The Specialist Orthopaedic Alliance was formed in the late 1990s from a group of specialist centres dedicated to providing orthopaedic services ranging from the straightforward to the highly specialised, to patients across the UK.
The Alliance worked to heighten national awareness of specialist orthopaedics to protect and enhance services, and quality of experience, for patients and staff. Alliance activity was focused on making a both clinical and an economic case for specialist orthopaedics – in terms of patient care, teaching and research. SOA members have led the way in delivering better care and value through improved outcomes and productivity.
In 2015/16 the SOA bid for and received NHSE Vanguard status and funding to develop a set of Quality Standards for Orthopaedic Care.
The Vanguard Project
The Vanguard Project has provided a framework for improving quality in orthopaedic care in England from a provider perspective. This is based on a quality standard membership model founded on evidence-based descriptors of ‘what good looks like’ in orthopaedic provision.
Where extensive professional guidance already exists, the standards will cite them and will refer members to existing guidance e.g. British Orthopaedic Association (BOA) Blue Books, NICE guidance, BOASTs etc. It is important to understand, that this is a mapping/sign-posting exercise and is a drive to create new guidance only where no guidance is available currently.
What has the Vanguard Project Achieved?
One of the primary objectives of the Vanguard Project was to improve the delivery of Orthopaedic services within its member Trusts across the country and to recognise individual services and processes within the NOA members for their excellence in delivery and outcomes, and as a result build a practical bottom up improvement methodology that is replicable nationally.
Macro – Economic Impact Assessment
This piece of work was aimed at providing a model to demonstrate the wide-ranging cost and quality benefits that can be achieved across the health and social care system by improving the efficiency and quality of orthopaedic care.
The Vanguard commissioned this work to underpin the value of the approach the NOA is exploring.
Clinical Coding Review
The objectives of the Clinical Coding Review are:
- Assess the current levels of coding quality measurement, including formal clinical coding audits and documented quality improvement processes
- Identify and clarify areas of variation in coded data
- Align the coding analysis with the needs of the other programme workstreams
- Provide recommendations to improve coding quality
- Develop a quality assurance framework for orthopaedic coded clinical data
- The review will include orthopaedic clinical coding data and departments at the NOA members for all orthopaedic activity (adults and children).
The scale of orthopaedic challenge
According to current Department of Health definitions, musculoskeletal conditions include 200 different problems, affecting the muscles, joints and skeleton. Over 9.6 million adults, and around 12,000 children, have a musculoskeletal condition in England today.
As older people are disproportionately affected by musculoskeletal conditions, this is a burden that will increase in the coming years as the population ages. By 2031, the proportion of people in the UK aged 65-84 is projected to increase by 50%.
Musculoskeletal conditions are the fifth highest area of NHS expenditure and there is significant variation in spend in different areas.
The reason for this variation is unknown, and poor orthopaedic outcomes are expensive as they can lead to increased rehabilitation costs, treating complications and the need for revision surgery.
The increasing financial burden on the NHS means that making the right decisions about how to save money and to deliver good patient outcomes is even more important. This is against a backdrop of a new health and social care services system, with new people and institutions responsible for different areas of orthopaedic commissioning.
Although musculoskeletal conditions have a significant impact on individuals’ quality of l Although musculoskeletal conditions have a significant impact on individuals’ quality of life, and often the wider economy due to inability to work, they do not generally afford the same political attention as other high areas of spend such as cancer or cardiovascular disease.
There have been some moves to address this balance, the appointment of Professor Peter Kay as National Clinical Director (NCD) for musculoskeletal conditions demonstrates recognition that national oversight might lead to better clinical outcomes and patient quality of life. Musculoskeletal conditions were not chosen as one of the areas for a Strategic Clinical Network (SCN) and there are few direct references to musculoskeletal conditions within the levers and incentives framework.
The National Orthopaedic Alliances role in overcoming the orthopaedic challenge
The creation of the National Orthopaedic Alliance (NOA) within the context of this is that the NOA will be a primary source of support and expertise to its members on the provision of orthopaedic services in order to promote high quality outcomes for patients and better value for money through productivity and long-term cost savings.
The NOA is facilitating an expanded evidence base for demonstrating what defines a “better outcome” for patients in orthopaedics and thereby underpins our belief that specialist services deliver this more effectively and at lower cost.
At its most basic this can be described as supporting its members and the NHS to ensure that policies and systems promote appropriate orthopaedic referrals getting to the right experts, in the appropriate setting, at the right time who, by getting it right first time, reduce complications, and use evidence-based treatments. Coupled with appropriate innovation and different modes of working, this approach will improve the quality of care.