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SUSTAINABLE AFFORDABLE HEALTHCARE


The report Getting It Right First Time was launched in the United Kingdom House of Commons by Prof. Tim. Briggs and Rt Hon. Stephen Dorrell, MP, Chair- person of the Commons Health Select Committee.


The full text can be downloaded at www.timbriggs-gettingitrightfirsttime. com. The report is supported by profes- sional and patient bodies across the U.K. including the Patients’ Association, the British Orthopaedic Association and the Royal College of Surgeons of Eng- land.


revision. These procedures – which are expensive, complex, and time- consuming – will continue to grow exponentially.


Complications following orthopaedic surgery are costly to the patient and to the NHS. Infection in hip and knee replacement can cost up to £70,000 per case to treat yet varies significantly in incidence between different providers. If the lowest infection rate of 0.2 per cent in the best units could be achieved across the NHS, current projected annual savings would be £200 to £300 million. This would allow an extra 40,000 to 60,000 joint replacements to be undertaken annually at no extra cost. This would reduce the need for rationing by commissioning groups. Large variations in orthopaedic


outcomes for joint replacements exist.


Many different types of implants are used and some may have little data on long-term effectiveness. Data from the National Joint


Register showed that in 2010 only 22,311 cemented polyethylene acetabular cups (used to replace the socket) were implanted at a cost of approximately £6.7 million. Conversely 42,297 uncemented acetabular cups were inserted at a cost of about £80 million. This is despite evidence showing that cemented prostheses remain the gold standard. Over the last 10 years there


has been an explosion of sub- specialization and treatments offered in orthopaedics, sometimes with little evidence of clinical efficacy. In shoulder surgery, there has been a 746 per cent increase in the number of patients undergoing arthroscopic


subacromial decompression (keyhole surgery) with little long-term data on outcomes. Potential NHS litigation costs are


currently valued at £15.5 billion. The NHS Litigation Authority paid out £1 billion in claims last year. Orthopaedics accounted for 15 per cent. The NHS cannot withstand this.


A critical global health agenda The NHS has to make savings of £20 billion by 2015. Some savings can be achieved by efficiencies and streamlining; but the majority can only be achieved by working “smarter” if we are not going to affect the quality of care provided. The pressure on GPs to refer


increasing numbers of patients for orthopaedic care, fuelled by rising obesity, the expectancy of an active retirement in an ageing, longer-living


population and the advances in new technologies will dominate the health agenda. The United States of America


suffers from similar problems to the U.K., with up to 30 per cent of the population affected by musculoskeletal problems at any one time, and 10 per cent suffering from osteoarthritis activity limitation. There has been a massive increase in the cost of this burden. Between 1997 and 2003 the cost of the disease burden has risen from $234 to $322 billion, of which $90 billion is specific to osteoarthritis. Within this, the amount specific to loss of earnings is approximately $16.3 billion, which is more costly than pulmonary, renal and neurological diseases combined. This trend is also being predicted


to worsen worldwide. Several continents have a large percentage


The Parliamentarian | 2013: Issue One | 41


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