SUSTAINABLE AFFORDABLE HEALTHCARE
“Only by working together now can we make changes that benefit the whole population that do not disadvantage some of the most vulnerable population groups. We need to have orthopaedic surgeons, general practitioners and managerial staff working closely together in both the primary and secondary care settings to ensure the best, appropriate, most cost-effective care for our patients.”
effective treatment whilst providing value for money for the taxpayer or insurer. This massive and increasing workload and disparity in service provision needs to be tackled by a medium- to long-term action plan which needs be removed from politics. Changes must be implemented that will benefit the whole population. The primary and secondary care sectors need to work more closely together to ensure the best, most cost-effective care for patients. Orthopaedics in the United
pressure to perform more efficiently yet maintaining its high standards of care.
There have been some high-
profile examples where this has failed and this has been a salutary lesson to everyone. It is not too late to solve this problem if it is acted upon now. Guidelines for referral and
treatment pathways are essential to try to contain cost and ensure patients receive the most appropriate and
Kingdom has been neglected, even though it is one of the most referred- to specialties. The three main areas that need addressing to move forward in orthopaedics in the U.K. are: • Appropriate primary care path- ways with a referral system designed to allow the right patient to be seen by the right specialist at the right place at the right time. There is also a need for co-operation between the patient and the primary care practitioner to ensure that patients maintain a healthy lifestyle and reasonable bodyweight. • Delivering Secondary Care “Getting it right first time”, a report published in September 2012, high- lighted the problems but also sug- gested solutions whereby reducing complications and improving quality of care could make significant annual savings; and • Appropriate patient follow-up.
To meet the increasing demand
and patient expectations in a challenging economic climate we need to recognize the value of improving the quality of patient
outcomes and the role that the frontline specialists can play. In a perfect society, there would
be no limit on healthcare spending to maintain the health of its population. The expectations of patients are increasing and will continue to do so. In order to fulfil these expectations, the NHS has been forced to change. Recently it did this by setting targets backed up by a managerial team to enforce the changes. The laudable aim was to reduce waiting times for outpatient and inpatient procedures, not the quality of care provided. This may at first sound very reassuring; but if you had a choice to have a treatment quicker which had a higher chance of failure or a slightly increased wait with a better outcome in the long-term, there is an obvious choice.
Patients would rather travel further
for better, higher-quality care in one location rather than a short distance for a poor service. Concentrating on waiting times rather than quality has led the NHS to overspend, which is now unsustainable as there has to be a balance between funding and service provision, especially in an economic downturn. The focused partnership of the
British Orthopaedic Association, its specialist societies, frontline hospital specialists together with GPs in Commissioning Consortia is the way forward to provide the population with access to high-quality care at the right time whilst ensuring the best use of taxpayers’ money. There has to be a new open and
honest relationship between senior management within the NHS and
orthopaedic clinicians to ensure this. If this fails then changes made may not be in the best interest of the patients and will ultimately lead to rationing of healthcare as demand becomes unaffordable. Instead of orthopaedic departments and clinicians acting alone, they will form part of a network of hospitals and treatment centres forming Specialist Units and working to quality assurance standards. This will generate standardized protocols for implants and treatment pathways across the NHS, to the benefit of patients. Protocols will be based on either their own accrued evidence or from the published literature or joint registries.
Working together to get it right the first time It is predicted that by introducing such changes, just in orthopaedics, will save the NHS over £2 billion over the next three to five years. If “Getting it Right First Time”, which is to be piloted across the NHS in England, is successful, then it is likely that other specialties will follow suit. Only by working together now
can we make changes that benefit the whole population that do not disadvantage some of the most vulnerable population groups. We need to have orthopaedic surgeons, general practitioners and managerial staff working closely together in both the primary and secondary care settings to ensure the best, appropriate, most cost-effective care for our patients. These changes must be led by frontline clinicians to ensure success.
The Parliamentarian | 2013: Issue One | 45
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