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​Update on elective orthopaedic centres: options evaluation
The options evaluation panel for elective orthopaedics met for the second time recently.

The evaluation panel was established to evaluate site options for the development of elective orthopaedic centres against the criteria developed by clinical and patient groups and signed off by the CCG committee in common (CiC). The CiC asked the panel to undertake a two-stage evaluation against non-financial and financial criteria. The CiC has agreed that the preferred site configuration should, if possible, be determined by non-financial criteria, so long as the preferred option is more cost-effective than the current arrangement of services.

The panel was made up of voting members comprising of clinicians and non-clinicians from all six boroughs in south east London, and non-voting members of the public with an independent clinical expert. The panel scored by consensus.

The panel examined four possible locations for the elective orthopaedic centres, put forward by NHS Trusts:

  • Queen Mary's Hospital
  • Orpington Hospital
  • Lewisham Hospital
  • Guy's Hospital

Following information provided via a joint response from Oxleas NHS Foundation Trust and Dartford and Gravesham NHS Trust, the panel recognised that the Queen Mary's site option does not meet the agreed criteria for an inpatient elective orthopaedic centre, and they will be recommending to the Committee in Common that this site is not taken forward, but instead it is developed in line with the agreed Queen Mary's Hospital strategic direction. The reason for its exclusion is that the Queen Mary's site cannot take the full range of activity for clinical and capacity reasons.

All other site options were evaluated against the non-financial criteria. As we are looking for a two-site solution options were scored as pairs.

  • Option 1: Guy’s and Lewisham
  • Option 2: Guy’s and Orpington
  • Option 3: Orpington and Lewisham

The scores for each option against the non-financial criteria were as follows:

  • Option 1: Guy’s and Lewisham 1.15
  • Option 2: Guy’s and Orpington 2.15
  • Option 3: Orpington and Lewisham 1.08

Options were scored against a -5 to +5 scale with 0 representing the status quo position. If an option has a positive score, therefore it is seen to have advantages over the status quo.

Our expert finance group has made a preliminary assessment against the financial criteria, and all three options appear to be financially viable and more cost-effective than the current configuration. However, there are further questions to be clarified to ensure each option has been assessed consistently. We anticipate this will take a further couple of weeks to resolve.

The CiC will meet on 8 November. We expect that the evaluation panel will complete its work well before then and be submitting a report to the CiC which identifies:

  • which options are viable
  • which option scored the highest against the evaluation criteria and should be considered, at this stage, the preferred option
  • a full financial assessment of each option.

The CiC will then decide whether or not to proceed to public consultation for 14 weeks starting this autumn and running into 2017, to test the options that emerge. The CiC will not make a decision on whether to develop orthopaedic elective centres until after the results of consultation have been considered, likely to be in April 2017.

For the orthopaedic centre proposal to go forward it will have to demonstrate:

  • that it does not destabilise any hospital
  • that trauma services can be maintained at our A&E departments
  • that it is affordable and makes a positive financial contribution.

It is important to note that the Evaluation Panel is not making any recommendation to the CiC at this point. The panel is expected to discuss these matters further once the financial options have been assessed and decide whether to recommend a preferred option. All three options will in any case be discussed by the Committee in Common, alongside additional information that the panel has requested to be made available in the weeks ahead.