Centre of excellence for inpatient orthopaedic surgery in north west London gets the go-ahead

A proposal to bring together most routine inpatient orthopaedic surgery in north west London in a new centre of excellence at Central Middlesex Hospital was approved today (Tuesday 21 March) by NHS North West London, the sector’s integrated care board. The proposal incorporates feedback from a 13-week public consultation that closed earlier this year involving almost 2,000 people.

The North West London Acute Provider Collaborative, made up of the sector’s four acute NHS trusts, developed the proposal to improve quality and reduce long waiting times, primarily for hip and knee replacements. Patients referred to any hospital in north west London for routine inpatient orthopaedic surgery who are generally in good health will have their surgery in the new ‘elective orthopaedic centre’ once opened. Over 4,000 patients a year are expected to have their surgery at the new centre.

End-to-end care for patients who have their operation at the new centre will continue to be the responsibility of the surgical team at their ‘home orthopaedic hospital’, with outpatient care provided locally or online. Patients will only need to travel to Central Middlesex for their operation. Their ‘home orthopaedic hospital’ surgeons will carry out the operation at the elective orthopaedic centre with the support of a permanent, specialist team. Door-to-door transport to and from the new centre will be provided for patients who are unable to travel independently or via an existing patient transport scheme and who would otherwise encounter a long, complex or costly journey.

Care pathways for patients with complex health needs and day-case patients are unchanged and surgery will be provided, as now, at a range of north west London hospitals. These patients will also benefit from shorter waiting times, as moving low-complexity, inpatient surgery to the new centre will free up capacity at these other hospitals.   

Dr Roger Chinn, chair of the group that developed the proposal and chief medical officer for Chelsea and Westminster Hospital NHS Foundation Trust, said: “Our new approach to orthopaedic surgery is excellent news for communities across north west London. Centres that focus on specific, routine operations have been shown to produce fewer surgical complications and shorter lengths of stay. They are more efficient too which means we can treat more people and reduce waiting times. Having a centre on a site without an A&E department, like the one planned for Central Middlesex, also means there is much less chance of disruption due to surges in urgent and emergency demand.

“The proposal agreed today benefitted enormously from feedback gathered through our public consultation, and we’re very grateful to everyone who took part. The feedback emphasised the need for additional transport support, for care – between hospitals and with community services – to be fully joined-up and to avoid leaving anyone behind with new ways of working, particularly in terms of expanding digital options. We have built on our initial proposal, committing to a door-to-door transport offer, patient navigators and ensuring in-person alternatives to all digital services.

“We also think the new approach will be good for staff, creating a wider range of roles and more opportunities to learn and develop. We will be creating more detailed workforce plans in partnership with our staff over the coming months but we don’t anticipate that anyone will be expected to move to the new centre unless they choose to do so. We need to appoint more permanent staff for orthopaedic surgery across north west London and so we will be working up a joint recruitment campaign.”

Central Middlesex Hospital is now set to benefit from a £9m investment to create a dedicated 41-bed unit through a small expansion and some re-modelling. The aim is to open the centre later this year, with the project expected to pass additional gateways over the coming months, including approval of a full business case and implementation plan.  

As well as feedback from the public consultation, the proposal reflects feedback and guidance from the London Clinical Senate, the North West London Joint Health Overview and Scrutiny Committee and the Mayor of London (who commissioned the Nuffield Trust to assess the proposal against his six tests for major NHS service change). The proposal is set out in a ‘decision making business case’ that has been published on the Collaborative website