexity procedures and elective orthopaedics – that’s hip replacements, knee replacements partial knee replacements some crucial ligament surgery bunion surgery and keyhole shoulder operations – that trusts with new hubs are delivering 22% more activity than trusts without hubs and that is statistically significant.