Surgical hubs
Rapid creation of a surgical hub to reduce waiting lists
As delays for elective surgery continue to grow nationally, compounded by the winter pressures being experienced by most Trusts and health boards, Chris Blackwell-Frost speaks with key people at South Warwickshire University NHS Foundation Trust, about how they established a surgical hub for elective orthopaedic surgery in a Vanguard mobile laminar flow theatre.
A successfully implemented surgical hub provides many benefits to individuals and to organisations, contributing towards the meeting of the NHS’s most important objectives. The headline is a reduction in waiting times for elective surgery and often this is for the Trust upon whose site the hub is located and for neighbouring Trusts. A surgical hub, because of the scheduled nature of its procedures, is also recognised to be a great environment for training. The timely completion of elective procedures also has knock-on effects for other areas of the NHS and for wider society. As Glen Burley, Chief Executive, South
Warwickshire University NHS Foundation Trust, says, “There’s a relationship between shorter elective waits and urgent care, particularly in orthopaedics. So, if we can manage those individual patients, they’re less likely to come in as an emergency, which has a bigger financial impact for the NHS and is a bad outcome. Just being able to mobilise, so that they’re able to live active, independent lives…The ongoing burden on the NHS when they’re not, is really significant.” Harkamal Heran, Chief Operating Officer at
South Warwickshire University NHS Foundation Trust, agrees. “We don’t want patients coming to us via our Emergency Department. We want them here on an elective waiting list, having received really, really good pre-op, healthy, fit, willing and able to receive the treatment and then go home as quickly as possible,” Harkamal comments. “From our perspective, patients get seen sooner and it’s a great experience for them. We don’t want patients to be waiting too long to get that treatment. We know that people can live between 16 and 20 years in ill-health in this area and that has a real cost and a real impact on our local economy. “So, helping people get their operations sooner, get mobilised sooner, get back to work or get back to not needing quite so much support, feels really important, and trying to
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The outside of the Vanguard laminar flow theatre, in position at Warwick hospital.
reduce time spent in ill-health is absolutely a driver for us.” The hub at Warwick Hospital, opened
in August and immediately achieved four orthopaedic procedures per day, and five on occasion. Before the hub was established, South Warwickshire University NHS Foundation Trust was already one of the better performing Trusts when considering RTT (Referral to Treatment Times), especially in the T&O (Trauma and Orthopaedic) category. Asked about the motivation for investing in the
hub, Glen, comments, “Firstly, we’ve got capacity to help the rest of the NHS. While we’re very focused on keeping waiting times down as much as we can locally, there’s a huge opportunity to improve waiting times in organisations around us. There’s a number of Trusts that have got some really long waits and their patients could come here quite easily for surgery.” Harkamal makes the point that as South
Warwickshire University NHS Foundation Trust is one of the best in the country in the T&O category, it makes sense to continue to invest in this area, especially taking into account the Trust’s experience in providing mutual aid. This hub is unusual in that it is on an
Emergency Department and trauma site. This
can create additional complications, particularly in protecting resources allocated to elective work, as Tim Robertson, Consultant Orthopaedic Surgeon at South Warwickshire University NHS Foundation Trust, explains: “You need a degree of ring fencing in a constructive way, so that you can have a lot of elective flows of patients which aren’t being interrupted with traumas and the day-to-day emergencies. Because we’re an acute Trust, that could be a pressure point for us.” Glen acknowledges these challenges and
believes that within close proximity to these services is the right place to undertake surgery, especially when considering the age profile of the Trust’s patients and the potential for complications to the surgery. “Being on a site that has physicians, and elderly care physicians, on it, is important. I also think it’s really important for the NHS to utilise all of its theatre capacity, and probably 90% of theatres are on acute sites. If we give up on being able to get productivity out of acute sites, we will face quite a bit of trouble”, he says. Ring-fencing the resources for elective care is important to the success of the surgical hub and in line with the Trust’s philosophy that it simply does not cancel elective activity. Harkamal expounds on this: “We do not cancel
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