Hip and Knee Pathway in South Central

Dr Geoff Watson

Clinical Director Planned Care

South Central SHA

“Efficiency is doing things right: effectiveness is doing the right things”

Peter Drucker

Together, the clinical programmes are engaged in building an even better NHS, one that we are all

proud of…..

• Delivering the fundamental principles of the NHS• Improving quality and equality • Every step of the way and at every opportunity• Focus on what really matters and what works• Maximising the potential of people to live well

All patients seen at the appropriate time, by the appropriate people in an appropriate place.

Enhanced Recovery In South Central

•April 2009 – Planned Care launch•September 2009 – National ERPP•October 2009 - MSK workshop•November 2009 - South Central ERP Workshop•February 2010 – MSK first draft

J Allison Glover, 1938

•10-fold variation in tonsillectomy

•8-fold risk of death with surgical treatment

“… tendency for the operation to be performed for no particular reason and no particular result.”

“…sad to reflect that many of the anesthetic deaths… were due to unnecessary operations.”

Slide courtesy of Dr Al MulleyFoundation for Informed Medical Decision Making and the Dartmouth Center for Health Care Delivery Science

‘Variation is the enemy of Quality’

W Edwards Deming

John E. Wennberg, 1973

•17-fold variation in tonsillectomy

•6-fold variation in hysterectomy

•4-fold variation in prostatectomy

“Professional uncertainty and the problem of supplier-induced demand”

Slide courtesy of Dr Al MulleyFoundation for Informed Medical Decision Making and the Dartmouth Center for Health Care Delivery Science

Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

Across England there is a four-fold variation in spend on knee replacements (adjusted).

• “It is difficult to get a man to understand something when his salary depends on him not understanding it”

• Upton Sinclair

• “….ambition to get all health care providers to be above average”

A. C. L. Blair

• LOL!D. J. N. Watson

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50

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150

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350

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Admitted treatment times for Trauma & Orthopaedics at South Central SHA

Feb-11

Jan-11

Dec-10

P

Percentage of treatments over 15 weeks in latest month is 47%

P

Percentage of treatments over 15 weeks in latest month is 47%

P

Percentage of treatments over 15 weeks in latest month is 47%

Distribution of elective lengths of stay, Primary hip replacement

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

- 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 Length of stay (days)

No

. ca

se

s

2009-10

2008-09

Primary Hip Length of Stay

The National Picture

Distribution of elective lengths of stay, Primary knee replacement

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

- 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 Length of stay (days)

No

. ca

se

s

2009-10

2008-09

Primary Knee Length of Stay

The National Picture

The National Picture

The National Picture

The National Picture

The National Picture

The National Picture

Progress Across South Central – April 2011

GYNAE 

Plans 

 Testing

 

 Live

 

 Live

 

 Plans

   Live    

 Live

 

 Live

 

U’LOGY 

Plans 

  

Live 

 

 Partially

Live  

  

Plans 

 Plans

 

 Plans

 

 Live

  

COLO 

Live 

Live 

Live 

 Live

 Plans     Plans

 Testing

 

 Live

 Live

MSK LivePartially

Live

 Live

 

 Plans

   Live

 Live

 Testing

 Live

 

 Live

 Live

  MK PHT SUHT IOW ORH NOC H&W BHT BNFT RBH WEHCT

LiveTestingPlans

Innovation SitesNo ServiceNo Plans Currently

Thank you for your attention.

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