Reviewing of planned adult orthopaedic surgery in north central London Pack of graphs and tables to accompany the case for change.

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1 Reviewing of planned adult orthopaedic surgery in north central London Pack of graphs and tables to accompany the case for change 16 August

2 This document should be read alongside: North London Partners in health and care Draft case for change Adult elective orthopaedic services These illustrative diagrams are referenced throughout the document 2

3 Figure 1: Total adult elective orthopaedic admissions /17 NCL NHS providers (activity across all commissioners) 12,000 10,000 8,000 6,000 4,000 2,000 - Royal Free London NHS Foundation Trust North Middlesex University Hospital NHS Trust Whittington Health NHS Trust University College London Hospitals NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust NCL Non NCL 3

4 Figure 2: Activity numbers: Total day case and elective admissions 2016/17 (NCL activity only) Royal Free London NHS Foundation Trust 3,390 North Middlesex University Hospital NHS Trust 2,523 The Whittington Health NHS Trust 1,971 University College London Hospitals NHS Foundation Trust 1,878 Royal National Orthopaedic Hospital NHS Trust 1,024 Highgate Hospital (Aspen) 290 The Cavell Hospital (BMI Healthcare) 259 The Kings Oak Hospital (BMI Healthcare) 223 Other NHS Providers (outside of NCL) 766 Other independent sector providers (outside of NCL) 214 Total 12,538 Source: NEL CSU Note: Royal Free activity includes Royal Free Hospital, Barnet Hospital and Chase Farm Hospital Note: UCLH includes University College Hospital and National Hospital for Neurology and Neurosciences 4

5 Figure 3: Orthopaedic services by site Site Royal Free London NHS Foundation Trus North Middlesex University Hospital NHS Trust Royal National Orthopaedic Hospital NHS Trust University College London Hospitals NHS Foundation Trust (including National Hospital for Neurology and Neurosciences) Orthopaedic Surgical Sub Specialty Barnet Hospital Royal Free London indicate elective orthopaedics no longer occurring at the Barnet Hospital site Chase Farm Hospital Lower limb arthroplasty Upper limb Hand (carpel tunnel release) Foot and ankle Royal Free Hospital Lower limb arthroplasty Upper limb Hand Foot and ankle Spinal (injections) Lower limb arthroplasty Upper limb Hand (carpel tunnel) Foot and ankle Spinal (injections) Lower limb arthroplasty Upper limb Foot and ankle Spinal (surgery and injections) Peripheral nerve injury Sarcoma (soft tissue and bone tumour) Lower limb arthroplasty Upper limb Hand Foot and ankle Spinal (surgery and injections) Other MSK Services Pain management and rehabilitation Pain management and rehabilitation Pain management and rehabilitation Pain management and rehabilitation London Spinal Cord Injury Centre National Specialist Rehabilitation Programmes Specialist Pain Management programmes (some delivered on RFL s Hadley Wood site) Pain management and rehabilitation Specialist sports surgery Whittington Health NHS Trust Lower limb arthroplasty Upper limb Hand Foot and ankle Spinal (surgery and injections) Pain management and rehabilitation 5

6 Figure 4: Growth in numbers of people in NCL and England 6

7 7 Figure 5: Deprivation levels across NCL Source: IMD 2015 by LSOA, ONS release

8 Figure 6: Activity by five-year age band, Whittington vs. national FY 2015/16 8

9 Figure 7: Activity by five-year age band, Royal Free vs. national FY 2015/16 9

10 Figure 8: Percentage of patients in top deprivation quintile for North Middlesex, Whittington and UCLH respectively FY 2015/16 10

11 Figure 9: Average IMD health score for patients admitted electively and in an emergency FY 2015/16 11

12 Figure 10: Referral to treatment times trauma and orthopaedics, 16/17 vs 17/18 NCL - T&O RTT Performance 16/17 vs 17/18 NCL- T&O- New Clock Starts 16/17 vs 17/18 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% April May June July August September October November December January February % Performance % Performance March April May June July August September October November December January February March Reporting Standard NCL T&O Weekly Waits Incomplete Pathway 16/17 vs 17/18 NCL T&O Weekly Waits Complete Pathway 16/17 vs 17/18 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 0-1 Weeks 03 to 04 Weeks 06 to 07 Weeks 09 to 10 Weeks 12 to 13 Weeks 15 to 16 Weeks 18 to 19 Weeks 21 to 22 Weeks 24 to 25 Weeks % % 27 to 28 Weeks 30 to 31 Weeks 33 to 34 Weeks 36 to 37 Weeks 39 to 40 Weeks 42 to 43 Weeks 45 to 46 Weeks 48 to 49 Weeks 51 to 52 Weeks 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5. 0% 0. 0% 0-1 Weeks 03 to 04 Weeks 06 to 07 Weeks 09 to 10 Weeks 12 to 13 Weeks 15 to 16 Weeks 18 to 19 Weeks 21 to 22 Weeks 24 to 25 Weeks % % 27 to 28 Weeks 30 to 31 Weeks 33 to 34 Weeks 36 to 37 Weeks 39 to 40 Weeks 42 to 43 Weeks 45 to 46 Weeks 48 to 49 Weeks 51 to 52 Weeks 12

13 Figure 11: GIRFT analysis of cost improvement opportunity 13

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