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HEALTHCARE DELIVERY


which rises to 0.33% six weeks after leaving hospital. For total knee replacements, this is 0.33% post surgery and 0.63% after six weeks in the community. “These are very low,” said Dr Jones. Last year, Nuffield also standardised


on the use of 2% Chlorhexidine for skin preparation. “Historically, there has been variation across the organisation, but the evidence now suggests that 2% Chlorhexidine is the most effective solution,” said Dr Jones. All theatre air ducts are tested regularly


for Aspergillus and air handling equipment is regularly serviced. In addition, Nuffield operates its own decontamination hubs which comply with European standards. There are six hubs in total, with 12 million operating instruments in circulation at any one time. Again, data is tracked rigorously to ensure the process is working. The defect rate from sterilising equipment is 0.2% – well below the industry average of 0.5%.


Patient satisfaction All patients are given a standard questionnaire following treatment to allow Nuffield to evaluate its performance. A return rate of 12% is good but Nuffield is trialling the use of tablet computers to see if that figure can be improved. Patients score Nuffield on a five-point scale and the results are impressive: • 88% rate nursing staff as excellent. • 80% rate overall care as excellent. • 74% rated Nuffield as excellent when it came to recommending them to a friend or relative.


• 70% rated the cleanliness as excellent.


The future Overall the figures have shown a 5% to 7% improvement over the past two years. Despite the challenging economic


backdrop of recent times, Nuffield has seen growth in all areas of the group, with hospitals performing particularly strongly. Dr Jones sees keyhole surgery, and its


safe and effective delivery, as a key growth area in the coming years. “We have a strategy for putting modern, digital theatres into at least half our hospitals in the next few years,” he reported. Some are already centres of excellence and are able to take on more challenging operations. One operation that is transforming the


life of bariatric patients is laparascopic gastric bypass. “This is an effective way to help patients lose weight and stay healthy. It reduces high blood pressure, the risk of diabetes and massively reduces the risk of health complications in the future and early death,” said Dr Jones, revealing that over 1,000 procedures have already been carried out across 10 Nuffield hospitals. Morbid obesity may be on the rise but


at the other end of the scale is an increasing interest in personal fitness – prompting a rise in sports-related injuries and increased demand for physiotherapy. “We have grown our services very rapidly over the last five years, driven by the need for people to see a physiotherapist due to problems with their joints or back,” Dr Jones continued. Nuffield continues to invest heavily in


services that people find increasingly difficult to access via the NHS. In addition to obesity surgery, this includes access to laser treatments for a variety of dermatological conditions, assisted conception services and chemotherapy treatments. One of the latest developments includes the provision of individualised treatment planning for early stage breast cancer. Patients at Nuffield Hospitals now have


access to the Oncotype DX Breast Cancer Test – which enables doctors and patients


‘Nuffield has achieved very low rates of venous thromboembolism, at just 0.02% for the past 10 months.’


with early stage breast cancer to make more informed, individualised treatment decisions. Oncotype DX is claimed to be the only


test that has significant clinical evidence showing its ability to predict the likelihood of adjuvant chemotherapy benefit as well as recurrence in early-stage breast cancer. The latest study results, presented at the 2011 San Antonio Breast Cancer Symposium (SABCS), show that 46% of the UK patients who were initially offered chemotherapy and hormone therapy were spared chemotherapy after review of the Oncotype DX Recurrence Score (RS). Overall physician treatment recommendations were changed by approximately 27% following knowledge of the RS. A second study, examining the cost-effectiveness of Oncotype DX, showed a 99.6% percent probability that the test would be cost-effective in the UK, versus current clinical practice. Mr Charlie Chan FRCS, consultant


surgeon at Nuffield Health Cheltenham Hospital and Cheltenham General Hospital, said: “Oncotype DX is the first genomic test that helps inform each woman with breast cancer about both her own personal risk of breast cancer recurrence and the likely benefit from chemotherapy. In the ideal world, cancer specialists would like to offer each patient a risk assessment and treatment plan that is specific for that individual. The use of this test in the planning of individualised cancer care can help patients and their doctors make treatment decisions with the best possible information. This will allow chemotherapy to be used where it will be most beneficial to women and spare some women from having chemotherapy, when it is not needed. Ultimately this will lead to significantly reduced financial costs and importantly improved wellbeing for many patients. The Oncotype DX Recurrence Score is a major advance and will help many women both now and in the future.”


‘Nuffield audits all infection control approaches to make sure that it is following best practice and sets a very high target of 95% compliance.’


52 THE CLINICAL SERVICES JOURNAL MARCH 2012





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