Surgical hubs
I’ve probably worked in some full-size operating theatres which have had less space. The big difference for Vanguard is that they’ve been thought through. You’ve got an environment where everything has already been considered in terms of patient flows and the basic idea of having an anaesthetic room at one end, an operating theatre in the middle and a recovery area at the other end works very well.” The greater efficiency comes from having
a degree of standardisation. Tim says, “It’s not been the situation for each of my five times working in a Vanguard (theatre), but in this instance, we are doing arthroplasty work, full stop, and we’ve got a group of committed surgeons who have agreed from the outset what kit they’re going to be using because immediately you start opening a theatre in a different part of the building, you’re going to need to increase your number of kits, your operating trays and all the other paraphernalia that goes with it. “The first thing is to actually be very focused on what are the particular procedures that we’re going to do, and then to do them as a production line, in a positive way; a good production line that has good quality control.” Supporting the surgeons is a clinical team
provided by Vanguard. Tim explains, “We’ve got a team of five all together and they’re all clinically qualified and are all able to undertake at least two of the three sort of standard roles in theatre in terms of anaesthetics, operating, and circulating and recovery. “They’ve been great. They’re all very experienced and one of the great things we’ve had is that, because our theatre is now very close to our elective ward, there’s been a huge amount of rapport building and acceptance. This isn’t a case of a bolt on service which people are viewing from a distance, it’s become very much part of our normal accepted practice.” That standardisation is part of what makes
a surgical hub conducive to training. The Trust gained university status in 2022 and Glen explains, “That was based on the experience of doctors in training. We work with Warwick Medical School predominantly, but also train other disciplines of staff. So, one of the other considerations of the orthopaedic team has been the way that we’ve developed our therapy team.
“Within our South Warwickshire Accelerated
Transfer Team (SWATT), those roles have been extended. We’ve got advanced clinical practitioners as part of the team, as well. So, the theory that we have, of making sure that every member of staff can reach their potential and work to the top of their license and to develop their skills, is why we developed the training
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Tim Robertson, Consultant Orthopaedic Surgeon at South Warwickshire University NHS Foundation Trust
centre and why we tried to create a bit of a magnet for recruitment. “We’ve been very focused on both training
and research. A lot of our clinicians, including our orthopaedic team, are really involved in delivering the next level of service and sharing that learning across the NHS. So, that in itself is an attraction to recruit future staff, but also training junior surgeons and ensuring that when they’re with us that they’re really busy and doing what they want to do as part of their training programme. Productivity is important as well.” Tim was asked whether the mobile theatre would contribute towards this at Warwick: “In this particular Vanguard, for our first month, we’ve had a very clear policy that we’re trying very much to do consultant-driven surgery. I think it was a case of not trying to start doing too many things at once. I’m a full time NHS consultant and I’m a surgical trainer, so I have a training grade registrar with me. My expectation is that, now we’ve ironed out some of the early issues around logistics and everything else, there will be time to do some training. Again, it’s a kind of protected space. Patients won’t get cancelled because of trauma. We’ll get the work done and I think the training is going to be very, very important.” The surgical hub’s high productivity also
leads to benefits such as shorter waiting lists, training opportunities, and reduced pressure on emergency services. Also, through Payment by Results (PBR), it generates the finances required
SCAN ME
for the project to be undertaken. The additional capacity, in the form of the Vanguard theatre and the additional staff, is an investment. Activity based funding, South Warwickshire University NHS Foundation Trust’s expertise in orthopaedics and their ability to offer a comprehensive service to neighbouring Trusts are all factors in the success of this venture. Glen explains, “The return of Payment By
Results has been an important element within our thinking on this, as has ensured that we get good productivity levels from the theatre. I pushed for the return to PBR because I think it’s a great way to motivate clinicians and I think, as long as you can build into it the ability to invest in their services, then they’re very willing to do that.” Asked about the key measures of success for the surgical hub, Glen answers: “Obviously, it’s about reducing NHS waiting times - that’s a national priority, and we are also ensuring that those around us, with longer waiting times, are accessing this. “It’s a great experience for patients, but it’s
working for the organisation as well. It’s delivering some income, which is helping us with our cost improvement target. So, it’s a win-win.”
CSJ
About the author
Scan here to watch the interviews with Glen, Harkamal and Tim.
Chris Blackwell-Frost is CEO of Vanguard Healthcare Solutions, having joined on 1 January 2023. A pharmacist by training, Chris has more than 25 years’ experience across the healthcare and pharmaceutical sectors in strategy, business development, proposition development, and marketing. He previously worked at Nuffield Health as Chief Strategy Officer and Chief Customer Officer, at Lloyds Pharmacy and AAH Pharmaceuticals. Chris is passionate about building on Vanguard’s position as a trusted partner to the NHS, developing the company to help address key issues including the elective backlog, continuity of care during refurbishments, and supporting the New Hospital Programme with Vanguard’s mobile and modular construction solutions.
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